Oestrogen Dominance: Symptoms and How to Restore Balance

Oestrogen is one of the most important hormones in women’s health. It plays a vital role in regulating the menstrual cycle, supporting bone density, maintaining cardiovascular health, and influencing mood, skin health, and brain function.

However, when oestrogen is not adequately balanced by progesterone, it can lead to a hormonal pattern often referred to as oestrogen dominance. Despite how commonly the term is used online, oestrogen dominance is frequently misunderstood and oversimplified, because it isn’t a condition, it’s a description. Medical professionals will use more targeted language to describe what is going on with your body and hormones.

This article explains what oestrogen dominance really means, the symptoms to look out for, including acne, hot flushes and sleep disturbance, and how it is assessed and managed in a clinically safe way.

What Is Oestrogen Dominance?

When people use tthe phrase “oestrogen dominance”, what they are describing is the effects of oestrogen outweighing the balancing influence of progesterone. Importantly, this does not always mean that oestrogen levels are “high” on blood tests. In many cases, oestrogen levels may be normal or fluctuating, but progesterone levels are insufficient, creating a relative imbalance.

Progesterone plays a crucial role in:

regulating the menstrual cycle
calming the nervous system
supporting sleep
counteracting the stimulatory effects of oestrogen on the uterine lining

This imbalance is particularly common during perimenopause, when ovulation becomes irregular. As progesterone is produced only after ovulation, missed or inconsistent ovulation leads to falling progesterone levels, while oestrogen continues to fluctuate — often resulting in symptoms associated with a relative oestrogen dominance.

Common Causes of Oestrogen Dominance

Oestrogen dominance is influenced by a combination of hormonal changes, lifestyle factors, and environmental exposures.

Perimenopause and hormonal transition
Progesterone tends to decline earlier and more predictably than oestrogen during perimenopause, increasing the likelihood of imbalance.

Higher body fat levels
Adipose (fat) tissue produces oestrogen. Higher body fat can therefore contribute to increased circulating oestrogen.

Chronic stress
Long-term stress increases cortisol, which can suppress progesterone production and disrupt overall hormone balance.

Diet and lifestyle factors
Low fibre intake, excess alcohol, insulin resistance, ultra-processed foods and lack of movement can impair oestrogen metabolism and clearance.

Hormonal contraception or hormone therapy
Some women experience symptoms associated with oestrogen dominance when oestrogen is not adequately balanced with progesterone.

Symptoms of Oestrogen Dominance

Symptoms vary between individuals and often fluctuate throughout the menstrual cycle. Common features include:

Heavy, painful or irregular periods
Breast tenderness or swelling
PMS or worsening premenstrual symptoms
Mood swings, anxiety or irritability
Headaches or hormonally triggered migraines
Weight gain, particularly around hips and thighs
Bloating and fluid retention
Reduced libido
Itchy skin/hives

Acne and Oestrogen Dominance

Acne can be a feature of oestrogen dominance, but it is usually indirect rather than caused by oestrogen alone.

In oestrogen-dominant states, progesterone is often low. Progesterone helps regulate oil production and balance androgen (testosterone-like) activity. When progesterone is insufficient:

androgen effects can become more prominent
sebaceous (oil) glands may become overactive
pores are more likely to block, leading to acne

This often presents as hormonal-pattern acne, typically affecting the:

jawline
chin
lower face and neck

Women may notice acne flaring:

in the premenstrual (luteal) phase
alongside PMS symptoms
during perimenopause

It’s important to note that acne is not specific to oestrogen dominance and can also be caused by conditions such as PCOS, insulin resistance, stress, or hormonal changes after stopping contraception.

Hot Flushes and Night Sweats

Although hot flushes are often associated with low oestrogen, fluctuating or dominant oestrogen levels can also disrupt the brain’s temperature regulation. During perimenopause, unpredictable oestrogen surges and drops may trigger:

sudden feelings of heat
flushing
sweating
night sweats

Some women notice that hot flushes worsen during periods of hormonal imbalance rather than improving with higher oestrogen levels alone.

Sleep Disturbance

Progesterone has a calming, sleep-promoting effect on the nervous system. When progesterone levels are low relative to oestrogen, women may experience:

difficulty falling asleep
frequent night waking
vivid dreams
early morning waking
sleep disruption due to night sweats

Poor sleep can then worsen stress hormones and further disrupt hormonal balance, creating a vicious cycle.

Health Risks of Prolonged Oestrogen Dominance

If left unaddressed, ongoing oestrogen dominance — particularly unopposed oestrogen — may increase the risk of:

Endometrial hyperplasia and endometrial cancer
Worsening fibroids or endometriosis
Increased lifetime exposure to oestrogen, linked to breast cancer risk
Bone density changes during the menopausal transition
Possible cardiovascular effects in susceptible individuals

This is why persistent symptoms should always be properly assessed rather than self-treated.

