As I discuss in detail in my endometriosis book, endometriosis is not caused by estrogen; rather, estrogen fuels the disease (like gas doesn’t make a car but powers it). For the conversation around weight gain, though, there is often an association between endometriosis and sex hormone imbalances. More specifically, most of us deal with estrogen dominance.

What is Estrogen Dominance?

Estrogen dominance is simply a condition where estrogen levels surpass those of progesterone. It doesn’t necessarily mean you have too much estrogen, although it can. Check the image, you can have high, normal or low amounts of estrogen and still have estrogen dominance which can lead to a cascade of effects, one of which is weight gain. This may be for numerous reasons, including:

• Metabolic Changes: Estrogen influences various metabolic processes, including insulin sensitivity, glucose metabolism, and lipid metabolism! And you thought it was just for being sexy ;) When estrogen levels are elevated relative to progesterone, it can disrupt these processes, leading to metabolic imbalances. For instance, estrogen dominance can contribute to insulin resistance, where cells become less responsive to insulin, resulting in elevated blood sugar levels. This can promote fat storage, especially around the abdomen, contributing to weight gain.

• Thyroid Function: Estrogen dominance can also impact thyroid function, which plays a crucial role in regulating metabolism. Thyroid hormones govern the rate at which the body utilizes energy from food. Imbalances in estrogen levels can interfere with thyroid hormone production and signaling, potentially slowing down metabolism and promoting weight gain, even with reduced food intake!

• Fat Distribution: Estrogen influences where fat is stored in the body. Higher estrogen levels tend to promote fat storage in subcutaneous tissues, particularly around the hips and thighs, giving rise to a pear-shaped body. However, estrogen dominance can disrupt this pattern, leading to increased fat accumulation around the abdomen, resulting in an apple-shaped body. Abdominal fat, also known as visceral fat, is metabolically active and is associated with a higher risk of metabolic disorders, including insulin resistance and inflammation, further exacerbating weight gain.

• Appetite Regulation: Estrogen plays a role in regulating appetite and satiety through its interaction with neurotransmitters and hormones involved in hunger signaling. If you’ve ever been starving the week before your period when estrogen levels  Estrogen dominance can disrupt this regulation, leading to increased appetite and cravings, particularly for sugary and high-fat foods. These dietary preferences can contribute to excess calorie intake and weight gain over time.

• Fluid Retention: Fluctuations in estrogen levels can affect fluid balance in the body, leading to water retention and bloating, which may contribute to temporary weight gain. While this may not represent true fat accumulation, it can still influence perceptions of body weight and shape.

As you can see, estrogen dominance may be an issue contributing to your increased BMI.

What Causes Estrogen Dominance?

Good question! I mean, if it’s so off-putting to the body, why would it happen in the first place?

The reality is that estrogen is rarely “acting alone.” Indeed we have over 50 hormones, and they all react and interact with one another. It’s why estrogen can impact insulin, how insulin can impact leptin, how vitamin D (yup, a hormone) can impact your endometriosis. These are just a few examples of many.

Simple truth? Hormones are messengers. And they communicate to and with the body. So when we’re dealing with a hormonal imbalance it will rarely be one thing. If you don’t believe me, here’s a list of a few possible options that can contribute to estrogen dominance:

1. Environmental Factors: Exposure to environmental toxins known as endocrine disruptors can interfere with hormone balance and contribute to estrogen dominance. These toxins are found in everyday products like plastics, pesticides, and certain cosmetics.

2. Dietary Factors: A diet high in processed foods, refined sugars, and unhealthy fats can contribute to estrogen dominance. Additionally, consuming non-organic meats and dairy products may expose you to hormones and antibiotics that can disrupt hormone balance.

3. Stress: Chronic stress can disrupt the function of the hypothalamic-pituitary-adrenal (HPA) axis, leading to imbalances in hormone production, including estrogen dominance. Stress management techniques such as meditation, yoga, and regular exercise can help mitigate this effect.

4. Obesity: Adipose tissue (fat cells) can produce and store estrogen, so excess body fat, particularly around the abdomen, can lead to higher estrogen levels. This can create a vicious cycle where excess estrogen promotes further weight gain.

5. Liver Dysfunction: The liver plays a crucial role in metabolizing hormones, including estrogen. If the liver is overburdened or not functioning optimally due to factors like excessive alcohol consumption, poor diet, or certain medications, it may struggle to metabolize estrogen effectively, leading to estrogen dominance.

6. Hormone Replacement Therapy (HRT): Some forms of hormone replacement therapy, particularly those containing synthetic estrogens, can contribute to estrogen dominance. It's essential to work closely with a healthcare provider to find the right balance of hormones for your individual needs.

7. Genetics: Genetic factors can influence hormone metabolism and sensitivity to estrogen, potentially predisposing individuals to estrogen dominance.

8. Endometriosis! Believe it or not, endo may predispose us to estrogen dominance due to some progesterone resistance, meaning we may have trouble with uptake of progesterone.

Do I Have Estrogen Dominance?

Testing is the best way to know where your estrogen and progesterone levels are at.

