From the FDA Drug Label
The times to diagnosis of endometrial hyperplasia over 36 months of treatment are shown in Figure 1. This figure illustrates graphically that the proportion of patients with hyperplasia was significantly greater for the conjugated estrogens group (64 percent) compared to the conjugated estrogens plus progesterone capsules group (6 percent)
The initial workup and treatment approaches for estrogen dominance are not directly addressed in the provided drug labels. However, the labels suggest that progesterone may be used to treat conditions related to estrogen dominance, such as endometrial hyperplasia.
- Key points:
- Progesterone capsules may be used to induce withdrawal bleeding in women with secondary amenorrhea.
- The combination of conjugated estrogens and progesterone capsules may reduce the risk of endometrial hyperplasia compared to conjugated estrogens alone.
- The Women's Health Initiative (WHI) studies evaluated the risks and benefits of daily oral conjugated estrogens alone or in combination with medroxyprogesterone acetate, but did not directly address estrogen dominance. 1
From the Research
The initial workup for estrogen dominance should include a comprehensive hormone panel measuring estrogen, progesterone, testosterone, and thyroid hormones, along with a detailed medical history focusing on symptoms like irregular periods, breast tenderness, mood swings, and weight gain. Treatment typically begins with lifestyle modifications including reducing environmental estrogen exposure by avoiding plastics containing BPA, choosing organic foods when possible, and limiting alcohol consumption. Some key points to consider in the workup and treatment of estrogen dominance include:
- Dietary changes should emphasize cruciferous vegetables (broccoli, cauliflower, kale) which contain indole-3-carbinol that supports estrogen metabolism, and increasing fiber intake to 25-35g daily to help eliminate excess estrogens.
- Exercise is essential, with 150 minutes of moderate activity weekly recommended to improve hormone balance.
- For supplementation, DIM (diindolylmethane) at 100-200mg daily can support healthy estrogen metabolism, while magnesium (300-400mg daily) may help alleviate symptoms.
- In more severe cases, bioidentical progesterone cream (20-40mg applied daily during the luteal phase) or oral micronized progesterone (100-200mg daily) may be prescribed to counterbalance excess estrogen, as suggested by studies such as 2. These approaches work by supporting the liver's ability to metabolize estrogens, improving the estrogen-to-progesterone ratio, and reducing the impact of environmental xenoestrogens on hormone receptors. It's also important to consider the role of selective estrogen receptor modulators (SERMs) in the treatment of estrogen dominance, as discussed in studies like 3 and 4, which highlight the potential benefits and risks of these medications. However, the most recent and highest quality study, 4, provides the most relevant guidance on the use of SERMs in the context of estrogen dominance. Ultimately, the goal of treatment is to alleviate symptoms, improve quality of life, and reduce the risk of long-term health consequences associated with estrogen dominance.