Our body is always in a state of hormone production and excretion. Once a hormone has completed it’s function, it is broken down and excreted by the gut or kidneys. Estrogen follows this same process, which we call estrogen detoxification or estrogen metabolism.
First let’s spend one minute talking about our active estrogens. There are 3 main forms of estrogen: estrone (E1), estradiol (E2), and estriol (E3). Estradiol (E2) is the prominent form of estrogen in menstrating women. It is important in fertility, bone health, cardiovascular health, and more! Estrone (E1) is the main estrogen during menopause, and estriol (E3) increases during pregnancy.
Estrogen detoxification occurs in 3 phases – in the liver Phase 1 & Phase 2, and Phase 3 in the gut via the microbiome (gut bacteria).
Phase 1 Detoxification
During Phase 1, estrone and estradiol are first converted into 3 different metabolites known as 2-OH-E1, 4-OH-E1, and 16-OH-E1.
Phase 1 detoxification results in 70% of 2-OH-E1, 10% of 4-OH-E1, and 20% of 16-OH-E1.
The 2-OH-E1 form of estrogen is considered the safe form, and is the preferred pathway of detoxification. 4-OH-E1 has the highest ability to damage DNA and contribute to the development of breast cancer, therefore we should go down this pathway the least. The 16-OH-E1 will help to maintain bone mineral density, but can also influence the development of breast cancer.
DIM (Diindolylmethane), I3C (indole-3-carbinol), and cruciferous vegetables such as broccoli, cauliflower, kale, cabbage, brussels sprouts, and bok choy all support the safe 2-OH-E1 pathway. Coffee is able to support Phase 1 detox, while a diet high in sugar and alcohol can inhibit it.
Phase 2 Detoxification
This phase prepares the 2-OH-E1 and 4-OH-E1 to be excreted out of the body. Through a process called methylation, the liver makes these metabolites water soluble to be safely excreted byt the colon and kidneys.
B Vitamins (B12, B6, folate) and magnesium are used to help Phase 2 detoxification. Cosmetic products that contain phthalate esters such as lotion and creams, nail polishes, hair products, deodorants, and fragrances can disrupt Phase 2 detoxification. Coffee inhibits Phase 2 detox.
Phase 3 Detoxification
Once estrogen is prepared and ready to be excreted, it enters the kidney’s for urination or leaves the liver via bile and makes its way into the colon to be excreted by stool.
A collection of gut bacteria called the estrobolome are capable of metabolising estrogen. They do this by producing an enzyme called beta (β)-glucuronidase, which takes the estrogen ready for excretion and sends it back into circulation. This leads to higher levels of estrogen in the body creating an estrogen dominance hormone imbalance. Calcium D-glucarate inhibits the activity of β-glucuronidase and can be found in supplement form. Eating a diet rich in fiber and fermented foods will support a healthy gut microbiome.
In depth hormone testing can provide insight into your detoxification pathways of estrogen. As a naturopathic doctor, I use one of the original comprehensive hormone testing kits called a DUTCH test by Precision Analytical. It provides information on each of the 3 main estrogens E1, E2, and E3, as well as how each of the 3 phases of detoxification are working.
Dr. Stephanie Liebrecht, BSc, ND Naturopathic Doctor