1. Blood Tests: Blood tests can measure the levels of various hormones, including estrogen, progesterone, and testosterone. Typically, these tests are conducted on specific days of the menstrual cycle to assess hormone levels accurately. For example, estrogen levels are often measured on days 3-5 of the menstrual cycle, while progesterone levels are measured around day 21 to evaluate the luteal phase.

1. Saliva Hormone Testing: Saliva hormone testing is another method used to assess hormone levels, including estrogen. Saliva samples are collected at various times throughout the menstrual cycle and analyzed for hormone concentrations. Some healthcare providers prefer saliva testing because it may provide a more accurate reflection of hormone levels that are biologically active.

2. Urinary Hormone Testing: Urine hormone testing involves collecting urine samples over a specific period, usually 24 hours, and analyzing them for hormone metabolites. This method can provide insights into hormone levels and their metabolism within the body.

3. Symptom Assessment: In addition to laboratory testing, healthcare providers may also assess symptoms associated with estrogen dominance, such as irregular menstrual cycles, breast tenderness, mood swings, and weight gain. While symptoms alone are not conclusive evidence of estrogen dominance, they can provide valuable information when interpreted alongside hormone test results.

For those of us without testing, here are some general clues as to where your estrogen levels lie:

Symptoms of High Estrogen Levels (Estrogen Dominance):

1. Irregular Menstrual Cycles: High estrogen levels can lead to irregular periods, including shorter or longer cycles, heavier bleeding, or breakthrough bleeding.

2. Breast Tenderness: Increased estrogen levels may cause breast tenderness or swelling, similar to symptoms experienced during PMS.

3. Mood Swings: Some individuals with high estrogen levels may experience mood swings, irritability, anxiety, or depression.

4. Weight Gain: High estrogen levels can contribute to weight gain, particularly around the hips, thighs, and abdomen.

5. Fatigue: Excessive estrogen levels may cause fatigue or low energy levels.

6. Headaches: Some people may experience more frequent headaches or migraines with high estrogen levels.

Symptoms of Low Estrogen Levels:

1. Irregular or Absent Periods: Low estrogen levels can result in irregular or absent menstrual periods, including shorter or lighter cycles.

2. Hot Flashes: Low estrogen levels, particularly during menopause, can lead to hot flashes or night sweats.

3. Vaginal Dryness: Reduced estrogen levels can cause vaginal dryness, itching, or discomfort, especially during intercourse.

4. Mood Changes: Low estrogen levels may contribute to mood swings, irritability, or feelings of sadness or anxiety.

5. Bone Density Loss: Estrogen plays a crucial role in maintaining bone density, so low estrogen levels can increase the risk of osteoporosis or bone fractures.

6. Difficulty Sleeping: Some individuals with low estrogen levels may experience insomnia or difficulty sleeping through the night.

Managing Estrogen Dominance and Endometriosis Weight Gain:

Before you go off and buy 1000 supplements and creams to try to combat estrogen dominance, I urge restraint! That is because balancing hormones is much more complex than that. The reality is, we have over 50 hormones, and they all react and interact with one another. It’s why estrogen can impact insulin, how insulin can impact leptin, how vitamin D (yup, a hormone) can impact your endometriosis. These are just a few examples of many.

Simple truth? Hormones are messengers. And they communicate to and with the body. So the best place to begin a hormone-balancing journey is really by offering your body a wide variety of soothing inputs to signal “safety” to these little communicators in an effort to start to retrain them. This may include:

• Balanced Diet: Focus on a balanced diet rich in nutrient dense foods and blood sugar balanced.. Minimize consumption of processed foods, sugar, and unhealthy fats, which can exacerbate hormonal imbalances.

• Regular Exercise: Engage in regular physical activity!. Both aerobic exercise and strength training can be beneficial. And by regular I mean, like, everyday if can. None of this 3x a week for 30 min stuff. Really focus on moving your body more.

• Stress Management: Chronic stress can disrupt hormone balance, including estrogen and progesterone levels. Incorporate stress-reducing activities such as meditation, yoga, or deep breathing exercises into your daily routine.

• Lifestyle Factors: Adequate sleep, hydration, and avoiding exposure to endocrine-disrupting chemicals found in certain plastics, pesticides, and cosmetics can also support hormonal balance and overall health. I talk about all these details in depth in my book.

These are all the factors I describe in depth in my endometriosis book. For now, take my word for it that these small changes can bring mighty balance.

Of course there are some of us who will need more support. A great consideration is supplementing to support bringing down estrogen (only when you know your estrogen is too high!!!) or to bring up progesterone (which, honestly, a lot of us with endometriosis could benefit from). For this, I recommend you meet up with a hormone-trained specialist to chat about your (very specifically tailored to you, not told by a random blog post) options.

Big Takeaway about Endometriosis, Estrogen Dominance, and Weight Gain?

In conclusion, estrogen dominance can contribute to weight gain through various mechanisms, including metabolic changes, altered fat distribution, appetite dysregulation, and fluid retention. By addressing the underlying hormonal imbalances and adopting healthy lifestyle habits, individuals can mitigate the effects of estrogen dominance and promote sustainable weight management. Consulting with a healthcare professional is essential for personalized guidance and treatment options tailored to individual needs.