I've asked this before but never posted the article which explains it in depth as I'm doing now. Does this make sense to anyone as to why maybe so many of us can't tolerate the P cream and give up on it maybe too quickly? (In my case I know I took too much but as you can see this was recommended to get over this supposed E wake up issue). Just curious on thoughts!

When we reintroduce progesterone back into our body thereby sensitising and stimulating the estrogen receptor sites, there are immediate, intermediate and long term benefits. This can include a period of discomfort which we term ‘estrogen dominance wake-up crisis’.

So what is estrogen dominance wake-up crisis? Well, it tends to be the ‘opposite’ reaction to that which you would have expected when you first start applying progesterone cream.

Instead of getting relief from symptoms like breast tenderness, heavy bleeding, lethargy, panic attacks, headaches, agitation or depression, fluid retention, insomnia, increased joint and muscle pain, weight gain, etc., you instead find that your situation is going from bad to worse! And you’re frightened.

When a woman is estrogen dominant her estrogen receptor sites will, in time, down-regulate in the absence of progesterone. Introducing progesterone will heighten these receptors (temporarily), thus estrogen dominance symptoms can appear to worsen before you notice a turn-around. We rarely sees cases where there is not a logical explanation for the abovementioned side effects. We interpret these symptoms as estrogen dominance wake-up crisis where the introduction of progesterone is `waking up' and stimulating the estrogen receptors exacerbating the estrogen effects in the body.

As your body settles down and progesterone begins to oppose estrogen’s action in the body, you start to feel better, particularly if you’re considerably progesterone deficient.

It's this discomfort experienced by some women that gets tagged as ’side-effects’. Technicially, your body is adjusting to the reintroduction of the hormone progesterone as distinct from responding adversely. It is a good sign that things are working, that the estrogen has been stimulated again and that progesterone is taking some effect on your body. We remind you that progesterone and estrogen sensitise each other thereby maximising their impact on the body.

In the case of severe wake-up in the body where the symptoms of estrogen dominance are exaggerated and debilitating, it is recommended women double their dose for the first 6-8 weeks in conjunction with a premium phytoestrogen formulation to help ride out this phase.

Phytoestrogens have application in progesterone therapy because they actually help reduce the impact of estrogen dominance when progesterone is reintroduced into the body. The reason is simple. Phytoestrogens help tone down the symptoms of estrogen wake-up.

Phytoestrogens refer to plant compounds with estrogen-like activity. They are usually considerably weaker than our own estrogens and compete for the same receptors throughout our body. They block the impact of more potent estrogens produced by the body or the environment, and subsequently reduce the impact of estrogen dominance.

Excretion of estrogen is accomplished by the liver. And the liver breaks estrogens into two main forms: a “good” form, called 2-hydroxyestrogen, and a “bad” form, called 16a-hydroxyestrogen.

Evidence suggests supplementing our diets with extracts of cruciferous vegetables allow for metabolism and clearance of estrogens down safer pathways that will help prevent symptoms and potential damage to DNA of cells.

Diindolylmethane, or DIM for short, is a plant indole — a plant compound with health-promoting properties. DIM and other plant indoles are found in all cruciferous vegetables. Cruciferous vegetables include cabbage, broccoli, Brussels sprouts, and cauliflower. These plants have cultivated for centuries and were initially used for medicines.

Regular use of supplementary DIM can shift the production of estrogen metabolites away from dangerous 16-hydroxy in favor of beneficial 2-hydroxy metabolites, ridding the body of excess estrogen via urine.

DIM is a conservative, well-studied, safe, and clearly effective natural substance. Human studies, often at ten times the typical supplement dose of DIM which benefits estrogen metabolism, have reported no side effects.

Hi Shar,

What an interesting article. This seems to be my biggest problem, I can't seem to handle the progesterone. I stayed away from it for several months, while still using my estrogen. At the time I was still having a few periods, so I felt safe. Now I am not having any periods since November. A couple weeks ago, I thought I'd try the progesterone again ( I use prometrium a pill), I was feeling fine for the first 5 days, then it dragged on and at day 9 I stopped. It always hit's me the same way, I start feeling tired, depressed and just don't care about anything. Which is exactly opposite of how I usually feel.

On another board, I followed many women who talked about using P for long periods of time and NEVER felt better. So I don't know if this is "golden" or not. I don't know if I could force myself to keep taking it daily. By day 9 I was spotting slightly each day, so I felt very PMS also.

I feel like we are just lab rat's. I had an appt this week with a new doctor and when I explained my hormone routine, I could see his eyes just glaze over!!! He has no clue. He is referring me to a gyno. I have little faith in the next doctor, but I will see what he says, which isn't for a month or so.

Thank you for sharing the article. Maybe some of the others will offer their insight!!!

Hugs, Juliann

Where'd you find it? It makes me feel more confused! I'm one of the progesterone-intolerant crowd, although early on progesterone would make me feel euphoric, energetic and in love with the world. It happened once in a blue moon and would only happen for a day at a time. That was years ago.

