Supporting The 3 Phases of Estrogen Detox

I get a lot of questions about estrogen. I mean A LOT. At least 3 a day.

And I get it. Estrogen feels confusing. Especially with social media–you have some people posting about estrogen dominance and what symptoms mean you’re estrogen dominant and then others posting about how to detox estrogen or an estrogen “cleanse” (gag me).

Here’s the deal:

You cannot know if you’re estrogen dominant until you test your hormones.

There, I said it.

Also, our bodies detox estrogen all day, everyday. You don’t need to do an extra cleanse to get rid of excess estrogen.

So please do not use supplements like DIM unless you know you really need them. DIM is a supplement that naturally lowers estrogen levels, but here’s the thing, it works. That means if you don’t actually need it you are lowering your estrogen (which is important for SO many things) and will probably feel like crap.

What can we do to support healthy estrogen levels? Understand and support estrogen metabolism AKA estrogen detox!

The 3 Phases:

Estrogen detox occurs in 3 phases.

  • Phase 1 is estrogen going down 1 of 3 pathways: 2-OH (most beneficial), 4-OH (least beneficial), 16-OH (mixed benefits)
  • Phase 2 is methylation, which takes estrogen and neutralizes it so it can leave the body. This is mostly based on genetics and amounts of certain nutrients in thebody.
  • Phase 3 is elimination and getting estrogen OUT of the body. We do this through our stool.

Phase 1 Estrogen Detox:

Estrogen detox is like a bath tub–phase 1 is filling the bath tub and it matters which pathway the body uses to fill it. As you can see in the image below–there are 3 pathways.

  • 2-OH is the most beneficial pathway and is the green part of the circle. This should be the pathway that the majority of your estrogen goes down.
  • 4-OH is the most problematic pathway. You want less than 10% of your estrogen going down this pathway. This is the least desirable pathway since it can make reactive estrogen products that have the potential to damage DNA. ⁣⁣
  • 16-OH is mixed. Ideally 13-30% goes down this pathway. We don’t want too much estrogen going down this pathway since it can exacerbate high estrogen symptoms, but it is important for bone health.⁣⁣

Why am I favoring a negative pathway?​
​There are a number of reasons that you could be favoring a less desirable pathway: ⁣⁣​
​🔹inflammation! if you have inflammation in the gut, poor digestion, etc. that could be impacting this pathway. ⁣⁣​
​🔹high fat, low fiber diets ⁣⁣​
​🔹environmental chemicals⁣⁣​
​🔹nutrient deficiencies (especially b vitamins)⁣⁣​
​🔹genetic mutations⁣⁣

The most common one I see is inflammation that is typically coming from the gut. This can also just raise estrogen in general so if you have high estrogen it could be coming from the gut (more on this in phase 3). ​
​How to support healthy phase 1 metabolism:

Phase 2 Estrogen Detox:

Sticking with the bath tub analogy, if phase 1 is filling the bath tub, phase 2 is draining it.

The main event of phase 2 is taking estrogen from the 2-OH and 4-OH pathways and neutralizing it. Your liver does this through methylation. This is not the same methylation process as the MTHFR gene since it’s in the liver, but it does involve B vitamins so it can be impacted if you don’t have adequate B vitamins from a MTHFR mutation.

As you can see above, your liver uses the COMT enzyme in order to deactivate estrogen. This is why phase 2 estrogen detox is genetically driven. If you have an issue with your COMT enzyme, you don’t methylate well (can’t drain your bath tub), you need support.

Other things that can impair phase 2 estrogen detox is nutrient deficiencies. We need adequate levels of B6, folate, B12, magnesium, choline, methionine, methyl donors, and TMG (tri-methyl-glycine).⁣⁣​
​Foods to consider: eggs (including the yolk), bone broth, leafy greens, grass fed/pasture raised beef, organ meats, and bone broth. ⁣

You also want to consider gut health–if you have an overgrowth, dysbiosis, or a parasite/pathogen that could be causing inflammation in the gut, this can impact absorption of nutrients (especially B12) and how well you are draining that bath tub.

