Health Babes Podcast #062: Symptoms & Common Drivers of Estrogen Dominance

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Intro: (00:03)

Welcome to the “Health Babes” podcast with Doctors Becky Campbell and Krystal Hohn, where we talk everything health.

Dr. Krystal Hohn: (00:14)

Hello everybody, and welcome to the “Health Babes” podcast. I am Dr. Krystal Hohn. Thank you so much for tuning in. We’re going to talk all about estrogen dominance today. So many drivers, so many things involved, and so many symptoms. Let’s dive in.

Dr. Krystal Hohn: (00:36)

There’s so much information when it comes to hormones and so many factors involved. I’m going to do my best to break this down for you and kind of walk you through how I work with estrogen, especially in the practice with patients and the many things involved. We could do so many different episodes on this, so that’s another thing, but this is a great start. Why don’t we dive in with symptoms of estrogen dominance? Whenever I’m working with patients, especially, symptoms can tend to drive you nuts, right? You start feeling like, “Oh my gosh, I’m gaining weight!” or “I have bad acne!” or “I’m losing my hair!”—things like that. Then we get on Mr. Google, and we start Googling all these symptoms. With hormones, the biggest thing to especially understand is that we have a lot of overlapping hormones or symptoms with various different hormonal imbalances. When it comes to really working with hormones, you really have to take a step back, do some thorough testing, and kind of really listen to your body. There are so many things you can do to support hormones, which we’ll talk a little bit about. But we’re going to stick mostly to estrogen dominance today.

Dr. Krystal Hohn: (02:10)

Some of the typical symptoms that I see with this are acne—I see a lot of acne, typically cystic acne; not all the time—but acne that [one] also has a lot of issues with when you’re eating higher histamine foods. Typically, when we’re more estrogen-dominant, we can see a lot of this acne presentation, not only on the chin area where it’s cystic. But I can also see a lot of redness with acne with estrogen dominance, especially if we’re eating higher histamine foods because we know that when we’re dealing with estrogen dominance, we’re typically having higher histamine-type symptoms. That’s a whole other episode that we could get into, too. Dr. Campbell just recently did a histamine episode, so if you haven’t listened to that, make sure you go back. But redness and itchiness with acne are very big signs that I see with estrogen dominance.

Dr. Krystal Hohn: (03:14)

Weight gain, especially around the belly area. And this goes for men, too! You want to look at that estrogen/testosterone ratio. You want to make sure you’re not converting or aromatizing a lot of your testosterone if you’re a man down these naughty estrogen pathways. Typically in men, we’re seeing belly weight gain, increased breast size, less muscle mass—things like that. In women, [it is] kind of the same presentation—weight around the belly area. But also weight resistance, like they’re unable to lose weight typically, is what I see.

Dr. Krystal Hohn: (03:58)

Waking at night—typically, with higher estrogen, we see this accompanied by higher cortisol. We’re waking up a lot during the night, things like that. You just want to pay attention to that. If you are struggling with that, you may want to look into your estrogen levels.

Dr. Krystal Hohn: (04:17)

Hypothyroidism—we see a lot of sluggish thyroids with estrogen dominance. With a sluggish thyroid, we typically see slower motility, which is also going to affect how our body gets rid of estrogen. We get rid of estrogen through our urine and our stools. So typically, with sluggish motility, we’re seeing a lot of constipation with estrogen dominance, so we’re not clearing it efficiently.

Dr. Krystal Hohn: (04:43)

Of course, painful periods—whenever I see patients with painful periods, I’m looking at a number of different factors, not just with estrogen dominance but also accompanied progesterone levels. You could be more estrogen dominant with progesterone. Let’s say your estrogen is normal but your progesterone is lower, it’s making you more dominant, and you can have a lot of those PMS-type symptoms: Cramping, increased breast tenderness, a lot of mood swings, and histamine symptoms in the week leading up to your period in that luteal phase. Even around ovulation, when we get that really big surge in estrogen right before we ovulate, oftentimes we see a lot of those types of symptoms with histamine with that, too. Painful periods are typically something that we see with estrogen dominance.