What I don't get about the article is the reference to depression and lethargy as being estrogen dominance symptoms. Aren't you and I finding relief from this by using estrogen? On the other hand, I have noticed a very nice sexual pay-off for enduring progesterone. It arrives after I stop the progesterone and fades after about a week. So, the reference to 'waking up estrogen receptors' makes sense to me. This article is yet another testament to the importance of getting our hormones back in balance. Thanks for posting it.
GK

Gilk I would get the euphoric feeling once in a blue moon and it also did increase my sex drive but actually like an aggressive feeling sexually like T would do too but mainly had anxiety, panic, depression...I think I was on too high a dose per the suggestion of increasing to 'override' this dominance symptoms and I gave it a good 4 months enduring the ups and downs so I still don't know the answers but whatever was going on in my body it didn't feel good. There's more articles on this on the Natural Progesterone Advisory Network. I don't think I can post link? But if you Google it it talks a ton on Progesterone usage and you can search even 'estrogen dominance wake up' crisis and find more on the site itself. Juli I don't think I ever felt all that great on it either. It's all the more confusing to me too I know but thought maybe someone with more experience on the issue could explain it out more. Everything I read makes sense until I find the next article that contradicts and makes sense too....

I just do not agree with this. Any peri woman I know with lethargy and depression either has a thyroid problem or is low in estrogen. P just worsens it. And one hormone group I'm on has many women who went on the Wiley Protocol which used high doses of P, and got worse and worse, and even after stopping P altogether, a year later they are still suffering from symptoms. And many of them swear that the P triggered the adrenal problems that occurred after. P can convert to cortisol

I just don't buy this 'estrogen dominance' thing. There are no studies or evidence to prove it even though so many gurus seem to believe it. I even believed it years ago and happily slathered on the P cream, never realizing until much later it had caused the weight gain and depression.

P is the hormone of pregnancy. It is designed to slow digestion and retain nutrients and weight for the baby. P is high in the luteal phase, but most women feel their best before ovulation when E is at it's highest. I found that all the symptoms they attribute to E dominance were in fact due to high P and low E. And judging from many posts here and elsewhere, that is the case for many women.

I was on a P Yahoo group once when I was considering using it again. I watched the owner tell women who were feeling awful using it to just keep using it, and I watched them get sicker and sicker.

As far as continuing to use it and then getting used to it, well the body also gets used to and adapts to many substances are not good for us, like tobacco, drugs, etc. It doesn't mean they are good for us.

Sariah,

What are your feelings about the articles that say "dont take estrogen without progesterone" if you have a uterus or you are increasing your cancer risk? Do you think there is any truth to that at all?

Dee

I just found an amazing compounding pharmacist who recently filled a prescription for me and this is exactly what he explained to me about how I'd been feeling on the P.
I also posted here about feeling E dominant and thought it was the P I was taking.
I learned so much from that guy in a 20 minute conversation.

BTW, thanks for posting that Shar.

Hi Dee,
That advice has some truth to it. I have seen articles and studies that show ultra low dose E does not promote endometrial proliferation and is safe to take without P. That low dose of E may not have all the benefits of a higher dose, but can relieve symptoms.

Also, one has to determine their cancer risk before starting any hormones therapy, since P has also been shown to cause breast cancer.

If the goal is to protect the endometrium, more studies have shown that the transdermal form does not do that, but that the oral and vaginal route does. Since many women have problems with P side effects, the vaginal route seems to be better tolerated.

Ultimately, though, it's an individual thing. A diet with plenty of cruciferous veggies that contain I3C indole3 carbinol, or DIM (Diindolylmethane) prevent the estrogen from metabolizing into the more dangerous estrogen metabolites that are known to increase cancer risk. One can also take those substances in supplement form.

I don't think there are any hard and fast answers to this one. One has to study all the pros and cons and then hopefully make the best decision for them.

OK here's another question I just thought of. If we'd get estrogen dominance wake up crisis with the P stimulating our E receptors then what about those of us who have used both P and E and didn't experience these awful side effects when using E? Wouldn't the E even wake up our E receptors MORE than the P cream would and cause us horrendous side effects as the ones listed and that P supposedly causes in converting and waking up E receptors? I have tried E without P and didn't feel that awful anxious, nite terror, major depressive, panicky feeling like I did on P. Yes I've had some issues wondering if my Estrogel is dipping or maybe inhibiting thyroid but the effects weren't near to what I felt so sick on the P. Hmmm...this makes me rethink it now. Am I making sense with this one or missing something else they're saying about the P?

I don't buy it either. I was taking P continuously while taking E for 2 years so one would think that my receptors had already awakened. It wasn't until a new doctor told me to cycle the P every other month and I went off P that I felt my best and my lethargic no drive self came back alive.

I don't know why Dr. Lee and others tout P the way they do unless they themselves believe it but I'm convinced it won't resolve my symptoms. It only makes them worse.

