Oestrogen dominance is described as an imbalance in the female sex hormones such that there is an excess of oestrogen compared with progesterone. There are 3 different types of oestrogens (E1, E2, E3) circulating within the body, some or all of which may be increased compared with progesterone. There is a group of women who seem to be sensitive to their endogenous oestrogen as well. There are two classes of oestrogen receptors: nuclear estrogen receptors (ERα and ERβ), which are members of the nuclear receptor family of intracellular receptors, and membrane oestrogen receptors (MERs) (GPER  and GPR30), which are mostly G protein-coupled receptors. Studies have shown that sensitivity of the G protein-coupled receptors can occur in some women. So even though oestrogen levels may be within the normal ranges, these women will present with oestrogen dominance.

The conventional medical mindset is that menopause is an estrogen deficiency disease resulting from ovarian failure. Women have been led to believe that at the slightest symptoms, they should run out and get estrogen replacement. While estrogen levels will decrease during menopause, the truth is, estrogen levels do not fall appreciably until after a woman’s last period. In a sense most women in the peri-menopause state can be considered oestrogen dominant.  These women present with heavy, clotty and painful periods of increased duration, Mittleschmerz, and other various pre- menstrual symptoms like mood swings-teary, angry, bowel disturbances, headaches, breast tenderness and sinusitis.  A previous history of menorrhagia, dysmenorrhoea, endometriosis, polycystic ovaries, ovarian cysts, obesity, breast cysts and other benign or malignant breast lesions could be indicative of an oestrogen dominant woman. Women can suffer from the symptoms of estrogen dominance for 10 to 15 years, beginning as early as age 35.

Treatment with progesterone is quite effective in stabilising up to 75% of presenting symptoms. In the peri-menopausal patient a cyclical dosing of gradually increasing Progesterone seems to work best. Due to severity of symptoms oral applications of progesterone provide the best outcomes; although in some cases progesterone creams can suffice. Plant derived Diindolylmethane in combination with the progesterone provides better coverage to combat symptoms of oestrogen dominance. Because every woman produces varying amounts of oestrogen and has different sensitivities to her oestrogen, treatment needs to be individualised. As a result treatment during this time tends to be more dynamic and compounded bio-identical hormones offer the flexibility of individualizing treatment.

In conclusion, oestrogens are necessary and vital hormones for the proper functioning of many activities in the body. It’s not all negative for oestrogen dominant women, they have much better skin and look younger than their age. Eventually even oestrogen dominant women will require some oestrogen when they become menopausal. But they need to be closely monitored to ensure they get the best outcomes from treatment.