Fix the Why: A Functional Medicine Playbook for PCOS & Estrogen Imbalance

PCOS & Estrogen Dominance? Yes, you Can Have Both!

What if the reason your chin hairs and heavy periods keep coming back is because you’re treating the symptoms, not the conversation between estrogen and progesterone?

If that made you sit up straighter, good. This is the part most blogs skip: the biology beneath the band-aids. 

You know the drill, we’re not symptom-chasing here, we’re root-causin’.

First Things First: What’s Estrogen Dominance?

PCOS is not only “too much testosterone.” It’s an ovulation-and-metabolism problem that frequently creates relative estrogen dominance, meaning even normal estrogen becomes too much when progesterone is absent. That combo explains why some women have both androgenic signs (acne, facial hair) and estrogenic problems (heavy periods, crippling PMS). Understanding how they talk to each other changes the plan.

Estrogen dominance doesn’t always mean sky-high estrogen. It often means estrogen is “too loud” for the amount of progesterone you actually produce. 

In plain terms: estrogen = the accelerator; progesterone = the brake. 

When the brake fails (not enough progesterone), estrogen’s acceleration feels out of control. Symptoms: heavy periods, breast tenderness, mood swings, migraines, and the “PMS x 100” meltdown.

Why Estrogen Gets So Loud (and who’s cheering it on)

Insulin is the microphone: when it’s high (yes, even in “lean PCOS”), it tells the ovaries to crank out more androgens. Some of those androgens don’t stay as androgens; they get converted into estrogen in fat tissue by an enzyme called aromatase. So a metabolic nudge becomes a hormonal megaphone.

The liver and gut are the clean-up crew. Your liver chemically tags estrogens for removal, and the gut shuttles them out in stool. But if liver detox pathways are overwhelmed or your gut is slow or dysbiotic, estrogen metabolites can be recycled back into circulation (hello, estrobolome and bacterial beta-glucuronidase). Instead of leaving the party, estrogen sneaks back in the back door.

Environment and stress turn up the volume. Endocrine-disrupting chemicals (think BPA and phthalates), poor sleep, chronic inflammation, and ongoing stress all nudge this system toward more active estrogen signaling—lowering SHBG, altering metabolism, and adding adrenal androgen fuel to the fire.

Put it together and you’ve got a living loop: 

Metabolic signals → Ovarian and adrenal hormone shifts → Local conversion and slowed clearance → More estrogenic tone. 

That’s why treating one symptom in isolation rarely works: your hormones are a team sport, not a lone ranger!

💡Tiny, practical starter: if this paragraph lit a bulb for you, start by stabilizing blood sugar (protein + fat + fiber at meals) and improving gut transit (hydration, fiber, movement). Those two moves quiet the mic and help the cleanup crew do their job. 

How estrogen dominance shows up with PCOS (the overlap)

You might see:

• Heavy or clotty bleeding
  
  

• PMS that’s catastrophic rather than annoying
  
  

• Migraines tied to your cycle
  
  

• Acne or facial hair that’s worsened despite “anti-androgen” treatments
  
  

• Irregular cycles or anovulatory months

If you have any of the above and PCOS, think: maybe estrogen is playing tag with testosterone, and progesterone’s absent from the park… meaning the kids are running wild without adult supervision.

Labs & testing that actually move the needle (what to ask for and when)

Okay, friend, time to trade in the hormone whack-a-mole game for actual data. Not just any labs, but the right ones at the right time, because timing and pattern beat a single random value. When you visit your healthcare provider, say, “I want targeted PCOS/hormone testing with timing,” and then ask for the items below.

Early follicular (cycle days 2–5), fasting:

• Fasting glucose + fasting insulin (insulin is the early warning sign)

• HbA1c

• Total testosterone + sex hormone binding globulin (SHBG)

• DHEA-S (adrenal androgen)

• LH & FSH

• Estradiol (E2)

• TSH, Free T4, Free T3

• Ferritin, Vitamin D, CMP (liver enzymes), hs-CRP
  

If ovulating / mid-luteal (~7 days post-ovulation):

• Serum progesterone (to confirm ovulation & luteal function)
  

When the picture is muddy or symptoms persist—consider advanced testing:

• DUTCH Complete (urine steroid profile): measures estrogen metabolites (2-OH, 4-OH, 16-OH), androgen metabolites, and cortisol rhythm. Very useful when estrogen dominance is suspected despite “normal” serum E2 because it shows how you metabolize and clear estrogens.
  
  

• Estrobolome/ stool testing if you have GI symptoms or slow transit (to see if gut dysbiosis is recycling estrogen).
  

Interpretation rules of thumb:

• Low progesterone + “normal” E2 = functional estrogen dominance.

• High free testosterone + low SHBG = high bioavailable androgen load (treat metabolic drivers).

• High DHEA-S with normal ovarian androgens = adrenal contribution (stress/adrenal support matters).

