We’ve always known hormones play a major role in our health and well-being, but the conversation—especially among women—has ramped up in recent years. According to a recent survey, a startling 47 percent of American women have experienced hormonal imbalances. At the center of it all: estrogen—and a hormonal phenomenon known as ‘estrogen dominance.’

What Estrogen Really Does

Women can thank the sex hormone estrogen (produced in the ovaries) for breasts, wider hips, pubic hair, armpit hair, and menstruation.

But that’s not all: Estrogen plays a role in bone formation, blood clotting, and pregnancy. It also affects skin health and hair growth.

As important as estrogen may be for all things female, it is possible to have too much of the hormone—especially in relation to another key female sex hormone, progesterone.

This state, known as ‘estrogen dominance,’ can cause all sorts of problems for women’s health.

What Is Estrogen Dominance?

Estrogen dominance is not the same as having high estrogen levels, explains certified hormone therapy expert Alex Spinoso, M.D., M.B.A., co-owner of Genesis Lifestyle Medicine “Estrogen levels themselves may be normal, but are imbalanced compared to their progesterone levels and therefore ‘relatively high.’”

Haven’t heard of estrogen dominance before? Many women haven’t. Thing is, women are more at-risk for the condition than ever, says hormone expert and integrative nutritionist, Alisa Vitti, H.H.C., founder of FLO Living and author of Woman Code. In fact, according to Vitti, most women are at some risk for estrogen dominance these days.

Causes Of Estrogen Dominance

In a perfect world, women’s hormones would ebb and flow appropriately throughout their menstrual cycle. However, a number of issues—many of which are the result of modern life—can throw off women’s hormones and leave them estrogen-dominant.

One of the most common culprits: being overweight. “Fat stores estrogen and other hormones, so having excess body fat can lead to an increase in estrogen being stored in the body,” explains Yalena Deshko, N.D., founder of Timeless Health Clinic in Toronto.

However, a number of other inputs—from other health conditions to lifestyle factors—can also throw us out of balance. Just a few: childbirth, PCOS, hyper- and hypo-thyroidism, certain medications (like the birth control pill and hormone replacement therapy), gut bacterial imbalance, certain personal-care and beauty products, and stress.

“We’re all constantly surrounded by endocrine disruptors, like pesticides in our food and preservatives and chemicals in our environment, furniture, and even nail polish,” says Vitti. Exposure to these chemicals can throw off our delicate hormonal balance and exacerbate symptoms.

Signs Your Estrogen Is Out Of Whack

Estrogen dominance can look and feel a little different for different women, but many experience a few telltale symptoms.

1. Weight Gain

Yep, not only is weight gain a potential cause of estrogen dominance, but also one of its most common symptoms. Why? Estrogen signals the body to store fat.

It’s a vicious cycle, says Kim Langdon, M.D., Ob/Gyn at Parenting Pod. “Estrogen dominance makes you prone to gain—and have difficulty losing—weight, which then further aggravates the hormonal imbalance and its symptoms.”

Plus, estrogen dominance can also signal the body to store more water. Without adequate balance of progesterone, which is crucial for normal cell death and rejuvenation, cells retain more water than usual, explains Spinoso. The result: bloating and water-weight gain.

2. Sleep Disturbances and Insomnia

According to Spinoso, our hormones and sleep cycles have a reciprocal relationship—meaning sleep affects our hormones and our hormones, in turn, affect our sleep.

Progesterone promotes sleep, so shifts in your ratio of estrogen to progesterone can result in sleep disturbances.

The issue often snowballs from there: “The lack of sleep can then create a negative feedback loop which increases levels of cortisol (a stress hormone), which just exacerbates sleep issues and the other symptoms of estrogen dominance,” he says.

3. Anxiety

Relatively high estrogen levels can also increase the body’s production of cortisol on their own, which can then spur feelings of anxiety, explains Spinoso.

Related: Cortisol Is Dragging You Down—Here’s How To Take Control Of It

In fact, this effect has even lead many doctors to avoid prescribing hormonal birth control to women with a history of anxiety, says Langdon.

4. Constipation

The far-reaching effects of estrogen—and its dysfunction—continue into the digestive system. “Estrogen has an impact on our gut bacteria, and on our digestive tract, “ says Natalie Rose C.N., author of The New Energy Body.

Estrogen dominance can slow down the digestive system, causing constipation, abdominal pain, bloating, and cramping, she explains.

Not to mention, the sleep trouble and anxiety estrogen dominance can cause often leads us to reach for sugary comfort foods, which can further mess with our gut.

5. Decreased Sex Drive

“When estrogen levels go up, so do sex-hormone binding globulin levels,” explains Langdon. The trouble with excess sex-hormone binding globulin: it binds to circulating testosterone, which is crucial for a healthy libido.

Without the proper balance of estrogen-to-testosterone, sex drive often takes a hit. (According to Spinoso, this can also cause vaginal dryness, fatigue, and muscle loss.)

Related: 6 All-Natural Libido Boosters

Plus, many of the other symptoms of estrogen dominance (like weight gain and mood issues), tend to leave women feeling less ‘in the mood,’ too.

6. Headaches

Headaches, particularly migraines, are often influenced by hormonal fluctuations, explains board-certified gynecologist Adeeti Gupta, M.D., founder of Walk In GYN Care.

Some women without estrogen dominance may experience migraines as estrogen levels change during menstruation, she says. However, it’s especially common in those with estrogen dominance.

7. Cold Hands And Feet

Though more research will clarify why many women with estrogen dominance notice cold hands and feet, “there is a link between estrogen and circulation,” says Gupta. Less blood-flow to the extremities can leave them feeling cold to the bone.

8. Hair, Skin, & Menstrual Issues

Though estrogen dominance manifests differently in different women, some may also experience symptoms like:

• hair loss
• facial hair growth
• acne
• worsened PMS
• irregular, heavy, or completely absent periods

Testing For Estrogen Dominance

“Since hormone interactions in the body are complex, not all patients with estrogen dominance develop all of the described symptoms,” says Deshko. If you’re experiencing two or more of the above symptoms without another explanation, pay your doctor a visit.

“See a professional who is familiar with these issues,” says Gupta. “A lot of OB/GYNs and primary care providers are not familiar with the condition and what’s needed to measure and control it.”

Testing typically starts with a blood test to measure progesterone and estrogen levels, says Vitti. If you’re pre-menopausal, they’ll typically do this a week before the start of your period, when the imbalance would be most problematic. (Urine and saliva tests, though considered more effective, usually aren’t covered by insurance.)

Treating Estrogen Dominance

Once you have a clear picture of your hormones, work with your doctor to create an individualized plan to balance your hormones.

Sometimes, regaining balance is as simple as changing your diet, fitness, and sleep habits. However, in more severe cases, you may need more extensive hormonal therapy—so it’s key to work closely with your doctor!

Pin this infographic for quick reference: