Protocol for Estrogen Dominence (1999)
Holistic Clinical Protocols are sources of information on options only.
They DO NOT define a treatment plan for any individual person,
that is always determined in clinical consultation with a caregiver.
HOLISTIC PROTOCOL FOR ESTROGEN DOMINANCE
Richard J. Clofine, D.O., F.A.C.O.O.G.
Theory of Estrogen Dominance
Lifetime estrogen exposure may be related to certain health risks to women. Estrogen is not a bad thing, it is Goddess essence. It is the top note in the bouquet of your hormonal milieu. It is a fruity, sweet note balancing on top of the body of progesterone, and way above the bottom note of testosterone. Estrogen is more manifesting female energy experienced most intensely just before the time of ovulation. The body of the bouquet is progesterone, which is a more internal introspective energy and provides the nurturing power of pregnancy. Testosterone is the grounding influence that drives desire, physical power and sexual appetite.
Throughout a women’s life, optimal hormonal function is about a delicate ballet of rhythm and balance. Hormones interact not only with each other, but also with every cell in the body and your brain chemistry. Progesterone and Estrogen are like the yin and yang of feminine balance. In a normal month a woman experiences estrogen from the time she finishes her period to the time she starts her next one. During her menstrual cycle, an egg is recruited by FSH (follicle stimulating hormone) and begins to mature and grow toward ovulation. The developing egg makes estrogen. Around 2 weeks after the start of the period, the egg is fully developed and LH (leutinizing hormone) signals come from the brain to make ovulation occur. The cells that supported the developing egg remain in the ovary and turn yellow becoming the corpus luteum (“yellow body”). This is where progesterone is made, so you do not get progesterone until after ovulation. These hormones feed and fertilize the lining of the uterus. The signal to get a period is a dropping down of the hormone levels, removing the hormonal support and resulting in the shedding of the uterine lining as menstrual bleeding.
If ovulation is irregular than the menstrual cycle becomes irregular and estrogen dominance may occur. This is common in perimenopause. If it takes four weeks to ovulate instead of two than the period comes two weeks late. In this instance instead of the usual two weeks of estrogen there is 4 weeks over balancing the two weeks of progesterone. Thus there is a relative dominance of estrogen. This is seen in other situations where ovulation is weak or irregular (polycystic ovaries or stress for example).
Lifetime estrogen exposure is about how many menses a woman experiences in her life. If she starts her period early, and goes into menopause late then she has increased lifetime estrogen exposure. Girls start their periods 3-4 years earlier than 100 years ago. Most women did not live to menopause 100 years ago. Women have periods starting at 11, menopause at 51 and life expectancy near 80; this is all very different than the past. Lifetime estrogen exposure is also dependent on the number of pregnancies a woman has. The more pregnancies and nursing, the fewer number of periods and less lifetime estrogen exposure. This becomes important because early onset of menses and late onset of menopause are related to an increase risk of breast cancer.
Exogenous and Xenoestrogens may increase estrogen exposure. Exogenous estrogens refer to those taken with intent such as birth control pills and hormone replacement therapy. Their use should always be considered carefully so that the benefits outweigh the risks inherent in their use. Effective contraception is a huge benefit and so is the relief of hormonally related insomnia. Xenoestrogens refer to pollutants in our environment from things like pesticides (ppb’s & ddt’s for example) and plastics and hormones given to farm animals. These chemical compounds can mimic estrogen and have effects that are unclear but with quite alarming and dangerous potential. This is a wonderful argument for an organic lifestyle honoring Mother Earth.
ESTROGEN DOMINANCE HOLISTIC SUPPORT PROGRAM
- CLARIFY YOUR ISSUES
- Consult your intuition: Body, mind & spirit.
- Confirm medical diagnosis.
- Collect useful data.
- Objective
- laboratory studies (maybe less helpful than you think)
- imaging studies
- biometric observation (i.e. basal body temperature studies)
- Subjective
- What do YOU think is going on?
- seek opinions of caregivers and loved ones.
- Obtain second medical opinion if indicated.
- DEVELOP A PERSONALIZED HOLISTIC SUPPORT PROTOCOL
- Preferably in association with a trusted & knowledgeable caregiver (i.e. “Healing Partnership”).
- It should be based around YOUR STORY (an individualized program).
- It should be practical to YOUR LIFE (in other words it should be ‘doable’).
- It should be inclusive, thus expanding options.
- PAY ATTENTION
- Set appropriate expectations.
- What will be required to evaluate the situation?
- What is an appropriate trial period to evaluate a therapy?
- How much will it cost?
- Evaluate your progress, frankly and honestly over an appropriate time period.
- Make changes slowly and carefully so you can tell whether you are benefiting.
- Be open to new options if progress is not satisfactory.
- Consistency is the key.
- MAKE DIETARY CHANGES
- There is no one perfect or correct diets here are some general guidelines.
- Generally a healthy lower fat, high fiber diet will help decrease estrogen levels.
- Avoid dairy, red meat, refined sugar, fried foods, saturated/hydrogenated oils, trans-fatty acids (in margarine and hydrogenated oils).
- Use healthy oils (olive oil, grape seed oil for sautéing).
- Increase the amount of unrefined foods, raw foods, fresh fruits and vegetables.
- Eat foods with a low glycemic index (they metabolize slowly and prevent blood sugar swings).
- Eat a high fiber diet or use a daily fiber supplement. This is very important as soluble fiber binds estrogen and helps your body eliminate it (detoxify)!
- Move toward an organic lifestyle and diet.
- Eat cold water fish regularly (salmon, herring, mackerel, anchovies, tuna) and other foods high in Omega-3 fatty acids.
