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[Diabolique]

Thanks! It sounds like my estrogen level might be okay? I am 40 years old.

At this point, I cannot wait to just see the doctor again already to hear what she might say. Tomorrow, I have an ultrasound to rule out fibroids and ovarian cysts or tumors.

And now for the first time in months, wouldn't you know it, I have a "normal" period this morning. So weird!

[CLKD]

Let us know how you get on!

[scriv]

Early menopause and thyroid disorders are linked, so this could well be peri menopause...  each can be the cause of the other and symptoms can be similar, making each difficult to diagnose reliably lol.

Let us know how you get on. Good luck.

[Hurdity]

Hi Diabolique

  from me too!

A note re the oestrogen levels - in US and I believe some private gynaes in UK, estradiol is measured in pg/ml but in NHS in UK it is in pmol/l - which is what I'm used to thinking in terms of! This means they are 565 pmol/l. To convert from pg/ml to pmol/l you multiply by 3.671 so you oestrogen levels are fine - although depends when in the menstrual cycle they were taken which you don't know.  However as your progesterone is also low then you will be most likely in late follicular phase ( first half) before ovulation. However low progesterone could be the cause of the bleeding as could other problems in your uterus eg fibroids, thickening of the lining etc. It may be that you are not ovulating and your oestrogen is increasing suddenly causing the side effects? As others have said FSH is low so this is all normal.

I've just looked up the ref ranges for UK and there are here:

Estradiol ( in pmol/l)
http://www.gpnotebook.co.uk/simplepage.cfm?ID=570818627

Progesterone:
http://www.gpnotebook.co.uk/simplepage.cfm?ID=-2127232957&linkID=27643&cook=yes

FSH:
http://www.gpnotebook.co.uk/simplepage.cfm?ID=436600899

The definition of peri-menopause is quite tricky because as you will see from this forum women begin to experience changes and especially in relation to pms when offocial peri-menopause has not yet begun ( ie when periods start to lengthen) and this is what causes most of the problems especially when moving from one stage to another. HRT does not necessarily help all women at this point - because it is often the extreme fluctuations that lead to symptoms - although preventing oestrogen from dropping too low at the end of the cycle by giving low dose hRT can help some women.

I'm sorry this is probably not of much use but hope you get something out of it!

Mary G - that is an extremely high level of oestrgoen from two pumps! I'm thinking you still have some of your own oestrogen!! Also 75.4 pg/ml is not completely useless!! It is 276 pmol/l - which for some women would be more than adequate to eliminate symptoms. Mine were 212 from what I remember and I have no symptoms.... I know there is no absolute level at which symptoms disappear but even so that is very high!!!!!

Hurdity x

[Mary G]

Hurdity, yes, that is what the gynaecologist said but she also said it fluctuates.  It is very strange but for some reason, I really soak up the gel.  I have temporarily come off HRT several times over the years for base line blood tests and the result is always the same, 20.0 pg/mL.

I do take 25mg DHEA tablets every day and also a tiny bead of testosterone daily so perhaps that makes a difference because apparently testosterone can convert into oestrogen?

I have already reduced from the prescribed 3 pumps of gel to 2 but perhaps I will reduce it further not least because I still have heavy periods which is not surprising.  It is certainly baffling. 
 

[Diabolique]

So, I have finally had an intravaginal ultrasound and have spoken with the doctor. She said my hormone levels were great but a few things -- and I am trying not to freak out since I have previously had cancer:

1.) I may not be ovulating, thus the heavy periods, and this is because I have a growth on my ovary that was 2cmX1cmX2.5cm that confuses me: she called it a "complex hemmhoragic cyst." She said it was a guess only because part of the cyst that was imaged on the ultrasound was fluid, which is a "simple" cyst" but part was not "simple" so it was complex. Everything I have read on line about hemmhoragic cysts say that they are "simple" and just filled with blood. She said maybe some of the blood coagulated. But either way, she thought this was the source of my problems. I also have a simple cyst on my right ovary that is 8cmX8cm or so. Additionally, she said my FSH was low, and that it was because I was probably not ovulating? However, I feel like I AM ovulating since I have severe mittelschmirz that leaves me gasping in bed, after which I begin with the brown, bleeding.

I actually had a "real" period this month. It lasted one day and was bright red but then stopped. It wasn't clotted.

The doctor said I would have another ultrasound in 3months to see if the complex cyst grew; she said she wasn't worried about the simple cyst even though it was large. She asked me to track my periods for three months for her to review.
She said I was not in pre-menopause.

None of this explains my extreme PMS feelings though! Which I did not have before.

It does, however, explain why I cussed out loud when the ultrasound tech pushed against my left ovary.

I also found I have three small uterine fibroids which I have never had before. She said they were normal and were the size of cherries.