Thanks for posting the article though,

Well, there are some women who respond well to P for whatever reason. But from my experience being in contact with many women on hormones, they are in the minority. That whole "P wakes up the estrogen receptors" is ridiculous. And if that's the point of taking it, why not just use estrogen instead and not be bothered with all the adverse symptoms of P?

Dee- I just have to say that I don't believe anyone here is an endocrinologist. Although I don't entirely disagree with Sariah's posts, I really think you should discuss this with your doctor. It can be a slippery slope, and your medical history, blood tests, etc.. are all a factor in determining what is best for YOU.

Using E without P if you have a uterus is not recommended by most physicians. Actually, I've never come across one that would recommend it.

I just want to add...

Sariah- I think you are very helpful, and extremely informed. I think you have only tried to help women through your knowledge, and from what you have experienced, HOWEVER I think it important to remember that these messages on the boards should in no way be confused with a medical diagnosis and a suggested medical treatment.

That’s the only point I’m trying to make. I certainly don’t want to step on anyone’s toes, it’s just we all have a different history and it’s not a one size fits all situation.

I saw my Dr. this week and asked him this very question. He told me you can take estrogen without progesterone

Leanne,
How were my posts confused with a medical diagnosis and/or treatment? I've never claimed to be the ultimate authority on anything. And I do believe most women here are smart enough to know not to take my opinions as the last word. I've often told women to see their doc or discuss things with them. I simply related that there was a study about ultra low dose E and endometrial proliferation, and I did say that there was some truth to the statement that progesterone should always be taken with estrogen. So I'm not sure what the problem is here? The information I give is easily googled by anyone. And there are women who have been on JUST Premarin for years with no P whatsoever, so obviously some docs don't feel it's a risk, it isn't just me saying this. I'm not pulling it out of thin air. THe OP asked a question and I gave her the info to show that not everyone thinks P is always necessary with E.

It goes without saying that whatever opinions or advice anyone reads here should always be discussed with their doctor. I have found wonderful advice posted here by others either with supplements or hormones that have been quite helpful to me. And I hope that someone has benefitted from my opinions. Sometimes the only way we get answers to our health issues is by listening to those who have already blazed the trail and have valuable experiences and opinions to share. I am deeply grateful to those who helped me along the way in my quest to feel human again. If it weren't for them, I would still be living a half-life in misery.

So I am sorry that it seems to you that I am attempting to diagnose and give medical advice in lieu of a doctor's opinion. That was never my intention, I only wanted to be helpful. If I can help even one person to feel better, then the 2 years of suffering I had will have been worth it.

My concern was in this post. Suggesting: "And if that's the point of taking it, why not just use estrogen instead and not be bothered with all the adverse symptoms of P??"

I'm just saying (once again) that we all have a different medical and family historys, and there is no one size fits all.

It doesn't always "go without saying.... ", sometimes it needs to be said.

I just checked out the NP advisory network and it seems to be another place thats touting the wonders and greatness of progesterone. I totally disagree. They have all sorts of ads promoting progesterone cream products which makes me even more suspect of their "claims". Too much progesterone can affect you in many negative ways. ie - raising insulin levels, suppressing estrogen levels, moodiness, sleeplessness, weight gain, etc. But, progesterone in the hands of a skilled doctor can do wonderful things. ie - infertility treatments and sustaining pregnancy and protecting the peri/meno uterine lining from hyperplasia. It amazes me that so many buy over the counter p creams and are so fearless in using the stuff. Everyone mentions "estrogen" receptor breast cancer. What about the Progesterone receptor/driven breast cancer? Not something to take without pause and reflection.

After my second 10 day trial of 100 mg Prometrium I felt awful and had the blood levels of a pregnant woman AND that was TWO weeks after stopping the med! How can progesterone "wake up" our estrogen receptors when it SUPRESSES our estradiol levels? I've read some theories that we need to cycle in some amount of P to turn on and off the various receptors but the jury is still out on that concept. Nature did not intend for us to have high sustained/continuous levels of the stuff.

Everyone seems to want to make money in this world we live in at the expense of those in need. Seem like everyone has an angle to promote and sell ie - Estrogen dominance, Progesterone dominance, This "converting" to That, etc.... Bottom line is that we are all physiologically different and there are NO SIMPLE answers. Best advice I was given years ago is to "listen to your body" and get several consultations. No one has all the answers - even if they claim to be an expert with impeccable credentials. I've found the best docs to be the ones who ADMIT they don't know the answer. They seem to try the hardest and care the most. Ok, I'll get off my soapbox for now. Regards, J.

Thanks JZZ,

I seem to agree with you and the others, progesterone is awful. I just spent 9 days trying to take my prometrium 100mg and I could barely get through it. It has been a week that I stopped it, and I still feel sluggish. I think you are right, everyone wants MONEY and will sell anything to get into our wallets.