- Eliminate caffeine, theophylline and theobromine found in coffee, tea, soft drinks, chocolate, and some medications.
- HYDRATE YOUR BODY WITH DAILY CONSISTENCY
- Drink half your body weight (in pounds) in ounces of water daily.
- (if you weigh 140 pounds, drink 70 ounces of water daily).
- Drink distilled water, or use a reverse osmosis filter, or a high quality filtered water
- “PISS CLEAR”. The color and appearance of your urine is the best barometer for daily hydration. Your urine should be copious and clear to very pale colored. When you are dehydrating your urine looks more yellow, cloudy and smells stronger. The one exception to this is after taking B vitamins that will turn your urine a funny yellow color.
- Check your lips and tongue. If they are dry you need more water now.
- BIRTH CONTROL PILLS & HORMONE REPLACEMENT THERAPY
- While these are best avoided, there are exceptions to every rule!!! Sometimes the need for effective contraception, or the relief of menopausal symptoms, or the control of menstrual bleeding requires inclusion of these medications as part of a holistic protocol.
- NATURAL PROGESTERONE SKIN CREAM (see separate handout in your seminar packet)
- Taking progesterone can help balance estrogen dominance.
- Use an over the counter product equivalent to “Progest” or “Restored Balance” (approximately 400 mg per ounce of cream).
- Use ¼ to ½ teaspoon of cream twice a day on days 12 to 26 (see FAQ sheet on natural progesterone cream).
- You will need advice of a physician if you are irregular or perimenopausal.
- Often time’s prescription strength creams are prescribed, which are much stronger than over the counter creams.
- No medical studies have been done on the use of Progesterone skin cream for fibroids.
- TAKE DIM (DIM = diindolylmethane = Indole-3-carbinol X 2)
This is a natural substance from cruciferous vegetables (broccoli, cauliflower, cabbage and Brussels sprouts). Composed of two molecules of indole-3-carbinol, DIM is much more absorbable. It helps shift the end products of estrogen metabolism to a more beneficial pathway (2-hydroxy-estrogens as opposed to the more problem causing 16-hydroxy-estrogen metabolites).
- These metabolites can be measured in blood or urine
- Take DIM at a dose of 200 mg/day
- Eat more cruciferous vegetables (though you will need to take the supplemnet to get a high enough dose to shift your estrogen metabolism).
- ADD PHYTOESTROGENS
- There is controversy over the use of phytoestrogens for estrogen dominance. I feel they are beneficial as they are very week (less than 1/2 of 1% the potency of estradiol). Thus when they bind estrogen cell receptors there is very little stimulation and this blocks more potent natural estrogens.
- Soybeans, lentils, pinto beans and other legumes have plant estrogens called isoflavones in them. Adding these to your diet may be helpful by blocking the more potent estrogens your body makes from binding their cellular receptor sights.
- Eat 3 servings of soy daily.
- Another option is to supplement with 50 to 100 mg’s of soy isoflavones daily.
- Red clover can be taken in many ways including tea and a product called Promensil.
- OMEGA 3 AND OTHER ESSENTIAL FATTY ACIDS
- I feel daily intake of Omega 3 and other essential fatty acids (EPA-eicosapentanoic acid, DHA-docosahexanoic acid) is extremely important.
- It is important to obtain oils from several different sources and there are many “Super Omega” supplements that do this for you. Check at your local health food store.
- Use ground flax see daily (grind it in your coffee grinder) at a level of two tablespoons (or more) per day Mix it into foods, add to cereal, use in cooking or shakes. This also provides beneficial fiber to the diet. Or take 1-2 tablespoons of flax seed oil daily.
- Eat more cold water fish and take fish oil supplements daily.
- Your supplement should contain at least about 18% EPA and 12% DHA (about 30% of the omega-3 fatty acids found in fish oils.
- They usually come in 500 to 1000mg capsules and I recommend 2000mg per day for general good health and 2 to 3 times this dose for specific therapeutic interventions.
- Include GLA (gamma linoleic acid) in the form of Borage Oil (highest percentage, 500 to 1000mg daily), Evening Primrose Oil (500 to 1500 mg daily), Black Current Oil, and other common cold pressed oils such as safflower, sunflower, sesame seed and soybean oil.b
- Organic sources of these plant based supplements can avoid the potential problem of polluted fish (i.e. xenoestrogens).
- OPTIMIZE BOWEL HEALTH
- Your healthy bowel function can have a great impact on hormonal balance and health
- OTHER SUPPLEMENTS
- A well formulated multivitamin-mineral high in antioxidants
- Bioflavanoids
- Inositol (a B-complex vitamin) up to 4 grams / day
- Choline (a B-complex vitamin) one to two grams / day
- Quercetin– up to 400mg three times daily before meals
- Or take vitamin C (500mg twice a day) with Bioflavanoids (you will get lower doses this way)
- Methionine (an amino acid) one to two grams / day
- Take potent B-Complex vitamin – one “B-50” / day (50 mg’s of each major B-complex element)
- Magnesium 400-800 mg / day
- Vitamin E, 800 IU / day and other antioxidants
- Ginger tea and other natural anti-inflammatory substances like Tumeric
- HERBS
- Vitex (Chaste Tree Berry)
- Tincture, 25-30 drops two to four times daily, often shrinks small fibroids within two months. But results come from long-term use - up to two years.
- Wild Yam Root
- Tincture: ¼ teaspoonful twice a day in the two weeks before menses (after ovulation)
- Strengthening the liver with herbs such as dandelion, milk thistle, or yellow dock root helps it metabolize estrogen out of the body, thus reducing fibroids.
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