The Role of Estrogen in Endometriosis

Medically Reviewed by Nivin Todd, MD on September 06, 2020

Endometriosis is a disease where tissue that’s normally inside a woman’s uterus grows outside the uterus, causing pain, heavy periods, or possibly infertility. It’s driven by estrogen, one of a woman’s two main sex hormones.

Estrogen is one part of hormone therapy used to treat endometriosis. So, what’s the connection between estrogen and endometriosis?

Estrogen dominance

Estrogen dominance is when a woman’s levels of estrogen and progesterone, another sex hormone, are out of balance. A type of estrogen called estradiol regulates how your uterine tissue grows. If you have endometriosis, high levels of this hormone can trigger inflammation and symptoms like severe pain.

Endometriosis is one of a few estrogen-dominant conditions that affect women. Others are:

Hormone imbalance

How do you know if your estrogen and progesterone are out of balance? You may be able to tell just by the way you feel. High estrogen levels can cause symptoms like:

Your doctor can also test your hormone levels with a blood or urine sample to see if high levels of estrogen are causing your endometriosis symptoms.

What can you do to balance your hormones?

Some women choose to treat endometriosis with hormone therapy, such as birth control pills, patches, or rings. Nonsteroidal anti-inflammatory drugs (NSAIDs) can ease mild endometriosis pain in women who don’t want to take hormones. You can have surgery to remove tissue growths.

Drugs or surgery aren’t your only options. Simple changes to your diet and lifestyle can also help you restore healthy estrogen levels and manage endometriosis symptoms.

Go veggie. The foods you eat can have a big impact on your estrogen production. Women who are vegetarians have 15%-20% lower estrogen levels and shed more estrogen through their poop than women who don’t follow a meatless diet.

Even if you don’t want to give up meat, make fresh fruits and vegetables the bulk of your diet. Get up to five servings of veggies and two servings of fresh fruit each day. Cruciferous veggies like broccoli, cabbage, bok choy, cauliflower, and Brussels sprouts may help you maintain a healthy hormone balance.

Bulk up on fiber. Foods high in fiber, such as fresh produce and whole grains, can help you retain less estrogen. High-fiber diets also increase how much estrogen you shed when you poop.

Eat more omega-3s. Another diet change that may help is to eat more foods rich in omega-3 fatty acids, like fish or flaxseed. Omega-3 fatty acids can help lower inflammation in your body.

Fill your cup.Green tea is rich in polyphenols and is linked to lower estradiol levels in postmenopausal women. Drink coffee, tea, or other caffeinated beverages and alcohol in moderation to keep estrogen levels in check.

What about soy?Diets rich in whole soy foods also help women achieve a healthier hormone balance. Soy foods contain nutrients called isoflavones. Women who eat more soy isoflavones can reduce their endometriosis risk. Soy foods include tofu, tempeh, miso, edamame, and soy nuts.

Soy is one of many plant-based foods that are also called phytoestrogens. You can get phytoestrogens in whole grains, peas, lentils, broccoli, fresh fruit, and dried beans too. Diets rich in phytoestrogens may lower your risk of some breast cancers but increase the risk of other types. Talk with your doctor about your personal risks and how to include soy foods in your diet.

Weight loss

If you’re overweight, take steps to get to a healthy weight and maintain it. Being overweight promotes insulin resistance, which also increases your estrogen levels. Excess weight and insulin resistance can trigger inflammation too.


Get regular moderate exercise to control your weight. Aim to exercise for 30 minutes or more each day.

Manage stress

Emotional stress may affect your hormone balance too. When you’re stressed, you produce more cortisol, known as the stress hormone. When you have lots of stress, your body’s levels of progesterone drop, so you have too much estrogen. Find ways to manage your stress to restore a healthy hormone balance.

Show Sources


Mayo Clinic: “Endometriosis.”

Nature Medicine: “Role of Estrogen Receptor-β in Endometriosis.”

Brigham and Women’s Hospital: “Medical Treatments for Endometriosis.”

University of Wisconsin-Madison: “Estrogen Dominance,” “Phytoestrogens.”

Current Neurology and Neuroscience Reports: “Hormonal Influences on Cognition and Risk for Alzheimer Disease.”

Hormone Health Network: “What Is Estrogen?”

American Association for Clinical Chemistry: “Estrogens.”

Harvard Medical School: “Endometriosis.”

St. Louis University School of Medicine: “The Anti-Inflammatory and Elimination Diet for Adults Living With Endometriosis.”

Annals of Epidemiology: “Is Green Tea Drinking Associated With a Later Onset of Breast Cancer?”

Epidemiology: “Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism.”

Breast Cancer Prevention Partners: “Phytoestrogens.”

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