Estrogen Dominance & High Functioning Anxiety

You are busy, but it is okay, because you always have been. In fact, it is what you are known for. Currently you are juggling a number of responsibilities; your motivation for getting them done and moving on to the next 10 things on your to-do list is a coursing pulse that you can feel throughout your body. Your mind races constantly; it flits between your daily work, the future, the past and everything you are trying to achieve. Everyday you work hard, perhaps even overworking, and you rarely let yourself sit still and confront the restlessness and anxiety you feel. Netflix or being with friends is the only time you can let your mind take a break. At night your mind’s constant review of all you’ve done and all you have to do keeps you from falling asleep within 20 minutes of your head hitting the pillow. This is what high-functioning anxiety can look like. 

Those who have high-functioning anxiety may look at their anxiety as a tool that makes them very effective and capable in this busy, pressed-for-time society. Many work environments praise and promote individuals with perfectionistic, type A personalities – it makes for very good employees. We often feel a great sense of accomplishment that our society has taught us to internalize as self-worth, which can make identifying high functioning anxiety very difficult for many. Hey, you’re getting a ton of things done and you are keeping it all together!  

However, we are not put on this earth just to get things done efficiently. And we are certainly not meant to carry worry and anxiety with us everyday. Anxiety disorders are the most common mental health concern affecting adults in North America. Women are twice as likely to be affected. Chronic worry and consistent anxiety changes your mental and physical health by flooding your body with hormones and cytokines associated with stress that affect the: 

  • immune system (decreased protection against pathogens, risk of autoimmune conditions)
  • brain function (memory, cognitive clarity, etc)
  • cardiovascular system (heart & lung health)
  • gut and microflora
  • hormone levels, fertility and menstrual cycle
  • energy levels through cortisol release
  • emotional resiliency

As a Naturopathic Doctor, I have seen a pattern emerging among female patients who present with a triad of anxiety, digestive issues and symptoms of hormone imbalances, specifically something called estrogen dominance. Estrogen dominance is a relative excess of estrogen signalling to a relative deficiency of progesterone signalling. 

Estrogen is the primary hormone in the first 2 weeks of the female menstrual cycle, while progesterone builds to rise in the last 2 weeks of the cycle. 

Estrogen and Progesterone can be thought of as the Yang and Yin of the system; Estrogen is the fiery, energetic Yang force and Progesterone is the calming, grounding, nourishing Yin force; both must balance each other for the sweet spot where healthy hormone levels lie.

In addition to anxiety, other symptoms of estrogen dominance include, but are not limited to: 

  • low sex drive
  • breast swelling & tenderness; fibrocystic breasts
  • painful periods
  • bloating & water retention
  • irritability
  • hair loss
  • fatigue
  • weight gain around abdomen and hips

Why is there a rising phenomenon of estrogen dominance with low progesterone?

Progesterone is considered the mother hormone of the steroid hormone family. When we are chronically stressed and make more cortisol (to allow us to adapt to increased stress), cortisol production steals from progesterone levels. The collective stress levels of most many cities in North America, particularly Toronto where I work, is palpable. The city’s energy itself hums as a different vibration level. 

Xenohormones, otherwise known as human-made synthetic substances in plastics, pesticides, fire retardants (found in furniture, even clothing) and more, contribute to a higher estrogen load and stimulate decreased production of progesterone. The birth control pill, made with synthetic estrogens and progesterones (or sometimes just progesterones) has been found to lower natural progesterone production and contribute to estrogen dominance. 

Digestive concerns, which are very common with the societal rise in stress levels (compromises digestion), thyroid dysfunction, processed food intake, and pharmaceutical / drug use (all of which change gut flora and digestive function), is another big contributor to higher levels of estrogen. Constipation or infrequent bowel movements, which in my naturopathic definition is less than 1, sometimes even 2, bowel movements daily or any hard to pass stools, coupled with changes to our gut microbiome, allows for the reabsorption and recycling of estrogen from the intestines back into the body’s systemic circulation. 

How does high estrogen and low progesterone contribute to anxiety?

  1. Metabolites of progesterone are anti-anxiety. Estrogen is anti-depressant, but too much can produce an “on edge” feeling.
  2. The higher our estrogen levels go, the more cortisol-binding hormone we make. If cortisol is bound to a hormone, it cannot act on our tissues, and this makes us less able to adapt to stress. If you are finding it feels like your body is “falling apart on you”, this can be a reason why.
  3. High estrogen levels over time can contribute to functional or subclinical hypothyroidism which decreases GABA release in the developing brain. GABA is a neurotransmitter with a calming effect. This can prime our brain to fire repetitive worry and anxiety circuits over and over again.
  4. Estrogen levels affect our DNA expression: the COMT gene breaks down estrogen into a heathy anti-anxiety, anti-PMS, anti-fibroid, anti-endometriosis metabolite. However high estrogen actually slows the COMT gene. The COMT gene is responsible for the metabolism of Dopamine, another feel-good neurotransmitter that plays a role in anxiety.
  5. A similar relationship exists between estrogen and the MAO gene that also controls Dopamine metabolism.
  6. The theory of the COMT and MAO estrogen / dopamine link is a reason behind why women often feel stress as anxiety and men (with their testosterone / COMT relationship) often feel stress as anger.

A new standard of care for anxiety

When we look at anxiety, we need to go beyond the traditional recommendations of psychotherapy and pharmaceutical intervention to include a look a healing the body holistically from the inside —> out. This is not to say that counselling and pharmaceutical use is not helpful in individual cases, but these are 2 options for care can be incorporated amongst many others in a burgeoning medical system that supports the patient in healing the root cause of their anxiety. Combining conventional medical care with lifestyle & nutritional medicine is a very powerful approach in making sustainable changes that resonate with how patients want to feel. In my practice I use gut, hormone and nutritional based treatment plans to help patients treat their anxiety, heal their digestive tract and re-regulate their hormones. This way we address the root causes for anxiety and bring the body back to health as a whole. 


Treating COMT and MAO: The Hormonal Cause of Stress and Anxiety. Dr. Andrew Rostenberg. August 27, 2015.

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Dr. Nicole Roberts, ND

Dr. Roberts, ND sits on the YPC Board of the Women's Brain Initiative and focuses her work in women's brain health on the gut-hormone-brain axis, concussion recovery and immune health. Her focus on pediatric brain health leads her to work with kids who have learning, focus and neurodevelopmental symptoms.