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Bleeding or actual period?

by Mari
(Phoenix, AZ)

Hello,

I'm 33 years old, and I've been seeing a doctor since January 2013 regarding the following symptoms: hair loss, facial hair, irregular periods, PMS, dry skin, low libido, and acne. A number of tests were done and I found that I have some follicles on both ovaries, low progesterone levels, high cortisol levels, very high LH (10) and low FSH (1). When I began treatment with my doctor, she said that I had mostly symptoms of Estrogen Dominance as well as borderline PCOS. I began taking supplements to reduce my cortisol levels, improve liver function in order to detox from the extra estrogen in my system, improve the health of my ovaries as well as supplement with 50mg of progesterone cream from a compounding pharmacy to be taken everyday except the days of my cycle.

Upon beginning treatment, I felt much better immediately. My lab results were getting much better; there were improvements in my thyroid function, CRP had gone down, my cortisol levels went down, my LH was moving down and my FSH was moving up, and my liver function was improving dramatically. However, my progesterone levels actually went DOWN, and my periods were still kind of sensitive and I found that I was getting my cycle around days 32 or 33, and the latest 37 or 38 (because of travel). I was told by my doctor to just begin progesterone from days 7-14 of my cycle because of this. When I did that for the next cycle, I found my symptoms got worse, and I developed an extreme case of dry skin on my feet and hands, I was emotionally miserable like I'd never been before in my life, my hair was falling out, I was retaining water and couldn't fit into my clothes and sleeping horribly because of waking up from feeling hot and very sweaty. I was told by my doctor at the appointment after that, that my recent blood test taken on Day 21 showed that my progesterone levels had essentially left the building (it was at .3). She said that I should wait until my period shows up, latest until 40, and then take the progesterone from Days 14-28 after my period, and if my period does NOT show up and it's already day 40, to take progesterone for 2 weeks to force my body to make a new cycle.

With how miserable I was feeling, I didn't wait until day 40 to see if I got my period...I lasted until Day 35 and began taking progesterone once a day. My period showed up after day 41. From Day 3 of my cycle until the end of my period, I had horrible hot flashes throughout the day as well as horrible night sweats. Although my doctor said to just take the progesterone from days 14-28, as soon as my cycle finished, I started taking progesterone every day from Day 7 onwards anyway because I felt my body needed it with the hot flashes and sweats I was getting--I felt I was prematurely going into Menopause!! I started out the first two days taking it once a day, about 1/2tsp from a brand that contained 500mg of natural progesterone (I didn't bother going to get the cream from the compounding pharmacy and went with this new brand instead). Then I upped my dose to twice a day, and then finally 3x/day the next day until Day 19. Since taking progesterone cream 3x everyday until now, I have noticed an increase in my libido, no more dry skin, clear thoughts, mind, and an improvement in my hair and nails. My sleep also improved in the sense that I was no longer feeling hot and sweaty at night, and I had no hot flashes during the day. I don't know exactly how many milligrams of progesterone I was taking each day, however; again, I just applied 1/2-3/4tsp, 3 times a day.

I am at Day 20 of my cycle and since yesterday, I have been having very light bleeding. At first, it was just spotting, and I thought this was the same spotting I was experiencing for the last couple of cycles between days 18-20 and dismissed it as just that. It's just that this time, I'm noticing more bleeding, and not just spotting. Last night, I was also feeling some mild hot flashes. I'm not sure if I should push through this and keep taking my progesterone or if this is an early period and I should stop taking my progesterone. My periods usually start with some spotting, but I'm still not sure this time. I don't feel any of the symptoms of a period, like tiredness, cramping, and the bleeding is SO light that I'm honestly not sure. This morning, I applied one dose of the progesterone cream and finished the tube. I recently ordered NatPro and will be using this brand from now on.

Having said that, what would you recommend I do? Should I continue to take the progesterone cream and if so, how much/often? I'm hoping you'll shed some light on this because I can't seem to figure out what to do now, and I would appreciate any advice you might have.

