From the Guidelines
High estrogen levels should be managed with caution, especially in patients with certain medical conditions, and the most recent evidence suggests that lifestyle changes and medical treatment should prioritize minimizing the risk of thrombosis and other complications. To manage high estrogen levels, it is essential to identify the underlying cause, which could be due to conditions like polycystic ovary syndrome, certain medications, obesity, or liver disease 1.
Lifestyle Changes
Lifestyle changes are often the first approach to managing high estrogen levels, including:
- Regular exercise
- Maintaining a healthy weight
- Eating a diet rich in fiber and cruciferous vegetables like broccoli and cauliflower
- Reducing alcohol consumption
- Limiting exposure to xenoestrogens found in plastics and certain personal care products
Medical Treatment
For medical treatment, the use of prophylactic anticoagulation therapy with heparin or low molecular weight heparin is conditionally recommended in asymptomatic aPL-positive patients during ART procedures 1. Medications like aromatase inhibitors (such as anastrozole or letrozole) or selective estrogen receptor modulators (like tamoxifen) may be prescribed depending on the specific condition and health history. Hormonal contraceptives might be recommended to regulate hormone levels in some cases.
Considerations for Patients with Certain Medical Conditions
In patients with certain medical conditions, such as antiphospholipid antibody-positive patients, the increased risk of organ- or life-threatening thrombosis due to high estrogen levels greatly outweighs the low risk of bleeding or other complications of unfractionated heparin or low molecular weight heparin 1. For patients with rheumatic and musculoskeletal diseases, deferring ART procedures while disease is moderately or severely active is strongly recommended 1.
Importance of Proper Diagnosis
High estrogen levels require proper diagnosis through blood tests measuring hormone levels, so it is essential to consult with a healthcare provider for personalized treatment rather than self-diagnosing or self-treating. The most recent evidence from 2020 and 2021 suggests that a holistic approach to managing high estrogen levels is crucial, considering factors such as nutritional needs, exercise, and hormonal profiles 1.
From the Research
High Estrogen Levels
- High estrogen levels can lead to various health issues, including autoimmune diseases and neoplasms 2
- Estrogen dominance can be caused by an increment in inflammatory agents in daily life, leading to an overexpression of estrogen receptors (ERα and ERβ) and harming tissues 2
- Estrogen level correction is a complex task, and a disciplined lifestyle with wise dietary and selective chemical usage choices can help restore estrogen levels to normalcy 2
Breast Cancer Treatment
- Aromatase inhibitors (AIs) have become a preferred treatment for hormone receptor-positive breast cancer in postmenopausal women, replacing tamoxifen in many cases 3, 4, 5
- AIs such as anastrozole, exemestane, and letrozole have shown significant improvements in disease-free survival compared to tamoxifen in adjuvant and advanced breast cancer settings 3, 6, 4
- The choice of AI may depend on individual patient preferences and adverse event profiles, with letrozole showing stronger evidence for use in postmenopausal women requiring estrogen-deprivation therapy 4
Prevention of Breast Cancer
- AIs are being tested as primary prevention therapy in large randomized trials involving tens of thousands of women at increased risk for breast cancer 6, 5
- The use of AIs for breast cancer prevention is based on hypothesis-generating contralateral breast cancer data from adjuvant trials, with anastrozole, exemestane, and letrozole being evaluated in phase 3 trials 6