Estrogen Dominance

by Christiane Northrup, M.D.


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.

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  • 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.


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  1. Shirley
    2 weeks ago

    Hello Dr. Northrup I’m 57 years old and have been taking Estradiol 2mg daily and Medroxypr ac 2.5 mg daily for years now however once a month usually the third week I expierence allergy and cold symtoms that last about a week or so but it never fails I catch a cold every single month /allergy sinusitis problems . I know this is a hormone related problem . What can I do? And when should I stop taking hormone therapy all together? Your reply would be very appreciated for at this time I’m in the process of finding a new Dr. Thank you.

  2. Sarah
    2 months ago


    I was hoping to get your opinion on my situation. To try to give you a detailed look, I’ll try to provide as many details as I can, though I’m not sure if they will all be relevant.

    I got pubic and underarm hair at 8, and I started my period at 10. My first two periods were perfectly normal and regular–they were beautiful. My third was light and was also late, and then my fourth skipped months before I got it. Ever since then, my periods have been awful. I’ll maybe get three or four a year if I’m lucky, and they’re always very light and only 3-4 days. My doctor didn’t bother to find out why–she merely put me on birth control and left it at that. I recently decided that I want to figure out what is really wrong with me, so I stopped taking the pill so that I can monitor my real body. Every single doctor I go to (even my gyno) doesn’t seem to care about my horrendous period schedule. They give me a weird look, say something with a super uncomfortable tone, and then move on. (And in the case of my gyno, she just told me that I’d probably have trouble getting pregnant, and then sent me out of her door.)

    Here goes some misc. things that I’ve noticed in my life (I’m not sure what’s relevant or not):

    Around the same age that I started my period, I started getting these weird red circular blotches all over my thighs. They still come and go.

    My optometrist told me that I have really dry eyes, and because of it, my eyelids rub off the coating on my eye.. Or something to that effect.

    I was skinny when I was young–never had trouble at all. Soon after I started my period I started gaining wait at more than a normal or healthy pace. I am definitely way overweight now, and very bottom heavy. Most of my weight is in my waist, hips, butt, and thighs (blah).

    A few years ago, my doctors and I were so sure that I had hypothyroidism, that they basically tested my blood as a formality. I had all of the symptoms (and still do)–extremely tired, cold hands and feet, slow metabolism, etc. Well, turns out, the blood test told us that I didn’t have hypothyroidism, and I basically got yelled at by the doctor and told to “stop making excuses and never come back.”

    I am so tired, all of the time. I have a Fitbit that tracks my sleep, and I can sleep for 12 hours and only get 4 hours of restful sleep. My sleep efficiency is atrocious.

    Since I’ve stopped taking my birth control, I haven’t had a period. It’s been 5 months. I’m not pregnant. I checked like 5 times at home, and once at the gyno. It’s not because of my weight either, I don’t think. It was just as bad when I had a normal BMI years ago.

    I used to have over 20/20 vision. Since I started my period, my eyes got insanely more awful every year. Now I’m basically blind without my glasses (nearsighted). I can only see at books length. Anything else is only a very, very vague shape.

    I don’t know if any of that helped–but do you have an opinion on my situation? I am so sick and tired of how fucked up my body is, and I just want answers–answers that no doctor gives a flying fuck about finding. I’ve been to 6+ doctors in my life, and every single one was either obviously super uncomfortable talking about it, or just told me I should be on birth control.

    I don’t want to mask my awful periods with birth control. I want to find out why they’re so off. Why I’m so off.

    Thank you so much,

    1. Sarah
      2 months ago

      I just left the above comment, and I totally forgot to tell you my age!

      I just turned 22

      (Also, many women in my family are very overweight/obese, including my mother)

    2. Sarah
      2 months ago

      Hi Sarah,
      Dr. Northrup talks about causes above. Do you have any issues with the following?

      -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

      These are deep places to go, but they start with you. Doctors won’t know your life or body like you do, and healing begins with you, beginning with how you talk to yourself. Notice how you use words like “i’m off” and “insanely more awful” and “flying fuck”…you are angry, understandably so—our doctors are supposed to know everything right? We trust them to analyze our symptoms, and deliver a diagnosis in a neat package. Well they don’t know anything when it comes to treating autoimmune issues, because there’s a very good chance that it is caused by our beliefs about ourselves and our beliefs about the safety of the universe we live in. Doctors can’t handle problems that big, and Pharma can’t make pills that don’t have harmful side effects. Besides, that’s treating the symptom, not the underlying problem.

      But healing begins with using loving words when we talk about ourselves and we thank our big strong body (the only one we have in this lifetime), and with acknowledging all the good things that we DO have. And it also helps to make sure we’re not eating processed food, aren’t suffering from anemia from a leaky gut caused by too much processed food and stress, and it helps to make sure that we are getting enough vitamins…and WATER. Have you had any water today, yet?

