Estrogen Metabolism: Why We Check How You Process Estrogen Before We Prescribe It
Most conversations about hormone therapy come down to one question: how much estrogen do you need? It’s a fair question, but it’s only half of the picture. Your body doesn’t just use estrogen. It also has to break it down and get rid of it.
That process is called estrogen metabolism. It gets far less attention than dosing, and it’s rarely tested in a thorough way. At Optim8, we look at it before we prescribe estrogen, and we keep checking it while you’re on it.
What happens to estrogen after it does its job
Estrogen doesn’t disappear once it has done its work. It goes through several steps before it leaves your body.
Your liver converts it. The liver turns estrogen into breakdown products called metabolites. It can do this along different pathways. Some produce milder metabolites. Others produce forms that, in laboratory research, can damage DNA if they aren’t processed further.
Your liver neutralizes it. Next, the liver attaches a small chemical tag to those metabolites. This step is called methylation, and it relies on an enzyme called COMT. Some people carry genetic variations that make this step slower.
Your gut removes it. The liver packages estrogen and sends it to the gut to leave in your stool. This is where gut bacteria come in. Some bacteria make an enzyme called beta-glucuronidase, which can unpack estrogen so it’s absorbed back into your bloodstream instead of leaving. Researchers call the group of gut bacteria that handle estrogen the “estrobolome.”
What’s left leaves in your urine and stool.
Why this matters before a prescription
If any of those steps is slow, estrogen can build up, or more of it can travel down the less favorable pathways. Adding prescription estrogen on top of a system that isn’t clearing it well doesn’t fix that. It can add to it.
That’s why we check first. For many women, estrogen therapy is the right choice, and this isn’t a reason to fear it. It’s a reason to know how your body handles it before you start, so your prescription fits you.
Signs that call for a closer look
No single sign means you have a problem processing estrogen. These are the markers we track and talk through with patients:
- Heavy periods, or low iron stores (ferritin), which heavy periods often cause
- Bloating, reflux or other digestive symptoms
- An imbalance of gut bacteria or yeast, or trouble absorbing nutrients
- Food allergies or sensitivities that haven’t been resolved
- Elevated liver enzymes or LDL cholesterol on bloodwork
- Signs of high histamine
- Drinking alcohol more than about once a month
- Low progesterone relative to estrogen
- Genetic markers that affect methylation or COMT
What we look at
Bloodwork gives us estradiol, progesterone, iron stores, liver enzymes and cholesterol. A functional hormone assessment using saliva and urine adds more detail, including which pathways your body is using to break estrogen down. When results point to a problem, more targeted testing may be recommended.
We review these markers when you start, then again at 3 months, 6 months and 1 year, so you can see what changes.
Who does what
Heather, our nurse practitioner, manages your prescription. If your body isn’t processing estrogen well, Laura works on the other side of it: your gut, your liver and your nutrition, along with cutting down your exposure to hormone disruptors. Both of them see the same results and work from the same plan.
Don’t stop or change prescribed hormones without talking to your prescriber.
Start with the Optim8 Health Reset
Hormone care at Optim8 starts with the Optim8 Health Reset. For $199, you get a 60-minute consult, targeted testing and a personalized 30-day plan, with no long-term commitment. We go over your symptoms, your history and any hormones you take now. Already have a prescription from somewhere else? Bring it with you.
