The conventional medical mindset is that menopause is an estrogen deficiency disease resulting from ovarian failure. Women have been led to believe that at the slightest symptoms, they should run out and get estrogen replacement. While estrogen levels will decrease during menopause, the truth is, estrogen levels do not fall appreciably until after a woman’s last period. In fact, far more women suffer from the effects of “estrogen dominance” during the transition—that is, they have too much estrogen relative to progesterone. And some women can suffer from the symptoms of estrogen dominance for 10 to 15 years, beginning as early as age 35.

Listen to Your Body

The symptoms listed below, as well as many others, often arise when estrogen overstimulates both the brain and body. All of these symptoms are exacerbated by stress of all kinds. Many women in their thirties and early forties find that they experience moderate to severe symptoms of estrogen dominance as they approach perimenopause.

  • Decreased sex drive
  • Irregular or otherwise abnormal menstrual periods
  • Bloating (water retention)
  • Breast swelling and tenderness
  • Fibrocystic breasts
  • Headaches (especially premenstrually)
  • Mood swings (most often irritability and depression)
  • Weight and/or fat gain (particularly around the abdomen and hips)
  • Cold hands and feet (a symptom of thyroid dysfunction)
  • Hair loss
  • Thyroid dysfunction
  • Sluggish metabolism
  • Foggy thinking, memory loss
  • Fatigue
  • Trouble sleeping/insomnia
  • PMS

Estrogen dominance has also been linked to allergies, autoimmune disorders, breast cancer, uterine cancer, infertility, ovarian cysts, and increased blood clotting, and is also associated with acceleration of the aging process.

What Causes This

When a woman’s menstrual cycle is normal, estrogen is the dominant hormone for the first two weeks leading up to ovulation. Estrogen is balanced by progesterone during the last two weeks. As a woman enters perimenopause and begins to experience anovulatory cycles (that is, cycles where no ovulation occurs), estrogen can often go unopposed, causing symptoms. Skipping ovulation is, however, only one potential factor in estrogen dominance. In industrialized countries such as the United States, there can be many other causes, including:

  • Excess body fat (greater than 28%)
  • Too much stress, resulting in excess amounts of cortisol, insulin, and norepinephrine, which can lead to adrenal exhaustion and can also adversely affect overall hormonal balance
  • A low-fiber diet with excess refined carbohydrates and deficient in nutrients and high quality fats
  • Impaired immune function
  • Environmental agents

Spiritual and Holistic Options

Here’s what you can do to decrease estrogen dominance: Increase nutrients in the diet: Take a high potency multivitamin/mineral combination.

Follow a hormone-balancing diet: Eat lots of fresh fruits and vegetables, adequate protein, and moderate amounts of healthy fat. Remember to get enough fiber. Estrogen is excreted by the bowel; if stool remains in the bowel, estrogen is reabsorbed.

Use transdermal 2% bioidentical progesterone cream: Many of the symptoms of estrogen dominance can be relieved with natural, bioidentical progesterone, available over the counter in a 2% cream (one-quarter teaspoon contains ~20 mg progesterone). Use one-quarter to one-half teaspoon 2% progesterone cream on skin (e.g., face, breasts, abdomen, hands) daily for two to three weeks prior to onset of period. If periods are irregular, use 2% progesterone daily, or from the full moon to the dark of the moon. (That way you’ll be teaming up with the cycle of the Earth itself — the same cycle that governs the tides and the flow of fluids on the planet.)

Lose excess body fatand get regular exercise—especially strength training.

Detoxify your liver: Traditional Chinese Medicine explains that menopausal symptoms are caused by blocked liver and kidney chi. This makes sense. The liver acts as a filter, helping us screen out the harmful effects of toxins from our environment and the products we put in our bodies. When the liver has to work hard to eliminate toxins such as alcohol, drugs, caffeine, or environmental agents, the liver’s capacity to cleanse the blood of estrogen is compromised.