I have a questions, purely for insight (not medical advise). If I take my prometrium every other month for 9-10 days at 100mg. Even if I don't have a bleed, is that still protection for my uterus??? I hate taking the P, and I want to avoid it, but I would take it perhaps quarterly just for the benifit. Wondering if that would be enough?? I think the point of cycling was to produce a bleed, but I think in order to bleed you would need to take 200mg for 10 days and I could NEVER handle that. Does anyone have suggestion???

Sariah, I did read the same article that low dosage of estrogel had no effect on the uterus lining. I think it said that dosage's under 1mg per day, do you remember the amount??

Thanks, Juliann

If you are meno than you can possible manage with only cycling in the P every 3 Months. Most docs get it wrong about having the withdrawal bleed. Not everyone will have a withdrawal bleed. Especially the further post meno you get. The goal is to to enough p into your system inorder to prevent the uterine lining from thickening. Easiest way to establish how much to take is to do a transvaginal ultrasound after the 10 to 14 days of P. This advice was given to me from my 2 gyn's (1 of whom is also an endocrinologist, infertility doc). For more info on cycling P see some of my responses under Progesterone. Sorry to tired to place more here and don't want to hijack the thread. Regards, J There are also many different types and modes of delivery for the P. Sometimes the delivery is as important as the type/dosage of P.

Thanks so much for that input. I wondered how important the bleed was. When I take the 100mg of prometrium I always start spotting by day 8 or 9. I don't get a bleed just some pinkish spotting, is that normal? My doc is ordering an ultrasound to check my lining just to be sure. I asked for this test because I have not taken the P for several months due to the horrible side effects. But now I am understanding that the bleed is not the most important thing. I will read up on your thread, thanks again for your response!

Juliann

I have to sit down and read through the article later, but a quick questions about ED....I can't help to think at times this is a problem for me, however everytime they have checked my estrogen level it is low, last it was 12, before that 21 and before that 32 and my fsh is/was 66...can you have ED when levels are this low? My periods are very irregular and recently missed one , but they are never light and when I missed I doubled up the next time it came as I posted on a nother thread....at times I feel so weak and dizzy from bleeding so much. I was put on BHRT and sometimes I think it helps, but now my breasts are sore constantly. I took progest some time ago when I first noticed something not right and it did wonders, but then after awhile I started to feel bad again. So back to the question can you have ED with low estro levels? HUGS Mikki

I read through some of the posts....when I get a normal period(ha,ha,ha I had to laugh at myself for saying that) I should say if I think I ovulated I feel good, almost symptom free for about a week after and then about 4 days or so before the actual period I can't funtion....literally struggle to get through the day, these feelings now continue through my period until I feel that twinge of side pain and a couple days after that side pain my symptoms vanish just like that. When I think I have ovualted, while ovulating I am also miserable almost the same set of symptoms I get just before a period, but when the pain stops I feel pretty good. Like now I am 10 days from when my period started and 4 days after it ended, the past 2 years If I have the side pain it's directly after my period sometimes I am still bleeding lightly, it is now 4 days and I am assuming I am not going to ovulate and feel aweful....what does that mean...I just say this in response to a post about feeling better the week before ovulation...I don't have a space between my period anymore and ovulation , it just runs all together now, but 4 weeks ago or so I know I did and I was out doing all kinds of stuff, symptom free for the most part afterwards for about a week and I have been down since..any thoughts.....

Sunflowermmh:

I am so with you on this one. Me too! No ovulation No progesterone = BAD MONTH FOR ME. I can almost always tell when I have not ovulated. There are many reasons for not ovulating or rather the follicle not "rupturing" and creating the progesterone surge on the second portion of the cycle which is known as the "corpus luteum" (I think!), the egg/follice is present but for whatever reason does not continue through the process. These are the worst months. I have tried diet (lost 55 pds); better nutrition, exercise, general life style changes which tend to help. One of the things is now just realizing what is going on has been a significant part of "recognition" and dealing with it. I would send my self into a tizzy fit having no idea what the #$# was happening to me and thus getting more scared and concerned. Where did the anxiety, cold/hands feet, insulin issues etc all of a sudden come from? This went on for 3 years without one Dr using the word "peri-menopause", it is not like a bad word, really! It sounds sort of bad but when my new health care provider used the word "peri-menopause" symptoms it really eased the matter for me and just put it into context. The idea of this going on for maybe 10 years is not exciting!! But that is another story. I have tried conventional BCP which did not help, just progestin which was no fun and a fairly large dose of oral 100 mg progesterone (mirconized) which I started at a terrible time in my cycle and was no fun.

My understanding is that it is about the Progesterone/E2 ratio and if that is off that you can still have "symptoms" no matter if your individual levels are in normal ranges they still may not be proportionally correct for you.

