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Estrogen is a wonderful hormone. Women primarily make it in their ovaries during their reproductive years and men make it in their testes, adrenals and via testosterone (through a process called aromatization). There are other estrogen production sites (called extra gonadal production) around the body as well, such as the parietal cells of the stomach. Yes, the even the stomach makes estrogen!

But not everyone appreciates the wonders of estrogen. Many women associate estrogen with heavy bleeding, PMS, fibroids, migraines and more. These are all symptoms of estrogen dominance.

In a bid to get rid of estrogen dominance, women will talk of ‘flushing’ estrogen out of the body. You definitely don’t want to do that. Too little estrogen is just as troubling as too much estrogen.

The main question to ask whether you have symptoms of estrogen dominance (or not) is:

“What is my body doing with estrogen? This is called estrogen metabolism

Estrogen is a ‘use it and lose it’ hormone. It is NOT just about the amount of estrogen in the body. It is not even just the ratio of estrogen to progesterone in the body (although that is the most well known determinant of estrogen dominance).

In order to see how you are metabolizing estrogen, you need to do a urine test.

Urine shows metabolites of estrogen. Blood and saliva do not.

I use the DUTCH complete hormone test to determine if there is estrogen dominance and at what level. There are 3 places to look on a DUTCH test to see if estrogen dominance is present.

Here’s the first place I look to determine estrogen dominance:

This is the sex hormone summary on the very first page of a DUTCH complete test.  Here, we are simply comparing the dial positions of estrogen to progesterone. When the estrogen dial is more turned to the right than the progesterone dial, it is considered estrogen dominance.

This example of estrogen dominance is quite extreme, as I am sure you can see!

high estrogen

This is extreme estrogen dominance. The estrogen is sky high and the progesterone is super low


By way of comparison, here is an example that is NOT estrogen dominant because the progesterone dial is more turned to the right than the estrogen dial.

non estrogen dominance example

At first glance, this is NOT estrogen dominance. But remember, this person could be estrogen dominant at the second and third level. Keep reading!


The second place I look to determine estrogen dominance is the levels of 2-OH, 4-OH and 16-OH metabolites. This is the second phase of estrogen metabolism. If you create too much 4-OH or 16-OH, you may have symptoms of estrogen dominance even though at first glance (such as the example above), you have overall better levels of progesterone than estrogen.

estrogen metabolites

This person makes too little 2-OH (you want at least 70% of that because it is considered protective) and too much 4-OH (which is considered more potentially carcinogenic).

The third place I look to estrogen dominance is methylation.

If methylation is low, it indicates that estrogen is having a hard time getting out of the body. We get a peek at methylation of estrogen on the DUTCH test by looking at the methylation dial. Here is an example of low methylation.

methylation of estrogen

The fan dial on this methylation gauge is low. This means that this person is having a hard time at properly detoxing estrogen.


There are other phases of estrogen detox such as sulfation and glucoronidation that are beyond the scope of this article.  However, the main takeaway is that you can be estrogen dominant on several levels. It is not as simple as your ratio of estrogen to progesterone.

Want to do a DUTCH test with me to find out how your 3 levels of estrogen detox are?

You can sign up for that right here

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