Understanding Estrogen, Endometriosis, Melatonin, and the Estrobolome

Estrogen is a vital hormone, but when out of balance, it can contribute to a range of chronic conditions, including endometriosis, PCOS, and even breast cancer. In functional medicine, we focus on the body as an interconnected system, aiming to identify and address root causes of imbalances. One key factor influencing estrogen levels and hormone-related conditions is the estrobolome—a collection of gut bacteria that plays a significant role in estrogen metabolism. In this blog, we will explore the estrobolome’s impact on conditions like endometriosis, delve into the role of melatonin and the circadian rhythm, and introduce the importance of tests like DUTCH and the innovative Ziwig Endotest for endometriosis diagnosis.

The Link Between Estrogen and Endometriosis

Endometriosis is a chronic inflammatory condition where tissue similar to the lining of the uterus grows outside it, often leading to pain, infertility, and systemic inflammation. Estrogen dominance is a common factor in the development of endometriosis, and addressing estrogen metabolism is key in managing the condition. Elevated estrogen levels drive the growth of endometrial tissue, exacerbating symptoms. Functional medicine looks closely at the estrobolome, a subset of the gut microbiome, which is involved in metabolising oestrogens. The gut bacteria that produce β-glucuronidase can lead to an increase in circulating oestrogens. This happens because β-glucuronidase breaks down conjugated oestrogens, making them more available to re-enter circulation rather than being excreted. In women with endometriosis, the estrobolome may contain higher numbers of β-glucuronidase-producing bacteria, contributing to an inflammatory and oestrogen-dominant environment.

Estrobolome, Gut Health, and Chronic Disease

The estrobolome not only affects oestrogen levels but is also linked to broader health issues such as breast cancer and PCOS (polycystic ovarian syndrome). In PCOS, an imbalanced gut microbiota can promote increased androgen production and reduce oestrogen levels due to decreased β-glucuronidase activity. On the other hand, women with oestrogen dominance are more prone to hormone-related cancers, including breast cancer. Antibiotics, poor diet, and environmental toxins can disrupt the estrobolome, leading to altered hormone metabolism and increasing cancer risk.

Dietary interventions, including the use of probiotics and prebiotics, can help maintain a healthy estrobolome. Foods rich in fibre, such as avocado and cruciferous vegetables, support gut health and help regulate oestrogen levels, while prebiotics like inulin found in garlic and chicory promote the growth of beneficial bacteria.

The Role of Melatonin and Circadian Disruption

Melatonin, commonly known for regulating sleep, plays an important role in hormonal balance, including oestrogen metabolism. Disrupted circadian rhythms, often caused by prolonged stress or irregular sleep patterns, can lead to decreased melatonin levels. This reduction can further exacerbate oestrogen dominance by increasing the body's inflammatory response and altering oestrogen metabolism. In fact, studies have shown that melatonin has a protective effect against endometriosis, likely due to its ability to modulate oestrogen levels and reduce inflammation.

Resetting the circadian rhythm is crucial for women suffering from hormone imbalances. Practical steps include practising good sleep hygiene, minimising exposure to artificial light at night, and incorporating stress-reduction techniques such as meditation and nervous system resets.

DUTCH Testing: A Comprehensive View of Hormones

For women with suspected hormonal imbalances, such as those seen in endometriosis or PCOS, DUTCH (Dried Urine Test for Comprehensive Hormones) testing offers valuable insight into hormone levels and metabolites. This test provides a detailed look at oestrogen metabolism pathways, allowing practitioners to assess how well oestrogen is being processed and excreted from the body. It also examines cortisol and melatonin, helping to identify the impact of stress and circadian disruption on hormonal health.

For women with oestrogen dominance, supporting the detoxification of oestrogens is critical. Glutathione, a powerful antioxidant, plays a key role in phase two detoxification, helping to neutralise harmful oestrogen metabolites and protect against oxidative stress. Increasing glutathione levels through diet, supplements, or IV therapy can be beneficial in restoring balance.

Ziwig Endotest: A New Frontier in Endometriosis Diagnosis

Diagnosing endometriosis has traditionally required invasive procedures, such as laparoscopy. However, the Ziwig Endotest, a new saliva-based diagnostic tool, promises to revolutionise endometriosis diagnosis. This non-invasive test can detect the presence of endometriosis with high accuracy by identifying specific biomarkers associated with the disease. By offering earlier and more accurate diagnosis, the Ziwig Endotest enables women to receive timely treatment and manage their condition more effectively.

Environmental Factors and the Estrobolome

Environmental factors, including exposure to antibiotics, endocrine disruptors, and mould, can further disrupt the estrobolome. Antibiotics, particularly those like ampicillin, have been shown to increase conjugated oestrogens in the gut, promoting reabsorption rather than excretion. This contributes to oestrogen dominance and heightens the risk of hormone-related diseases. Additionally, low-fibre diets and exposure to environmental toxins such as phthalates, parabens, and pesticides can skew hormone balance by affecting gut bacteria and oestrogen metabolism.

Conclusion: A Functional Medicine Approach to Estrogen and Endometriosis

Balancing oestrogen levels is critical in managing conditions like endometriosis, PCOS, and hormone-related cancers. Functional medicine provides a holistic approach to achieving hormonal balance, focusing on the gut microbiome, melatonin regulation, and environmental factors. With advanced tools like DUTCH testing and the Ziwig Endotest, we now have better insight into oestrogen metabolism and can offer more targeted interventions for women suffering from hormonal imbalances. Restoring gut health, supporting detoxification pathways with glutathione, and addressing circadian disruption are key steps in helping women regain hormonal balance and improve overall health. By incorporating these insights into daily practice, we can help women manage endometriosis and other hormone-driven conditions more effectively.

‍