Is Progesterone the Answer to Estrogen Dominance and Hypothyroid?

Thyroid blocksA Hypothyroid reader wrote: Hi all! I was diagnosed this week with estrogen dominance and prescribed bio-identical progesterone. I’m very hopeful that this is the last piece of the puzzle for me and I’m going to finally find a healthy balance and I’m going to finally find a healthy balance.

Most Healthcare providers look at how estrogen affects our body. Very few look at what must happen for estrogen to leave our body or what happens when it doesn’t.

To clear Estrogen hormones from the body are metabolized first in the liver. Estrogen hormones are metabolized initially to form three different estrogens – 2-OH, 4-OH or 16-OH estrogen.

  • 2-OH has a very weak estrogenic response
  • 4-OH and 16-OH have very strong estrogenic response

Estrogen should be bound-up and deactivated during this process, mostly as 2-OH estrogen and released with bile into upper gastrointestinal tract for elimination. Subsequently making it all the way out exiting in the stool. This is how it is supposed to work. Estrogen is unable to leave your body when estrogen is unbound by increased inflammation due to dysbiosis in your GI tract. The increased inflammation, putrefaction, and fermentation of dysbiosis create more 4-OH estrogen and 16-OH estrogen. The estrogen is reactivated and reabsorbed into your body increasing the estrogenic response resulting in Estrogen Dominance with bad consequences.

Metabolic pathways are synchronized from one part to another. When a hormone loses it feed back loop coordination through hormone replacement, the hormone levels will continue to rise but that increase is inappropriate for the rest of the body.” Using bio-identical or natural progesterone does not reduce estrogen levels. It only shifts the ratio of estrogen to progesterone by increasing the progesterone level.

This begs the question: Is it an estrogen dominance, progesterone deficiency, thyroid or a gut inflammation problem?

Thyroid and Progesterone

Optimal thyroid metabolism requires normal progesterone levels. Circulating thyroid hormone levels impacts progesterone receptor site sensitivity. Hypothyroid and Hashimoto’s patients do not have healthy thyroid metabolism.

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When progesterone receptors are not exposed to adequate thyroid hormones, they will lose receptor site sensitivity and the ability to allow progesterone into the cells. Progesterone stimulates thyroid peroxidase (TPO) activity. TPO is the catalyst for thyroid hormone production.

Anything that stimulates the thyroid is going to make you feel better, at least initially, until your body is able to respond to the changes in your hormone levels – albeit a thyroid, sex or stress hormone. Unfortunately, those with Hashimoto’s are producing TPO antibodies. Increasing TPO activity also increases the inflammation from the antibodies.

Thyroid hormone conversion of T4 to T3 is dependent upon proper 5’diodinase activity and can be altered by:

  • Increased Free Cortisol
  • Estrogen dominance
  • Liver dysfunction
  • Dysbiosis, (Inflammation, putrefaction, and fermentation)

Thyroid hormone receptor binding and response may be altered by:

  • Inflammation
  • Vitamin A status
  • Essential fatty acid levels, etc.

There seems to be a common link between gastrointestinal problems, estrogen dominance and thyroid deficiency. The link is inflammation. Inflammation is a general term describing the effects of too many inflammatory cytokines and stimulating neurotransmitters unopposed by too few anti-inflammatory cytokines and inhibitory neurotransmitters.

Progesterone Increases Cortisol levels

Progesterone is a “precursor” hormone that is converted into other steroid hormones like testosterone, estrogens, cortisol and aldosterone. Elevated progesterone is commonly associated with topical progesterone creams causing a secondary increases in free cortisol. Once progesterone levels exceed physiological levels, progesterone starts binding with cortisol binding protein limiting the amount of Cortisol binding protein in the body resulting in increased free Cortisol. Free cortisol will make you feel like your adrenals are working better.

Hormones Influence the Immune System

Progesterone reacts differently in every woman’s body. For most women, it has left the system when your period starts. Estrogen and progesterone are primarily responsible for changes in the inside lining of the uterus during the menstrual cycle. These endocrine and paracrine hormones are disturbed in women with menstrual issues, contributing to inflammatory responses, abnormal tissue remodeling, and hormone replacement therapy is hard or impossible to manage.

Endocrine hormones travel great distances in the body, Autocrine hormones are used by the cell that produces it. Paracrine hormones are produced and used locally.

Endocrine hormones travel great distances in the body, Autocrine hormones are used by the cell that produces it. Paracrine hormones are produced and used locally.

