If you’re dealing with PCOS symptoms and suspect something deeper is going on hormonally, you might have stumbled across the term estrogen dominance PCOS. But what does it really mean and what can you do about it?
Let’s dive into how estrogen dominance shows up in PCOS, the risks it poses, and evidence-based ways to help your body restore balance naturally.
Estrogen dominance in PCOS is about the ratio between estrogen and progesterone being out of balance.
Progesterone is the hormone we produce after ovulation. It helps to stabilize the uterine lining and prepare it for pregnancy but it also has importance for other bodily functions. Progesterone is a calming hormone and acts as a balance to the more stimulating estrogen.
In PCOS, chronic anovulation (not ovulating regularly) leads to low progesterone, leaving estrogen unopposed. Even if estrogen isn’t out of range, it becomes “dominant” simply because progesterone is too low to counterbalance its effects.
In addition, with PCOS we make too many androgenic “male” hormones like testosterone which leads to an increase in symptoms. But what a lot of women don’t know is that all hormones follow the same breakdown process- they turn from testosterone into a form of estrogen in order to be finally excreted from the body. This makes it much easier to become estrogen dominant with pcos than it would seem on the surface!
Estrogen dominance PCOS can show up as:
The symptoms of estrogen dominance in PCOS overlap with many classic PCOS issues, which is why it’s often missed. Here’s what to watch for:
These symptoms often stem from estrogen’s stimulating effect on tissues like the uterus and breasts. (source)
High, unopposed estrogen can increase the risk of certain gynecological conditions, including:
Endometrial hyperplasia: Thickening of the uterine lining, which can raise risk for abnormal bleeding or endometrial cancer.(American Cancer Society)
Fibroids: Benign uterine tumors linked to estrogen dominance that can impact your ability to conceive.
Breast health changes: While not always harmful, excess estrogen can contribute to fibrocystic breasts or increased breast density.(Facts Views Vis Obgyn. 2011)
For Gynecological Cancer Awareness Month and PCOS Awareness Month, I recorded Episode 20 of “An Amber A Day,” diving deeper into estrogen dominance in PCOS, how it ties to cancer risks, and practical strategies to restore balance naturally.
So what can be done about estrogen dominance PCOS?
The functional medicine/nutrition approach focuses on:
Estrogen goes through three phases of detoxification in your body:
Phase 1 (liver): Turns estrogen into metabolites, including protective 2-OH estrogen and potentially problematic 4-OH and 16-OH types.
Phase 2 (liver): Adds a “tag” (methylation, glucuronidation) to help your body eliminate estrogen.
Phase 3 (gut): Excretes estrogen out through stool.
Research shows certain foods and nutrients help favor protective estrogen pathways, especially cruciferous veggies like broccoli and compounds like DIM (diindolylmethane).
Try adding:
If you eat according to the principles of the ideal diet for pcos, you’ll take care of a lot of these estrogen dominance pcos needs naturally.
Your gut houses bacteria that influence estrogen metabolism, sometimes called the estrobolome (Mol Nutr Food Res
. 2024). When gut health is poor, excess estrogen can get reabsorbed instead of leaving your body, worsening estrogen dominance.
Support your gut by:
Your liver is crucial for estrogen detoxification. In PCOS, fatty liver and insulin resistance can slow this process.
Support your liver naturally by:
When it comes to estrogen dominance in PCOS, it’s easy to feel like your hormones have a mind of their own. But here’s the truth: many of the root causes of estrogen dominance are things we can influence every single day.
That’s both overwhelming and incredibly empowering.
Let’s break down how lifestyle, environment, and daily habits fuel estrogen dominance pcos and exactly what you can do to start shifting the balance in your favor.
Chronic stress is one of the biggest drivers of hormonal chaos in PCOS. When your body senses stress, it releases cortisol, your primary stress hormone.
Here’s the kicker: high cortisol suppresses progesterone production.
Cortisol and progesterone share a biochemical “mother molecule” called pregnenolone.
When your body prioritizes stress, it diverts pregnenolone toward making cortisol, not progesterone.
Low progesterone leaves estrogen unopposed, fueling estrogen dominance symptoms like heavy periods, mood swings, and water retention.