My healthcare provider, who I just switched too from a conventional Ob/GYN is *AWESOME*. They explained to me that the impacts of the adrenal, thyroid and reproductive system should be evaluated as a system. Many women have symptoms when measured "values" fall within normal lab ranges. It should be, as always, a combination approach which takes into consideration how you "feel"not just the papework. I am not a Dr but I believe in this principle, as what has been communicated on this thread is that indeed everyone is different and process things differently. I actually review toxicology studies as my day job and route of administration can have a huge impact on the effect of any given substance being administered. If one thing does not work for you, you need to decide if you are willing to try something different and go from there to see what works for YOU. It sounds terrible and like an experiment but the way that I have been able to deal with this is to remind myself to "listen" and "be aware" of my body and what it is telling me. Maybe this is part of the "wisdom" process of getting wiser and more in tune with ourselves. I do not know but I will share this story with you. I was taking a BCP, and frankly it was just too much... called conventional Dr and said can not take it... very nauseous, fogged, mood swings, depressed, sleeping for 3-4 hours after taking it etc... knew that I did not need anymore estrogen and that 1.5 mg of progestin was too high for me (sleeping after taking the pill); he calls in a lower dose BCP, I go pick it up, open it up and start coaching myself that I can do this... sat there for five minutes, mentally going back and forth on it.. in the end, I said "No" I can do this differently. I wanted to know what my body needed and where I was at prior to just taking something to "fix it."

Not to go on about it, but my lesson is to be your own advocate.

In general though and not directed necessarily to you, I noticed that there are many discussions of issues with taking progesterone. I would like to ask if the folks that are having problems with some of the "effects" are actually getting monitored or having hormone testing done fairly regularly to ensure that dosing is correct or if changes need to be made? Obviously, if you are feeling good health care providers are less likely to perform testing but it is always good to establish a baseline and move forward from there. My healthcare provider recommends frequent basic hormone testing (at least quarterly) along with verbal communication on how you are feeling to determine the best path forward and if any "tweaking" of the dose or combination of treatment needs to be changed. this is done more so if one is feeling bad with proper adjustments being made.

Anyways, I know it is hard to walk through when you do not feel good or yourself but wishing everyong the best in moving through this!! Remember to discuss treatments with your healthcare provider and if your healthcare provider is not approaching this in a manner that you would like, maybe it is time to find another!

Wow, great response. I agree with you on the ovulation and symptoms. Also, on what you stated above. Sooooooooo, athough I'm fairly happy with my 2 gyns (diff practices and specialities), I still have to remind them to retest my bloodwork. Where state is your doc located in? I want yet another consult! Also, great to see that a doc isn't afraid to use the word - PERIMENOPAUSE. Best Regards, J

I do have a problem with progesterone and am rather obsessive about monitoring my serum levels. I order my own tests, so I do not need to pay for an expensive office visit. I test when I feel good and test when I feel awful so that I can know where my hormones are at either point. So far, when estrogen is low in relation to the P is when I feel bad, and when it is higher, I feel much better. At the time I first started with anxiety and panic and had no clue what was doing it, my doc had put me on 100mg/day of P cream. My blood results showed very high P. Thankfully, after doing a search on progesterone and anxiety I found the answer.

I find that my method of testing only when I feel good or bad gives me more helpful info that correlates with my symptoms, rather than just testing in the follicular or luteal phases (which aren't relevant to me anymore since I'm skipping periods more and more) or testing randomly. I order the paperwork for the test online, then I can hold on to it and have it immediately available if I'm having a very bad or very good day. Then I run and get the labs drawn at LabCorp.

But my thyroid is also a factor so I also monitor that regularly.

I am in Richmond, Virginia and have had some problems with being "heard" as the conventional Dr.'s just do not want to go there... BCP just way too much for me along with the Aygestin. If you send me a PM, I will send you my new Nurse Practioner information who is excellent along with the compounding lab that I use. The fella that runs the compounding pharmacy and his staff are fab!! I am so fortunate to have a practice like this in the area!

Cheers

Leslie

[quote name='Sariah' date='Apr 25 2009, 02:41 PM' post='281286']
I do have a problem with progesterone and am rather obsessive about monitoring my serum levels. I order my own tests, so I do not need to pay for an expensive office visit. I test when I feel good and test when I feel awful so that I can know where my hormones are at either point. So far, when estrogen is low in relation to the P is when I feel bad, and when it is higher, I feel much better. At the time I first started with anxiety and panic and had no clue what was doing it, my doc had put me on 100mg/day of P cream. My blood results showed very high P. Thankfully, after doing a search on progesterone and anxiety I found the answer.

I find that my method of testing only when I feel good or bad gives me more helpful info that correlates with my symptoms, rather than just testing in the follicular or luteal phases (which aren't relevant to me anymore since I'm skipping periods more and more) or testing randomly. I order the paperwork for the test online, then I can hold on to it and have it immediately available if I'm having a very bad or very good day. Then I run and get the labs drawn at LabCorp.