Comments for Bleeding or actual period?

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May 15, 2013
 Update
by: Mari

It's been a couple of days, and it's most definitely a period! My flow is very light and when I looked at my calendar, I found that this period showed up exactly at the time it was supposed to show up after the previous period had it not been late.

I'm still getting mild hot flashes on and off, not frequently though. I'm not sure if I should still take progesterone cream or not while I'm on my period?
May 16, 2013
 Bleeding or actual period?
by: Wray

Hi Mari Like so many you were told to use too little progesterone. Initially it can make us feel good, but then Oestrogen Dominance kicks in and all the symptoms come back often with new ones. To go back a bit, with those symptoms I would have said you had PCOS. With an LH:FSH ratio like yours I would not have called it borderline! I'm pleased you've been given a liver detox and taking cortisol reducing supplements. Zinc reduces cortisol too, and I feel this is partly to blame, maybe you are taking it? High oestrogen depresses zinc levels and causes copper to rise. Copper also depresses zinc levels. With a progesterone level so low, it wouldn't surprise me to hear your zinc is low. Progesterone raises zinc levels, and depresses both copper and oestrogen. But not 50mg/day. I've tried to work out how much you are now using. You say the cream had 500mg progesterone, is that per container or per 30g (1oz)? Assuming it is this, then you are now using about 125 to 150mg/day. This is a far better amount and it doesn't surprise me you responded, although I feel with PCOS you should consider using 200mg/day. With your erratic cycles, the average of the figures you've given me is 35 days. 35 days less 14 days (luteal phase length) brings us to day 21, 18 to 20 for the shorter cycles. This is when you should ovulate, assuming you are, the bleeding could be from a follicle bursting, it's called Mittelsmerz. But if it is a normal period, this I also don't find surprising as progesterone can upset the cycle when first using it. So I feel you should continue the progesterone. Not only that but I would suggest using it daily, with no break for your period. And to do this for at least 2-3 months or until you feel stable enough to start following it again. If you're not taking zinc, please consider it. Please have a look through these other pages we have on Acne, Hair Loss, Hot Flushes and Nutrition. Please have a vitamin D test done, PCOS is caused by oxidative stress, and large amounts of antioxidants are needed to reverse it, vitamin D being so important. Let me know how you get on. Take care Wray
Jul 25, 2013
 Update
by: Anonymous

Since receiving NatPro cream back in May (since this post), I was applying 1tsp every day. I had an appointment with my doctor and she showed that my progesterone had risen just a little (it was at 1.9 on the day of the test, which was Day 21 of my cycle). I was still experiencing night sweats and because most of my issues are brought on by stress and it seems I do well on progesterone not just for hormonal issues, but for my adrenal healing, she actually recommended I increase my dose to 300mg!

Since end of May, I have been applying 2tsp of Natpro, about 332mg/day. Initially, I had quite a bit of brown discharge after a couple of days of use, but no bleeding. I got my period on Day 37 (technically Day 1). I have noticed a reduction in my symptoms for sure, including an improvement in my hair and a reduction in the night sweats (haven't disappeared completely though). On the link you mentioned regarding Hot flashes, it mentioned that they are eliminated only with doses 400mg or higher. Should I then increase my dose to 400mg?

What I've noticed is whenever I have an increase in my dosage, for the initial week I see a huge improvement in my symptoms but what seems to happen is that this improvement starts to decline again. I've been applying the cream twice a day, every single day since the last week of May.

As for my Vitamin D levels, they have been on a steady rise since January; here are the numbers:

Nov. 2012: 32
Feb. 2013: 42
Apr. 2013: 54.9
May 2013: 48

I don't know why I had a decline in May, but I have since increased my dose for Vitamin D to 20,000IU/day.