Top signs you might have high cortisol in PCOS:
Managing cortisol is essential if you want to balance estrogen dominance PCOS. I wrote an article on the top signs of high cortisol and adrenal dysfunction in pcos and how you can fix them.
Remember: your body isn’t designed to be in fight-or-flight mode 24/7. Creating safety signals for your nervous system is the first step in shifting hormone balance.
Body fat, especially around your belly, hips, and thighs is hormonally active tissue. Fat cells produce estrogen through an enzyme called aromatase.
The more fat tissue you carry, the more aromatase converts other hormones (like testosterone) into estrogen.
This becomes a vicious cycle: extra fat = extra estrogen → estrogen dominance symptoms worsen → weight gain becomes easier.
It’s not about being skinny. It’s about keeping fat cells from producing excess estrogen that your body can’t clear efficiently.
There are often several reasons it may be difficult to lose weight or maintain weight in PCOS and also some strategies for making losing weight with PCOS easier.
Endocrine-disrupting chemicals (EDCs) are substances that mimic or interfere with hormones in your body, including estrogen.
Top EDCs that affect estrogen dominance PCOS:
BPA (Bisphenol-A) → Found in plastic bottles, canned food linings, receipts
Phthalates → Found in fragrances, personal care products, vinyl
Parabens → Used as preservatives in cosmetics, lotions, and shampoos
Pesticides and herbicides → Residues on non-organic produce
Research shows these chemicals can increase estrogenic activity in the body, making estrogen dominance symptoms worse (Gore et al., 2015).
These small changes add up significantly over time, reducing the estrogen load your body has to detoxify.
Blood sugar imbalances and insulin resistance are core drivers of PCOS but they also feed into estrogen dominance in surprising ways.
High insulin levels stimulate ovarian theca cells to produce excess testosterone.
Excess testosterone can then be converted into estrogen through aromatase.
Chronic high insulin → chronic inflammation → impaired estrogen detox pathways in the liver.
Blood sugar spikes increase cortisol → lowers progesterone → relative estrogen dominance.
So while we often think of insulin as a “blood sugar hormone,” it’s also a major hormone disruptor for estrogen balance.
Here’s your Functional PCOS action plan for reducing estrogen dominance at the source:
Estrogen dominance PCOS isn’t just a hormone problem, it’s a systems problem.
Your stress levels affect your hormones.
Your gut and liver determine how well you detoxify estrogen.
Your body composition and blood sugar affect estrogen production.
Your environment exposes you to estrogen-like chemicals every day.
The beauty of functional nutrition is that every small change you make nudges the system toward balance.
While food and lifestyle are the foundation, some PCOS-friendly supplements may help with estrogen dominance:
DIM: Helps favor protective estrogen pathways. Before supplementing with this alone, I recommend working on your gut health first as supporting the liver too much without good gut health could cause more issues. The body will need good gut health to finish the hormone metabolism process.
Calcium D-glucarate: Supports phase 2 detox in the liver
I usually recommend a supplement called DIM detox for estrogen dominance pcos as it’s a good blend of DIM, Calcium D-glucarate, and other things we need to support the full hormone metabolism process. It’s part of my Fullscript Estrogen Dominance PCOS protocol.
B Vitamins (especially B6, B12, Folate): Support methylation and are best taken as part of a well-rounded PCOS friendly prenatal vitamin.
Probiotics: For gut health and estrogen elimination. I recommend a spore based probiotic like the one in my estrogen dominance pcos protocol above or a high CFU count one.
Omega-3s: Help reduce inflammation and support the full metabolism process.
Estrogen Dominance PCOS is more commone than you’d expect, especially with irregular periods but it also can be managed well with lifestyle changes. If you have any of the symptoms we discussed above for estrogen dominance PCOS, especially abormal bleeding, I highly recommend a checkup with your physician to check on everything. Let them know about the abnormal bleeding.
My personal PCOS story included years of battling hyperplasia and eventually endometrial cancer and I don’t wish that experience on anyone. No matter your age or weight, ensure you are advocating for proper care for yourself at the doctor’s office.
If you’re feeling overwhelmed, you’re not alone. PCOS is complex but you deserve to feel empowered and informed.
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