But my thyroid is also a factor so I also monitor that regularly.
/quote]


That is excellent information. I have often wondered about testing when I do not feel good. I can get pretty Obssesive/Compulsive on things particularly when I am not feeling good. I just can not seem to get the Dr to test when I am feeling in the tank... I am still cycling so I am really not sure if I am having major/minor estrogen fluctuations or if it is just "P". i have also had experiences with the anxiety but I have started experiencing that without taking anything, laid out on the couch for a week freakn out. Afraid to take anything. Sometimes I have blood sugar swings about a week before my cycle and for the most part I am a very positive high energy functioning individual but there are those days where I am just flat and can be apathetic and lethargic... I have symptoms that cross between hypothyroid/adrenal fatigue/low progesterone. Most importantly I did not do well on BCP or Aygestin, so I am hoping titrating up on P cream will work out for me.

I may have to try some of this additional testing but I am to start taking the P cream tonight (day 5 thru 26 of cycle) and am hopeful that titrating up will work for me. Although I am in the "normal range" I am almost at the bottom of the range while my E2 was in the middle of the normal range. The ratio ended up being something like 30.

I am just praying that the p cream converts into what ever it is suppossed too and that I end up with balance!!! I am also taking a thyroid and adrenal supplement and so far they seem to be helpful. My temp has also been low in the morning but the TSH, T3/T4 always shows up "normal." Good thing the new Nurse Practioner is also considered with how one "feels."

I also recognize that any given month or day within the month can be different.. so I am not necessarily clear on what is going on when I feel terrible as it has never coincided with the day my conventional Dr ordered any tests.

Which tests do you perform regularly? My recent testing was about $250 USD via saliva. E2, P, T and four Cortisol readings/results were provided, along with DHEA. They also provided a ratio of P/E2. Just curious, as it sounds if you are going to Lab Corp that you are having blood work drawn.

Any additional information on how you accomplish this would be appreciated as I have often wondered if it is really a P deficiency.... or a combination there of.

Thanks so much for your information, it is helpful

Leslie

Leslie,
So did you do saliva testing for the sex hormones? Because studies have shown them to not be consistently accurate for that, although saliva tests are reliable for cortisol. When I first started testing I did do saliva tests for both thyroid and sex hormones, and also did some blood tests. The saliva tests were way off according to the blood tests and also my symptoms. I would be very concerned about dosing hormones according to saliva tests. The blood tests are routinely used by fertility clinics and are considered the gold standard.

Have you been able to read through the older messages about hormones? Progesterone has proven to be a nightmare for many of us, although there are a few here who do quite well on it. We all have horror stories about what it did to us. It's the "make you fat, make you tired and sad" hormone.

Promoters of P all seem to say it converts to other hormones and 'wakes up' the estrogen receptors, but I find this not be true at all. Most of us in peri are suffering due to declining estrogen levels and taking P exacerbates that. And transdermal P builds up in the tissues over time, resulting in too-high levels. P CAUSED sudden onset of anxiety and panic attacks with me and it didn't go away until I stopped it and took enough E. Anxiety is usually relieved with E. Some of the top hormone docs agree that E dominance is a fallacy and that they are finding that even younger women are low in E during the luteal phase, which is when PMS symptoms appear.

I would urge you to get serum tests both of sex hormones and thyroid. A proper thyroid panel will include both antibodies, TSH, free T3 and free T4. It is becoming quite common for women entering peri to start having thyroid problems which will exacerbate peri symptoms.

You might want to consider ordering your own tests. Your first thyroid tests will be more expensive due to getting the antibodies tested, but once you do that there is usually no need to repeat them, then the tests are cheaper thereafter. I just ordered the thyroid panel (sans antibodies) and sex hormones, and it was $200 total. I will keep that lab order handy for a day when I feel really bad or really good so I can correlate symptoms with hormone levels.

Leslie,
I tried to send you a PM but it said your private messaging was disabled.

Sariah,
You said "Progesterone has proven to be a nightmare for many of us, although there are a few here who do quite well on it. We all have horror stories about what it did to us. It's the "make you fat, make you tired and sad" hormone." I am not any progesterone or anything else. I feel so fat, sad and tired all the time. Does that mean I have too much normal progesterone? Or can it mean estrogen is too high or low? Or is it a combo? I have had blood test that I'm in meopause (haven't had period in 2 years) but I never got any numbers omenopausen where my hormones are at. My gyno recently said to try over the counter progesterone cream and Estroven but I haven't done that yet. She also did a thyroid test (blood work) and said it was OK. I just thought I could go through this naturally with no meds, etc. But after 5 years and it's still affecting my quality of life I am debating on it. I don't know that much about this stuff and get confused when I read posts on it. How do you order your own tests? Is there one for cortisol?
Thanks for any insights,
Robin

Hi Robin,

Unless you have had blood tests for estradiol and progesterone, you'd be just guessing at your hormone levels. While it's true that our hormones are fluctuating, nevertheless, it's helpful the first time to get a blood test, especially when you are feeling poorly, to get some idea if one or both hormones are really off.

Most likely you did not have the right thyroid tests done, the standard ones done do not give the full picture. And your levels can be in the 'normal range', yet at the low end and can cause symptoms. You need both thyroid antibodies tested, free T3 and free T4 (must be *free*) and TSH. Until those are done and a thyroid -literate doctor interprets them, you can't rule out thyroid problems.