I was advised by my doctor to keep eating lots of carbohydrates because for some reason, if I don't eat carbs, I don't have a BM for days! She mentioned that the carbs are very healing for the adrenals and this is what I have noticed also. I sleep better, my mood is better, I am more regular (daily like clock work) and I am energetic and productive during the day. Interestingly enough, my doctor said that she herself had been on progesterone cream every single day for two years until her adrenals healed and I may have to follow the same sort of regimen until my progesterone numbers are high and stable consistently over a few months.

As for the Zinc... what I have is a Zinc Assay (pictured here: http://www.amazon.com/dp/B007SOV1YA). I have not had my zinc levels checked so I don't know if/how much I should be taking. I'd appreciate any advice on this.

Thanks again for replying!
Jul 27, 2013
 Update
by: Wray

Hi Mari Thanks for the update, I find feedback so useful. Very pleased things are improving. You have an amazing doctor, don't loose her! I'm delighted she suggested 300mg/day, although I have found 400mg/day and more is needed for the hot flushes. These are sometimes quite difficult to control, but as you are only 33 and not in Peri-menopause, I don't think you'll have the problems which beset women then. So you could try increasing it, or with time you might find the 300mg/day does work. I'm not sure why they tested you on day 21, as that is the day you should ovulate. Which means progesterone is not very high, as reflected in the test. The test should have been done mid-luteal phase, i.e. ± day 28. I'm so pleased your doctor is also aware of how healing progesterone can be for the adrenals. It does calm us, which therefore relieves the stress off the adrenals, which also means cortisol should come down. I'm a bit confused when you say "whenever I have an increase in my dosage, for the initial week I see a huge improvement in my symptoms". Are you increasing it gradually, and not all at once? I know initially you increased from 50mg up to about 125 to 150mg/day. Then you went up to 300mg/day, or was that gradually? As this can upset things. Alternatively if it was an immediate increase, then it could indicate you do need more progesterone at the moment. You say "this improvement starts to decline again." Which means oestrogen is now responding to the progesterone increase. They each activate the other, and sometimes it's difficult to adjust the amount to once and for all suppress the oestrogen. I'm so pleased your vitamin D is coming up and that you've increased your dose. I think you'll find this will eventually kick in and begin helping. If you should experience any aches and pains, it means your magnesium is too low. As the higher vitamin D is 'using' it up. If this should occur please take about 800mg/day until things settle, then drop back to about 250mg/day. I was a bit alarmed when your doctor told you to eat lots of carbs, as nothing could be more harmful. Unless you are avoiding the sweet, starchy carbs and eating only the green ones? All grains, legumes and sweet starchy fruits and veggies should be avoided. They disturb blood glucose and then all hell breaks loose. High testosterone initiates acne, see here. If bound to SHBG (sex hormone binding globulin) testosterone becomes inactive, progesterone raises levels of SHBG, see here, so preventing the rise of free testosterone and severe PMS. SHBG drops if sugars are eaten, even those found in all grains, legumes, processed milk and sweet starchy fruits and vegetables. Continued below
Jul 27, 2013
 Update Part 2
by: Wray

Hi Mari Fructose, sucrose and glucose, reduce SHBG by 80, 50 and 40% respectively, see here. Thereby allowing testosterone to rise. It's best to avoid all the foods and sugars mentioned. Low SHBG is a marker for Insulin Resistance. Wine and beers contain carbs, so it's best to avoid those too. Plus alcohol affects hormone levels in women, see here and here. It decreases progesterone levels and increases androgen levels, both the total testosterone and free testosterone become higher. Testosterone is notorious at increasing visceral fat, which causes abdominal fat gain, see here and here. The lowered progesterone, higher testosterone probably accounts for the increased risk in breast cancer risk among women, see here and here. Higher testosterone is also associated with an increased risk for Insulin Resistance and heart disease, see here. Sugars and large meals also drop progesterone levels, see here. Plus insulin drops levels too, see here. This means SHBG also drops, testosterone rises, another vicious cycle. I've looked at three websites, but none of them tell me how much zinc you're getting. 15mg/day is the recommended amount, although I've often told people to increase to 100mg/day for a month to get levels high. Take care Wray

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