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The Estrobolome - Hormones & Digestion

How balancing your gut microbiome can help hormone symptoms.

"One of my biggest frustrations in healthcare is how easily we dismiss hormone and reproductive concerns. "Take birth control" seems to be the only option.

Our science is better than this! The connection between the intestinal microbiome and our hormone systems is a rapidly growing field.

And one of my FAVORITE things to talk about."

- Dr. Rebecca Sand

We are learning there are many conditions related to gut-hormone imbalances.

The Science

A lot of this comes down to how estrogens are processed in the body, specifically how estrogens are removed from the body when they're no longer needed.

Estrogen detoxification and removal is a 3-phase process:

Phase 1 - Estrogen detox starts in the liver. Here, we want to look at what forms of estrogen are building up to be detoxified.

Phase 2 - Next, estrogens get flagged as ready to leave the liver. This is mostly controlled by an enzyme called catechol-O-methyltransferase (COMT) but also via sulfation and glucuronidation. This phase makes the estrogens inactive and water soluble so they can be eliminated through the kidneys or the digestive tract.

Phase 3 - This is the intestinal removal of these "flagged" estrogens. Estrogen that is no longer needed then leaves the body in our stool. This phase is largely mediated by our microbiome! This cross-over between our gut microbiome and our hormone systems is called the estrobolome.

Bringing Balance to the Estrobolome

Gut-hormone symptoms are related to dysfunction in the estrobolome. An imbalance in the intestines alters the processes of Phase 3.

Therefore, effective treatment of gut-hormone conditions must start with Phase 3 and go backwards from there.

The first step is investigating intestinal microbial imbalances that we know contribute to impaired hormone regulation. I regularly use serum, stool, and/or breath testing to better understand the root cause of the imbalance. Getting clear data on where the imbalances are (whether gut, hormone, or both) allows for a more tailored treatment and longterm resolution of symptoms.

💡 Learn more about Estrogen Balance in


Case Study and Personalized Treatment

Mira is a 33 year old cis-female with chronic constipation, PMS, and bloating. Her digestive symptoms always got worse around her periods. Lab testing revealed high b-glucuronidase and high levels of methane-producing Archaea in the intestines.

After a long discussion of treatment options, Mira ultimately selected to treat her imbalances with herbal antimicrobials, probiotics, and a concentrated form of glucurate, a naturally occurring ingredient in apples, oranges and broccoli-family foods.

Mira learned to time her meals to optimize digestion and learning how to increase foods that would specifically foster the healthy intestinal bugs she was lacking. In the first month, Mira noticed a decrease in PMS moodiness and bloating. By the second month, constipation had improved, and Mira was able to expand her diet by month three.

The information in this article is not intended to replace your doctor’s advice. Consult with your local healthcare professional before starting or stopping any medication or supplement.


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