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Seems like I am low estrogen

by Kelly

I am 34 and appear to be going into early menopause. I am confused about progesterone as it appears most with estrogen dominance have problems during the luteal phase, but my worst is during the follicular phase. A couple days after my period I get horrible anxiety, nausea, can't sleep, digestive issues, bladder issues. These get better as I enter the luteal phase. My breasts have also considerably shrunk; this all seems to point to low estrogen. I have eliminated all xenoestrogens I can from diet and skin care and am extremely thin (105 pounds, 5' 7"), always have been, it's just my genes, no disordered eating. Do you still believe progesterone will help? I took 30 mg for 12 days during my last period, it didn't seem to do anything but I don't imagine 12 days in a 49 day cycle would impact much. I am very confused and hesitant to add estrogen because my mom had ovarian cysts and endometriosis, but I already have low bone density and heart disease and alzheimer's runs in my family so I want to protect from that as well. Any advice would be very appreciated.

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Dec 28, 2012
 Seems like I am low estrogen
by: Wray

Hi Kelly It's interesting you don't get the adverse symptoms just prior to bleeding as most do, but after it. Progesterone begins dropping sharply a few days prior to bleeding, down to it's lowest level. Oestrogen drops too, but not to the same extent. It's this withdrawal of progesterone which causes the symptoms, as it leaves oestrogen dominant. It appears your progesterone doesn't drop as sharply, but once it does reach it's lowest level, then your symptoms appear. By this time oestrogen is rising again. It continues to rise slowly until about 50 hours prior to ovulation, when it increases exponentially. Progesterone also rises exponentially at the same time. This surge comes from the brain, see here, here, here and here. Ovulation then takes place and levels continue to rise. You are obviously getting the pre-ovulatory surge, because if you didn't your symptoms would worsen then. It's obvious too you are ovulating, because your symptoms would just get worse during the luteal phase. There's more info on our Menstruation page. The 30mg/day would not have made much impact. Not even 40mg/day raises it to levels found in the luteal phase, see our page on Progesterone Misconceptions for more info. I recommend 100-200mg/day, more if symptoms are severe. In your case I would suggest you use it daily, through any bleeding, for at least 2-3 months, to overcome the excess oestrogen. 49 days for a cycle puts you outside the normal range, which varies from 21 days to 35 days. It makes me suspect PCOS, and yet you don't have any of the normal symptoms. Although oestrogen is generally high, progesterone low, as ovulation occurs rarely, in your case it appears you are ovulating. With a 49 day cycle you would be constantly making testosterone and oestrogen until the 12-14 day luteal phase, i.e. 35 to 37 days of testosterone and oestrogen production. Continued below
Dec 28, 2012
 Seems like I am low estrogen part 2
by: Wray

Hi Kelly So I don't think you need more oestrogen, as Endometriosis and Ovarian Cysts are exacerbated by it. And if your mother had these it's not worth it. Oestrogen is an excitatory, inflammatory hormone, so in excess it only makes matters worse. For instance women with high oestrogen, or on HRT, are at greater risk of getting dementia and heart disease. With the risk of endo and cysts, plus you have low bone density and heart disease, and Alzheimer's runs in your family, I would say you, and your family, are all very short of vitamin D. It appears oxidative stress is behind all our modern diseases, this leads to Inflammation and all it's attendant problems. The most important antioxidant is vitamin D, cells malfunction without it. These are a few papers on CVD here, here, here and here. Plus this video Vitamin D and Cardiovascular Disease Prevention. These on Alzheimer's here, here, here, here, here, and here. Continued below
Dec 28, 2012
 Seems like I am low estrogen Part 3
by: Wray

Hi Kelly And these on osteo here, here, here, here, here, here and here. Please have a vitamin D test done. For more info on vitamin D levels, test kits etc see the Vitamin D Council, GrassrootsHealth and Birmingham Hospital. Blood levels should be 70-100ng/ml (175-250nmol/L) and not the 30ng/ml (75nmol/L) most labs and doctors regard as adequate. The minimum daily dose should be 5000iu's per day, although recent research indicates it should be 10,000iu's per day, see here. Take care Wray
Dec 28, 2012
 Thanks!
by: Kelly

