Endometriosis and Your Hormones: Oestrogen 101 - a podcast by Jessica Duffin

We talk a lot about oestrogen on this show, and so today, I want to give you a complete low down on oestrogen – what it does, how it benefits you and how it can affect you when things go wrong. 

Now, before we go ahead, I just want to share a trigger warning – I talk about reproduction and pregnancy in this episode. It’s not a huge part of it, but it’s there, so please feel free to skip this episode if you need to.

Another trigger warning in this episode is that I talk about the connection between oestrogen dominance and obesity. If this feels triggering for you, please skip! It is the final point on the causes of excess oestrogen/oestrogen dominance, and comes after the point on endocrine disruptors.

So, let’s start with what oestrogen does in the body…

Oestrogen is what fuels the growth of hips, breasts, the start of the menstrual cycle and in short, the onset of puberty. Oestrogen is responsible for fertile cervical fluid, thickening the uterine lining and kicking off ovulation, and it boosts serotonin production, which is not just crucial for cognitive function, but also helps us to feel more energised, sociable and positive. Oestrogen, alongside testosterone, increases libido - oestrogen actually increases blood flow to the pelvic area, and this heightens sensation and arousal. 

Basically, this combination of feeling more energised, more positive, more lubricated, having heighten sensations, etc. – all of these changes, are ultimately an attempt to get us pregnant. This is why, if you have a partner, you may overlook certain issues or see your relationship in a really positive light, only to find them irritating or to have those issues resurfacing in your luteal phase. Now of course, you might want to get pregnant, but that’s oestrogen’s intention.

Additionally, oestrogen is crucial for bone density, heart health and cognitive function, not to mention a huge list of other organs and roles in the body.

Now, if the above doesn’t sound like your experience of oestrogen, I get it. The phases of the cycle we’re going to cover today, are normally when people who don’t have endo, have more energy, feel more outgoing, more optimistic, etc. But for some of us with endo, we’re worn out from our period in the first half of our follicular phase, and then as we reach ovulation, we get pain. I know clients whose worst endo flares are around ovulation, so I understand if this doesn’t resonate with you – but I’m at this stage, just sharing the purpose of oestrogen. 

In a little while, I’ll briefly touch on why you may be struggling with oestrogen, but first, let’s talk about what’s happening with oestrogen in your cycle.

Oestrogen and the menstrual cycle

Oestrogen is at its lowest point during menstruation and tends to stay low for the first 1-2 days but begins slowly rising around day 3. 

This rise occurs because oestrogen is made from maturing follicles in the ovaries, think of follicles like water balloons with an egg in the middle. A couple of these are picked to begin maturing, and then by days 5 to 7, one of these follicles is picked and will eventually go on to release the one egg that bursts through the ovary during ovulation. 

As these follicles develop, they begin to make testosterone, which is largely converted into oestrogen. You’ll tend to feel a change in mood and energy around day 3 as that handful of follicles slowly begin to produce oestrogen, and then at about day 7-ish once the queen follicle has been chosen, you’ll get a real surge of oestrogen and you’ll move into the second half of your follicular phase. The oestrogen production really gets underway here and continues to climb right up until ovulation. 

During this process, oestrogen is working on thickening the uterine lining, but it is also supporting lubrication and helping to create fertile cervical fluid. Initially, just after your period you’ll likely still feel dry, but as oestrogen rises, you’ll begin getting a pasty, lotion type fluid in your underwear, and you may feel a little lubricated from time to time, but not noticeably so. 

Now, as I mentioned, oestrogen continues to rise in increasing levels, thanks to the queen follicle growing and maturing, and as we get closer to ovulation, we’ll begin getting a sticky, almost clear, egg-white like fluid, and we’ll feel very lubricated. This is fertile cervical fluid. 

Once oestrogen reaches its peak, this peak triggers a cascade of hormonal shifts which trigger ovulation. Without this peak, ovulation cannot occur. After this peak, oestrogen drops, ovulation occurs and progesterone then dominates over oestrogen. Oestrogen is still present but it’s lower than progesterone and continues to decrease. 

However, shortly before your period begins, we get another brief surge in oestrogen. This occurs to support possible implantation of a fertilised egg, and you’ll notice similar cervical fluid that you had before and around ovulation, it’s no longer fertile cervical fluid, but it looks the same. Of course, if you are pregnant, then further changes will occur, if not, oestrogen drops down again to its lowest point in your cycle and menstruation begins.

