Hormone Help Part 2: Estrogen

In Part 1 of our Hormone Help series, we reviewed what hormones and neurotransmitters (NTs) are and how important it is to consider them together when dealing with any hormone related or mood/mental health issues. As we continue go deep into hormone health, we will define some of the “heavy hitter” hormones that can have life-altering effects particularly in women. But don’t worry, we will write very soon about male hormones because it is an incredibly important topic that virtually no one is talking about! This article will dive into Estrogen, only 1 of the 5 primary female hormones. Stay tuned for “Part 3” to learn more about progesterone, testosterone, DHEA and cortisol.

It is so common for us to hear from women how their energy, mood, and feeling of emotional balance have decreased as they age. They have been to their family medicine or gynecological practitioner to no avail because they are on hormone replacement, and continue to feel quite poorly for years before coming to us. While there are many many hormones, we will tackle 5 major female hormones starting with Estrogen to show you where your current treatment (or lack thereof) may be falling short and the health possibilities available to you with a functional medicine approach to hormone health.

If you suffer from any of these symptoms, consider the need to fully understand your hormone picture and work with a doctor who will also consider the role of neurotransmitters:

  • Mood swings
  • Anxiety or depression
  • Bloating, constipation, and or gas
  • Sleeplessness/Insomnia
  • Low libido
  • Sinus and allergy issues
  • Brain fog and memory loss
  • Infertility
  • Continuous weight gain
  • Life altering fatigue
  • Dry skin, eczema, or psoriasis
  • Heavy or irregular menstrual cycles
  • Migraines and headaches
  • Hot flashes
  • Irrational mood swings
  • Hair loss


Most people have a very oversimplified understanding of estrogen in both men and women, and even in our attempt to dig deeper, we will still not be able to cover estrogen as in depth as your functional medicine practitioner understands it. Did you know you can be in estrogen dominance even though your estrogen level is within normal levels? Did you know there are actually 3 types of estrogen produced by your body and there are a variety of metabolites that these estrogens can turn into if systems are not working properly. Keep reading and we will explain it.

Estrogen’s primary role is growth which is good when you are a girl moving into puberty, or growing a baby. However, estrogen driving growth in the wrong areas or metabolic pathways can cause hormone based weight gain, cancer, and more. There are three main types of estrogen that your body produces.

Estrone (E1)

This type of estrogen is made in the ovaries and is most prevalent type in post-menopause. This kind of estrogen isn’t as active as some other forms, but it can turn into other active forms. It is made by the ovaries, the placenta during pregnancy, and fatty (adipose) tissue also produces this hormone. It is made by converting hormones like testosterone, so many other hormones can affect estrone levels. Estrone can also convert into the other two types of estrogen (estradiol and estriol). Your functional medicine practitioners looks at all three types of estrogens because the balance of these levels compared to each other and other hormones can give insight into the origin of your symptoms as well as risk for cancer.

Estradiol (E2)

Most active type of estrogen and produced by the ovaries. An enzyme called aromatase also converts testosterone to this type of estrogen which is the most biologically active. Many people actually have overactive aromatase enzyme processes which too aggressively converts testosterone into estrogen. Your functional medicine doctor can test your aromatase activity to better understand how your body is likely to deal with the different types of estrogens and their metabolites (more on metabolites coming). Estradiol is most proliferate from puberty through your 20’s and begins to decline until almost gone in menopause. Testing estradiol can show if menopause is starting, and depending on your age, if menopause is occurring too early supporting estradiol levels can hold off this process until the appropriate time.

Estriol (E3)

This is the estrogen that increases most during pregnancy. When not in pregnancy it can be made by conversion from the other two types of estrogen. Estriol has often been ignored since there are only significant amounts during pregnancy, but it does have a protective benefits for bone health and supports symptoms that come with menopause. Seeing a comprehensive view of each type of Estrogen can help your functional medicine practitioner understand more about your hormone health and develop the right treatment plan for you.

Estrogen metabolites

We can’t talk about Estrogen without talking about estrogen metabolites. This is a very important part of estrogen metabolism that gets largely ignored by standard medical practice. Estrogen metabolites are a significant factor in cancer development- specifically breast cancer and other hormone sensitive cancers. All estrogens break down into metabolites that get processed to be excreted by the body. This requires enzyme processes and many enzyme processes can be diminished or inhibited by genetic hiccups, chronic stress, and chronic and acute chemical exposures. When the process of getting rid of excess estrogen doesn’t go as it is designed, it gets pushed into what are called estrogen metabolites. There are at least 14 different metabolites, but those of primary concern are:

  • 2-hydroxyestrone
  • 4-hydroxyestrone
  • 16-hydroxyestrone

When the metabolism of estrogen is turning into these metabolites, the risk for certain cancers increases significantly. Birth control medications are a large cause of estrogen metabolites since the estrogens these are made with are not as well recognized by the body, therefore they do not get processed adequately. Estrogen dominance is another way estrogen gets turned into harmful metabolites. When symptoms like the ones listed at the top of this article are occuring, it is important to not just have a comprehensive understanding of hormone levels, but also know if your metabolism of estrogen is causing you harm. By testing for estrogen metabolites, your functional medicine practitioner can help your body shift out of these dangerous metabolic pathways into safer estrogen metabolism. Not only can this improve your hormone imbalances, but it be a big part of cancer prevention.

Estrogen Dominance

There is a clear pattern of high stress lifestyle, high cortisol, and estrogen dominance in both men and women. Particularly women who are high performing, “corporate warrior” type personalities tend to lean towards estrogen dominance. Estrogen dominance occurs when there is too much estrogen compared to progesterone. That does not mean that estrogen levels are necessarily high since it is about the balance of the two. Most often, estrogen dominance occurs when progesterone is too low so the ratio of estrogen and progesterone is off. When estrogen dominance is occuring, there is a higher risk of pushing estrogen into the dangerous estrogen metabolites. Estrogen dominance is often a key factor in chronic issues like endometriosis and heavy, painful periods.

Symptoms of estrogen dominance can be:

  • Weight gain
  • Menstrual problems such as light or heavy bleeding
  • PMS
  • Fibrocystic breasts
  • Uterine fibroids
  • Fatigue
  • Loss of sex drive
  • Depression or anxiety

Men also can experience estrogen dominance and symptoms are typically enlarged breasts, sexual dysfunction, and infertility. More on men’s hormone health in subsequent articles.

While there is so much more that can be said about estrogen, you can be better informed about your medical care and better understand why your functional medicine practitioner may be ordering the tests they are when you have a little more knowledge of the whole story of estrogen and all its components. Particularly for women, optimal estrogen levels and making sure your body is metabolizing the estrogen you have into safe metabolites for excretion in the urine is a huge part of not just feeling better, but also preventing devastating health conditions in the future.

If you have any history of breast cancer, have endometriosis, have taken birth control pills at any time, are chronically stressed, or have known exposures to heavy metals, it is vitally important that you work with a practitioner who truly understands estrogen, estrogen metabolites, and estrogen dominance. The team at in2GREAT is ready to help you feel better because we know you were not meant to live in fatigue, depression, irritability, and anxiousness. There is a better way, and we are here to help.

Dr Corey Priest, DC - Functional medicine practitioner

About the author

Dr. Corey Priest has been practicing functional medicine since 2001. in2GREAT was founded in 2014 by Dr Priest after 13 years of experience with his other practices. Over his career, Dr. Priest has worked with and helped well over 10,000 patients under a functional medicine model.

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