Progesterone, whose production increases in the second half of the menstrual cycle, plays a pivotal part in preparing the uterine lining for implantation of an embryo. After ovulation, rising progesterone levels stop the proliferation of endometrial cells. Progesterone matures the stroma and glands of the uterine lining, turning them into cells that can nourish and support a developing embryo. The blood supply to the uterus increases and the lining thickens with additional fluid and nutrients.

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Outside of the uterus, estrogen and progesterone play a remarkably different role. Estrogen therapy is pro-inflammatory, promoting an invasion of neutrophils and macrophages immune cells.

Estrodiol can stop periods from occurring and stimulate an immune attack on the uterus and nearby organs. Estradiol is proinflammatory, preventing the endometrial cells from shedding and these effects appear to be exacerbated in women with endometriosis. In women suffering from endometriosis, even normal estradiol concentrations are able to induce an enhanced inflammatory response with chemicals that attract and direct the immune cells to attack.

Progesterone lining

Now combine estrogen dominance with increased progesterone levels. Estrogen stops the uterine lining from shedding and progesterone matures and thickens the uterine lining. This is called Endometrial Hyperplasia, which may cause menstrual issues like heavy periods, postmenopausal bleeding with increased risk of endometrial cancer. It now becomes a gynecological problem.

Progesterone has potent anti-inflammatory effects within the uterus; but a loss of normal progesterone response would likely lead to a more inflammatory-like situation. Excess progesterone reduces immune cell movement to sites of infection, resulting in a weak immune response, while in more extensive endometriosis stronger immune cell activation by the estrogen has a proinflammatory effect.

Progesterone inflammation

The Trap: Your Body Will Know What To Do With The Excess Hormones.

As the upstream hormones are over saturated, two things occur:

1. Hormone receptors shut down

2. The hormone is converted to the next upstream hormone.

Have you ever known someone who gardens? As the zucchini are ready, they offer you some and you gladly accept because they are good for you. Every day they show up with a basket of zucchini. What are you going to do with it? After a while your zucchini receptors are shut off. You made every zucchini recipe on the web, frozen it and tried giving it away until finally you have zucchini coming out your ears.

The same things happen when using these seeming innocuous hormones that are good for you. Actually after reaching a saturation point, progesterone can be converted into estrogen while increasing free cortisol. Not directly but through the hormone pathways. Progesterone can be converted into 17-hydroxyprogesterone, which can be converted into Androstenedione, which is either converted into testosterone(s) or the estrogen(s).

Notice the plural (s) on testosterone and estrogen. There are several different forms of each. I am reluctant to say this because there are no good or bad hormones. There are only good or bad ratios because of high or low amounts of hormones. High amounts of certain hormones that should be in low quantity can cause bad things to occur.

Etiocholanolone hormone pathway

In between Androstenedione and estrogen there is another route the upstream progesterone can take towards Etiocholanolone. This inflammation inducing hormone, Etiocholanolone is made from progesterone. It is not a sex or stress hormone so little attention is paid to it. Look it up and you will find it causes short-term inflammation similar to a hot flash under normal circumstances. It must be cleared out through the liver. DeJarnette’s Working Law of Health states that, “No part of the body can be understood separate from the whole.” Waste, toxins and hormones are packaged for elimination through the colon. Bacteria overgrowth combined with poor colon function prevents hormones from being eliminated leading to estrogen dominance and high levels of etiocholanolone with increased inflammation.

Call today! 530-615-4083

The pyrogenic effect of Etiocholanolone has been shown to be due to the release of interleukin-1 (IL-1) from the leukocytes that are mobilized in response to the SIBO bacteria. Failure of the liver clearance causes increased levels of etiocholanolone to be exposed to pro-inflammatory cytokines. Once stimulated by IL-1, Etiocholanolone will stimulate IL-6, which is a TH17 pro-inflammatory cytokine. These aberrant inflammatory responses are likely to be critical factors for tissue injury and progression damage. The pathogenic contribution of TH17 cells to inflammation will vary upon the cause of the disease, for example, between metabolic, hormonal, infectious and autoimmune disorders.

When the activity of the immune stimulation is excessive and not balanced by regulatory cells of the immune system then there is the increased risk for development of autoimmune diseases. Therapeutic supplement protocols for treatment of autoimmune diseases such as Hashimoto’s thyroiditis, Rheumatoid arthritis, or Multiple Sclerosis (MS) must focus upon immunosuppression, immunomodulation, or even immunoregulation of immune cells such as Th17.

The Common Link – Inflammation

There seems to be a common link between gastrointestinal problems, estrogen dominance and thyroid deficiency. The link is inflammation. Inflammation is a general term describing the effects of too many inflammatory cytokines and stimulating neurotransmitters unopposed by too few anti-inflammatory cytokines and inhibitory neurotransmitters.