Takeaway: phase 2 is heavily genetics and nutrient driven!

Phase 3 Estrogen Detox:

Phase 3 is elimination. Once your liver has processed estrogen and packaged it all up in a nice bow, you can now eliminate it.

Estrogen gets transported to our bile (made in the liver and stored in the gallbladder) and then excreted into the digestive system. ⁣⁣⁣

We all have what is called a estrobolome, which are bacteria that handle estrogen excretion, and finally it gets eliminated through the stool.

I often see issues with phase 3 of estrogen detox, which can lead to inflammation and recirculating of estrogen causing problems with phase 1 and 2. So if you think you have estrogen issues, always start by supporting phase 3 first.

What Can Impair Phase 3 Estrogen Detox?


In order to get the estrogen into your bile to be excreted, we need a transporter. Inflammation slows this transport process down and can make phase 3 estrogen detox slow leading to unwanted excess estrogen symptoms (mood swings, breast tenderness, painful, heavy periods, etc.)⁣⁣⁣.

🔹Gut Bacteria⁣⁣⁣

If our estrobolome is out of balance, we may not excrete estrogen properly. ⁣⁣⁣If we have dysbiosis in general in the gut (an imbalance in the good and bad bacteria), this can increase a retoxification enzyme (see below). ⁣⁣⁣

🔹High Beta-glucuronidase ⁣⁣⁣

Beta-glucuronidase is an enzyme produced by intestinal bacteria that can take your nicely packaged estrogen and rip it apart. This means your body reabsorbs that estrogen and has to do all of that work over again. ⁣⁣⁣

When we have an overgrowth of bad bacteria, parasites, pathogens, or yeast, beta-glucuronidase can increase and cause retoxification of estrogen (and other toxins). ⁣⁣⁣

You can see below that this person has a high beta-glucuronidase on her GI Map (stool test). This is not surprising since she also has a parasite and some bacterial overgrowth. She also has high estrogen levels, which we know are being impacted by this enzyme. How do you fix this? Fix the imbalance of bacteria and eradicate the parasite.

🔹Poor Digestion⁣⁣⁣

When we don’t break down food properly, it can increase inflammation in stress in the gut leading to an imbalance in gut bacteria. ⁣⁣⁣

🔹 Constipation⁣⁣⁣

I think this one is obvious–we have to actually poop if we want to eliminate the estrogen that is in our stool.⁣⁣⁣

If you’re struggling with constipation, you are likely recycling estrogen. Like I mentioned before, if you suspect an estrogen issue, work on gut health and digestion first since it’s likely part of the root problem.

Supporting Estrogen Detox:

Time to put it all together! In order to fully support estrogen detox you want to know where your issues are (which phases need to be supported).

You can see the functioning of your first 2 phases with a DUTCH test. It’s a dried urine hormone test you can do at home. I recommend working with a practitioner so you can have someone to properly interpret the test for you and take into consideration your current and past health history.

I cannot say it enough, gut health is REALLY important for estrogen levels. Inflammation can impact all phases and potentially be your root issues. It’s what I see most frequently in practice.

One note on constipation:

Constipation is a tough one. When you are constipated you are impairing phase 3 of estrogen detox and likely recirculating estrogen. This increases the burden on your liver and if you already have impaired phase 1 or 2 can lead to increased estrogen levels.

If you struggle with constipation focus on this first. You want to have 1-2 bowel movements daily. Digestive bitters or raw apple cider vinegar prior to meals and first thing in the morning would be my first suggestion. Please talk to your doctor or dietitian before making any changes.

Eating prebiotic and probiotic rich foods can help too.

I hope this estrogen detox/metabolism series was interesting and helpful for you!

Learn more about estrogen waves and healing in my podcast episode, Estrogen Waves & The Ups and Downs of Healing.

And don’t forget to sign up for my Feminine Periodical Weekly Newsletter if you haven’t already so you don’t miss any information on how to support your health!

reminder: i’m currently taking on 1:1 clients. if you’d like to explore what it would be like to work together and if we are a good fit, fill out this form to get more details!​

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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