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Treatment Options for Relative Estrogen Dominance

The term “estrogen dominance” was coined by Dr. John R. Lee, MD.1 Estrogen dominance is a common underlying cause of many symptoms associated with the menstrual cycle, and there are two types of estrogen dominance – relative and frank. Relative estrogen dominance is present when the estradiol level is normal or low, but there is insufficient progesterone to balance the estradiol. Frank estrogen dominance is present when the estradiol level is elevated.2

It is important to note that many women are not estrogen dominant due to excessive estrogen. Rather, they are in a state of relative estrogen dominance due to an insufficient progesterone level. The treatment protocols for estrogen excess and inadequate progesterone are different; therefore, it is best to monitor salivary hormone levels regularly to prescribe an individualized and effective treatment protocol for each patient. Always consider potential treatment protocols within the context of your patient’s overall clinical presentation and other factors, including family history.

Symptoms and conditions associated with estrogen dominance may include:

  • Insomnia1
  • PMS1,3
  • Miscarriage1
  • Fibrocystic breasts1
  • Breast tenderness1
  • Unexplained weight gain1
  • Cyclical headaches1
  • Migraines1,4
  • Anxiety1,5
  • Infertility1
  • Bloating and water retention1
  • Mood swings1
  • Menorrhagia1,6
  • Depression1,7
  • Brain fog1
  • Facial flushing1
  • Weepiness1
  • Accelerated aging1
  • Allergies1
  • Autoimmune disease1
  • Cancer1,8
  • Low libido1
  • Fatigue1,5
  • Hair loss1
  • Gallbladder disease1
  • Hypoglycemia1
  • Hypercoagulability1
  • Increased risk of stroke1
  • Irritability1,5
  • Memory loss1
  • Osteopenia and osteoporosis1
  • Seizures related to the menstrual cycle1
  • Thyroid dysfunction1
  • Uterine fibroids1
  • Endometriosis1,9
  • Irregular menstrual cycles1,10
  • Hot flashes & night sweats1
  • Sluggish metabolism1
  • Ovarian cysts1
  • Anovulation


For more information, please review Treatment Options for Relative Estrogen Dominance on the Provider Tools page.

To screen for the presence of estrogen dominance in patients who have a menstrual cycle, consider ordering the Expanded Cycling Female Hormone Panel (eFHP). A Sample eFHP Report is available in your Provider Portal HERE.

To place a test order, click here. You will find the Expanded Cycling Female Hormone Panel listed under the section header Reproductive Hormone Panels & Tests.

As a reminder, DiagnosTechs will drop ship test kits directly to your patients. You may select this option at the top of the order form.


  1. Lee JR, Hopkins V. John Lee’s Hormone Balance Made Simple: The Essential How-to-Guide to Supplementation, Dosages, and More. New York, NY: Warner Books; 2006.
  2. Brighten J. Beyond the Pill a 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill. New York, NY: HarperOne, and imprint of HarperCollins Publishers; 2020.
  3. Roomruangwong C, Carvalho AF, Comhaire F, et al. Lowered Plasma Steady-State Levels of Progesterone Combined With Declining Progesterone Levels During the Luteal Phase Predict Peri-Menstrual Syndrome and Its Major Subdomains. Front Psychol. 2019;10:2446. doi:10.3389/fpsyg.2019.02446
  4. Ripa P, Ornello R, Degan D, et al. Migraine in menopausal women: a systematic review. Int J Womens Health. 2015;7:773-782. doi:10.2147/IJWH.S70073
  5. Ziomkiewicz A, Pawlowski B, Ellison PT, et al. Higher luteal progesterone is associated with low levels of premenstrual aggressive behavior and fatigue. Biol Psychol. 2012;91(3):376-82. doi: 10.1016/j.biopsycho.2012.08.001.
  6. Jewson M, Purohit P, Lumsden M, et al. Progesterone and abnormal uterine bleeding/menstrual disorders. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020;69:62-73.
  7. Joffe H, de Wit A, Coborn J, et al. Impact of Estradiol Variability and Progesterone on Mood in Perimenopausal Women With Depressive Symptoms. J Clin Endocrinol Metab. 2020;105(3):e642-e650. doi:10.1210/clinem/dgz181
  8. Lieberman A, Curtis L. In Defense of Progesterone: A Review of the Literature. Altern Ther Health Med. 2017;23(6):24-32.
  9. Marquardt RM, Kim TH, Shin JH, et al. Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis?. Int J Mol Sci. 2019;20(15):3822. doi:10.3390/ijms20153822
  10. Sweet MG, Schmidt-Dalton TA, Weiss PM, et al. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012;85(1):35-43.