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Why Estrogen Dominance Is Missed By Most Doctors

Many people with thyroid and autoimmune thyroid conditions not only have an imbalance in thyroid hormone, but also have other hormone imbalances as well.  As I’ve mentioned in past posts and articles, an imbalance in the hormones estrogen and progesterone is very common.  Despite this, most endocrinologists and other types of medical doctors don’t evaluate for these other hormone imbalances.

If you have hypothyroidism or Hashimoto’s Thyroiditis, then you know what most medical doctors will usually do is to give synthetic thyroid hormone to manage the symptoms.  And if you have hyperthyroidism or Graves’ Disease, then you’ll be told to either take antithyroid drugs, and perhaps a beta blocker, or to receive radioactive iodine treatment.  There aren’t too many medical doctors who will even consider whether someone with a thyroid or autoimmune thyroid condition has an imbalance of the sex hormones.

One Simple Test Can Make A Big Difference

When it comes to detecting whether someone has a hormone imbalance, the person’s symptoms can be an obvious red flag.  For example, common symptoms of estrogen dominance include weight gain, depression, breast tenderness, mood swings and irritability, fatigue, and there are numerous other symptoms.  So without question, when I consult with a new patient I look at the person’s health questionnaire and symptom survey I have them fill out, and see if any of their symptoms indicate a potential hormone imbalance.  Although you can’t go by symptoms alone, often times it is obvious that the person has some type of hormone imbalance, while at other times it isn’t as clear.

The only way to confirm that someone has a hormone imbalance is through the proper testing.  So when I suspect that a patient has such an imbalance I will recommend for them to receive a male or female hormone panel.  I have mentioned in the past that I use the company Diagnos-Techs, mainly because they do a great job and have accurate reference ranges.  There are of course some other good labs out there.  And there are also other labs which aren’t too good.

In any case, I almost always will recommend an expanded male or female hormone panel.  And the reason for this is because the expanded hormone panel also includes the pituitary hormones, which are important to evaluate.  And the reason for this is because if there is an imbalance of the the pituitary hormones (FSH and LH), then this can tell us about the output of estrogen and progesterone, and the reason why there is a hormone imbalance in the first place.  In other words, looking at these two pituitary hormones can potentially tell us the cause of the estrogen dominance condition.

One-Sample Testing Usually Isn’t Sufficient In Cycling Women

While most medical doctors don’t perform any additional hormone testing other than for thyroid hormone, most doctors who DO perform such testing only collect a single sample of the hormones estrogen and progesterone.  This might be sufficient with menopausal women.  But it’s not sufficient for many pre-menopausal women and definitely not sufficient for cycling women.  The reason for this is because the hormone levels are fluctuating, and so taking a one sample test of estrogen and progesterone won’t give the complete picture of what’s happening throughout a woman’s cycle.

This is actually one reason why some women have fertility issues which aren’t resolved.  Most women who have difficulty getting pregnant obtain a one-sample test of progesterone, and if the levels on this single sample are sufficient, the doctor will usually rule out a hormone imbalance as being the cause of the problem.  However, just because the progesterone levels are normal for a single day doesn’t mean it’s normal for the entire length of the cycle.  In fact, it’s not only the total output of progesterone we’re looking at, but the distribution of progesterone throughout the cycle.  This is why multiple sample testing is important in cycling women.

An expanded female hormone panel requires the cycling woman to collect multiple saliva samples over the course of her menstrual cycle.  This will give a much better indicator as to whether she has a problem with the hormones estrogen and progesterone.  These panels also measure the levels of some of the other hormones, such as testosterone and DHEA, which don’t directly relate to estrogen dominance, but since hormones are interactive they can plan a role in this condition.

Estrogen Dominance Can Affect Men Too

While estrogen dominance is more common in women, it can also affect men too.  As a result, if a man has symptoms which indicate a potential hormone imbalance, I will recommend an expanded male hormone panel.  This will measure the levels of estradiol and progesterone, testosterone, DHEA, Androstenedione, and DHT, along with the pituitary hormones LH and FSH.

In summary, the reason why most medical doctors “miss” the diagnosis of estrogen dominance is because they don’t test for it to begin with.  And those who do hormone testing usually only obtain a one-sample test, which might be sufficient in menopausal women, men, and some women in pre-menopause, but isn’t sufficient for cycling women.  So if you’re a cycling woman with symptoms of a hormone imbalance then you definitely want to make sure you receive a multiple-sample test.  And regardless of whether you are in menopause or not, or what gender you are, if you do any type of hormone testing then it’s a good idea to obtain an expanded hormone panel to determine the levels of pituitary hormones, which in turn relate to the output of estrogen and progesterone.


 

9 Comments

  1. Lisa says:

    Hello,
    Thank you for all the useful information. I enjoy reading your articles in hopes to manage my Hashimoto’s more efficently. I underwent a hysterectomy two weeks ago. My ovaries were removed too. I had very large fibroids. I am not on any estrogen replacement as of yet. I am wondering what i should start with if I do decide as I am concerned about osteoporosis and heart disease which can increase when there is no more estrogen. I have read that taking a pill can bind with thyroid medicine and that a patch would be better because it is absorbed through the skin and not in the digestive tract. Hope you could shed some light on this subject.

