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Adenomyosis fibroid, polyp, Dr. Prescribed Biest w/ progesterone?

by Mel
(North GA, USA)

I am 49 and have been suffering with extremely heavy periods for 9 years. I also have a huge list of perminopausal/Estrogen dominent symptoms - very sore breasts after mid cycle, moodiness, brain fog, dry vagina with diagnosed atrophy... no libido. I have just been diagnosed with adenomyosis, a fibroid, and a polyp after my period became so heavy that I sought out a BHRT gyn to hopefully help me lighten it. In the last 9 years, I have tried progesterone cream and few times for several months each time and now realize I probably just wasn't using enough. Last month, Joy suggested heavy bleeding protocol, and I started it on day 19 of my cycle, directly following a hormone saliva test which I took for my doctor. My subsequent period volume was nearly cut in half from 700ml to 420 ml with using 400mg/day of cream divided into 3 doses.

My saliva hormone test came back with e2 at 1.2 pg/ml, Pg at 131 pg/ml, and a ratio of 109. Also with low DHEAS and low cortisol. Testosterone was mid range.

At my follow up appt they did an ultrasound and my lining had thinned from 17 last month to 13.7. They also discovered the adenomyosis, fibroid, and possible polyp. They told me that BHRT alone will not significantly.reduce my bleeding because of these issues.

The PA at the gyn office says my pg/e2 ratio is good, estrogen is low, and progesterone is fine - that it's the polyp causing the heavy bleeding and that I need a D and C to clear the polyp and lining. She prescribed a biest with 0.3 estrogen and 10 mg progesterone 1x/day on days 1-25. "just so the estrogen isn't unopposed." I don't feel comfortable with this - won't it lower my ratio and increase symptoms?

Does any of this sound reasonable? Is it possible that 109 is not a high enough ratio for my body? I feel like I need more progesterone to build a higher ratio since my understanding is that adenomyosis, fibroids, polyps, and heavy bleeding are all caused by too much estrogen. It seems wrong to add any estrogen into my system (which she is doing mainly for vaginal dryness/atrophy) unless I was also going to add a much, much higher dose of progesterone.

Considering calling them back to express my concerns but i worry about the ramifications of doing so. I don't even want to pick up this prescription from the pharmacy at this point, although I had considered using the prescribed cream in addition to heavy bleeding protocol.

Also, is a D and C something I should.consider or can it lead to more issues?

Thank you for your thoughts on all of this! I feel lost, worried, and overwhelmed.... not to mention disappointed in my care team.

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Jan 14, 2025
 Adenomyosis fibroid, polyp, Dr. Prescribed Biest w/ progesterone?
by: Joy

Hi Mel

Gosh where to begin?  Peri-Menopause (PM) usually starts at around 35.  The fact that you have been battling with heavy periods for 9 years makes sense although not all women in PM experience excessive heavy bleeding. The symptoms that you are experiencing are all part and parcel of PM.  You are suffering from Estrogen Dominance, as you suggested

Adenomyosis is similar to Endometriosis and is caused by oxidative stress and Inflammation.  The same applies to Fibroids and PCOS. Progesterone is most beneficial for all of these but one has to address the inflammation that is going on. I have found over the years that fermented foods are excellent for this plus they provide the best probiotics.  Better than any OTC ones at a fraction of the price.  You might like to include this food in your diet. When the gut is not healthy, neither are you.  Progesterone helps the body to absorb smaller fibroids.  Sadly surgery is required for larger ones.  They also cause heavy painful periods.

You really should be using progesterone every day going forward as it becomes increasingly difficult to use during your luteal phase and monthly periods become erratic. Plus your adverse symptoms require it.

The heavy bleeding protocol, when followed correctly, has helped so many women.  Progesterone therapy is a long-term commitment.  Once you stop using it, most symptoms will return as estrogen has been allowed to become dominant again. When you say you have tried progesterone for several months, how many months and how much were you using?  You stated that you used 400mg, but for how long?  If the 400mg didn't help you needed to increase as per the protocol.  It can take anything from 2-6 months before one notices its benefits. Longer if symptoms are severe.  Usually between 100-200mg progesterone is required.  However, more is often required for certain symptoms.  Heavy bleeding for example requires 400-500mg using a good quality progesterone cream such as Natpro which is a 3% organic cream.

Here is the protocol again:

400-500mg Natpro Progesterone Cream per day
2000mg N-Acetyl-Cysteine (NAC) per day
2000mg Taurine per day
5000iu's Vitamin D3 per day
1000mg Bioflavanoids or Vitamin C per day

Your progesterone:ratio is 109:1 as confirmed. It really should be around 600:1 before one feels benefits. Please read the Hormone Testing page, compare your other test results. The advice given by the gyn office is incorrect. Progesterone is not fine.  You really should be working at getting your level higher.

I also feel that your adrenals are taking strain which will affect cortisol levels.  Have you tried the Adrenal Fatigue Cocktail?  If not, please consider trying it.
  
Adrenal Fatigue Cocktail
125ml Orange Juice or *Grapefruit Juice, you are looking for vitamin C. Some people can't take grapefruit for several reasons. 
1/4 teaspoon Celtic Sea Salt or pink Himalayan
1/4 teaspoon Cream of Tartar - this provides the potassium needed.

Mix the above at the start of the day with enough liquid for two (2) applications i.e. 8oz/125ml of orange juice. Drink it mid-morning, as well as mid-afternoon. In addition, any time that you are feeling particularly anxious it would be advisable to prepare another mixture and take it.

The lining of the uterus would have thinned because of the progesterone. I do not think that a D and C is necessary.  Progesterone is already working or was working. More time is needed.  At the end of the day, it is your decision. You must do what you feel is best for you.

As you have most probably read, I do not believe that any woman should use extra estrogen.  There are well over 100 estrogen mimics in our Environment as it is.  The amount of progesterone they have advised is not enough.  This will aggravate your estrogen receptors making estrogen dominance symptoms worse.  I do wish that the medical professionals would do their research properly.
  
I can't speak for all progesterone creams as they all contain different ingredients, but with Natpro, inserting it in the vagina at night helps greatly with dryness.  I do this every night.

Please read the Libido and How to use Progesterone Cream pages.

Another thing to consider and is often overlooked is Vitamin D3. A deficiency reduces the benefits of progesterone. It is connected to every single functioning cell in our bodies making it vital.  Cofactors are equally important, namely magnesium, vitamin K2 and zinc.  Do you know what your D3 level is? If not, consider having a test done. Optimal level is between 70-100ng/ml.

I hope this helps. 

Take care.

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