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What every woman needs to know about estrogen and the gut

Reading time: 8 minutes

The balance of bacteria in your gut can have a big impact on your estrogen levels and your health, says Marcelle Pick. Here’s how to heal your gut for long-lasting hormonal health

When I asked some of my closest friends if they knew what the estrobolome was, their answers sounded like they were playing a game of Balderdash.

A new amusement park ride? The puff of powder released when putting on latex gloves? A Polish bread served at Easter? A women’s health condition related to low levels of certain hormones?

While some of their answers were intentionally silly, this last one wasn’t too far off; the estrobolome does relate to hormones. Basically, the estrobolome is a collection of bacteria within your gut microbiome that can modulate and affect your estrogen levels.

Researchers Claudia Plottel and Martin Blaser defined the estrobolome as “the aggregate of enteric bacterial genes whose products are capable of metabolizing estrogens.” In less scientific terms, that means the collection of bacteria that can convert estrogen to its active form.

I think it’s important for women to understand what the estrobolome is and how it can impact their health. Most are aware of the way fluctuating hormones can make them feel. They’ve experienced ups and downs around their menstrual cycle, and any perimenopausal or menopausal woman can tell you all about hot flashes, mood swings and other uncomfortable symptoms.

Not only can estrogen imbalance be behind these symptoms but it’s also connected to a number of serious health conditions. And it’s crucial to understand that the balance in your gut has a big impact on your estrogen levels.

Estrogen and the gut

It may seem odd, but though estrogen is produced mainly by the ovaries and adrenals, levels are regulated primarily in your gut. That means that if your gut is out of balance, this important hormone may also be skewed.

Research is expanding in this area all the time. One review explored the way that the estrobolome might impact the risk of developing postmenopausal estrogen receptor-positive breast cancer. Looking at the composition and activities of the estrobolome in healthy individuals as well as in women with estrogen-driven breast cancer could lead to the development of microbiome biomarkers and interventions to mitigate cancer risk, the authors said.1

The estrobolome regulates circulating estrogen as well as excreted estrogen levels. Microbes produce an enzyme, beta-glucuronidase, that converts estrogens to their active forms. Active estrogen can bind to receptors and impact certain physiological processes.

If the gut is well balanced, beta-glucuronidase activity is normal. But when dysbiosis (imbalance) occurs, levels of estrogen can become too high or low, increasing the risk of estrogen-related disease.

When estrogen is metabolized by the liver, it’s then sent to bile to be excreted into the gut. When the estrobolome is healthy, this estrogen is safely removed as waste. But when dysbiosis is present, estrogen can be reabsorbed into the bloodstream, causing estrogen dominance. This can lead to a wide range of health issues.

Estrogen-related disease and microbiome balance

Three types of estrogen are produced by a woman’s body: estrone (E1), estradiol (E2) and estriol (E3). Each one influences different tissues and functions in the body.

E2 is the dominant form of estrogen before menopause, while E1 becomes the dominant circulating estrogen after menopause. E3 is the least potent estrogen but is dominant during pregnancy. All the types interact with each other, so it’s important to give attention to the overall balance of each form.

Estrogen regulates many processes in the body, including reproductive function, body fat deposition, cardiovascular health, bone turnover and replication of cells. Reduction of circulating estrogen can block healthy functioning, leading to a long list of problems, like obesity, metabolic syndrome, cancer, endometriosis, endometrial hyperplasia, PCOS, cardiovascular disease, osteoporosis, infertility and poor cognitive function.

Did you realize estrogen could impact so many conditions beyond reproduction? Many women don’t.

Research has shown that imbalances in the gut can increase the risk or exacerbate symptoms of these conditions. Patients with obesity,2 cardiovascular disease3 and osteoporosis4 have all shown a high prevalence of gut dysbiosis.

When circulating estrogen declines, osteoclastic activity rises, resulting in bone resorption and decreased bone strength. In one study, giving certain bacteria to mice that have undergone ovariectomies has been shown to improve bone formation and reduce bone resorption.5 Other studies have shown similar positive effects with the introduction of specific bacteria.

Estrogen can also change the bacterial makeup in both the urinary tract and vagina, causing infections. As estrogen decreases, so too can Lactobacilli since estrogen stimulates growth of this valuable bacteria. Lactobacilli have several protective roles in women’s health, including maintaining the proper acidic environment and preventing the adhesion of undesirable bacteria.

Over the past two decades, research into the relationship between the gut microbiome and breast cancer has grown significantly.6 This research has demonstrated the key role of the gut microbiome in regulating estrogen.

Diversity in the gut is a critical element of overall health, including breast health. Research has shown that the microbiota is significantly different in patients with breast cancer as compared to those in control groups, including being much less diverse.

How everything is connected

The significant connection between hormonal health and the gut is an example of how just about everything in your body can be connected to what’s going on in your gut—and the same goes with your hormones.

For example, a research review published in July 2022 zeroed in on the connections between estrogen, gut health and skin health.7 And while at first glance these areas might all seem separate, it makes perfect sense that they’re intertwined.

If the gut microbiome influences estrogen production (and estrogen influences the gut microbiome), and if both our hormones and our gut health affect our skin, then we should be looking at these things all together.

The causes of dysbiosis

The signs of dysbiosis are clear (see below) but the symptoms can be caused by other conditions as well. Testing can help definitively determine the balance of bacteria in the body. Still, if you’re experiencing symptoms, taking steps to heal your gut won’t hurt you—and it just might help.

While there can be a number of root causes of dysbiosis, some have consistently been found to negatively impact the bacterial makeup of the gut.

Antibiotics and hormonal contraceptives change both the gut microbiota and estrogen levels. Chronic infection can also lead to dysbiosis, so it’s a delicate balancing act of addressing those conditions with antibiotics when necessary but without going overboard and using them too often.

Diet has a significant effect on gut microbiota as well. A diet high in carbohydrates and processed foods can leave you more susceptible to dysbiosis due to nutrient deficiencies.

Consumption of phytoestrogens in food has been found to change the gut microbiota and increase the risk of estrogen-related diseases. Food allergies can also cause dysbiosis (and dysbiosis can cause food sensitivities, so it can be confusing to unravel).

Alcohol consumption, genetics, weight, age and environmental toxins can all alter the composition of the gut microbiome and lead to dysbiosis.

Stress can also lead to dysbiosis. It may be real or perceived, physical or emotional, and everyone is impacted by it. It’s when stress becomes chronic that problems develop. Most people are familiar with physical reactions to stress (such as nausea before public speaking) but don’t realize that constant exposure to these reactions changes the balance of your gut.

How to heal your gut

Now that you know how important a healthy gut is to estrogen balance, which is in turn vital to good health, what can you do to maintain the right balance?

Gut balance relies on a healthy lifestyle. From dietary choices to exercise, from stress reduction to targeted supplementation, we have control over so many factors that can reduce imbalances in the gut.

Here are some quick tips to help you make healthy choices for yourself (and your gut).

Improve your diet. Make good food choices at least 80 percent of the time. A dessert every now and then is fine, but the more you avoid sugar, processed foods and anything else that may be causing you digestive distress (gluten and dairy are two common culprits), the better. A balanced diet that includes healthy fat, protein and complex carbohydrates is key.

Increase your intake of fermented foods, such as sauerkraut, kimchi and kombucha, to boost diversity and rebalance gut flora.

Eat more prebiotic foods to encourage the growth of beneficial bacteria. Some great options are asparagus, garlic, onions, leeks, Jerusalem artichokes and bananas. High-fiber plant-based foods, such as nuts, seeds, legumes and vegetables, also support a healthy gut.

Cruciferous vegetables like broccoli, cabbage and cauliflower help regulate the “good” bacteria and support healthy elimination of excess hormones, including estrogen. Just be sure to cook them first since they can be behind thyroid imbalances when consumed raw.

Reduce stress. Don’t let emotional issues fester. Address upset, both old and new, and release them so your body can let go too. Try meditation or mindful practices to help soothe your central nervous system.

Find joy. The best way to relieve stress is to do something you love every single day. When you do, you don’t allow that stress to build up in your system. Dancing, reading, writing in a journal, playing an instrument, playing a game with family or friends, running—the options are limited only by your imagination!

Get quality sleep. Resting well keeps cortisol levels balanced and reduces stress on your body. A lot of work happens within your body as you sleep, so making sure you have an adequate amount of rest is vital to your health.

Reduce toxin exposure. Examine the labels of your beauty and cleaning products, and use all-natural products whenever possible.

Avoid exposure to heavy metals and eliminate the use of plastics for food and drink, particularly when heated (for more details, see Metalhead: Could toxic heavy metals be making you ill? and Healthy shopping: Your guide to going plastic-free). Eat organic food whenever you can to reduce your exposure to pesticides.

Limit alcohol consumption. Alcohol changes the composition of the microbiome and increases gut permeability.

Keep moving. Exercise is great stress relief, and physical activity helps balance circulating levels of estrogen. It’s important, however, to keep activity levels appropriate. Too much (or too vigorous) exercise can cause your body undue stress.

Try supplements. Nutritional deficiencies can contribute to poor digestion and hormone imbalances. It’s best to get tested to work out your individual needs, but here are some supplements that may help to fill in the nutritional gaps and balance your microbiome and your hormone levels:

A high-quality multivitamin. A good option is my Multi Essentials+ (available from marcellepick.com along with my other supplements).

Suggested dosage: Follow label instructions

Vitamin D. Exposure to sunshine is the best way to get vitamin D, but most of us don’t get enough.

Suggested dosage: 2,000 IU/day

Omega-3s. These essential fatty acids are lacking in the standard Western diet. A fish oil supplement providing DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid), like my EPA/DHA Support supplement, is a good choice.

Suggested dosage: 720–1,440 mg/day EPA, 480–960 mg/day DHA

A probiotic. As I mentioned above, Lactobacilli are crucial for restoring proper balance to your gut. Bifidobacteria are another important probiotic. Look for a supplement that contains both, such as my Biotic Support.

Suggested dosage: Follow label instructions

DIM (diindolylmethane). This metabolite of indole-3-carbinol, found in cruciferous vegetables like broccoli, cabbage and kale, can help regulate estrogen levels and fight estrogen-dependent cancers.8

Suggested dosage: 100–200 mg/day

Do you have dysbiosis?

These are some signs and symptoms of an imbalanced gut microbiome:9

  • Bloating and gas
  • Diarrhea
  • Constipation
  • Changes in weight
  • Sensitivity to certain foods
  • Skin irritation
  • Fatigue
  • Hormonal imbalances
  • Autoimmune conditions

 

 

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References
  1. J Natl Cancer Inst, 2016; 108(8): djw029
  2. Nature, 2006; 444(7122): 1022–23
  3. Curr Cardiol Rep, 2014; 16(11): 540
  4. Crit Rev Food Sci Nutr, 2017; 57(8): 1664–72
  5. J Cell Physiol, 2014; 229(11): 1822–30
  6. Perm J, 2020; 24: 19.129
  7. Dermatol Ther (Heidelb), 2022; 12(7): 1535–50
  8. Nutr Rev, 2016; 74(7): 432–43; Anticancer Res, 1999; 19(3A): 1673–80; J Nutr, 2000; 130(12): 2927–31
  9. “Maintaining a Balanced and Healthy Microbiome,” marcellepick.com
MAR24, 'A fine balance'
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