Thanks so much for the response Wray! I was leaning more towards the "use more progesterone" route instead of adding in estrogen, all your information is so helpful. I was unclear in my original post, my worst symptoms start after my period, meaning after the start of bleeding. I start feeling low the day before, but the issues don't get their worst until day 3 or so (I have even more than listed, like heart palpitations and back pain), then they stay that way until 2 weeks before my period starts. My cycles were 28 days on the nose until a couple years ago after the birth of my second daughter. They then went to 21 days and were very heavy with clotting (no PMS symptoms ever though). Then, this year started being hospitalized with intense gallbladder-like pain but no stones found, however the lining of the gallbladder was thickened. This all seemed to point to too much estrogen, but then I skipped a cycle, then they lengthened (28 to 38 to 49 days) and the bleeding is much lighter. That with the breast shrinkage and the rough follicular phase made me think it was too little estrogen. It's all so confusing! I had a transvaginal and abdominal ultrasound, no cysts and endometrium was fine. On blood tests my FSH and LH was high and estrogen in range, they didn't measure progesterone. I must say I am a bit concerned about using so much. What do you think about this case study ((http://www.zrtlab.com/component/docman/doc_download/113-casestudy-postm-excess-progesterone?Itemid=464)) from ZRT labs with a postmenopausal women who was taking 100 mg progesterone daily and had a level of 11,000? At any rate I think it's clear I'm not taking enough for long enough, so I will definitely up the dosage and I really like the advice to just take it continually for a few months.

I did have my vitamin d level tested 2 months ago and it was abysmally low at 24. I am supplementing 32,000 ius 2x per week to get that up, will get tested again in a month and my goal is definitely at least 60. I also started eating primal at about the same time, which I see you recommend on your site. I have had some symptom relief from both of these plus magnesium supplementation. The worst thing that I can't kick is the anxiety. Your page about this is excellent and I wonder if I should try treating with some of those recommendations. I just hate taking so many supplements and get ticked that I can't figure out how to make my body work correctly through diet/lifestyle alone.

Thanks so much for all the excellent work you do on this site!
Dec 29, 2012
 Thanks!
by: Wray

Hi Kelly Well I'm glad you were leaning towards more! Well that solves a puzzle for me, I did think you meant after bleeding had stopped. As invariably it's progesterone withdrawal prior to bleeding which causes the adverse symptoms. Then round about day 4 to 5 oestrogen begins rising again. One of those papers I gave you, showed about 6 graphs of oestrogen rising, it should give you an idea of what's happening to you. It's typical they don't measure progesterone, the most important hormone! Plus it's the ratio of the two hormones which is the critical factor, not the amount. ZRT is one of the few labs that give it. If that study had been done by another lab, I would have questioned the progesterone level, but ZRT are to my mind one of the best there is. I must admit to being very puzzled though, as 100mg/day is not a high amount, plus she was taking oestradiol too, which would have a detrimental affect on the progesterone. The ratio was high, we've found from Saliva Tests we run that it should be 600:1 and over to feel well. Although I tend to go by symptoms, so in the case of the ZRT woman, I would have told her to increase her progesterone and stop the oestrogen! It's evident with the high FSH and LH that they are trying to stimulate an egg to mature and to then ovulate. But as you don't have any adverse symptoms during your luteal phase, I could only assume you do ovulate. Such a pity they didn't test the progesterone, if you do have a test done, it should be done ±7 days after ovulating or before bleeding. As progesterone peaks mid-luteal phase, which in all women is always 12-14 days long. But as yours is so long now, it's impossible to tell when it should be done. So I'm also confused! I do wonder if the gall bladder pain was not a cyst bursting, and that by the time they did the scan it had healed. This might account for the odd cycle lengths you've had recently. For encouragement, you might like to read these comments from others who've used amounts far higher than the 100-200mg/day I suggest, see here, here, here and here. This last is a long page, put "Sage" into control find. If your heavy bleeding had continued, I would recommend 400mg/day, as I've found it has to be this high, or more to help. Continued below
Dec 29, 2012
 Thanks! Part 2
by: Wray

