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Estrogen metabolism - Balance is Key

Updated: Apr 19, 2020

Estrogen metabolism is the process by which estrogen is broken down and eliminated from our bodies in both MALES AND FEMALES. We want estrogen metabolism to be optimal and be free from any disruption. We also want to be removing more harmful forms of estrogen that can pose a risk for cancer and inflammatory disease. Depending on what factors are affecting our lives, estrogen metabolism may also be affected and the way we look at estrogen metabolism may change. These factors may include: menopause, PMS (pre-menstrual syndrome), hormonal birth control, prior history of a female reproductive cancer, stress, weight gain, fatigue and more. Also note that estrogen and all our other hormones impact one another – THEY ARE ALL RELATED!! Therefore, if we want to achieve hormonal balance, we must investigate all hormones and how they are metabolized in our bodies. These hormones include, but are not limited to: thyroid, cortisol, progesterone, testosterone, insulin & DHEA. In today’s blog, I will be keeping things as simple as possible, since endocrine health is quite complex!

There are 3 main forms of estrogen that we focus on:

  1. E1 – Estrone – may increase a woman’s risk for breast cancer

  2. E2 – Estradiol – provides antioxidant support

  3. E3 – Estriol – studies have shown protection against breast cancer

We are going to focus on 3 potential pathways/metabolites of E1 (Estrone) metabolism:

  1. 2-hydroxyestrone

  2. 16-hydroxyestrone

  3. 4-hydroxyestrone


This is a more favorable and a more protective estrogen metabolite. If there are any forms of estrogen that are pro-inflammatory and pose a risk for cancer, this is the metabolite that helps to prevent their action. It is ANTI-INFLAMMATORYin nature. Ultimately, we would like this metabolite of estrogen to undergo a second pathway of methylation to form 2-methoxyestrone, because this methylated form is what offers protective effects against breast cancer.


Research suggests that this metabolite of estrogen is associated with a higher risk of breast cancer. This particular estrogen metabolite is considered PRO-INFLAMMATORY, and is therefore associated with and condition or disease related to inflammation including hypothyroidism, insulin dysregulation, etc.


This is the estrogen metabolite that is capable of DIRECT DAMAGE TO DNA! It can bind to DNA forming what we call quinone adducts. Research is showing the association between this metabolite and cancer and of course other inflammatory conditions.

Briefly, here are factors that can affect the metabolism of Estrogen:

  • Obesity (can also be a result of impaired estrogen metabolism!)

  • Alcohol consumption

  • Tobacco

  • Xenoestrogens - synthetic or chemical compounds that mimic estrogenic activity in the body

  • Other toxins - mold exposure, heavy metals, fragrances, etc.

  • Immune health, because of INFLAMMATION. Our immune system is what ultimately regulates inflammatory responses both internally and from external sources such as the above. Therefore, we must address inflammation prior to and during beginning treatments to help with hormone metabolism!

This is why testing hormones alone is NOT ENOUGH. Testing the metabolites can show us how your body is functioning metabolically to store and or eliminate the hormones.

Hormonal imbalance impact our:

  • Energy

  • Mood (irritability, anxiety, depression)

  • Concentration

  • Memory

  • Metabolism/weight

  • Skin

  • Digestion


Did you know that there is testing available to test your hormones AND their metabolites? Get all the information you need by booking an introductory 15-minute consult with myself to discuss what your options are for testing.


  1. There is no such thing as a “one size fits all” approach to treating hormone imbalance AND;

  2. It’s always best to test, not guess!


Dr. Mawji

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