Dr. Krystal Hohn: (05:42)

Of course, bloating—typically with estrogen dominance, there’s a big inflammatory component with it. So, you’re wanting to peel back the layers and figure out, “Okay, what’s driving a lot of that inflammation?”

Dr. Krystal Hohn: (05:57)

These are typical symptoms: Acne, hair loss, weight gain, waking up at night, hypothyroidism, painful periods, and bloating, among many other things. If you feel like you’re struggling with any of those symptoms, look into your estrogen. I personally like the DUTCH Test because it’s not only looking at your levels, but it’s showing us: How are we breaking down that estrogen in the body? Where are we struggling at? And what things do we need to be doing to support the body specifically? Everybody is so different, and there are so many different supplements and helpful tools you can do to help with estrogen metabolism, but you really do have to figure out: “Okay, what is the best thing for my body with the presentation of what my hormones are doing?” So keep all of that in mind.

Dr. Krystal Hohn: (06:55)

Here are some of the common presentations that I typically see with estrogen. What does it look like? What does estrogen dominance look like? You could typically have just overall higher estrogen, so it’s in the red. This is typically where patients know it, too, with the typical symptoms that I described earlier. But you can also have estrogen higher [when] compared to progesterone. Whenever I’m working with estrogen dominance, I’m always wanting to look at what the progesterone levels look like because sometimes really working on ovulation and really focusing on trying to work with increasing progesterone levels helps balance out these estrogen-dominant symptoms or even helps balance estrogen dominance. You want to look at that estrogen/progesterone ratio. You can also have lower estrogen with even lower progesterone. So typically, patients will come to us too and say, “You know, Doc, I feel like I have all of these estrogen-dominant symptoms”,but I’ll also see really low estrogen even though they’re estrogen dominant. That’s typically because progesterone is lower. You want to look at a lot of these factors and make sure that you’re seeing the big picture when it comes to estrogen dominance.

Dr. Krystal Hohn: (08:24)

Okay, so let’s dive a little bit into the common causes of estrogen dominance. I wrote some of these down so that I don’t miss them for you guys. And we could do so many episodes on this, but I’m going to hit a couple of the factors that I look into when it comes to this. Some of the common causes are xenoestrogens. If you don’t know what xenoestrogens are, how I like to easily describe them [is that] they’re estrogen-mimicking, but they’re fake estrogen coming from different toxins within our environment and the products that we use. And our bodies just don’t recognize the difference from these xenoestrogens compared to naturally produced estrogen that our body makes. What happens is that when we’re consuming or using a lot of these xenoestrogens, they can go down and favor these less favorable pathways with estrogen. It can make us more dominant.

Dr. Krystal Hohn: (9:30)

And what I mean by xenoestrogens—let me give you just a couple of examples: The water that we drink, especially with fluoride or medications that are in the water. You have to make sure that you’re drinking filtered water because of a lot of the crap that’s in the water, just to be honest, especially in city water. Birth control pills within our water system, medications—a lot of this stuff can be xenoestrogen-mimicking, causing us to go down these naughty pathways when we’re trying to metabolize estrogen and just start to wreak havoc on our system, among many other issues that xenoestrogens have, not just the stress that it overall puts on our liver and our body. So, water is a big one. We have beauty products—things that have fragrance. Fragrance, phthalates, parabens—this is big!—we need to make sure that we’re using products that don’t contain a lot of this stuff because our bodies just cannot handle it. It’s a lot of toxin load, and it can really cause us to be more dominant.