Hi Kelly The heart palpitations are interesting. Oestrogen causes prolongation of the QT interval, which results in palpitations, arrhythmia, Torsades de Pointes and sudden death. Whereas progesterone shortens the QT interval, see here, here, here, here, here, here and here. This is why more women get these problems than men, they have very little oestrogen, whereas we have a great deal more. Men naturally have a short QT interval. If it's not too much of a bore, it's best to take vitamin D daily, as that's how we were designed to make it, naked in the sun of course! I feel you should be taking about 20,000iu per day with a level that low, currently you're getting about 9000iu. I will be interested to hear what the result is when you have your next test. Don't be too hard on yourself about getting your body to work. It seems you had a child about 2 years ago, that takes it out of us. Stress does too, pollution, oestrogen mimics, they're over 100 of these now, see Our Stolen Future, lack of vitamin D, lack of progesterone, both these drop when stressed. Many amino acids drop with stress, and if stressed the body can't get enough from food to bring them up again. For instance glutamine, abundant in our food, becomes a 'conditionally' essential amino acid, as we can't extract enough. The same with taurine too. I'm pleased you are eating primal, not heard that expression before. That will help, but even if it's all organic, we don't have the planet we used to, we have far more stress too. Thanks for the kind words! Take care Wray
Dec 30, 2012
 Interesting
by: Kelly

Thanks for the links to the people taking large doses. I especially found the discussion about magnesium interesting. I've been doing Epsom salt foot soaks a few times per week, and while it's been helping everything else, I have suddenly had some acne pop up. So I have to wonder what the connection is there with DHEA as well.

I find it interesting that people (myself included) are hesitant to take large doses of natural progesterone. Most endometriosis treatments aim at suppressing ovulation with progestins, and, after all, isn't endometriosis just a symptom of estrogen dominance? Even Cemcor, which is more mainstream while still advocating Prometrium, focuses on the bone dangers when using large doses of natural progesterone. Would you say the difference is that progestins suppress both estrogen and progesterone, while going the natural route will give you higher levels of natural progesterone and therefore negate the issues that may arise from suppressed estrogen?

http://www.cemcor.ubc.ca/ask/endometriosis_progesterone

I have started taking 30 mg 2x per day and it's helping the anxiety, even though if I miss a dose by a few hours the anxiety comes back pretty hard.

Thanks for the thoughts on the vitamin d. My dr prescribed 50,000 iu of d2 once per week, but from reading online I figured that wouldn't be enough, and I should be using d3. I may up it further, seems that some people take 50,000 ius twice per week. Makes sense to take it everyday, I just have trouble remembering! I read that someone on the vitamin d council recommended 1,000 ius per 25 pounds of body weight, but that may be for maintenance without sun exposure. We're lucky that doctors are finally testing correctly for this. I had to fight hard several years ago and they still wouldn't give me the correct 25 test. This past time I asked it was the test they always use now. Progress.
Dec 31, 2012
 Interesting
by: Wray