Sorry, new to this, will figure out how to turn that on. Should be done in a few.

Hi Sariah,

I have actually had both blood and saliva testing done. Interesting enough the results are consistent although the way the numbers are reported have not been. Upon blood work my 17-OH progesterone was low but "overlooked" as normal by my conventional Dr and the same was true for my vitamin D and DHEA. My TSH and T3/T4 are in the normal range. Follow up was only done by an endocrinologist on the TSH and it was normal. What Endocrinologist just orders TSH? It really is not a good mechanism for actually identifying a deficiency. Do not make me go there. Needless too say, I was not a happy camper once I received a copy of the results 6-9 months later to find the deficiencies which I had confirmed by another health care provider when I showed up saying I was told everything was in normal limits and I have gained 40 pds!!! Not normal.

I was taking Yaz and a small dose of Lexapro...and I disliked both and in the end they did not "resolve" the situation they only masked it as weight continued to be put on.. particularly in my stomach area. I can tell you that it was not a progesterone issue for me but "estrogen." I came off everything and had some really tough months. I had unruptured follices "cysts" on my ovaries but not the typical PCOS string of pearls, my testosterone was in normal limits but on the high side compared to my other hormones and the FSH and LH were slightly reversed. Need I say more. I started taking metformin, changed lifestyle dramatically but still had problems but the weight came off fairly quick within a 6 month period I have dropped 55 pounds. I am about a size 12 so there should be no problem with estrogen availability and my blood work and saliva tests show that there is plenty there and my FSH numbers are still low. I have a cycle monthly, but the days between, the days of, and the blood flow change on any given cycle. Along with this, the PMS changes too which includes GI distress (very constipated, lack of motility), irritability, anxiety... , some days high energy and others very low/depressed etc... I just call it the month roller coaster ride.. and I am looking to be on the little kids roller coaster instead of the one that really gives you that thrill.

So my approach is to get things to a point of "tolerable", I do not mind if I have some of the symptoms as I move through this as long as I can function at a decent level and enjoy life. Not functioning is not cool by my standards.. and that has been the hardest part... At least now, I have a better understanding of what is going on as oppossed to "your fine, your blood work is fine, lets just give you an anti depressant" which unfortunately happens to many women and just makes matters that much worse!!!!

In the end, the saliva testing showed different numbers but the same result. I actually also did a 24 hour cortisol urine test that the conventional Dr requested which showed "normal" where as, my saliva showed on the very low end of the normal range in the morning and low in the afternoon/evening.

I can tell you that I took my first 0.1 ml of progesterone cream last night and that this morning upon awakening I definately had two hot flashes that were more noticeable than before... my GI was also a bit off... I felt a bit more irritable after taking it but my 4 yr old was up till 11 pm and I just needed a break!!!! So we shall see how it goes. I am taking a really low dose of the progesterone cream to see how it goes, lower than over the counter doses and o.1 ml does not even come close to 1/8 teaspoon. So I am not too worried about it and will follow up with my new healthcare provider after my next cycle. they recommend either blood work and or saliva tests will be drawn in one to two cycles to see what is going on. They may even do both!

I do not know if the hot flash is from cortisol just getting started in the morning or why it primarily occurs in the morning but it is almost always upon wakening.

I actually have some girlfriends that are on progesterone cream and doing wonderfully, however, it is not over the counter cream... they go to the same health care provider that I am seeing and they work together to help everyone feel better. They are also not afraid to order blood work or saliva testing regularly.

I felt HUGE on BCP/lexapro, lack of energy etc...... did not find BCP to be a solution and I tried several different brands just recently and could not make it through the initial dosing period. I was very nauseous taking the BCP and I assume that this from pumping more estrogen into my body and putting a massive dose of progestin. I can tell you that I do not care for the synthetic progestins and that I definately noticed changes in blood sugar (very crazy responses)!! My response to this is that if someone is deficient in something, you can NOT just give them a "NORMAL" dose and think that everything is going to be okay.. In my case, my body just freaks out and does not know what do with that!! Low and slow is my philosphy with a goal of balance.

I have also read the progesterone threads on this website. I guess the best way to put it, is everyone is different and these things effect everyone differently, so I am going down a path of just sorting through what works for me. I also believe dosing strategies and levels are a big factor in what works for folks and what does not.

I would like to note that my health care provider has made it very clear that we move through different stages of this process and what may work now may not work in the future. So from that perspective, things need to be tried, "tweaked" and/or sometimes just completely readjusted. It comes down to how willing the patient is to move forward along with the health care provider.

I did not know that you could get the orders for the blood work and have the testing done so inexpensively. Would you mind sharing where you get the paperwork and where you are sending them? Is Lab Corp just drawing the sample and then sending it to another lab or sending it to a Lab Corp lab?

$200 seems reasonable to me. I assume you have someone willing to sign the orders or do they require signature? Although my new healthcare provider is terrific, I would love to be able to have the ability to request lab work when I am not feeling well. My last testing (saliva) testing was actually done on a month that I had a great cycle... and of course that is all relative.

