In previous blogs, we explored the relationship between estrogen, progesterone, and endometriosis, along with gut health, thyroid function, immune health, and gluten. Now, we’re focusing on how gut health specifically impacts estrogen metabolism and its role in estrogen dominance—an often-overlooked factor in managing endometriosis.
We are coming full circle!
Gut Health and Estrogen Detoxification
The gut and liver work together to process and eliminate excess estrogen. Specifically, gut bacteria are involved in breaking down estrogen into metabolites that can be excreted from the body. The key player? The estrobolome—a group of gut bacteria responsible for regulating estrogen metabolism. We did a post on this specifically HERE
When gut health is compromised (think dysbiosis, leaky gut, SIBO), this process becomes inefficient. Instead of being properly eliminated, excess estrogen is reabsorbed into circulation, contributing to ‘estrogen dominance’ (go back and read THIS blog specifically discussing this and progesterone resistance)—which can drive endometriosis symptoms.
Beta-Glucuronidase: The Enzyme That Fuels Estrogen Recycling
Beta-glucuronidase is an enzyme produced by certain gut bacteria, plays a natural role in breaking down conjugated (bound) estrogen, which can then be reabsorbed or excreted. However, when beta-glucuronidase activity is excessive, it can lead to increased estrogen reabsorption, worsening symptoms in individuals with estrogen-driven conditions like endometriosis.
What Can Cause Elevated Beta-Glucuronidase Activity?
Gut Dysbiosis: An overgrowth of certain bacteria can drive higher beta-glucuronidase production.
Escherichia coli (E. coli) – There are several strains and not all are considered ‘bad’, but certain strains can increase beta-glucuronidase activity, contributing to estrogen recycling and gut inflammation.
Clostridium spp. – Some species within this genus, particularly Clostridium perfringens, have been linked to elevated beta-glucuronidase levels and gut dysbiosis.
Bacteroides fragilis – While considered as normal or if looking at a GI Map “commensal/keystone’ resident of the microbiome, overgrowth can increase beta-glucuronidase activity and promote inflammatory responses, impacting estrogen metabolism.
Chronic Inflammation: Ongoing immune activation in the gut can disrupt microbiome balance, increasing enzyme activity and leading to excess estrogen reabsorption.
Slow Gut Motility & Constipation: If estrogen metabolites aren’t efficiently excreted through stool, they remain in the gut longer, increasing the chance for beta-glucuronidase to reconjugate and recycle estrogen.
Increased lipopolysaccharides (LPS) from bacterial overgrowth can trigger inflammatory cascades, which in turn enhance beta-glucuronidase activity—further fueling systemic inflammation
Now, let’s pause here to clarify something important. Gut bacteria are not the enemy. In fact, they are essential workers that do more than just exist—they actively support gut health by producing polysaccharides that feed other beneficial bacteria/workers and help strengthen the mucosal barrier and regulate the immune system.
However, lipopolysaccharides (LPS) is a different story. LPS are found in the outer membrane of Gram-negative bacteria (like E. coli and Klebsiella—point 1 above ), LPS is highly inflammatory when it enters circulation due to gut permeability ("leaky gut"). Once released, LPS triggers immune responses, driving chronic inflammation and compounding hormonal unhappiness. (Another gentle nudge to revisit THIS blog for more on gut health and the immune system)
For individuals with endometriosis, this excessive recycling of estrogen can:
Fuel lesion growth and inflammation
Exacerbate pain and tissue proliferation
Contribute to progesterone resistance (since higher circulating estrogen can downregulate progesterone’s effects--think of it turning progesterone's effects into a whisper as far as what you may feel) —more on this HERE
While beta-glucuronidase itself isn’t inherently bad, it becomes problematic when gut health is compromised, leading to an increase in estrogenic burden—one more factor stacking against those managing endometriosis.
Symptoms of Poor Estrogen Detox via the Gut
Bloating, gas, or sluggish digestion
Hormonal acne (face and body)
Breast tenderness (or flat out engorgement–not fun, speaking from personal experience)
Worsening PMS symptoms (name anything)
Weight gain, especially around the midsection
The Liver’s Role in Estrogen Clearance
The liver is your body’s primary detox organ, and estrogen metabolism is a major part of its job. When liver function is sluggish (due to inflammation, gut dysbiosis, stress, poor diet, or even genetics), estrogen metabolism slows down, leading to higher circulating estrogen levels.