The key to restoring balance is quenching the inflammation by rebalancing the cytokines and neurotransmitters. This also involves restoring the gastrointestinal environment through the sequencing of the digestive chemistry, which controls microbial behavior. There is a delicate balance

This involves knowing when and where to intervene in the delicate balance of these vicious cycles causing your condition. Everyone is different. Thus, it is best to work with someone who understands the effects inflammation has on thyroid, sex hormones and gastrointestinal issues.

High hormone levels

Alternative MD prescribed Bio-Identical Hormones and Chiropractor muscle tested this woman telling her, she needed Bio-Identical two days prior to doing this Menopause Panel. Neither did any lab testing. This is just one of many similar lab tests I have.

Hormone ratio

Looking at the ratios. This woman was in Zone 1 for Breast and Uterine Proliferation. Cancer is another name for proliferation.

This is an example of bio-identical progesterone. Progesterone is >1000. Estradiol, which is the predominant estrogen during the reproductive years is >99. Estriol, the predominant estrogen during pregnancy is >100. While estrone the predominant estrogen during menopause is slightly elevated at 79. The “>” means it is so elevated the hormone was off the chart. What happens to a 55 year old woman with elevated estriol? Estriol at her age forces her uterine lining to thicken and develop blood supply like she was pregnant. Her risk of uterine cancer increases exponentially.

Nine Months Later!

After nine months on protocol: No hot flashes and able to maintain through diet & lifestyle after protocol.

After nine months on protocol: No hot flashes and able to maintain through diet & lifestyle after protocol.

Now she is in the Optimal Zone for minimal risk of Breast Proliferation and Zone 3 Potentially Proliferative for Uterine Proliferation.

Now she is in the Optimal Zone for minimal risk of Breast Proliferation and Zone 3 Potentially Proliferative for Uterine Proliferation.

Laboratory testing is about probabilities. Not absolutes. No marker on any test is an absolute indicator of pathology – only a probability . When defining measurement values of certain levels of human fluids, there are no absolutes that can be written in stone.  The value that “should be here” has to be balanced against other values that “should be there”. Without lab testing are you doing symptoms suppression?

Call today! 530-615-4083

7 thoughts on “Is Progesterone the Answer to Estrogen Dominance and Hypothyroid?

  1. Dr. Dave, great article as usual! You are saying that it’s about the ratio. What about if the level of progesterone and estradiol are high, but the ratio is relatively normal. What would that say?

    • Hi Anne, That is a great question. As you can see from the graphics I added of hormone testing from one of my patients. She was soaked in bio-identical hormones so much so that the lab just reported them as (>) greater than. Otherwise they would have been off the chart.
      High levels of progesterone and estrogen/estrodiol with a normal ratio would still put a person in one of the higher Proliferation zones. It would be just a matter of time before it became a problem.

  2. Ok, the fact that someone has high levels of hormones i.e. progesterone and estrogen/estradiol, with a normal ratio, this would be a question of time before it become a problem, however, isn’t a better status to be in than someone with abnormal ratio? Isn’t more protective?

    • No, it is not more protective. There may be a temporay decrease in symptoms or hot flashes. Recent studies have shown increased risk of breast or uterine cancer with high levels from Hormone Replacement Therapy. There is a tendency to view hormones only in relation to the breast or uterus but not the immune system or fat cells.

  3. How about if both Progesterone and Estrogen are low and bio-identical Progesterone converts to Estrogen hence creating even more Estrogen Dominance?

    • The example at the bottom of the blog is an example of bio-identical progesterone. Progesterone is >1000. Estradiol which is the predominant estrogen during the reproductive years is >99. Estriol, the predominant estrogen during pregnancy is >100. While estrone the predominant estrogen during menopause is slightly elevated at 79. The “>” means it is so elevated the hormone was off the chart. What happens to a 55 year old woman with elevated estriol? Estriol at her age forces her uterine lining to thicken and develop blood supply like she was pregnant. Her risk of uterine cancer increases exponentially.
      If both Progesterone and Estrogen are low? I was taught it was due to a failure to produce the hormones. Hot Flashes are the common complaint. In theory, raising the levels should stop the hot flashes. Very seldom does this work long term. Now I look at the down stream. The other option is that the hormones are being funneled into the inflammatory hormone pathways to Etiocholanolone, which causes fevers under normal circumstances. If this finely tuned system goes off the fever may be mistaken for a hot flash. But it not just a fever. Etiocholanolone signals an alarm to the immune system promoting an autoimmune response.

  4. Pingback: Period Abnormalities: Should I be Worried? – PSLove

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