Dr. Krystal Hohn: (10:48)

Plastics, BPA, and things like that in our food storage—you have to be careful with that stuff because it’s also very estrogen-mimicking. It’s a xenoestrogen. The way that you’re storing food in plastic containers [is a concern]. This is a hard one because, with patients especially, not everybody can take everything in their house and throw it away. It’s just not cost-effective. What I like to tell patients and even listeners who are listening here is to start off with a couple of things. Once you run out of your lotion, replace it with something that doesn’t have fragrance in it, parabens, or things like that. That’s going to be better for you and a little bit more cost-effective. Same with kitchen utensils—the things we cook with. I personally like cooking with stainless steel or stone. I also like cast-iron skillets. But you have to be careful with cast iron too because of the iron. We see a lot of iron overload in the practice. But these are still better options than a lot of the coated pans, Teflon pans, plastic, and things like that. Do more stainless steel or even glass cookware where you’re storing your food.

Dr. Krystal Hohn: (12:12)

So that’s a big area. Xenoestrogens are a big reason why we see a lot of estrogen dominance in the practice. Then we have low progesterone like I talked about. We can be more estrogen dominant simply by having lower progesterone levels. When I’m working with patients, I’m also looking at: “Okay, why don’t they have strong ovulation or strong progesterone levels? Where are they at in their cycle?” Are you a menopausal woman? Are you perimenopausal? Are you still cycling? If you’re cycling, I’m wanting to figure out, “What’s driving your low progesterone?” Things like that. You want to peel back the layers when you’re working with hormones. There’s a driver for everything, and there are usually a lot of accompanying imbalances to fix other things. I love to put the pieces of the puzzle together, especially when working with testing and with hormones, because it’s really like a puzzle—it is.

Dr. Krystal Hohn: (13:15)

Another reason I see higher estrogen is a lack of fiber in the diet. We need to be getting in lots of color, lots of fruit, and lots of fiber. This is so important to give us really healthy, strong bowel movements. When we make estrogen, we need to metabolize it through the liver and then get rid of it in our urine and stools. Typically, I’m seeing a lot of constipation in patients who are dealing with estrogen dominance, so you want to make sure that you’re getting in lots of fiber. We want to make sure that we are pooping every day, if not twice a day, three times a day, and having regular bowel movements.

Dr. Krystal Hohn: (14:04)

When I’m working with estrogen and hormones specifically, I’m typically really starting backward with patients assessing diet, looking at: Are you pooping every day? How much water are you drinking? How much fiber are you getting in? What does your diet look like? These are such important factors when working with any hormonal imbalance, and they’re some of the easiest tools that you can implement. Most people don’t realize that they have such easy tools that they can utilize other than supplements, things that we may need to work with, or other contributing factors that we’ll talk about in a second. But some of these basic things that we can be doing on a daily basis and working on can really help our hormones and are oftentimes not thought about. They seem too simple to patients, like, “Oh, I’ve just really got to poop,” right? So it’s a big factor when it comes to working on estrogen metabolism.

Dr. Krystal Hohn: (15:08)

Getting in enough fiber [is important for] constipation and a sluggish liver, especially with the amount of toxins we’re exposed to. I always like to baby and take care of the liver. So we can do gentle castor oil packs. Making sure we’re getting in complete protein sources and looking at those phases of estrogen metabolism. I work a lot with the DUTCH test. But there are different areas that you can support with this to make sure we’re clearing well and good. This is very specific when we’re working on a sluggish liver or even working with gentle detox pathways. You want to make sure you’re definitely working with a practitioner because sometimes you have to go really slow with that stuff, and it’s very dependent on the person, depending on the overall toxic load. Just be aware of that. Don’t just run out and get a bunch of liver supplements and things like that. You want to definitely take care of and baby that area.