      Louise Hay has an affirmation that she tells herself, and she is a healthy, happy 88 today! She thanks her body and tells it “I love you.” and “I love every cell of my body” (you can view this pretty affirmation here:

      Good luck, sister! You can DO THIS! Health is yours!
      – Sarah

  3. karen
    3 months ago

    Hello Dr Northrup
    I have breast pain – specifically on left side, it comes in waves, like tightness and into the top of my underarm, have just started applying trans dermal cream. Could you clarify a few things for me ?
    sometimes i apply it and the pain starts like just now…..
    when i first did apply it to my chest It felt good so i guess that’s good but I think it may have brought on my period…is this possible ?
    I’m nearly 47yrs old. it seems to come on when my little ones are being seemingly demanding and when in front of the computer.
    i started using it after hearing you on embodied wisdom talk about it……
    thank you and hope to hear back


  4. Karen
    3 months ago

    I experienced nodules in my thyroid for over 30 years and it has been over active or under active. during that time. A few years ago after my partner died a sudden and tragic death, I started forgetting things, unable to focus as well as sleep through the night. I was in a constant fog. My doctor said that my estrogen and progesterone were non- existent from my blood tests and suggested estrogen & testosterone implants while taking oral progesterone. I started after being being post menopausal for ten years to have break through bleeding every month for over a year. I went to a top doctor in Chicago who works with post menopausal women and he took me off progesterone all together. I told him I would bleed more and he said he didn’t care. Sure enough within months, I started bleeding for 60+ days. He then said I had to back on it as I had a thickening in my uterus lining. The oral prescription was the exact same thing he took me off. I continued to bleed and still bled every month. Eventually I saw another doctor who gave me a progesterone cream. Now three years later my breasts have more cysts and I worry about breast cancer. Any correlation?

  5. Gail M Drouin
    5 months ago

    Good Morning,
    I am 61 years young. I had my uterus removed at 36 ( large fibroid ) & at 52 I had my ovaries removed ( l ovarian cysts & endometriosis throughout my abdominal cavity). Not once has hormone balance been discussed. For the past 8 or 9 years my vagina has thinned out, intercourse (if it were a part of my life) would be extremely painful. I am quite sure my cortisol is high ( lots of stress ). Whenever I try talking to my pcp about hormone imbalance she tells me I am postmenopausal. And then that is the end of the discussion. Do you have any recommendations?


  6. Rebecca Casey
    5 months ago

    I am in remission from Stage 3 breast cancer (diagnosed and treated 2012) –high estrogen –and am now on Anastrozole. I am experiencing its side effects–hair loss, fatigue, weight gain, bone ache, etc. Are there any alternative treatments to Anastrozole (which is an estrogen blocker)?

  7. Shannon
    5 months ago

    Dr. Northrup, I am a 46 year old woman who is fairly active but slightly overweight (+10-15 lbs.). I have read one of your books, but I am still not clear about when kind of birth control/hormones I should be taking. I believe I have a hormone imbalance, as the last two years i have been getting migraines about two weeks before my “period” is to begin (most often I do not actually have a period). I am on birth control pills and last year at my annual checkup I mentioned the headaches to my doctor and noted that I thought they were related to PMS and it was suggested to change my BC pills and increase the estrogen (I thought I remembered from your books NOT to do that so I declined). Also, I have severely dark skin on my neck which i have recently come to believe is acanthosis nigricans. Last year, my doctor sent me to a dermatologist who took a biopsy and stated that is was an allergic reaction to something (NOT for five years!). I believe I need to have some blood tests done for diabetes and will talk to my doctor about that at this year’s visit. I know I need to lose some weight and I am working on that. I want to know what kind of birth control/hormones I should be taking as I believe that is part of the issue (with the dark skin and the headaches). I want to take some BC pills, because I did stop taking them for a few months earlier this year and my headaches got even worse and I believe I still need some form of birth control. I apologize for the length of this question. Any advice will be greatly appreciated.

  8. Jacqurline
    5 months ago

    Dr. Northrop, what is the correct ratios of Estrogen to Progesterone one should be on? I am currently taking a combination of 1.5mg Estriol, 7.5mg Estradiol and 125mg Prosterone (bio identical). The Estradiol was reduced from 1.5mg to 7.5mg because I had breast tenderness and weight gain. I take them together in a slow release capsule and am wondering what is your opinion. I am 57 years young. I look forward to your response. Thank you!

  9. lori
    6 months 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?

  10. Heather
    6 months 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

  11. Lillian Roberts
    7 months ago

    Estrogen dominate after menapause

  12. heather
    8 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
      6 months 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?

  13. Stephanie Kartinos
    8 months ago

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

  14. Julia Dederer
    9 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

  15. Joan
    7 years ago

    you may find peppermint too stimulating for sleep.

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