Thanks to everyone here, and now I am going to sit around hoping I don't have to have my left ovary removed, or worse, that it isn't more than a "complex hemmorhagic cyst" because I can't understand what that is. They are usually the opposite of each other. I am worried of course that it is a tumor, and that's causing me a lot of anxiety since I have played the waiting game before and wound up having cancer that time.

And why is she not concerned about the simple cyst the size of an orange on the right side? Okay, it's fluid-filled. But I have these EVERY TIME I go get an ultrasound? One was larger. Some are smaller. But I literally always have them.

Are fibroids really no big deal? I don't know anything about them.   

[dogdoc]

Hi Diabolique. Your symptoms sound very similar to mine and I too started in my late 30's. Symptoms 'hit like a brick' at 40 and went through 2 years of absolute HELL while doctors kept telling me it was 'stress and anxiety'. If only they would learn that 'stress and anxiety' are just symptoms of perimenopause instead of the cause of all the problems we'd be so much better off

I too had no hot flashes during that entire period, but hey have started in the last 6 months and I am currently in the process of missing my first period. Prior to this they were all over the map, but generally coming closer together initially ( very early peri) and much much heavier (with clots). So far for me I have found peri to be sort of a mountain. Symptoms started manageable, grew increasingly worse until there was a crescendo ( the Hell I mentioned) and for the last year or so I seem to be coming down the other side ( I pray this persists and my body is just not lulling me into a false sense of security

During the entire time my FSH was in the NORMAL range, estrogen always consistently low. FSH varies day by day and hour by hour and is VERY unreliable in predicting perimenopause. Anti-Mullerian hormone might be better but the labs have no consistent criteria at the moment, and the test is not generally run. Diagnosis should be based on symptoms, and ensuring there's nothing else going on ( i.e. thyroid, fibroids, iron levels etc). I have had every test in the book ( all normal) and yet here I am three years later with the hot flashes etc. They told me it was DEFINITELY not peri ( too young). I wanted to scream from the rooftops....speaking of which I highly recommend "SCREAMING TO BE HEARD".. it's validating if nothing else.

Good luck....at my worst I thought it would NEVER get better, but I maybe can glimpse the light at the end of the tunnel.
tara

[dogdoc]

Yes Sparkle. I'm still having blips of anxiety, weeping, generally feeling unwell but compared to 2014 its practically paradise. Hot flashes start in the wee early morning hours and almost all the anxiety, negative thinking and mood issues are isolated to a few hours in the morning when I get up...thinking it's the high cortisol in the morning which is 'normal' but i'm guessing out of whack.

I pray for both of us, and all the other  'peri ladies in the middle of the hell time' that the mountain has been climbed, conquered and that it'll be much smoother sailing from here on out. If there is one thing that peri has taught me however is you never know what's coming next....

[GypsyRoseLee]

Dogdoc can I ask why is it that our cortisol surges so much in the early morning?

I go to bed feeling calm. If I wake in the small hours to use the loo, I feel perfectly calm. But when I wake at 6am (it's always dead on 6am now) within 15 seconds I can feel the cortisol surging and I HAVE to get up.

[dogdoc]

It is normal to have a cortisol surge in the morning. Everyone who has normally functioning adrenal glands has one. The problem with hormonal imbalance is everything is exaggerated. All our hormones are interconnected ( for instance lower estrogen often can cause low serotonin, which is why some women are helped by SSRI's during this time). My theory is that my entire endocrine system has been thrown out of whack. Cortisol, estrogen, progesterone ( and their ratios to each other), testosterone, even T4, serotonin etc. all of them. Makes sense when you think about what 'master hormones' estrogen and progesterone are. They have an effect on virtually every tissue in our bodies, including our adrenal glands, pituitaries, and neurons- the very tissues that produce most of our chemical messengers.

Fun times for everyone

Tara

[GypsyRoseLee]

That makes sense dogdoc. I also feel that my previously delicately balanced hormonal system is now just fizzing and exploding willynilly.

I had a couple of days last week where I woke feeling nicely calm, and just 'normal' inside. This proves to me that just occasionally my confused hormones align correctly with themselves, and the HRT, to create normality again, but only briefly.

I think probably the most effective treatment for me would be to just have my own ovaries completely shut down, with that injection. At least then HRT would have more chance to work without my own hormones creating havoc in the background.

I think taking the HRT I am at the moment is giving me too much oestrogen on some days, and too little on others, and only occasionally are the levels alright. Then when you factor in the effects of synthetic progesterone... well, it's just chaos, really.

Good days, bad days, evil days, desperate days, bland days - with no respite. Since starting peri I have never enjoyed more than 2 weeks of feeling consistently okay and normal.