Dr. Krystal Hohn: (16:06)

We have some genetic components, especially with estrogen. We’re looking a lot at that COMT gene. A lot of the time, patients are dealing with a slower COMT gene; their drain is just a little sluggish when clearing estrogen, especially in phase two of estrogen metabolism. There are areas that you can really support when it comes to estrogen metabolism. But again, this is specific to the person, what their body needs, and what they can handle personally. You have to be careful. Some areas that are really supportive of that COMT gene are really good: Methylated B vitamins, choline, magnesium, and making sure we’re getting in amino acids from complete protein sources. These are some areas too that you can really support the liver with. This is also why you want to make sure your first step is getting in really good, nutrient-dense foods. A nutrient-dense diet is important for hormones—not just estrogen, but a lot of our other sex hormones, thyroid, and things like that. So yes, our COMT gene. There are certain genes, things like our MTHFR. How well are we methylating and detoxing? You want to look at various areas like this when you’re working with estrogen.

Dr. Krystal Hohn: (17:27)

I’m a big, big component of diving into gut health. This is so important. It’s a very big piece of the puzzle when it comes to estrogen metabolism. When we make estrogen, we break it down in the liver, and we get rid of it through our stools. Typically, with a lot of estrogen dominance, I’m seeing gut infections. This could be coming from opportunistic bacteria: H. pylori, parasites, fungal infections like candida, and things like that. Oftentimes, what’s happening is that this bacteria is really stopping us from fully getting rid of the estrogen and clearing it through our stool. What’s happening is that we’re recycling a lot of that into our system. There are a lot of processes, enzymes, and things like that involved in this process. I won’t get into all of that, but the big piece of the puzzle that you want to take here with estrogen is that you’ve got to dive into gut health. You have to support the liver and work backward that way. Also, working on our stress, working on a nutrient-dense diet, and making sure we’re staying away from those xenoestrogens. Also, looking at nutrients, oftentimes, when patients are dealing with infections in the gut, we’re not absorbing a lot of the nutrition from our foods, too, because it’s also impacting our digestion, absorption, stomach acid, and all the things like that. So just keep all of that in mind when you’re looking into trying to support your hormones, not just estrogen.

Dr. Krystal Hohn: (19:15)

Just to reiterate, doing certain gut testing [can be beneficial]. There are a lot of different tests out there. We work with the GI-MAP test. It’s an amazing test, and it’s very specific. I’ve worked a lot over the years with different companies, so we personally love the GI-MAP. And this is testing a lot of these microbes. It’s also testing an important marker, beta-glucuronidase, that’s important for phase two estrogen metabolism, looking at that glucuronidation in the liver and how we’re breaking things down. There’s a lot. When I’m working with estrogen dominance, I’m doing a lot of gut testing, but I’m also working with the DUTCH Test to see where else I can support this. I would definitely start there if you’re thinking about doing any functional testing with doctors. They’re phenomenal tests, and I absolutely love them.

Dr. Krystal Hohn: (20:15)

Another thing that’s a big driver that we see accompanied by high estrogen is high cortisol. Stress is not stressed enough, and it’s not the easiest thing to take care of or remove. We all have it. It’s something that we all have to work through, deal with, maneuver, and juggle. But we have to put the proper tools in place to really help our hormones. It’s one of the best things you can do long-term for any hormonal imbalance. Whether you’re putting in place these proper stress management techniques like meditation, limbic system work, or really retraining that brain and the limbic system from chronic stress, trauma, or things like that, somatic therapy is excellent for trauma that impacts our hormones. Breathwork, vagus nerve work—there are so many things we can do to really help [reduce] the impact of what stress does to our bodies and to our hormones. You really have to find what resonates with you and what works for you. But there’s a plethora of information out there and a lot of free resources, too. If you’re dealing with estrogen dominance, you have to put stress management at the forefront, and that’s with anything.

Dr. Krystal Hohn: (21:47)

I see a lot of low thyroid with estrogen dominance, and some of the symptoms that we start to see are sluggish motility. That’s really going to impact estrogen clearing. I don’t see it all the time, but for the most part, I’m seeing sluggish T4 to T3 conversion. You’ve really got to start in the gut and support the liver to really start working on that thyroid. When I’m working with estrogen dominance, as you can see, I’m looking at a lot of these factors. It’s never just one simple thing when we’re working with a hormonal imbalance. We’re wanting to put all those pieces together to best support your body, peel back those layers, and figure out what’s causing that within your system so that we can really start to give you the tools to properly take care of these things.

