Many women put up with long-standing heath conditions that are driven by their hormones, as well as monthly anxiety, pain and mood swings thanks to PMS. Unfortunately, many health professionals are not aware that the health of the gut can directly impact the health of the female hormones, particularly oestrogen.
A quick recap on the monthly female hormone cycle
There are four main hormones that control a woman’s menstrual cycle: oestrogen, progesterone, luteinising hormone (LH) and follicle stimulating hormone (FSH).
They each play a part in what should be a beautifully orchestrated sequence of events that causes an egg to be released each month. They also prime the uterus for the possibility of fertilisation. If this doesn’t occur then they trigger the breakdown of the uterine wall. This leads to menstruation.
So, here’s a quick recap of what they do and when. The timings are approximate, based on a 28 day cycle:
Days 1-5 – The period, the time when the uterus lining is shed if the egg was not fertilised.
Days 6-14 – This is the follicular phase. Oestrogen levels rise, peaking just before ovulation, which causes the uterus lining to thicken in readiness for a pregnancy. FSH levels also increase which prompts the follicles in the ovaries to grow and develop into an egg.
Days 14-15 – Ovulation occurs. This is accompanied by a sharp rise in LH which triggers the release of the egg.
Days 15/16-28 – The luteal phase, during which the egg travels to the uterus. Levels of progesterone rise to thicken the uterus lining in case of pregnancy. If this doesn’t happen, both oestrogen and progesterone slowly drop and the lining is shed.
What are the symptoms of imbalanced oestrogen?
There are two main scenarios of imbalanced female hormones that are very often linked to women’s health issues – low oestrogen and high oestrogen.
Low oestrogen can be a result of too little being produced in the first place, or too much being cleared from the body. It may be a caused by low body weight, over exercising, the contraceptive pill or the menopause. Symptoms include:
- mood swings
- dry skin
- vaginal dryness
- breast tenderness
- irregular periods or no periods
- hot flushes
- brittle bones
In contrast, high oestrogen can be a result of too much oestrogen circulating in the body either through over production or poor clearance. It can be a contributing factor to conditions such as PCOS, breast cancer, endometriosis or fibroids. Symptoms include:
- heavy or painful periods
- swollen, tender breasts
- lumpy breasts
- mood swings
As you can see, there is some overlap in the symptoms so it may be helpful to run a hormone test such as the DUTCH test to get a clear picture of your personal levels. Please do let me know if you’d like to find out more about how testing might be able to help you.
How does the body clear excess oestrogen?
The liver detoxifies active oestrogen in a two phase process that renders it inactive and packages it in a form that can easily be removed from the body. During the phase II process, it is ‘conjugated’ – joined – to another molecule.
From the liver it is passed to the kidneys or gut, via bile, and is excreted in urine or stool.
How does gut health play a role in female health?
As we have seen above, too much or too little active oestrogen can lead to many unwanted symptoms. The gut microbiome is an important way in which levels of active oestrogen are controlled in the body.
When levels are low, the gut bacteria secrete an enzyme called beta-glucuronidase. This can deconjugate (literally un-join) the packaged oestrogen molecules. Once deconjugated, the now reactivated oestrogen can be reabsorbed and recirculated in the blood stream. If there are not sufficient levels of beta-glucuronidase, then less deconjugation takes place and the effects of low oestrogen may be felt.
In contrast, a dysbiotic gut flora (with pathogenic bacteria outweighing beneficial bacteria) may release too much beta-glucuronidase. In contrast to the above scenario, this could lead to over-deconjugation and allow excess active oestrogen to be reabsorbed into circulation.
Constipation is another way that gut health can affect oestrogen levels in the body. If a stool – containing conjugated oestrogen ready for clearance – sits for too long in the digestive tract, there is more time available for beta-glucuronidase to work. Fewer than one bowel movement per day may affect oestrogen clearance.
And finally, a dysbiotic bowel can lead to increased gut permeability – a ‘leaky gut’. This then allows deconjugated oestrogen to be reabsorbed more readily into the blood stream.
What can I do to improve my hormonal health?
There are several areas to focus on in order to improve hormonal health, specifically in relation to oestrogen levels.
- The first would be to look at supporting the liver, and its detoxification pathways – phases I and II – particularly when high oestrogen is the concern. This will render more oestrogen inactive and allow it to be removed from the body.
- In terms of gut health, the next step would be to look at supporting bile flow. This will allow the inactive oestrogen to be swiftly taken into the gut for clearance.
- The health of the gut microbiome follows – promoting the beneficial bacteria to encourage optimal levels of beta-glucuronidase. Not too much, and not too little. This will have the added benefit of reducing gut permeability.
- Lastly, ensuring that constipation is not contributing to symptoms of high oestrogen.
If this sounds familiar, and if you’d like to take a more detailed look at your hormones, or work on improving your gut health to optimise your hormonal health, then please get in touch. I’d love to offer you a free 30 minute chat to go over things.
Baker J.M., Al-Nakkash L. and Herbst-Kralovetz M.M. (2017) Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 103:45-53. doi: 10.1016/j.maturitas.2017.06.025
Briden, L. (2018) The period repair manual: Natural treatment for better hormones and better periods. Greenpeak Publishing.
Thomas M.P. and Potter B.V.L. (2013) The structural biology of oestrogen metabolism. The Journal of Steroid Biochemistry and Molecular Biology. 137:27–49. doi:10.1016/j.jsbmb.2012.12.014