Oestrogen excess – a modern disease

Oestrogen excess or dominance is where the relative levels of oestrogen to progesterone are unbalanced in favour of oestrogen – it is the cause of many female reproductive problems, and also some male reproductive problems.

It is a modern disease in that most of the causes have only been present for the last century – a longer menstruating life (it has been estimated that modern women have 350-400 menstrual cycles compared with 30 -40 for our ancestors), oestrogenic medication (the contraceptive pill and HRT) and environmental oestrogens (xeno-oestrogens – pesticide residues, parabens, plastic compounds such as phthalates and bisphenol A, animal and fish hormonal treatments, polychlorinated biphenols -PCBs) together with a modern diet high in dairy products and refined carbohydrates, and relative inactivity. An excess can occur in the body because a compromised liver and bowels cannot clear it efficiently and also when insufficient progesterone is present to counterbalance the effect of oestrogen – ie oestrogen is unopposed.

Oestrogen stimulates cell proliferation and an increase in oestrogen receptors and can result in the following list of problems associated with oestrogen excess:

  • endometriosis

  • polycystic ovaries

  • breast cancer

  • mastalgia and fibrocystic breasts

  • fibroids

  • PMS – all types

  • abdominal fat gain (and associated syndrome X problems)

  • infertility

  • menorrhagia

  • uterine cancer

  • and in men, prostate cancer

Some of these are directly due to the growth promoting effects of oestrogen, and others are due to the relatively low levels of progesterone.

Treatment involves dietary changes, liver and bowel function improvement and use of phyto oestrogenic herbs. The last statement might seem rather contradictory but plant phyto oestrogens are anti-oestrogenic in premenopausal women because they are competitive antagonists of oestrogen receptor sites – that is, they fill the site so that it cannot be occupied by any other oestrogen. Where endogenous oestrogen is high phyto-oestrogens have an anti- oestrogenic effect, where it is low, eg post menopause, they have a net oestrogenic effect

Phyto-oestrogens are found in seeds, and in plants when they are going to seed, and are present in highest amounts in plants under stress from drought or predators. They appear to be a protective device to reduce fertility of grazing animals and protect the plant. Herbs that have this effect include red clover, alfalfa and linseed. The most important active chemicals in herbs are isoflavones, coumestans, phytosterols and lignans

Coumestrol is the only oestrogenic coumestan and it is found in legumes, and especially in sprouted legumes such as alfalfa and mung bean.

Oestrogenic isoflavones include genistein, diadzein, biochanin A and formononetin. They are found especially in legumes including soya, alfalfa and red clover and all require a healthy intestinal flora to make them bioavailable. Isoflavones are not well extracted in water so herb teas are not the best source.

Oestrogenic lignans are found in seeds and grains. They are especially high in flaxseed (but are not present in the oil) and must also be converted by bowel flora into the active forms.

Oestrogenic isoflavones and lignans are cancer preventatives because they are able to reduce the effects of endogenous oestrogens. This is especially true in pre-menopausal women and obese post menopausal women where peripheral aromatisation of androgens to oestrogen is high. They are also able to increase levels of sex hormone binding globulin (SHBG) which appears to be protective against breast cancer and coronary heart disease in women. There is also the perennial question of whether to treat oestrogen dependant breast cancer with red clover or not, in theory the phyto-oestrogens will occupy receptor sites but there appears to be no definitive answer yet – there are some studies indicating that phyto-oestrogens act in a similar way to Tamoxifen in protecting against breast cancer.

Steroidal saponins can also have an oestrogen like response – herbs such as Chamaelirium, Dioscorea, Trillium, fenugreek, liquorice and Tribulus terrestris – these herbs seem to be safe to use in oestrogen excess conditions because they are able to improve progesterone-oestrogen balance by stimulating ovulation.

Circulating blood oestrogen is conjugated in the liver for excretion in the bile. However this can be reabsorbed by the action of beta glucuronidase enzyme from certain intestinal bacteria, which are present in higher levels in those who eat saturated animal fats. Reducing saturated fat intake helps with oestrogen clearance; slow bowel transit time will also aggravate this problem. An inefficient liver will not be able to deal with circulating oestrogens, so diet and herbs must be geared to improving liver and bowel function.

The more fatty tissue in the body, especially abdominal fat, the more conversion of androgens into oestrogens in the tissue – so weight loss is important too.

 

Dietary changes to reduce oestrogen levels:

  • increased dietary fibre will reduce beta glucuronidase, and also the amount of oestrogen that can be reabsorbed in the intestines. This can be soluble or insoluble fibre and is best from wholefoods. Linseeds are the best as they contain oestrogenic lignans. Pectins are also useful fibre – from fruit and vegetable fibre – whole cooked apples are especially good.

  • phyto-oestrogenic foods such as chickpeas, soya and other pulses, legumes and seeds, especially if they are sprouted

  • brassica family – contain indoles which help the liver to process oestrogen and also competitively inhibit oestrogen

  • reduced intake of animal fats – see above

  • remove dairy products - milk contains oestrogens which are far more powerful than phyto-oestrogens

  • vitamin B6 – if deficient, uterine and breast tissue is more susceptible to oestrogen stimulation

  • alcohol intake should be kept to a minimum to maintain good liver function

  • coffee, beer and cannabis all have oestrogenic effects and need removing from the diet

  • methionine containing foods – beans, legumes and allium family – help with oestrogen breakdown in the liver

  • good bowel flora is essential

 

Herbal therapy :

  • phyto-oestrogens – as above

  • laxatives – to maintain bowel function

  • herbs to improve liver function – milk thistle, dandelion and schisandra are all liver herbs which are also useful in oestrogen breakdown

  • Vitex agnus castus – increases progesterone indirectly by acting on the anterior pituitary gland and inhibiting prolactin – relative oestrogen excess is reduced

  • Lithospermum officinale – also known as gromwell or stoneseed - acts on the anterior pituitary gland to reduce FSH and LH which will reduce oestrogens - it cools liver heat and is useful for fibroids, mastalgia, PMS and hot flushes

  • Cyperus rotundus – contains beta-sitosterol which is phyto-oestrogenic and is useful in all oestrogen excess situations – it is a cooling herb and also acts on the liver and digestion

  • Paeonia lactiflora - white paeony – is effective for most of the gynaecological conditions listed above – anything involving hormonal irregularity and especially where there is pain also such as in endometriosis. Paeonia has been shown to positively influence low progesterone, reduce elevated androgens (testosterone) and acts to modulate oestrogen and prolactin. Where the problem is low oestrogen levels, such as post menopausal hot flushes, paeony is able to correct this also.

  • Pulsatilla vulgaris - pasque flower – this has been considered to be an oestrogen inhibitor and it would be useful where there are painful or spasmodic uterine conditions

    Christine Herbert christineherbert.co.uk

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