Estrogen Dominance PCOS: What It Is & How to Fix It

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.

What is Estrogen Dominance PCOS?

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:

• Heavier, longer periods
• Breast tenderness
• Mood swings or anxiety
• Trouble sleeping
• Weight gain around hips/thighs
• Worsened PMS symptoms
• Some women also feel generally “puffy” or inflamed.

What are the Signs of Estrogen Dominance PCOS?

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:

• Heavy or prolonged menstrual bleeding
• Breast tenderness or fibrocystic breasts
• Worsened PMS: mood swings, irritability, or anxiety
• Bloating and water retention
• Fatigue and sleep issues
• Weight gain, particularly hips and thighs
• Headaches around your cycle

These symptoms often stem from estrogen’s stimulating effect on tissues like the uterus and breasts. (source)

What are the Risks of Estrogen Dominance in PCOS?

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)

Estrogen Dominance PCOS Podcast

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.

How to Fix Estrogen Dominance PCOS?

So what can be done about estrogen dominance PCOS?

The functional medicine/nutrition approach focuses on:

• Supporting estrogen metabolism
• Improving gut health
• Reducing testosterone production
• Optimizing liver detoxification
• Reducing hormone overload from lifestyle factors
• Targeted supplements (if needed)

Support Hormone Metabolism | Estrogen Dominance PCOS

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:

• Cruciferous veggies daily
• Ground flaxseed
• Fresh herbs like parsley and cilantro
• Plenty of fiber (at least 25-30g/day)

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.

Gut Health for Estrogen Dominance PCOS

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:

• Eating prebiotic fibers (e.g. onions, garlic, asparagus)
• Including probiotic-rich foods like sauerkraut or kefir
• Avoiding chronic constipation
• Keeping inflammation low with a Mediterranean-style diet

Liver Health for Estrogen Dominance PCOS

Your liver is crucial for estrogen detoxification. In PCOS, fatty liver and insulin resistance can slow this process.

Support your liver naturally by:

• Drinking plenty of water ( I recommend 2 liters or more per day)
• Including bitter foods like arugula, dandelion greens, and citrus peel (or matcha- which also has many other supportive health benefits for PCOS)
• Limiting alcohol
• Using herbs like milk thistle that support liver detoxification

Stop Hormone Overload at the Source for Estrogen Dominance PCOS

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 and High Cortisol: The Silent Hormone Saboteur

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:

• Trouble falling or staying asleep
•  Feeling wired but tired
• Increased belly fat
• Mid-afternoon energy crashes
• Sugar or salt cravings
• Anxiety, restlessness, or feeling overwhelmed easily

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.

How to Lower Cortisol Naturally:

• Practice deep belly breathing a few times daily
• Try gentle movement like yoga, stretching, or walks instead of punishing workouts
• Prioritize 7–9 hours of quality sleep
• Limit caffeine if you’re sensitive (it spikes cortisol)
• Build in micro-breaks during the day to decompress
• Journal or talk out your stress instead of bottling it up

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.

 

Excess Body Fat and Estrogen Production

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 Disruptors: Hidden Hormone Hijackers

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).

How to Reduce EDC Exposure:

• Swap plastic food storage for glass or stainless steel
• Avoid microwaving food in plastic containers
• Choose fragrance-free or naturally scented personal care products
• Wash fruits and veggies thoroughly or buy organic for the Dirty Dozen
• Check labels for phthalates, parabens, and BPA
• Limit handling of receipts, which are coated with BPA

These small changes add up significantly over time, reducing the estrogen load your body has to detoxify.

Blood Sugar Imbalance, Insulin Resistance, and Inflammation

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.

How to Balance Blood Sugar for Estrogen Dominance PCOS:

• Include protein, fat, and fiber in every meal to slow glucose absorption
• Avoid skipping meals, which can spike cortisol
• Limit high-glycemic carbs and sugary drinks
• Try gentle exercise after meals (like a 10-15 min walk)
• Monitor your personal carb tolerance as some do better with moderate carbs, others lower

How to Lower Estrogen Load in Everyday Life

Here’s your Functional PCOS action plan for reducing estrogen dominance at the source:

•  Maintain stable blood sugar with balanced meals, higher protein, and fiber-rich carbs
• Eat an anti-inflammatory diet focused on colorful veggies, berries, healthy fats, and lean proteins
• Prioritize sleep and aim for 7-9 hours per night
• Minimize exposure to BPA, phthalates, and parabens in products and packaging
• Manage stress daily to lower cortisol and preserve progesterone
• Support gut health for healthy estrogen elimination
• Keep body composition in a healthy range to reduce aromatase activity

Why This Matters

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.

Supplements for Estrogen Dominance PCOS

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.

 

Learn More About PCOS

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.

Explore my PCOS Foundations course here for a step-by-step guide to understanding your hormones, metabolism, and how to start healing naturally.