Are You Self-Sabotaging Your Hormone Therapy?

Yahoo

4 days ago

If you've been navigating the ups and downs of estrogen in midlife, you've probably heard the names: estradiol, estrone and estriol—the three main types of estrogen in the body. But new research is turning the spotlight onto another form of estrogen that may play a bigger role than previously thought—2-hydroxyestrone, sometimes referred to as a 'protective' estrogen.
In a recent study published in Menopause: The Journal of The North American Menopause Society, researchers looked at how a naturally derived supplement called 3,3′-diindolylmethane (DIM), a compound found in vegetables like broccoli and Brussels sprouts, may help shift estrogen metabolism in a beneficial direction. Specifically, they found that DIM supplementation increased levels of 2-hydroxyestrone while reducing levels of 16α-hydroxyestrone, a form of estrogen some studies have linked to increased breast cancer risk.
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So what does this mean for your hormones, your health and your hot flashes? Here's what experts say you should know about DIM, 'good' estrogens and the future of hormone support in midlife and beyond.
That 'Natural' Supplement Might Be Messing With Your Hormones
DIM is a compound your body produces when you digest cruciferous vegetables like broccoli, kale and cabbage. It's been turned into a supplement and heavily promoted online as a way to 'detox' estrogen, clear hormonal acne or 'balance' hormones during perimenopause and menopause. But in supplement form, you're often getting much higher doses than you'd ever get from eating vegetables, and that can affect how your body processes hormones like estrogen.
'I like to say estrogen is a 'use it and lose it' hormone meaning you want to get the benefit of the estrogen, but you don't want it lingering in the body longer than it needs to because then it starts to accumulate and cause issues,' Dr. Stephanie Wallman, medical director at The Lanby, tells Flow Space. 'For menopausal women, who don't have much naturally cycling estrogen, there is not as much estrogen around and therefore do not require DIM to help move estrogen out of the body.'
In other words, if you're using DIM during menopause, it may disrupt hormone balance rather than restore it, especially in women already dealing with fluctuating or low estrogen levels.
And for women using hormone therapy, you may be undermining your own treatment without realizing it.
That could explain sudden changes in how you feel—like hot flashes returning, mood dips or other symptoms flaring up again. Some experts also caution that while altering estrogen metabolism may reduce certain risks (like estrogen-sensitive cancer), the long-term effects of sustained DIM use—especially in high doses—haven't been well studied.
'Each woman is programmed through their genes and environmental factors to process (detoxify) estrogen differently,' says Wallman. 'If a woman is predisposed to hold on to estrogen more or to process it through a less desirable pathway, this will still happen during menopause.'
Other Side Effects of DIM
You've probably seen the promises: DIM will 'balance your hormones,' 'detox estrogen' and 'support healthy metabolism.' But what's actually happening under the surface is far more nuanced, and for women in midlife, it's worth a closer look.
For starters, DIM doesn't remove toxins.
'Detoxify sounds appealing, but it's not a scientific term here,' Dr. Neha Pathak, chief physician editor at WebMD, tells Flow Space. 'DIM doesn't remove anything from the body, it just changes how estrogen is broken down.'
That might be helpful in some cases, but it's not inherently good or bad; it depends on your body, your symptoms and your overall hormonal profile.
When estrogen is metabolized, it can take different 'routes' in the body. Some metabolites—like 2-hydroxyestrone—are considered gentler and possibly protective, while others—like 16α-hydroxyestrone—may be more active or linked to cancer risk. DIM pushes metabolism toward the former. But experts caution that we don't fully understand what those changes mean in the long run.
'It's more complex than just 'good' or 'bad' estrogen,' says Pathak. 'We still have a lot to learn about what these changes really mean for long-term health.'
Another gray area? Cancer prevention. While some studies suggest that certain estrogen breakdown patterns are associated with a lower risk of breast cancer, there's no strong evidence that taking DIM as a supplement will actually reduce your risk.
'That's still a big question mark,' says Pathak. 'We don't know if trying to manipulate estrogen metabolism in this way leads to better outcomes.'
Talk to Your Doctor Before Mixing Supplements with Hormone Therapy
Many women start taking DIM often without realizing it could impact their hormones in significant ways. And many never bring it up with their doctor. But that silence can be risky, even if you're not on hormone therapy.
'DIM works very well and has become very popular among supplements that women try on their own,' says Wallman. 'But it can also cause side effects that are not so obviously tied to taking DIM, so I certainly recommend that doctors understand what DIM is—and what you can expect to happen when someone starts using it.'
The issue is that DIM doesn't behave like a harmless vitamin. It influences how your body breaks down estrogen, sometimes shifting the balance of estrogen metabolites in unpredictable ways. That might be helpful in some situations, but it could also affect mood, sleep or energy levels, and even change how other medications or hormone therapies work.
'In my practice, no one walks out without me knowing everything about their hormones, so I'm certainly asking about DIM,' says Wallman. 'But many practitioners are not—and they should be.'
Before adding anything new to your wellness regimen, talk to your healthcare provider, ideally someone who's experienced with menopause, perimenopause or hormone health. The goal isn't just to get a green light, it's to make sure the supplement actually makes sense for your body, your symptoms and your treatment plan.
Pathak, suggests bringing a few key questions to your appointment:
Do I really need this?
Could it affect other medications or supplements I'm taking?
Can I get similar benefits from diet instead?
How will we track if it's helping—or doing more harm than good?
Because while DIM may support healthy hormone metabolism in certain situations, it's not a one-size-fits-all solution. Your needs in midlife are unique—and so is your hormonal landscape.