Understanding Estrogen and Supporting Hormone Balance the Functional Way

Hormonal health is one of the most important, yet often misunderstood, aspects of women’s well-being. Hormones influence everything from mood and sleep to energy, metabolism, and reproductive health. And when something feels “off,” it’s often because of subtle—or not so subtle—shifts in hormone levels.

Among the key players in the hormonal symphony is estrogen—a complex family of hormones that changes throughout a woman’s life. Understanding how estrogen works, how it’s metabolized, and what you can do to support healthy hormone balance is an empowering step toward long-term wellness.

Meet the Estrogen Family: Estrone, Estradiol, and Estriol

Estrogen isn’t a single hormone but a group of three:

• Estrone (E1)
  Estrone becomes the dominant form of estrogen after menopause. It’s produced mainly in the liver and fat cells and often rises when estradiol levels drop with age. This shift can help explain why many women notice an increase in belly fat during perimenopause and menopause—it’s the body’s way of continuing to make estrogen. However, excess estrone, particularly in overweight individuals, is linked to higher risks of estrogen-related conditions like fibroids, fibrocystic breasts, and uterine hyperplasia.
• Estradiol (E2)
  The most potent and active estrogen, estradiol is made primarily by the ovaries before menopause. It supports libido, mood, vaginal health, and skin elasticity, and helps reduce fine lines. It’s also key for strong bones and cardiovascular health. Estradiol boosts serotonin, our “feel-good” neurotransmitter, which explains why adequate levels are linked to calmness, clarity, and stable mood.
• Estriol (E3)
  Estriol is the weakest of the three and becomes dominant during pregnancy. Outside of pregnancy, estriol is formed in the liver and breast tissue and is thought to have a balancing effect on estradiol. It binds to estrogen receptors but with a gentler touch—about one-eighth the strength of estradiol. Some research suggests that higher estriol exposure during pregnancy may reduce breast cancer risk later in life.

Why Estrogen Metabolism Matters

All estrogens are eventually broken down (metabolized) in the body, primarily by the liver. But not all metabolic byproducts are equally helpful—or safe. There are three major metabolites of estrone:

• 2-Hydroxyestrone – Considered protective; has mild anti-estrogen effects
• 4-Hydroxyestrone – Potentially harmful; may promote cancer growth
• 16-Hydroxyestrone – Also linked to increased cancer risk

Which pathway your body uses most depends on genetics, liver function, gut health, diet, and lifestyle. Some women are genetically predisposed to favor the less beneficial pathways, but lifestyle can significantly influence these patterns. That’s where functional medicine plays a pivotal role.

Functional Medicine: A Personalized Approach to Hormone Balance

Rather than masking symptoms, functional medicine looks upstream—seeking the root causes of hormone imbalance. This approach is especially effective for navigating perimenopause, menopause, and estrogen-related conditions.

Let’s take a closer look at the core pillars that support hormone balance in functional medicine:

1. Blood Sugar Balance and Insulin Sensitivity

Spikes and crashes in blood sugar can lead to insulin resistance, which then throws off other hormone levels—estrogen included. A whole-foods diet that includes complex carbohydrates (think sweet potatoes, quinoa, lentils), healthy fats (avocados, nuts, seeds), and lean proteins helps keep blood sugar steady, which stabilizes your hormonal environment as a whole.

2. Nutrition for Estrogen Metabolism

Certain nutrients and foods help the body metabolize estrogen more efficiently, favoring the protective 2-hydroxyestrone pathway. Here’s what supports healthy estrogen metabolism:

• Cruciferous vegetables like broccoli, Brussels sprouts, and kale
• Iodine-rich sea vegetables (like kelp or dulse)
• Flaxseeds, berries, and grapefruit
• Herbs like rosemary
• Omega-3 fats from fish, flax, and chia

Supplements such as Indole-3-Carbinol (I3C) and Diindolylmethane (DIM)—derived from cruciferous vegetables—can also support this pathway, especially for women with genetic predispositions.

3. Gut Health: The Estrobolome Connection

The gut microbiome helps regulate hormone metabolism and excretion. A balanced, diverse gut supports proper estrogen detoxification and reduces the risk of estrogen reabsorption. A sluggish or imbalanced gut can lead to estrogen dominance. Prebiotics, probiotics, fiber, and fermented foods (like sauerkraut or kimchi) can help build a healthy gut ecosystem.

4. Liver Detoxification Support

The liver plays a central role in processing and eliminating excess estrogen. Functional medicine strategies include:

• Minimizing alcohol and processed foods
• Eating leafy greens and sulfur-rich foods (like onions and garlic)
• Taking liver-supportive nutrients such as milk thistle, NAC, and glutathione (under professional guidance)

Environmental toxins also act as endocrine disruptors, mimicking or interfering with hormones. Reducing exposure to plastic containers, synthetic fragrances, and conventional cleaning products further supports detoxification.

5. Stress and Adrenal Health

Chronic stress disrupts the entire hormone cascade, often leading to estrogen-progesterone imbalances and low thyroid function. Elevated cortisol steals resources from other hormones and exacerbates symptoms like fatigue, irritability, and poor sleep.

Mind-body strategies such as yoga, breathwork, meditation, and even regular nature walks can help regulate the nervous system and restore hormonal balance. Adaptogenic herbs like ashwagandha or rhodiola may also support adrenal resilience—though individualized recommendations are key.

6. Movement and Sleep: Essential Rhythms

Too much or too intense exercise can tax the adrenal system, while too little movement slows metabolism and detoxification. The sweet spot is a mix of strength training, cardiovascular activity, and recovery-based movement like stretching or walking.

Sleep is another hormonal cornerstone. Restful, consistent sleep helps regulate cortisol, melatonin, and sex hormone rhythms. Addressing sleep issues is often a game-changer for hormone health.

7. Testing and Personalized Care

If you’re wondering whether your hormones are in balance, testing is available to assess estrogen levels and metabolites. A 24-hour urine test can measure the ratios of estrogen metabolites, giving insight into how your body is processing estrogen. From there, a personalized plan—including supplements, nutrition, and lifestyle changes—can be designed to support optimal hormone health.

Hormonal balance isn’t about chasing ideal numbers or relying solely on hormone replacement—it’s about creating a supportive environment where your body can do what it’s naturally designed to do.

Whether you’re experiencing the transitions of perimenopause, navigating symptoms like fatigue or irregular cycles, or simply wanting to optimize long-term health, the right foundation makes all the difference:

• Nutrient-rich, whole-foods-based diet
• Balanced blood sugar and gut health
• Effective detox pathways
• Restorative movement and sleep
• Stress resilience
• Personalized testing and care

At my practice, I work with women to uncover the underlying imbalances contributing to their symptoms—and support them with evidence-based, natural solutions that create lasting change. You have more power over your hormonal health than you may realize. And sometimes, the smallest changes in your daily habits lead to the biggest improvements in how you feel.

Dr. Tranchitella provides expertise in hormonal imbalances, mid-life issues, digestive health, and autoimmune disorders. Whether working independently or in collaboration with your primary provider, we help you move forward with confidence on your health journey. Get started on your journey to better health! Schedule a consultation today  >> LEARN MORE