Key phases of estrogen detox in the liver:
Phase 1: Estrogen is converted into different metabolites, some of which are more potent than others at this stage.
Phase 2: These metabolites are bound to molecules that make them water-soluble for excretion.
Phase 3: Excretion via bile and stool (which loops us right back to gut health—see why it all connects?).
If any of these steps are impaired, estrogen can accumulate and increase its influence on endometrial tissue.
Metabolic Preference and the 16-OH Pathway
As I just mentioned. Not all estrogen metabolites are equal. Some women have a metabolic preference for certain estrogen breakdown pathways, such as a stronger tendency toward the 16-OH pathway—which can amplify estrogenic symptoms.
In the context of endometriosis, this preference may contribute to:
More severe inflammation
Tissue proliferation
Increased pain
If the liver and gut aren’t detoxifying estrogen efficiently, the body may convert more estrone (E1) to 16-OH estrone, which is linked to conditions like endometriosis, fibroids, and estrogen-sensitive cancers.
Okay let’s get to the main points and some key steps:
The Cliff Notes:
The gut microbiome plays a critical role in estrogen metabolism by regulating reabsorption and excretion of estrogen.
Certain gut bacteria produce beta-glucuronidase, an enzyme that reconjugates estrogen and allows it to be reabsorbed instead of eliminated.
Dysbiosis, slow motility, and high beta-glucuronidase activity can increase circulating estrogen, potentially favoring the 16-OH pathway.
Chronic inflammation can upregulate cytochrome P450 enzymes in the liver, further favoring estrogenic activity.
Disrupted gut health can also impair hormone receptor signaling, making estrogen metabolism more unpredictable.
Practical Steps to Support Healthy Estrogen Detoxification:
Drink Water and kick the soda (just the messenger)
Look after your Oral Hygiene :Check out the Gut and Gums Connection HERE
Support Gut Health:
Add in Colorful Whole Foods
Increase fiber intake slowly : Read Why Fiber Matters HERE
Chew food thoroughly, eat in a relaxed state: WATCH why HERE
Consider probiotic-rich foods or targeted probiotics for gut balance.
Reduce Beta-Glucuronidase Activity:
Consume calcium-d-glucarate, which helps block beta-glucuronidase.
Eat cruciferous vegetables (broccoli, cauliflower, Brussels sprouts) to support estrogen detox.
Support Liver Detoxification:
Get our FREE Liver Love Guide HERE
Ensure adequate protein and healthy fats for Phase 2 detox.
Optimize bile flow with bitters, dandelion root, apple cider vinegar and/or lemon water.
Reduce chronic inflammation to prevent liver overload: Read THIS BLOG on Lowering inflammation
Final Thoughts: Your Body is Not Working Against You
When managing endometriosis, it’s easy to feel like your body is betraying you. But remember your power! Your body is always adapting to the inputs it’s given. If estrogen isn’t being properly detoxified, if inflammation is running high, if your gut microbiome is out of balance—it’s not because your body is broken. It’s because it’s responding to the conditions it’s in.
This means that you have leverage—even when symptoms feel overwhelming. Supporting gut health, reducing inflammation, and improving estrogen metabolism aren’t quick fixes, but they shift the terrain in your favor over time.
It’s also why rigid thinking won’t serve you here. There is no single food to eliminate, one nutritional method or one supplement to take that will “fix” endometriosis. It will always be a matter of being consistent, having long-term support and making informed choices, AND—- staying curious about what helps you feel better.
If you take one thing away from this blog, let it be this: Your daily choices shape your hormonal health more than any one-off intervention ever will. Keep focusing on what you can control today—and trust that those efforts add up.
If you’re a coach looking to deepen your understanding of hormone health or a woman navigating endometriosis and looking for real, actionable guidance, reach out. Mentorship, education, and professional consultation can make all the difference in reclaiming control of your health.
This blog was inspired by our Group Mentorship Call and ongoing inquiries from coaches and clients looking to level up their understanding of endometriosis. If this conversation resonates with you, let’s connect!