Hi Kelly I found the affect magnesium had on acne very interesting too. I do know I tried to piece it together on one page, but heaven knows which one! I think it's natural to be hesitant about the high amounts of progesterone I advocate, after all nearly every website, doctor and therapist recommends amounts of 20-40mg/day. But I was lucky enough to read Dr Dalton's books and then meet her. She used far higher amounts of progesterone for her patients, see here, going up to 2400mg/day for those with post natal psychosis. She found low amounts did not work, I've found the same, unless symptoms are very mild. But the people who come to this site are usually struggling with severe symptoms. Endo is treated with progestins, doctors believe it to be the same as progesterone, in fact they use the two terms interchangeably. But the progestin molecule is radically changed, moreover it is not metabolised into the all important progesterone metabolites. Allopregnanolone being but one, but is probably far more important than progesterone itself. But of course without progesterone the body cannot produce it. Endo itself is caused by oxidative stress, see here, as are most of our modern 'diseases'. And is exacerbated or stimulated by oestrogen, as Prior agrees. Oestrogen is an excitatory, inflammatory hormone, it's also a mitogen causing cells to proliferate. Progesterone inhibits it, plus it's a potent antioxidant, whereas oestrogen causes free radicals to increase "This loss of opioid neurons is prevented by treatment with antioxidants indicating that it results from estradiol-induced formation of free radicals", see here. I admire Prior greatly, she was instrumental in finding progesterone was involved in bone building, see here. She received much flack from her peers too, as progesterone was, and still is, looked upon as a pregnancy hormone and nothing more. She also found high dose oral progesterone was needed to stop Hot Flushes, see here. Continued below
Dec 31, 2012
 Interesting Part 2
by: Wray

Hi Kelly But oral progesterone is the least effective Delivery system, "The liver and gut region removed a mean of 96 per cent of the progesterone entering these tissues" see here. So I never recommend it, besides it does make one sleepy as she says. I can't agree with bone loss being caused by the suppression of oestrogen. Yes it is needed to prime progesterone endogenously, but if using supplemental progesterone the priming affect is not required. There are over 30 nutrients needed for bone development, oestrogen is one tiny part. Excess calcium causes gall and kidney stones, arthritic spurs and calcification of the arteries and brain. Plus depression, blood glucose problems and increased risk of myocardial infarction. If any one mineral were taken, it should be magnesium, the most important co-factor for vitamin D. Our food usually has a high level of calcium, but it's low in magnesium. There have a been a few studies on D2 versus D3 and the D3 wins hands down, see here and here, here and here. I also feel it should be taken daily, large infrequent doses are not as effective. Most doctors believe, including Prior it seems, that "suppressing periods and estrogen levels" is dangerous. But there's strong evidence we should not be having the 400 odd periods we have in a lifetime, that in fact it should be no more than 100, see here. This is another worth reading, see here. Please consider increasing the progesterone. If you want further confirmation about it's safety, then please see this page here. Take care Wray
Jan 01, 2013
 Wow
by: Kelly

Thanks once again for all the information Wray. You really are tireless in helping the women who come here. I am gobsmacked that the study revealed so much of the oral progesterone was destroyed! It appears that it also had something to do with their diet, but it was mostly over my head. My gyn prescribed 12 pills of Prometrium (200 mg) every month, and I'm hesitant to give it up since my insurance covers it. I am also using cream on top of that, and it's getting expensive, but if most of it's destroyed then there isn't much point. I am almost tempted to use it vaginally, as I know some do to sustain pregnancies.

I agree with you about women probably having way more periods than necessary. Part of me wants to just take the high progesterone doses and suppress, but then I am hesitant to make what feels like a fake pregnancy, after all, pregnancy isn't just high progesterone, it is also high estrogen. I tried to read about hormone levels during lactational amenorrhea but couldn't make much sense of it.
Jan 02, 2013
 Wow
by: Wray

Hi Kelly Bless you for the kind words! Please don't give up the Prometrium, anything you can get out insurance do! But I did forget to tell you what I tell others, empty the contents into a small amount of skin cream and apply that to your skin. That way you get the full benefit, see this comment here. Pregnancy is high progesterone, but it's high oestriol, and the oestrogen women are always prescribed is oestradiol. Excess oestradiol causes the death of the foetus, and of course a miscarriage. Excess testosterone in pregnancy also causes foetal death and miscarriages, see here. If you wish to see the passage, please put 'Expression of 5-alpha-Reductase in the Brain' into 'control/find', it's a hugely long paper! Yes that one paper was rather long and complicated. I find most papers are, and wish they would get editors to make them into English one can understand! They tend to use words with ambiguous meanings, leaving you wondering what was it they meant! Take care Wray

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