Estrogen Metabolism or Clearing Excess Estrogen

Sex hormones are produced in the body via the following assembly line:
Cholesterol —-> Pregnenolone —-> Progesterone —–> Androstenedione —-> Testosterone —-> Estradiol (one form of estrogen).  Estradiol is our end product and when there is the right amount of our end product, it’s the liver’s job to take any extra and break it down through a series of steps known as Phase I and Phase II liver detoxification. There are several ingredients required for successful breakdown and clearance of estrogen, as well as chemicals, pollution, pesticides etc. that can act like estrogen. We want to remove any excess estrogen and these waste products so that they don’t accumulate and do harm such as promoting reproductive cancers.

The first step in estrogen breakdown is conversion of estradiol to estrone. Estrone is then metabolised through Phase I liver detoxification (hydroxylation) into 2-hydroxyestrone. Cruciferous vegetables, flaxseeds, soy and rosemary supply substances like indole-3-carbinol that are necessary for this step to occur. The next step in estrogen breakdown is Phase II detoxification (methylation) which converts 2-hydroxyestrone to 2-methoxyestrone. This step requires vitamin B6, B12 and ACTIVE folic acid (5MTHF) to proceed. The active folic acid part is important as most folic acid from supplements is inactive. Some people have a defective gene that doesn’t allow them to process folic acid properly, so that they cannot make 5MTHF. This causes sluggish liver detoxification. There are 3 final procedures the liver can do to our 2-methoxyestrone to package it up for elimination. Glucuronidation requires glucaric acid, methlyation requires active folic acid again (5MTHF) and sulfation requires sulfur.

If any of these ingredients is missing, estrogen breakdown will be incomplete and estrogen, estrogen breakdown products and other waste like it, can build up in your system creating health problems like endometriosis, acne, fibroids, painful periods, hormone related cancers, heavy periods, infertility and other hormone imbalance conditions. In treating these conditions, I find it successful to provide (in the form of supplements) each component necessary for successful completion of phase I, phase II and the final packaging steps.

The typical benefits of enhancing estrogen metabolism this way include reduced risk of hormone related cancers, lighter periods, less cramping, less breast tenderness, reductions in fibroids, improved fertility, and clearer skin.

How Often Should I Do an Estrogen Detox?

That depends on the person and their particular symptoms, but for the average person, once per year.

Should Men do Estrogen Detoxification?

Yes!  Men produce estrogen as well and  excess estrogen and accumulation of estrogen like chemicals like bisphenol a, can bind to estrogen receptors in men and promote cancer such as prostate cancer.

Source: Medicine (Baltimore). 2015 Jan;94(1):e211 . Bisphenol a and hormone-associated cancers: current progress and perspectives.  Gao H1, Yang BJ, Li N, Feng LM, Shi XY, Zhao WH, Liu SJ.

What’s New with Fibroids?

There’s a new drug on the market that is a “selective progesterone receptor modulator”.  What that means is that the drug moderates the effects of progesterone.  I have had a couple of patients on this medication prior to fibroid surgery and for both it does seem to have shrunk their fibroid.  The thinking with fibroids has always been that estrogen was the culprit causing the fibroids to enlarge and in many of the women that I’ve treated for fibroids, that has been the case.  However, in some fibroid patients, that’s not the case as demonstrated by the efficacy of this drug.  For these women, we need more of a progesterone moderating approach.

How can we moderate the effects of progesterone naturally, without drugs?

  1. Ensure a healthy balance of all of the sex hormones so that no one hormone dominates over the others.  That means two main things to me: a) keep insulin levels low by avoiding processed starches and sugars and b) keep the endocrine system working optimally, that includes the ovaries, thyroid, adrenal glands, pituitary and hypothalamus.
  2. Vitamin B6 in it’s active state, pyridoxal-5-phosphate (P5P) modulates the cell’s capacity to respond to steroid hormones.  Although some of the professional lines contain the active P5P, most vitamin supplements don’t contain the active form of B6, relying on the body’s capacity to convert the inactive pyridoxine hydrochloride into the active P5P.  Source: FASEB J. 1994 Mar 1;8(3):343-9.
  3. Scutellaria barbata is a Chinese herb that has been shown to have progesterone moderating and anti-proliferative effects.  Source: Phytother Res. 2008 May;22(5):583-90

Signs and Symptoms of Hormone Imbalance

How would you know if you had a hormone imbalance? Most of the women I see already have an inkling that something is out of balance by the symptoms that they are experiencing:

  • Hair loss
  • Acne
  • Irregular periods
  • Night sweats
  • Hot flashes
  • Infertility
  • Heavy periods
  • Painful periods
  • Fibroids
  • Ovarian cysts
  • Uterine polyps
  • Excessive facial or body hair
  • PMS
  • Premenstrual migraines

Most often they have already visited their family doctor who “checked their hormones” and told them “everything is normal” or offered them the birth control pill.

There are three main problems here:

  1. By checked their hormones, most doctors mean they’ve done a very superficial screening of hormones, LH, FSH, maybe estradiol and maybe progesterone, but often not measured on specific dates of the menstrual cycle that make the results clinically meaningful.
  2. When “everything is normal” even though you feel that hormones are imbalanced, it’s because the “normal” ranges for hormones are extremely wide and so even abnormal people fall into the “normal” range.
  3. Birth control pills only mask the existing hormone imbalance, they don’t correct it.

If you feel like you have a hormone imbalance, always ask for a copy of blood work results so that you can see exactly how extensive testing was and exactly where your results fall in the “normal” range (normal is always in quotes because lab ranges rarely refer to what is actually normal, it is more often an average of unhealthy people).  99% of the time you will find that either: a) only a very few hormones have been tested and/or b) one or more of your results were borderline.

Fibroids and Estrogen

There are a couple of prevailing theories as to what causes fibroids. One, is that there is too much estrogen which is promoting proliferation of the uterine lining.

I saw an excellent example of this recently where we actually confirmed by blood test that the day 3 estrogen level was about 3 times the norm for that specific day of the cycle. The range for the follicular phase of the menstrual cycle (roughly day 1 to day 14) is 46-622 pmol/L. Because estrogen is at its lowest around day 1 of the period, and it increases to a peak at day 14, on day 3 you would expect estrogen to still be at the lower end of this range. The higher number would occur closer to day 12. This particular woman’s estrogen was already close to 500 on day 3. Ideally, estradiol measured on day 3 should be around 110 – 200 pmol/L. Random estradiol measurements that don’t take into account where exactly the person is in their cycle are fairly useless and will almost invariably be interpreted as “normal”.

What kind of symptoms would this cause?
1. Heavy menstrual bleeding. With this much estrogen so early in the cycle, there is a thick uterine lining being built, which means a lot of blood to discharge at her next period.
2. Painful periods. Excessive estrogen can promote inflammation and cramping.
3. Fibroids. Inflammation and estrogen are considered to be contributors to fibroids and with this much estrogen she’s got both going on.

The solution?
Provide specific nutrients that help the liver detoxify and eliminate excess estrogen. This particular person has already seen significant improvement in only 3 weeks of this type of treatment.

Source:
Hum Reprod Update. 2014 Sep 8. pii: dmu048. Ovarian steroids, stem cells and uterine leiomyoma: therapeutic implications. Moravek MB1, Yin P1, Ono M1, Coon V JS1, Dyson MT1, Navarro A1, Marsh EE1, Chakravarti D1, Kim JJ1, Wei JJ2, Bulun SE3.