Primary Causes & Action Plans

Estradiol (Serum)

Measures active circulating estrogen; elevated levels drive dominance symptoms
Estradiol is the most potent circulating estrogen. Elevated estradiol (with low progesterone) produces breast tenderness, bloating, mood swings, and increased cancer risk. Estradiol should be tested in both follicular and luteal phases in premenopausal women.
Target Follicular: 30-100 pg/mL. Luteal: 50-150 pg/mL
Suggested Action Plan

If estradiol is elevated, support estrogen detoxification: increase fiber (especially cruciferous vegetables), increase Phase 1 & 2 liver support (milk thistle, NAC, curcumin), optimize gut health (probiotics, fermented foods), and minimize xenoestrogens (plastics, pesticides).

Progesterone

Opposes estrogen action; deficiency allows estrogen dominance
Progesterone is the natural antagonist to estrogen. When progesterone is low relative to estrogen, estrogen-dominant symptoms emerge (water retention, breast tenderness, irritability, insomnia). Progesterone deficiency is the most common cause of estrogen dominance.
Target Luteal: 8-20+ ng/mL (normal cycle)
Suggested Action Plan

If progesterone is low, support production through stress management, adequate sleep, and vitamin B6/magnesium. Consider bioidentical micronized progesterone 100-200 mg during luteal phase. Retest in 2-3 months.

SHBG (Sex Hormone-Binding Globulin)

Binds and inactivates estrogen; low SHBG allows free estrogen dominance
SHBG binds estrogen and reduces its free, active form. Low SHBG allows excess free estrogen despite normal total estradiol. SHBG is suppressed by insulin resistance, obesity, and inflammation—all common in estrogen-dominant women.
Target > 40 nmol/L
Suggested Action Plan

Raise SHBG by improving insulin sensitivity (low-carb diet, exercise), losing excess weight, and reducing inflammation. These interventions lower free estrogen without needing to lower total estradiol production.

Estrone (E1)

Storage form of estrogen produced in fat tissue; overproduction drives dominance
Estrone is produced in fat tissue through aromatase enzyme activity. Obesity produces excessive estrone, contributing to estrogen dominance. Estrone is measured less commonly but is important in the full estrogen picture.
Target < 60-70 pg/mL
Suggested Action Plan

Reduce estrone through weight loss (if overweight), reduced inflammatory foods, and aromatase inhibition (through zinc, DIM, or calcium d-glucarate). Optimize estrogen detoxification through liver support.

Liver Enzymes (ALT/AST)

Elevated liver enzymes indicate impaired estrogen metabolism
The liver metabolizes and excretes estrogen. When liver function is compromised (elevated ALT/AST), estrogen is poorly cleared and accumulates, worsening estrogen dominance. Liver support is essential.
Target ALT < 30 U/L; AST < 30 U/L
Suggested Action Plan

Support liver function through antioxidants (milk thistle, NAC, curcumin), adequate hydration, limited alcohol, and Phase 1/2 detoxification support. If ALT/AST are elevated, investigate causes (viral hepatitis, fatty liver, medication side effects).

Also in Hormonal Health

Andropause & Low Vitality Hypothyroidism Polycystic Ovary Syndrome (PCOS)

Explore by Biomarker

Estradiol (Serum) Guide
Perimenopause
SHBG (Sex Hormone-Binding Globulin) Guide
High Estrogen in Men (Estrogen Excess)
Progesterone Guide
Hormone Imbalance

Getting Started

1
Test Your Estrogen and Progesterone Levels

Get serum estradiol, progesterone, SHBG, and liver enzymes. If you still menstruate, test during both follicular (days 3-5) and luteal (days 19-21) phases. Your specific pattern determines whether you need progesterone support, estrogen detoxification, or weight loss.

2
Identify Your Specific Estrogen Dominance Pattern

Do you have high estradiol, low progesterone, or both? Is your liver function compromised? Is insulin resistance preventing SHBG production? Your specific pattern guides targeted intervention.

3
Support Estrogen Detoxification

Eat 2-3 servings of cruciferous vegetables daily (broccoli, cabbage, Brussels sprouts). Take milk thistle, NAC, and curcumin. Optimize gut health with probiotics and fiber. These interventions help clear excess estrogen through the bile and feces.

4
Consider Bioidentical Progesterone

If progesterone is low, bioidentical micronized progesterone (100-200 mg daily during luteal phase) typically resolves breast tenderness, bloating, and mood swings within days. This is far more effective than nutritional support alone.

5
Retest Every 2-3 Months

Biomarkers should improve within 2-3 months of targeted intervention. Retest to confirm improvement and adjust doses if needed.

Why I built this guide.

"Estrogen dominance is highly treatable once you understand your specific pattern. Testing is essential."

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