Now, a side note, which is really a whole episode in itself – if you’re feeling depleted when oestrogen is rising, we need to look at why. It could be that you lost too much iron and magnesium due to heavy bleeding, so we need to work on lightening that (and actually we’ll talk about why you may have heavy bleeding later on). It could be that you had horrendous endo pain on your period that wiped you out, so we need to look at lowering inflammation and using other tools and practices to lower that pain. It could be that you have low cortisol levels or HPA axis dysregulation, which is common in endo, and leaves you feeling constantly fatigued or fatigued in the mornings. If you’re having pain towards ovulation, we need to consider whether you’re sensitive to histamines, which rise with rising oestrogen or whether you have too high levels of inflammation, which is naturally part of the ovulatory process, but can cause pain in excess. Or perhaps you have an adhesion from surgery, tugging on your ovary, so that makes ovulation particularly painful. Or of course, you might have an endometrioma. So, these are some considerations to make and everything I’ve listed can be helped, addressed, reduced or even entirely resolved depending on your body and circumstance and what the issue is. Now of course, that’s what my work is all about, so scroll through my episodes to see which ones might help you with your personal issues during this phase.

Now, back to oestrogen specifically, a few things can go wrong.

Let’s look at the first part of the cycle. We know we want oestrogen to reach its peak, but one possible scenario is that it doesn’t get there, because your oestrogen levels are low. Low levels of oestrogen can occur from:

• The pill or other forms of hormonal treatment or birth control designed to lower oestrogen or stop ovulation.

• Stress – stress can lower sex hormones because reproduction is not a priority to the body in times of stress, and if you look at it from an evolutionary standpoint, stress back in caveman days was literally famine, or wild animals, or exclusion from our tribe; real life or death situations, so the priority was survival not reproduction. In many cases, it wouldn’t be safe to raise a baby in those kind of scenarios. Additionally, the stress response requires a lot of energy and resources from the body, the stress response literally diverts blood, glucose, etc. away from non-essential functions like reproduction and redirects them to the brain, heart and muscles. A one off acute bought of stress probably won’t do much damage, because the body was designed to cope with acute moments of stress, but chronic or prolonged stress can end up delaying or stopping ovulation entirely.

• Low calorie or nutrient intake

• Over-exercising

The follicles require energy and nutrients to mature and to reach the point where ovulation can occur, so depriving the body of these nutrients and calories can end up slowing their growth, preventing enough oestrogen from being made and ultimately, delaying ovulation or stopping it. Additionally, under eating and/or over exercising is a stressor on the body, so again, resources and energy are preserved for the stress response and directed away from the menstrual cycle process.

Now here’s the thing. You may be thinking that low oestrogen isn’t a problem for you because you’re having a period still. That’s not true. You can STILL have a period if you haven’t ovulated or if you have low oestrogen, this is because whether it got to the thickness it needed or not, you still have some uterine lining to shed and eventually, the oestrogen is going to drop, and that will kick off a shedding of the lining. 

Symptoms of low oestrogen include:

• Dyspareunia or painful sex, of course we need to consider that painful sex may also be from endometriosis or a tight pelvic floor in our case.

• Night sweats

• Low levels of cervical mucus or vaginal dryness

• Low to non-existent libido

• Joint pain

• Low mood

• Brain fog and low energy

• Infrequent periods or no period at all, or a prolonged cycle

• Dry eyes

• Dry skin 

Low oestrogen is linked with heart disease and a lack bone density, so it’s important to get it addressed if this seems to be an issue for you.

So now let’s look at the other scenario. High oestrogen levels or oestrogen dominance.

This can look like a few different scenarios –

• Low oestrogen but even lower levels of progesterone in the second half of the cycle, which means oestrogen is dominating over progesterone in this phase, when it should be the other way round.

• High oestrogen and normal progesterone, again, oestrogen is dominating over progesterone but is actually also high

• High oestrogen and low progesterone

• Normal oestrogen and low progesterone 

A few things can create these scenarios:

• Low progesterone, in which case, we need to look at why that’s low, and that tends to be lack of ovulation, caused by stress, dysregulated blood sugar, etc.

• An overburdened liver. Your liver processes and packages up used oestrogen, it then filters it into the gut, for removal in your daily bowel movements. When the liver is overwhelmed by environmental toxins, excess alcohol and sugar, caffeine, smoking, or even everyday chemicals from your beauty and body products, it will prioritise getting rid of those, because they’re more harmful than oestrogen. As a result, your oestrogen levels stack up in the blood stream. Additionally, it’s worth mentioning here that alcohol actually raises oestrogen levels. 

• Blood sugar dysregulation, which increases oestrogen levels in the body.

• Endocrine disruptors, which are chemicals and toxins which affect or mimic hormones, some of the most disruptive being xeno-oestrogens, which mimic oestrogen in the body and are now showing to be the reason young girls are getting their periods so early. Just as a side note – if you get your hormone levels tested, these won’t show up in the test because the test is measuring oestrogen, which these toxins are not, they just mimic it.

• Excess fat cells – now I want to be really clear here, this isn’t about being sizest or fat shaming, but I am just reporting on what we know from the research. Fat cells can also raise oestrogen and so the more we have, the higher the levels of oestrogen in the body. That doesn’t mean we need to have no body fat at all, that would actually stop ovulation! But generally, the research is showing that obesity is linked to oestrogen dominance. You can do whatever you like with this information, and I do not recommend you start focusing on dramatic weight loss! But it’s important to share all of the information and not just provide you with selective info, so you at least have it all and can decide what’s relevant to you.

