Jamie Sculley, ND
Why Hormone Blood Tests Aren't Giving You the Whole Picture And What You Need To Know Instead
Updated: Aug 3, 2020
If you’re a woman who suffers from irregular or painful periods, cramping, headaches, and bloating you may have had your hormones tested. But what do you do if they come back normal? You know there’s something wrong and have probably tried to fix it with herbs, PMS formulas or progesterone cream, but what if these don’t work?
While it’s important to know about the levels of estrogen and progesterone, but we also need to know how your body is metabolizing these hormones. Some metabolic pathways are protective and some are damaging so knowing which your body prefers is an important starting place in coming up with a plan for what to do.
We also need to know if you have any genetic tendencies that speed up or inhibit these pathways and how to support them all with diet and nutrition.
If you’re experiencing hormonal imbalance, keep reading to find out more about estrogen metabolism, how it works, and what you can do about it!
A Quick Hormone Overview
When it comes to estrogen and progesterone it can be easier to think about them in relation to the menstrual cycle. In general, estrogen is highest during the beginning of the cycle where it gets the uterus ready for implantation and stimulates ovulation. Then, in the middle of the cycle, you ovulate and progesterone gradually increases. Progesterone continues to maintain and get the uterus ready for implantation while estrogen decreases at this time. If pregnancy happens, progesterone will continue to rise, but if there is no pregnancy, the drop in progesterone will cause your period to start.
Other than reproduction, estrogen is involved in many other functions including blood clotting, maintaining skin tone and elasticity, protecting and supporting the brain, regulating mood and keeping bones strong.
The Three Types of Estrogens
There are 3 forms of estrogen with different strengths and functions depending on whether a woman is of reproductive age or in menopause. Estrogen comes from the ovaries and adrenal glands before menopause and from the adrenal glands after menopause.
Estrone (E1): this form is a weak estrogen and mostly converted to estradiol (E2). It's the form that's most prevalent in menopause.
Estradiol (E2): this form is most prevalent during the reproductive years and is the most potent and active form of estrogen.
Estriol (E3): this form is found in low amounts in non-pregnant women when it is less potent and active. Levels increase dramatically during pregnancy.
How Your Body Metabolizes Estrogen
Now that we know about the different types of estrogen, we can talk about how the body breaks them down. This breakdown happens in the liver during Phase 1 and 2 detoxification. As estrogen is metabolized, it’s broken down into estrogen metabolites.
Sometimes these metabolites are protective and sometimes they aren’t. It’s important to know which your body prefers and which pathways are fast or slow because there are actions you can take to influence these pathways and reduce symptoms of hormonal imbalance.
The Estrogen Metabolites
There are two steps or phases that happen during metabolism. In Phase 1, the liver starts breaking down estrone into either 2-OH, 4-OH or 16-OH estrogen metabolites. These metabolites can be either protective or damaging so it’s important to know the ratios of these metabolites to know if your body favors the helpful or harmful ones.
In Phase 2, these metabolites are attached to molecules called methyl groups that allow them to be excreted.
2-OH estrogen: is a "good" metabolite, has weak estrogen activity and is protective against breast cancer. This is the form you want to be high in comparison to the other two.
4-OH estrogen: is a strong estrogen and considered a "bad" metabolite since it can damage cells, be carcinogenic (cancer causing), and promote inflammation. However, it can go down a less harmful pathway if your body is good at methylation or has an abundance of antioxidants.
16-OH estrogen: is also a strong estrogen and considered a "bad" metabolite because it can be involved in estrogen dominance.
It’s Not Just About the Hormones
I’ve mentioned methylation and antioxidants in the previous section because these are also important in how estrogen is metabolized. But what are they and why are they important?
Methylation just means that a small group made up of carbon and hydrogen is attached to a larger substance. Methylation is part of phase 2 so if you’re not methylating well, this part of the process can get slowed down or you can get a higher amount of the harmful metabolites like 4-OH estrogen.
How well your body methylates can be influenced by your genes. You may have heard of an enzyme called MTHFR because testing is becoming more popular through home tests like 23andme that allow you to find out if you have a mutation or variant in the genes that code for it.
If there’s a variant in this enzyme, you can have problems with folate and homocysteine, which can lead to health issues like cardiovascular disease, mood disorders and infertility. Testing for and finding out if you have a gene variation for MTHFR can be important when solving hormone imbalance and is why I do genomic testing in my health program, the Rise Into Wellness Plan.
The other factor to think about is your antioxidant status. During the metabolism of the 4-OH estrogen, it can go down a harmful pathway that can damage DNA, but it can also be saved by an antioxidant called glutathione. Glutathione and other antioxidants stabilize damaging free radicals by donating an electron, making them more stable.
Ways You Can Support Estrogen Metabolism
Supporting Phase 1
In this phase estrone is converted to the other metabolites: 2-OH, 4-OH or 16-OH. Eating cruciferous vegetables including cabbage, cauliflower, broccoli, kale, and Brussels’s sprouts may help to support this phase. They contain compounds called DIM (diindolylmethane), IC3 (indole-3-carbinol) and sulphoraphanes that may help to metabolize estrogen. Also, herbs like rosemary, holy basil and lemonbalm may also support this phase.
Supporting Phase 2
The process of methylation happens in this phase. Depending on which pathways your metabolites are traveling down, antioxidant support may also be needed. Antioxidants can be found in the diet in fruit, vegetables, whole grains, nuts, seeds and healthy fats like avocado and olive oils. Glutathione or NAC (N-Acetyl Cysteine) are two antioxidants that are particularly important. Getting genetic testing for MTHFR and other enzymes involved in this phase as well as supporting methylation with SAM-e, B vitamins, magnesium, and methyl-folate may also be helpful.
It's important to know about the levels of estrogen and progesterone but we also need to know how your body is metabolizing these hormones. Some metabolic pathways are protective and some are damaging so knowing which your body prefers is an important starting place in coming up with a plan for what to do. There are 3 forms of estrogen with different strengths and functions depending on whether a woman is of reproductive age or in menopause. The the forms are estrone, estradiol and estriol. Their breakdown happens in the liver during Phase 1 and 2 detoxification. Supporting phase 1 includes eating cruciferous vegetables, DIM, IC3 and herbs. Supporting phase 2 includes antioxidants, glutathione, NAC and genetic testing.
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