How Is Oestrogen Dominance Managed?

Management should always be individualised and based on symptoms, life stage, medical history and risk factors.

Lifestyle and nutrition
A fibre-rich diet with plenty of vegetables (especially cruciferous vegetables), adequate protein and healthy fats supports oestrogen metabolism. Reducing alcohol and ultra-processed foods is also beneficial.

Stress management
Addressing chronic stress through realistic lifestyle changes, gentle movement, mindfulness or support can significantly improve hormone balance.

Exercise
Regular movement helps regulate insulin, reduce excess body fat and support healthy hormone clearance.

Targeted supplementation
Some women benefit from magnesium, vitamin B6, omega-3 fatty acids or liver-supportive nutrients. Supplements should be tailored and clinically guided.

Hormonal treatment
In some cases, prescribed progesterone or carefully balanced hormone therapy may be appropriate, particularly during perimenopause or menopause. This should always be personalised and reviewed regularly.

When to Seek Medical Advice

You should seek medical advice if you experience:

heavy or irregular bleeding
worsening PMS or mood symptoms
persistent acne with other hormonal features
hot flushes or night sweats
ongoing sleep disruption

Hormonal symptoms overlap with many conditions, and proper assessment ensures safe and effective treatment.

Frequently Asked Questions (FAQ)

What is oestrogen dominance?

Oestrogen dominance refers to a hormonal imbalance where the effects of oestrogen outweigh those of progesterone. This does not always mean oestrogen levels are high; it is often due to low or insufficient progesterone, particularly during perimenopause when ovulation becomes irregular.

Is oestrogen dominance a recognised medical condition?

“Oestrogen dominance” is not a formal diagnostic label used in guidelines, but it is a useful clinical concept to describe a common hormonal pattern seen in women with symptoms related to relative progesterone deficiency and fluctuating oestrogen, especially in perimenopause.

What are the most common symptoms of oestrogen dominance?

Symptoms vary but commonly include:

Heavy or irregular periods
PMS or worsening premenstrual symptoms
Breast tenderness
Bloating and fluid retention
Mood swings or anxiety
Hormonal headaches or migraines
Weight gain around hips and thighs
Acne (particularly jawline and chin)
Hot flushes and night sweats
Poor or disrupted sleep

Can oestrogen dominance cause acne?

Yes, acne can be a feature of oestrogen dominance, but usually indirectly. Low progesterone allows androgen effects to become more prominent, increasing oil production in the skin. This often causes hormonal-pattern acne, particularly on the jawline, chin and lower face. Acne should always be assessed in context, as it can have multiple causes.

Can oestrogen dominance cause hot flushes?

Yes. While hot flushes are often associated with low oestrogen, hormonal fluctuation and imbalance — including oestrogen dominance — can disrupt temperature regulation in the brain, particularly during perimenopause.

Does oestrogen dominance affect sleep?

Very commonly. Progesterone has a calming effect on the nervous system and supports sleep. When progesterone is low relative to oestrogen, women may experience difficulty falling asleep, frequent night waking, vivid dreams or sleep disruption due to night sweats.

Is oestrogen dominance the same as perimenopause?

Not exactly. Perimenopause is a life stage, whereas oestrogen dominance describes a hormonal pattern that commonly occurs during perimenopause. Many women in perimenopause experience periods of oestrogen dominance due to declining progesterone.

How is oestrogen dominance diagnosed?

There is no single test that diagnoses oestrogen dominance. Diagnosis is based on:

symptoms
menstrual history
life stage
medical history
targeted blood tests where appropriate

Symptoms and clinical context are often more informative than hormone levels alone.

How is oestrogen dominance treated?

Treatment is individualised and may include:

lifestyle and dietary changes
stress management
targeted supplementation
hormonal treatment (such as progesterone or balanced HRT) where appropriate

Management should always be guided by a healthcare professional.

When should I seek medical advice?

You should seek medical advice if you experience persistent symptoms such as heavy bleeding, significant mood changes, worsening acne, hot flushes, or ongoing sleep disruption, particularly if symptoms affect your quality of life.

Final Thoughts

Oestrogen dominance is a common but often misunderstood hormonal pattern, particularly during perimenopause. It can affect many areas of health — including mood, periods, skin, sleep and temperature regulation — but it is manageable with the right support.

Understanding your hormones is a powerful step towards feeling more confident and in control of your health. With personalised care, symptoms can improve and long-term risks can be reduced.

Oestrogen Dominance: Symptoms, Acne, Hot Flushes and How to Restore Hormonal Balance