    Sincerely
    Lisa

    • Dr. Eric says:

      Hi Lisa,

      I’m glad you have found the information on my website to be valuable! I wouldn’t just randomly take bioidentical estrogen. The first thing I would do is obtain a female hormone panel to look at the different hormones. While the hormones estrogen and progesterone are of course the most important to evaluate, it’s not a bad idea to look at the other hormones as well (testosterone, FSH, LH, etc.) since they interact with one another. But based on the levels of these hormones a competent doctor will be able to determine what dosage of bioidentical hormones you may need. When I recommend bioidentical hormones to my patients I typically recommend them in sublingual form, but I honestly haven’t looked into a patch. But taking them sublingually shouldn’t impact the thyroid medication you’re taking.

  2. lisa Miller says:

    I saw an endo who did test for sex hormones.. my estradial level was over 800 when I asked about the level I was told “dont worry about it.. You were probably always high” Well… I am 52 years old and had a partial hysterectomy 10 years ago (ovaries intact). My estradial doubled from over 400 the previous year. My question is this.. At what point would he have me worry about it? Why even test the level if apparently any level is nothing to worry about? Needless to say.. I fired that endo!

    • Dr. Eric says:

      Hi Lisa,

      Obviously I have no idea at what level of estradiol your former endocrinologist would have been concerned with, but I’m glad to hear you fired him!

  3. Anna says:

    Thanks for sharing. This adds more info about estrogen dominance.

  4. Vicki says:

    I had a hysterectomy 8 weeks ago due to massive uterine fibroids. I didn’t come across the concept of estrogen dominance until it was to the point that a hyster was my only option. At 41, I still struggled with adult acne, fibrocystic breasts, weight issues, etc. Although the plan was for me to keep my ovaries, he had to remove one because the fibroids had glommed onto it and dragged it up 8 inches (explains the twinges on that side!) Since surgery, my skin has cleared up and my breasts are less lumpy! Does one less ovary mean half the estrogen? My gyn had said there was no treatment for fibroids except going on the pill (can’t because of migraines) and the Derm just wanted to give prescriptions! No one saw a connection. I’m wondering if I need to find a new doctor who is open to this concept, or if the problem should be “fixed” now that I only have one ovary. Your thoughts?

  5. TheresaS says:

    I appreciate the helpful information and I am hoping you could perhaps make a recommendation of what I should do next. I was diagnosed with Graves Disease in 2011 and have been on anti-thyroid meds since..and slowly decreasing dosage over time and currently on 2.5 mg of methimazole. I eat EXTREMELY healthy/organic ant-inflammatory and exercise regularly. My weight has maintained for the most part with the exception of a couple of times when my thyroid took a swing into low levels (FT3/FT4) and I went into subclinical hypo. I then would adjust meds and my weight would go back to norm. Over the past year, I am baffled…I have been eating even better (minimal sugar, no processed, no grains, organic..etc), working out more and my meds are at their lowest dose and I have good FT3 and FT4 levels (mid-high range), but I have gained 10 lbs over past 10 months and now it won’t budge. I have run all gut health tests and adrenals and have some minor issues..but not enough for 10 lbs. My doctors think there is something off with overall hormones. I am on birth control and have been for over 15 yrs, I just turned 40 as well. I want to run a full hormone panel,but worried I will get inaccurate results with being on BC. I also should note that I tried coming off BC once about 2 yrs into Graves and I gained 12 lbs in two months, I panicked and started back on BC and weigh came straight off. I want to come off BC, but I am terrified of more weight gain..but also want to know if I have other hormone issues. Can you offer any advice? And is it worth doing full hormone panel while on BC?
    Thank you.

    • Dr. Eric says:

      Hi Theresa,

      Being on birth control definitely will affect the hormones, and so while there is a chance that a hormone imbalance could be responsible for the weight gain, I usually don’t recommend hormone testing for my patients on birth control, and even if you stopped taking it you would want to wait at least a few months before doing such testing. Insulin resistance can be a factor with weight gain, although if you have been eating well for a prolonged period of time then this probably isn’t an issue, although inflammation from another source could be a factor. Toxins can also sometimes cause weight gain as well.

  6. Lee says:

    Hello,
    Thank you so much for the article. It chimes with what my specialist says about one-off hormonal tests over the years (I have PCOS) being inadequate because hormonal levels change day to day. I wasn’t entirely sure about what he meant, so this article has been so useful.
    I have a question, if you have the time to answer it 🙂
    My gyno (in the UK) has diagnosed estrogen dominance on symptoms (non-stop bleeding for months, uterine polyps, exhaustion getting worse, overweight all my life but recent rapid weight gain, anxiety, depression, insomnia) which he says may have been brought on by a variety of factors including obesity, and the fact that I am no longer ovulating,
    He has prescribed the Merina coil, for site-specific, low-dose synthethic progesterone and says this is preferable to oral progesterone (more in the bloodstream, more side effects). I did not know about progesterone cream, which is unlicensed in the UK but could still be available via prescription if I insisted.
    I am afraid of the Merina coil. I don’t want something inside me. But I must have help with these symptoms. I am really quite depressed and unable to address the weight gain at this level of fatigue and insomnia.
    IS the Merina coil a positive way forward for me or should I fight for cream? 🙂

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Natural Treatment Methods:
Graves Disease Treatment
Hypothyroidism Treatment
Hyperthyroidism Treatment
Natural Thyroid treatment


Conventional Treatment
Methods:
Radioactive Iodine
Thyroid Hormone