Symptoms of oestrogen dominance or high oestrogen levels include:

• Worsening endometriosis symptoms

• Swollen and tender breasts, and maybe breast cysts

• Worsening PMS or PMDD symptoms

• Heavy periods 

• Clotty periods

• Painful periods

• Mood swings 

• Ovulation pain

• Brain fog 

• Bloating and water retention, especially in the second half of your cycle

Now, this is where the connection to endometriosis comes in.

Oestrogen thickens the uterine lining, largely through proliferation, which is the process of cells growing and dividing to make more cells. So, cells that have oestrogen receptors, can also grow too, which is how oestrogen forms breasts. But we know that many endometriosis cells contain oestrogen receptors (though not all of them, as we’ve come to learn), and so having high levels of excess oestrogen could potentially worsen the endometriosis. 

However, this isn’t a call to go straight on the pill to lower oestrogen. Why? Well, you’ve already heard the risks of low oestrogen, but the pill won’t necessarily stop endometriosis growth because endometriosis doesn’t just rely on oestrogen to grow. In fact, if some of your endo cells don’t have oestrogen receptors, it won’t be a contributing factor. Endo also uses histamines, prostaglandins, excess iron and other chemicals to grow. Additionally, endometriosis makes its own oestrogen supply, so cutting oestrogen production off at the ovaries, doesn’t actually solve the oestrogen problem.

Often, what doctors are doing with the pill, is suppressing symptoms, but they cannot guarantee growth suppression and the pill only works for a portion of endo patients. Now, everyone has to do what works for them, so please, please, please do what is right for you – if it’s working for you, great, but I just wanted to briefly raise this. 

A quick side note on this, curcumin in animal studies has been shown to reduce levels of oestrogen directly in the endometriosis cells, so whilst we don’t have the same evidence in humans yet, it’s a really exciting development. 

Now of course, having oestrogen dominance or excess oestrogen not only creates a set of symptoms that look a lot like endo symptoms – like heavy bleeding, cramps, fatigue, ovulation pain, etc. but it also exacerbates endo symptoms too.

So, what can you do if you suspect you have an oestrogen imbalance? Well, it of course depends on whether you have low oestrogen or excess oestrogen or oestrogen dominance. 

Either way, working to support your overall hormone health will help with both scenarios – so everything we cover on the podcast, such as nutrition, blood sugar balance, stress management, sleep, supporting the liver, etc. These may all sound like the foundations of a general healthy lifestyle, and that’s exactly right – you need a healthy lifestyle for your hormones to thrive. 

If you want to test your levels, you can get a simple blood test on Day 3 of your period for oestrogen and day 21 of your cycle for progesterone. Now these are only going to give you a snapshot of what your cycle is doing during this time. Your oestrogen might look fine on Day 3, but by 21 it may be way higher than your progesterone or your body might be struggling to filter it out. So, if you do want to go a bit further, a DUTCH test will give you an in-depth look at your hormones, with the most comprehensive being a DUTCH Cycle Mapping Test.

Often, testing is not necessary at first. I prefer to go through the foundational changes with my clients first, and then if they’re still not responding, we test. 

So where to get started? One of the most foundational changes you can make for your hormones is balancing your blood sugar, and this is almost where I start with nearly every client who shows signs of hormonal problems. I have several episodes and articles on balancing blood sugar, and I also of course cover it in my courses and masterclasses, so you can pick whatever suits you best! 

So, I hope that this has given you a deeper insight into the wonders of oestrogen, and as you can see, the ideal is healthy levels of oestrogen, rather than demonizing it and wanting to get rid of it completely!

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Show Notes

Oestrogen and the menstrual cycle

https://www.ncbi.nlm.nih.gov/books/NBK279054/#female_the-normal-menstrual-cycle-and-the-control-of-ovulation.REF.1

Oestrogen and bone density

https://pubmed.ncbi.nlm.nih.gov/8865143/

https://pubmed.ncbi.nlm.nih.gov/29962257/

Oestrogen and brain

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743731/

https://jnnp.bmj.com/content/jnnp/74/7/837.full.pdf

Oestrogen and heart

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709037/

Causes of hormone dysregulation

https://pubmed.ncbi.nlm.nih.gov/22115162/

https://www.ncbi.nlm.nih.gov/books/NBK279054/#female_the-normal-menstrual-cycle-and-the-control-of-ovulation.REF.1

https://link.springer.com/article/10.1007/s40750-014-0004-2

https://pubmed.ncbi.nlm.nih.gov/10397281/

https://onlinelibrary.wiley.com/doi/abs/10.1111/jne.12179

https://academic.oup.com/endo/article/145/3/1314/2878187

https://pubmed.ncbi.nlm.nih.gov/11511861/

Hormone testing

https://nicolejardim.com/hormone-testing-cheat-sheet/

https://nicolejardim.com/the-best-way-to-test-hormones/

https://drbrighten.com/when-is-the-best-time-to-test-hormone-levels/

Oestrogen and endo

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215544/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077338/