• Skewed estrogen metabolites (high 16-OH, low 2-OH) on DUTCH = prioritize liver detox/metabolite support.
  
  

How to actually begin fixing the system (no fluff & real steps)

Alright, enough theory. Let’s roll up our sleeves and talk about the steps that move the needle, the ones you can start this week without getting lost in fluff."

Ready to turn insights into action? Because knowledge is power, but it’s the doing (even the tiny tweaks) that rewires your hormones for the better.

1) Stabilize insulin (the primary metabolic lever)

Why: Insulin lowers SHBG and stimulates ovarian androgen production early.
Actions (do these this week):

• Breakfast within 60 minutes: aim for ~25–30 g protein + healthy fat + fiber (scrambled eggs + spinach + avocado).
  
  
  

• Plate rule: ½ non-starchy veg, ¼ protein, ¼ slow carbs.
  
  
  

• Post-meal movement: 20–30 minute walk after a main meal reduces insulin surge.
  
  
  

• Consider myo-inositol and d-chiro inositol (40:1 ratio) — studies show benefit for ovulation in PCOS.
  
  

2) Bring ovulation back so progesterone can do its job

Why: Progesterone balances estrogen and supports metabolic health.
Actions:

• Track ovulation (BBT, cervical mucus, ovulation tests). Use the data; it matters.
  
  

If lifestyle shifts alone aren’t enough, be kind to yourself. Your doctor might recommend letrozole (the current gold standard for ovulation induction in PCOS) or the use of micronized progesterone to support your cycle once ovulation happens. Think of these not as band-aids, but as short-term helpers to remind your body how to find its rhythm again.

3) Optimize estrogen metabolism (liver + gut)

Why: How you metabolize estrogen determines whether metabolites are protective or problematic.

Actions:

• Daily cruciferous vegetables (broccoli, Brussels sprouts) — they support the favorable 2-hydroxylation pathway and boost sulforaphane/DIM pathways.
  

• Support bowel regularity: fiber + hydration + movement (estrogen excreted in stool).
  

• Consider DUTCH testing if bleeding is heavy or E2 looks “normal” but symptoms persist — it tells you which metabolites to target.

4) Clean up exposures (EDC hygiene)

Why: BPA, phthalates, and other endocrine disruptors lower SHBG and mimic estrogen.

Actions:

• Swap plastic food storage for glass, and avoid microwaving in plastic.

• Prioritize organic for the Dirty Dozen produce.

• Choose fragrance-free or low-toxin personal care products.

5) Calm stress, protect sleep, support adrenals

Why: Chronic stress increases adrenal androgens (DHEA-S), blunts ovulation, and worsens insulin resistance.

Actions:

• Anchor mornings with daylight and gentle movement.
  
  

• Two 5-minute breathwork sessions per day (before breakfast & before bed).
  
  

• Move caffeine earlier and protect 7–9 hours of sleep.

6) Targeted nutrients & careful herbs (with supervision)

Useful, but individualized:

• Magnesium glycinate (gentle, supports sleep and metabolic pathways)

• B-complex (supports methylation and liver detox)

• Zinc & selenium (reproductive support)

• DIM / sulforaphane — for estrogen metabolite support, but only when indicated (check DUTCH).

• Vitex — can help luteal support in certain patients, but should be used selectively and not if estrogen dominance is driven by high estrogen metabolites.
  
  
  

Note: While herbs and supplements may be “more natural,” that doesn’t mean they are harmless. Always consult with a health care provider, preferably someone who knows women’s hormones!

A realistic week-by-week start (patients love this)

Week 1: Breakfast change + 20–30 min post-meal walk; swap one plastic item for glass; add one cup of cooked cruciferous veg daily. Book fasting labs.

Week 2: Track BBT or cervical mucus; add magnesium glycinate at night; breathe 5 min before dinner daily.

Week 3: Review labs with clinician; if fasting insulin is high, start more targeted insulin interventions (inositol, medical options if needed). If anovulatory after 6–8 weeks, discuss ovulation induction options.


Week 4: Reassess symptoms; consider DUTCH if symptoms persist despite normal serum labs.

Zoom Out: The Whole System Matters

One lab result will never tell your whole story. Your body is constantly giving you feedback — little breadcrumbs that, when pieced together, reveal the bigger picture. When we zoom out and connect hormones, metabolism, liver, gut, and even environmental factors, that’s when the “mystery” of PCOS finally starts to make sense.

Root-cause work doesn’t just patch the leaks; it re-routes the entire system so it can flow the way it was designed to.

And please remember:

• You’re not alone.

• Your symptoms are data, not flaws.

• And there are real answers beyond quick fixes.

💛 If you’re craving guidance and community, my waitlist is open — or just slide into my DMs. I love hearing from women walking this same path. Together, we’re rewriting the PCOS playbook with science, compassion, and a whole lot of real talk.