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.

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.

Endometriosis and IBS

These two often seem to go hand in hand and it’s difficult to differentiate whether the gut issue is part of the endometriosis or a separate entity. In one study, 29% of endometriosis patients had either IBS or constipation.

Here are potential links between endometriosis and the gut:

1. Adhesions – abdominal tissue stuck together and not functioning normally due to endometriosis
2. Gluten sensitivity has been linked to both IBS and endometriosis
3. Endometriosis tissue adhering to the gut and causing gut irritation or inflammation
4. Ovarian hormones affect sensorimotor gastrointestinal function, modulate pain, and modulate susceptibility to stress. So the same imbalances that are causing or contributing to endometriosis can also be causing IBS symptoms.
5. Gut dysbiosis – overgrowth of unhealthy microorganisms in the gut can disrupt the ability to excrete excess estrogen and create more inflammation in the gut. An inflamed gut will increase endometriosis related abdominal pain.

Naturopathically we can address all of these issues, improving gut health, hormone balance and endometriosis.

Sources:
1. World J Gastroenterol. 2014 Jun 14;20(22):6725-43. doi: 10.3748/wjg.v20.i22.6725.
Gender-related differences in irritable bowel syndrome: potential mechanisms of sex hormones.
Meleine M, Matricon J.
2. Colorectal Dis. 2011 Jan;13(1):67-71. doi: 10.1111/j.1463-1318.2009.02055.x.
Irritable bowel syndrome and chronic constipation in patients with endometriosis.
Meurs-Szojda MM1, Mijatovic V, Felt-Bersma RJ, Hompes PG.