First off let's start with the idea that “estrogen dominance” is not really a thing, it’s more of a term to describe low progesterone. Why is this important? Well let’s talk about period poop, PMS and clots these are not because you have too much estrogen, they are probably due to not having enough progesterone. Because while there is one pro-gest-erone (a steroid to keep you gestating with a baby friend) there are 4 different types of estrogen!!
Estrogen makes people soft in a strong way. Soft powerful belly, luscious bouncy hips, lustrous soft skin, and juicy vajayjays. All people have estrogen in them, as well as testosterone and progesterone, all of which happen to be steroids.
Perimenopause can bring on its form of “roid rage”.
But let’s focus on estrogen, there are estrogen receptors all over the body, from top to tail and beyond. That includes skin, heart, brain, bladder, pelvic floor, genitals, uterus, prostate, lungs, bones, kidneys, and of course most famously the breasts, boobs, tits, and milkshakes, one reason there is caution around supplementation.
So estrogen is not as simple as “one and done” when we talk about estrogen.
There are four types of estrogen. E1, E2, E3, and E4. They differ in function, origin, and strength.
Let's talk impact instead of going in order 1-4.
E2 - Estradiol is the estrogen that all people possess until they don't. It is sometimes referred to as E2. It is made in the ovaries and the testicles. When we think of hormone supplementation this is the type of estrogen that is usually prescribed. Estradiol is known for helping mood, bone strength, hot flashes, and feeling moist where moisture is desired.
E1 - Estrone, synthesized from cholesterol, liver, and fat cells, takes over when E2 is no longer able to do its job. E1 can make us fluffy and increase our cholesterol levels to give the body some estrogen before it transforms to E2. Once menopause sets in (no period for one year +), E1 takes over. This is the reason that we love an elastic band.
E3 - Estriol, well this one may bring the luster to the skin, luscious locks on the head, and is virtually nonexistent without a placenta pumping it out. Meaning that pregnancy makes this abundant and E3 is synthesized in the placenta. It has been recreated in a lab, the E3 is not a placenta, and many compound pharmacies add it in combination with E2. Some companies use E3 in skin care products. But who knows if they help.
E4 - Estetrol is the newest estrogen to hit the estrogen marketplace. In the lab, the formulation is synthesized from soy but IRL, meaning the body's factory, is the result of pregnancy. More specifically it is the estrogen that is produced by the fetal liver. No livers are in the actual pharmaceutical so calm down. This newest formulation does not connect to the estrogen receptors in the breast. There is a ton to be discovered with this new medication however it looks promising for all bodies dealing with the change in hormones.
Cutting out the middle Es.
Finally, when we talk about hormone treatment/therapy. Lots of compounders may talk about Bi-est or Tri-est treatments, this is combining 2 or more of the estrogens into a pellet or cream some people swear by them, but the North American Menopause Society, as well as international organizations, do not endorse any compounding. I have my thoughts, I go more with evidence-based medicine however if you like it, I love it as long as you know the risks. Mainly, unregulated and also less estradiol and more of the other types. Now the ones that insurance will pay for, the estradiol patch, for example, is placing the formulation that was most abundant in your body back into the body.
I have tried the bi-est cream as an adjunct to my E2 patch and it was a MEH for me. I then tried, because I told the Mistresses I would, the E4 formulation in a pill, and while it may be great for nubile bodies this old heffa went right back to the E2 patch before any of her loved ones were harmed. This old heffa is me.
Here’s the thing, the more you know the more you can make the best choice for yourself. The idea is to take the pressure off.
Wanna know more. Want to hear from others who are figuring out just what their options are? Join the Mistresses of the Menopausal Mind or book a free 1:1 and let's chat about changes!