Dr. Krystal Hohn: (21:47)

Some action steps that you guys can do, for listeners that are listening, if you feel you’re dealing with estrogen dominance: Testing. I would do some blood work looking at a full thyroid panel, important nutrients like your B vitamins, homocysteine levels, copper/zinc ratios, and a full iron panel—especially for estrogen, that’s important. Your blood sugar—that’s also a very big component when you’re dealing with any hormonal imbalance. DUTCH testing—I absolutely love it. It’s looking at your pathways; it’s not just a blood spot check. We’re testing in the specific area or at the time that we should be testing these important hormones. That’s important—you can’t just test these at any time. And then, of course, diving into gut health—you want to dive into that and really figure out if you are dealing with any infections or things like that. So that is as far as testing that I would go.

Dr. Krystal Hohn: (23:58)

If you are someone who can’t work with a functional medicine practitioner or someone who just can’t go that route yet—which I understand; everybody’s situation, finances, and things are so different—some areas that I would just start off [with] for you would be: 100% eliminate processed, inflammatory foods. Get in nutrient-dense foods, lots of color, lots of plants, and complete protein sources where we’re getting our amino acids in. Lots of fiber. Make sure that you are pooping every day, and if you’re not, you have to peel back those layers and figure out, “Why am I not going to the bathroom?” This is so important for estrogen dominance. Going to the bathroom, making sure that you’re drinking lots of water—these are some action steps you can take. Making sure that we’re working on stress. Stress is going to impact ovulation, which is going to impact progesterone levels. If we’re not working on our stress, it’s going to affect a lot of our hormones. So putting those tools in place is going to be at the forefront of some things that you can do.

Dr. Krystal Hohn: (25:16)

There are other things, like gently and safely working on your detox pathways—moving your body and sweating. Our skin is one of our biggest organs, and we get rid of a lot of things and detox through our skin. So making sure that we’re sweating every day if you’re able to. Typically, when patients aren’t sweating, I’m seeing issues with detox pathways, so you want to keep trying at that. Really supporting the liver with gentle castor oil packs. Even getting in complete protein sources in a nutrient-dense diet. You’re already supporting the liver so greatly by doing those things. Incorporating dry brushing, things like that, and Epson salt baths if you don’t have any issues with that. Of course, you always want to check with your doctor when implementing or taking any new supplement or therapy safely to see if it’s best for you. But these are some areas that you can really start to pay attention to and really support for any hormonal imbalance, specifically for that estrogen dominance.

Dr. Krystal Hohn: (26:30)

This is going to be part one for you guys. We’re definitely going to do more when it comes to estrogen dominance and hormones. We have so many plans for the podcast. It’s been such a labor of love. We love it. We’ve had so many amazing guests, made so many new friends, and [are] learning so much. That’s what life is all about, especially in healthcare. We’re constantly learning, constantly evolving. I do want to do part two, in which I will be getting in and diving more into specific things that I work with on the DUTCH Test—looking at pathways, some of the different supports I work with, and the dos and don’ts of some of those supporting things.

Dr. Krystal Hohn: (27:15)

Thank you so much for listening. We appreciate all of your support, you guys, really and truly. Thank you so much for all the beautiful reviews. We appreciate and love them so much. Words are my love language. It’s just so helpful in the support that you guys give. If you find an episode that you do love, make sure you leave a review if you can. It just takes a second. I hope you guys have a great rest of your day!

Dr. Becky Campbell: (27:49)

Thank you, guys, so much for listening to this episode. If you love this episode, please leave a review. It only takes a couple of minutes, and you can find out more about us on You can follow us over at Instagram on @HealthBabesPodcast, @DrBeckyCampbell, and @DrKrystalHohn. Have an amazing day!