Hormone health involves more than how much oestrogen your body produces. It also depends on how that oestrogen is processed and eliminated after it has done its job.
Your liver, bile, gut bacteria and bowel movements all play a part. This is why I consider digestion and liver health when exploring hormonal symptoms.
What is oestrogen dominance?
Oestrogen dominance describes a pattern in which the effects of oestrogen are relatively strong compared with progesterone. This may involve increased oestrogen, lower progesterone, or changes in how the body processes and clears oestrogen.
Symptoms and conditions discussed in this context include menstrual clotting, fibroids, endometriosis, cystic breasts, irregular periods, PMS, PMDD and fatigue. These can have several causes, so understanding your individual pattern matters.
How your liver processes oestrogen
Your liver uses several biochemical pathways to transform oestrogen and prepare its breakdown products, called metabolites, for removal.
Phase I: transformation
Enzymes begin changing oestrogen into different metabolites. These compounds then need further processing.
Phase II: preparation for removal
Several pathways contribute to this stage.
Methylation helps process certain oestrogen metabolites through an enzyme called COMT.
Glucuronidation attaches glucuronic acid to compounds, helping prepare them for excretion.
Sulfation attaches sulfate groups and also contributes to oestrogen processing.
These pathways depend on coordinated enzyme activity and adequate nutrition. They need to work together, rather than simply having one pathway stimulated in isolation.
Elimination: completing the process
Processing is only part of the picture. The body also needs to remove the resulting compounds through urine and bile.
Some oestrogen metabolites enter the intestine in bile, where they may leave in stool or undergo recycling.
So, how does oestrogen recirculate?
Some gut bacteria produce an enzyme called beta glucuronidase. This enzyme can undo part of the glucuronidation process, making some oestrogen available for reabsorption.
Instead of leaving the body in stool, it can return to circulation and the liver for further processing. This movement between the intestine and liver is called enterohepatic circulation.
The gut bacteria involved in oestrogen metabolism are often referred to collectively as the estrobolome.
Why bowel regularity matters
Effective elimination is an important part of hormone support.
When bowel transit slows, intestinal contents remain in the gut for longer. This may allow more opportunity for bacterial processing and reabsorption of some compounds intended for elimination.
That is why I consider constipation alongside hormonal symptoms. Supporting liver pathways without addressing ongoing difficulties with elimination leaves part of the picture unexplored.
The aim is comfortable, regular bowel movements without straining, with support adapted to your digestion.
My approach
I consider your menstrual pattern, bowel habits, digestion, food intake, stress, thyroid function, metabolic health and existing results. If necessary, I will recommend further testing.
Where appropriate, I may recommend specific blood tests and review individual laboratory markers to gain more detailed insights into liver health, nutrient status, blood sugar regulation and other factors relevant to your symptoms.
I may also recommend a comprehensive stool analysis to explore digestive function and gut health in greater detail. Depending on the test selected, this can provide information about digestion, markers of intestinal inflammation and the microorganisms present in your gut. Bringing these findings together with your symptoms and health history can help identify possible contributors and guide more individualised support.
Support may include improving nutritional intake, addressing constipation and digestive symptoms, and selecting nutrients or other support according to your individual needs.
Healthy liver processing and effective elimination are important foundations for hormone metabolism and overall health. The aim is to understand where support is needed and bring the different parts of your health together.
If you feel you need support in this area, please reach out and let’s take the next steps together towards improving your overall wellbeing.
Lisa Cahill
Qualified nurse and naturopathic nutritionist
Evolve Female Wellness
lisa@evolvefemalewellness.com