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hot flushes stop during a period

by Kim
(UK)

Hi Wray,
I'm 54 and have been having peri-menopausal symptoms for 5 years now - hot flushes, weight gain, depression, dry skin, no libido, anxiety, lethargy, foggy thinking etc.
I used the birth control pill continuously for 20 years plus, from age 17 to about 38 and have never been pregnant.
About 2 years I had a saliva test that showed Progesterone of 30pg/ml and Estradiol of 0.5 pg/ml giving a ratio of 60:1. I started using the Emerita Progesterone cream but only at a low dose e.g. 30 mg per day so nothing really changed.
About 15 months ago I went to a private doctor in the UK, mainly to find relief from the hot flushes and weight gain. I had a blood test that showed Progesterone of 1.9 nmol/l and Estradiol of 559 pmol/l giving a ratio of 3:1, I think (other results were Testosterone 0.5 nmol/l, free testosterone 0.23 pg/ml, SHBG 121 nmol/l, DHEA sulphate 3 umol/l, thyroid was in ok range).
The doctor put me on Bi-est cream with added progesterone and testosterone plus DHEA tablets.
In the following months I noticed thinning hair on my head, acne and dark facial hairs so I stopped the DHEA and testosterone and these improved.
Despite many changing doses of Bi-est and progesterone the hot flushes have continued day and night, as did the other symptoms (the progesterone dose was never very high, between 25mg and 100mg).
Having read your fantastic site I think I'm most likely very low on progesterone and high on oestrogen and I feel very sad that I've probably totally messed up my hormones by using the BCP for so long.
I have separate tubes of Bi-est and Progesterone so I've stopped using the Bi-est and started trying increasingly large doses of Progesterone, I'm up to 500mg per day and the hot flushes are improved but not gone yet.
At my next Dr's appointment I want to persuade her to prescribe a much higher dose, as I'm sure this will work but I have one problem - since I started having hot flushes 5 years a go the only thing that has stopped them is having a period. Periods have become very infrequent now but I had 3 in a row in March/April this year and still the flushes stopped. Why does this happen? I think my doctor thinks it is the rising oestrogen that makes a period happen and also stops the flushes. I usually feel very hungry during these times and gain weight horribly fast which points to oestrogen dominance.
I would hugely appreciate if you have an explanation for this and apologies if you have covered it elsewhere but my searches didn't find anything. Thanks

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Aug 14, 2013
 hot flushes stop during a period
by: Wray

Hi Kim You are right about the Contraceptives, they can upset the system, although we're never warned about this. Both your ratios are correct, progesterone does stimulate oestrogen, particularly if low amounts are used, hence the rise in it, and the lowering of your ratio. Mine was 5:1 and I was a basket case! I can't imagine what you must be feeling like. Extraordinary you would be given both testosterone and DHEA, neither of which is needed. Yes your testosterone shows low if compared to the normal range, but the affect of giving you more was very noticeable, I'm glad you stopped both. As our oestrogen is all converted from testosterone, to give you more oestrogen too was daft. Either one or the other, but not both. Preferably neither! I've normally found 400mg/day stops or reduces Hot Flushes, although some some do need more. Please have a vitamin D test done, a lack of this reduces the benefits of progesterone, see here, here and here. It could be yours is too low, hence the need for more progesterone. Magnesium has helped some women with hot flushes too. As this is the most important co-factor for vitamin D, it doesn't surprise me it helps. It's progesterone withdrawal which causes us to bleed. Or to be more accurate, it's the MMPs which cause the lining to break down, oestrogen stimulates them, whereas progesterone inhibits them. Once progesterone withdraws at the end of the cycle, it allows them to get to work. We have more info on our Menstruation page. With the withdrawal of progesterone at the end of the cycle, it also causes the ratio of the two to become skewed, with oestrogen becoming dominant again. That does drop too, although not to the extent of progesterone, hence all the symptoms we have. Continued below
Aug 14, 2013
 hot flushes stop during a period Part 2
by: Wray

Hi Kim It could be because your ratio is so low, but with the dropping oestrogen the ratio has lessened, and the antagonising affect they both have has also lessened, so the hot flushes stop. The hunger and weight gain are most definitely oestrogen related, it disturbs blood glucose, see here. I haven't covered the hot flushes stopping during a period, so you wouldn't have found it anywhere, so please don't apologise. We do have a few pages you could look through, Anxiety, Libido, Peri-menopause and Menopause which you're not far off. If you don't have success getting a higher script for the progesterone, you might like to contact Julienne via her website here. She lives in London and stocks Natpro, plus she can advise on the vitamin D too. Take care Wray

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