Any info would be appreciated.

Thanks
Leslie

Sariah.

I turned on my PM feature but tried to send you a message and the system would not "allow" me too. Not sure what to do.

Is it okay to provide names of facilities that we recommend on these threads? I just want to ensure that I respect the rules of the message boards.

Cheers

Leslie

Leslie...when you say it was more an estrogen issue than progesterone issue with your symptoms are you referring to having too high or too low estrogen? Also either way are you attributing the dominance/loss partially to your weight gain?

I took metformin years ago with success of weight loss with working out (when working out alone never budged my weight) and felt as if my hormones all fell into place when taking it somehow too feeling much better. I have tried it since and taking it now as well but with no results. I was always trying to figure out if my weight along with tons of symptoms was related to higher or lower E then and how/if the metformin can effect our hormonal levels since it worked so well for me in the past and is working for you so well now too. I know it helps with insulin resistance yet my guess of whether I maybe needing a boost of E or P with it back then and now still is a puzzle in progress.

The only things that ever helped me in the past stabilizing my moods, fatigue, weight gain, etc was the BCPs on one occassion lasting for about 4 years till they pooped out for some reason then symptoms all flooding back and for some reason metformin helped alleviate them for years until again something pooped out/changed and I'm back to square one. I know there's a reason behind those two methods helping me in the past...if I could just piece together the puzzle more I think I can better figure out my balancing act and since you're finding help in that area please fill me in on your thoughts and again what you meant more as it being an estrogen issue.

Hi Shar14,

You sound much like me where I have to know what is going on!!! I would say E dominant with the weight gain, definately, have blood levels to support my p was in the tank along with DHEA. At this stage and after loosing 55 pounds the P has come back along with the DHEA but I am still not balanced and working on that..... The weight gain just made things worse and no matter what I did it just kept packing on the pounds. The word PCOS was used, I was reactive hypoglycemic... I never ate regularly and that although my testosterone was not high it was higher than my other hormones when comparing the ranges of which they fell (looking for the correct proportional balance.) The metformin is interesting. I had hormonal #@$ gettin on it right up there with the BCP. Mood swings etc... and I took a very low dose of just 500 mg/day broken into two 250 mg doses. It just impacted my hormones (all of them). The metformin did a good job of "alleviating" the follicles/cysts on my ovaries. I did not have all the "lab work results" that supported PCOS but with the weight gain I was on my way to type 2 diabetes along with my hormones just getting worse. I totally changed my lifestyle, diet etc... the metformin helped me loose the weight with out a doubt and the follicles were not present on a follow up ultrasound. I also did the life style changes. I have not taken the metformin for four months and have kept the weight off... 55 pounds total weight loss and I would still like to loose another 10 -15 pounds in a healthy way. I have had one really bad cycle and one really great cycles and two tolerable cylces since. I am not sure that I would say that it is/was PCOS per say, but that I do experience anovluatory cycles which is common in peri-menopause and when I look back at my younger years would guess that was part of the issue then too...

My guess is that I have had imbalance issues for a LONG time. There are different ways to try and do the same thing to get the body back in balance. For me, I had cervical dysplasia when I was younger, my grandmother had uterine cancer.. for me having a full cycle is important as it is important to "shed" the uterine lining. So although I have a period regularly I can tell when I am not having an appropriate cycle by how I feel the during and after ovulation along with the type of cycle I am having. Probably way TMI, but I pay attention for a reason. A level "4" cervial dysplasia made me very much aware.

My understanding is that sometimes things that worked before just do not work again and so you just need to look for alternative solutions. For me, I am trying to resolve the same situation I have had for years but there is an added component.. I am definately moving through a new stage in my life and I have new symptoms that I did not have before that I could not relate too...which for me added a level of fear since no one could tell my why I was anxious, nervous.. constipated, GI distress etc.... i would have loved to be able to take the BCP again but it just was not working out and felt like things were just getting worse. The progestin that was recommended was just frankly too high and it is difficult to taper/titrate when dealing with pills, particularly synthetic.

My new healthcare provider really put it in perspective and since things are changing with our bodies alot during this time period it really comes down to trial and error of what works for you. One cycle everything may be great, the next the p may take a dive, you may get it back up have a good cycle and then the make a dive or just be erratic... so my lesson on this one is to just give my body as much support as possible so that I am on the baby toddler roller coaster instead of the thrill ride roller coaster at the other end of the amusement park. At least, I now know what it is and am no longer freakn out and wondering what the @#$# is wrong with me... it has a name and is just another stage of life.

So the blood work and recent saliva testing results still have me as not being balanced and it appears that E dominance is still present but it is not anywhere close to where it was prior to having started the metformin back in August for about 5 months. I am trying the p cream at a very low dose along with taking a supplement to aid the thyroid and adrenals. I am just like everyone else and praying this works.

Hope this helps!
Leslie