Decrease stress: Learn how to say no to excessive demands on your time. Remember, perimenopause is a time to reinvent yourself. This means investing time and energy in yourself, not everyone else.

Learn More — Additional Resources

Christiane Northrup, M.D.

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. lori
    1 week ago

    Hi Dr. Northrup,

    I am 53 and no periods for 3 yrs. My only neg. symptom of menopause has been chronic insomnia. I eat a high fiber predominately vegetarian diet with antibiotic free poultry and some salmon or other seafood. I have eaten this way since my 30s. My last labs showed low serotonin, high cortisol am and pm and low progesterone and high estradiol. I exercise 4-5 times per week, also meditate and do yoga and have been practicing Tai Qi for 25 yrs. I am confused as to how my serotonin got so low and why the progesterone is so low compared to estradiol and why estradiol is high at all. I am 5’2 and weigh 135 so that could be one reason but I wouldn’t say I’m overweight. I know cortisol is a problem but I didn’t have trouble sleeping until my periods stopped, I may have had high cortisol before that. Even with all I do to counteract stress, it’s there. I am going to start a bio identical progesterone sublingually, I am taking phosphatidylserine at night for the last 3 wks and just started 50mg of 5HTP and will increase it slowly. What do you think?

  2. Heather
    4 weeks ago

    I am 43 years old and am in early remission from triple negative breast cancer. I have always had very low progesterone levels and took a synthetic progesterone to get pregnant. I have been using a natural progesterone cream each nice about once or twice a day. Is this healthy to do while in remission? is it a healthy way to prevent unopposed estrogen? Can I do this everyday or should I take a break and is this a good thing for triple negative cancer? Thank you!!! I am desperate for some alternative, preventative advice

  3. Lillian Roberts
    2 months ago

    Estrogen dominate after menapause

  4. heather
    2 months ago

    Hello Dr. Northrup,
    My name is Heather I am a mother of two and very active 35 year old. I am healthy, workout and eat smart. I need some direction. I only feel normal about one week out of the month. The rest of the days are controlled by estrogen dominance. Severe: breast tenderness, weight gain, bloating, mood swings, fatigue and depression. When I have my period it’s like the black clouds go away and I can physically feel my body come back to normal. I have tried birth control and seen many doctors and have tried progesterone (and was told this is feeding the fire). I need some direction, I am a nurse so very knowledgeable but I am really at a dead end please help.

    1. ANNA
      4 weeks ago

      Like you I only feel like me one week a month the week of my period. The rest is severe bloating, water retention, moody, headaches, irritable, fatique and deprssion. My doctor prescribed spirolactolone (25 mg) starting two weeks before my period. It seems to have made a difference with the bloating and water retention and my moids seem a bit more stable. I was wondering what Dr. Northup thinks about this?

  5. Stephanie Kartinos
    3 months ago

    Need a progesterone cream safe for having had breast cancer at one time. Thank you

  6. Julia Dederer
    4 months ago

    I am 66 years old, was on the vivelle patch for at least 10 years.
    I had stage 1 breast cancer – high estrogen, then, lumpechtomy, radiation, now arastrazole for 5 years (diagnosed March of 2014). Oncologist said not to be on
    estrogen of any kind. I tried A-Ma-Ta not thinking it had estrogen. In 30 days my bad hot flashes, nite sweats,
    and dry vagina were 75% better. I was so happy. I mentioned what I was taking to my oncologist last week.
    He did not recognize any of the ingredients, but said, if it was having those kind of results, it must have some form
    of estrogen, and, he requested that I back off slowly and not take it.
    Does it contain estrogen. If, yes, what is the amount. Is there some indication that it operates differently than normal estrogen? Should I stop. If, yes, do you have another recommendation for the hotflashes, etc? Thank you very much, Julia

  7. Joan
    6 years ago

    you may find peppermint too stimulating for sleep.

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