Do you have hormonal symptoms? I would comfortably assume you also have stomach or bowel complaints or dysfunction. And this isn’t just a coincidence. But what might not be as obvious is how closely connected hormones are to the gut microbiome. While this may seem complex, it really can be simple.

To begin, let’s discuss how estrogen breakdown (metabolism) works.

Estrogen metabolizes physiologically in numeric order—phase 1, phase 2, phase 3. But we need to address it in reverse – phase 3, phase 2, phase 1.

Let me explain why.

Imagine a bathtub. This bathtub has 3 faucets, the tub, and a drain.

Phase 1 is the hydroxylation phase. It occurs in the liver, where estrogen has three metabolic pathways by which it can be metabolized: CYP1A1, CYP1B1, and CYP3A4. This process results in three forms of hydroxylated estrogens: 2-OH-E1, 4-OH-E1, and 16-OH-E1. To simplify, think of these three pathways as the 3 different faucets on the bathtub. One is hot, one is cold, and one is just right. We want majority of our estrogens doing down that “just right” pathway.

Phase 2 is the conjugation step. This also takes place in the liver. Estrogens become deactivated, specifically through sulfation, glucuronidation, and methylation, so they can be eliminated. This requires certain activated nutrients (methylated B vitamins, magnesium, glutathione, MSM, molybdenum, and amino acids) and enzymes in the body, namely COMT and MTHFR. Again, more simply put, this is the size of the bathtub. We don’t want it too small (lack of nutrients) so the water just overflows. And we don’t want it to be so big that we don’t feel the water.

Phase 3 is the final stage – elimination. The deactivated estrogens from Phase 2 are packaged up and eliminated from the body through the stool. Bile is also necessary to facilitate this process. Things like inflammation, imbalances in the gut microbiome, and overall intestinal health can all impact how smoothly this process takes place. This phase is the drain. It is either open or plugged.

Imagine the drain is plugged. (Think constipation, diarrhea, irritable bowel, autoimmune disease, nutrient deficiencies, food sensitivities, mold exposure, gallbladder removed, candida/yeast overgrowth, leaky gut, etc.) It doesn’t matter if we have the perfect water temperature, and that the bathtub is the correct size, if the drain is plugged, all of that water (hormone metabolism) is going to overflow.

It is now very clear that if Phase 3 is backed up or working inefficiently, estrogen metabolism backs up and even slows entirely. And fun fact, bowel movements every few days is NOT normal. You should be pooping at least once daily or your drain is considered plugged.

This is why I address Phase 3 first with my patients.

If you have hormonal imbalances, and you’ve tried conventional methods such as birth control, topical acne medications, other pharmaceutical drugs like spironolactone or doxycycline, consistently take ibuprofen for cramping, done everything your fertility specialist suggests, and then some. It’s time you meet with us to discuss your gut and it’s significant impact on your hormones.