Estrogen metabolism and why it’s SO important to your hormones

Adapted from a video by Dr. Ashley Alexis, ND.

Estrogen metabolism affects how hormones behave and how you respond to hormone therapy.

Estrogen dominance is usually talked about in women who are still menstruating and having cycle-related issues. It also matters for women in perimenopause and menopause. There are three different phases of estrogen metabolism.

There are three phases. In phase one, after estrogen is made and used, it is broken down and eliminated through biochemical pathways.

One of those pathways is called 4-hydroxy and when it’s used in a high percentage in the body to break down estrogen, it produces metabolites that, in laboratory studies, can damage DNA; researchers are still working out what that means for cancer risk. The 2-OH (two hydroxy) pathway is generally considered the more favorable route for breaking estrogen down.

In phase two, estrogen goes through methylation, a process facilitated by the enzyme COMT. Genetic variations (SNPs) in COMT or other methylation issues, such as the common MTHFR variant that makes it harder to use B vitamins, may slow this phase.

In phase three, estrogen is excreted through stool. This is why regular bowel movements matter.

Problems in this process may contribute to PMS symptoms, to side effects from estrogen therapy, and possibly to conditions like fibroids, cysts and endometriosis. This is why our care team prefers to look for the underlying cause rather than treating birth control as the default answer for every cycle problem in perimenopause.

Your provider can evaluate these three phases when relevant to menopause, perimenopause or pre-menopause, and use the findings to guide treatment.

If you want more information about hormone testing, contact our care team at (760) 542-8898 or book a first visit.