Here’s a powerful tip that will help you to support many women who seek help via a functional medicine perspective: Be on the lookout for symptoms of low thyroid function in those who have estrogen dominance. We talk often in our classes about the epidemic of undiagnosed hypothyroidism. This epidemic stems from many causes…reliance on an overly broad “normal” reference range that includes many hypothyroid individuals, lack of awareness in conventional practices of the full scope of hypothyroid symptoms, and failure to run a full thyroid panel in assessing thyroid function (aka over-reliance on TSH as being accurately indicative of thyroid hormone health). But as I have shared with you before, we also have an epidemic of estrogen dominance. And these two dynamics are more interconnected than you might imagine!
High estrogen action increases thyroid binding globulin (an example of a study showcasing the effect here) which prevents thyroid hormone from being able to have cellular effects. This is one (of many) reasons why a person can have “normal” thyroid levels and still be suffering (legitimately) from low thyroid function (e.g. constipation, weight gain, fatigue, lethargy, high LDL cholesterol, GI bloating/reflux, foggy thinking).
Keep in mind that estrogen “dominance” doesn’t necessarily mean high estrogen (though it might – especially in the obese); it may also (or instead) involve imbalance with other hormones such as progesterone and testosterone. Some clinical studies suggest that increasing progesterone when it is suboptimally low (which balances estrogen) can increase Free T4 thyroid hormone. Other common reasons for estrogen dominance include high exposure to xenoestrogens or poor detoxification of estrogen, both of which may result in strongly estrogenic (and potentially carcinogenic) metabolites. Unfortunately these types of imbalances are simply not going to show up in conventional labwork, especially typical sex hormone blood markers. This is yet another reason why I have become such a big fan of DUTCH hormone testing. Common symptoms of estrogen dominance include bad PMS, heavy/clotty periods, headache/migraine, anxiety, increased belly fat, tender breasts/fibroids, and infertility. These patients may need help with reduced synthesis (e.g. body fat), decreased exposure to estrogenic substances (e.g. xenoestrogens), estrogen balancing (e.g. vitex to boost progesterone), estrogen clearance (e.g. methylation, sulfation, constipation), aromatase inhibition (e.g. zinc, ground flaxseed), and/or reduced receptor sensitivity (e.g. magnesium). These are powerful areas of functional medicine interconnectedness in the body that you can learn to use in your practice with confidence!
So be on the lookout for women who wrestle with symptoms of both estrogen dominance and low thyroid function (which includes a LOT of women who are searching for answers and who have been dissatisfied with conventional medicine’s inability to get to the root of their struggles). Make sure that you fully assess their thyroid hormones (get a full panel; not just TSH); you will find that many have suboptimal Free T4 (and even*more* will have suboptimal Free T3, often due to nutrient deficiencies – if you’re new to this topic, we can teach you how to do this with confidence). You may even uncover some chronic autoimmune thyroid dynamics (alas, this happens to our practitioners all the time!). Then fully assess their sex hormone balance, detox capability, and xenoestrogen exposure.
This interconnected hormonal dis-ease is a great example of the power of functional medicine insight and support. I hope this quick clinical tip serves you and your patients and clients!