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[dangermouse]

This is just a hypothesis that I've been trying to work out for my friend who has bad PMT (possibly peri) and who is on Studd's regime.

She started out feeling great on 3 pumps of gel, the best she'd felt for years, but after about a month or so she started to feel dreadful with all her symptoms returning with a vengeance. She didn't have to take the Utrogestan for about 2 months and when she finally added this in she felt even worse and had moments of feeling suicidal. When she saw Studd 3 months later he was puzzled by her reaction and suggested she go up to 4 pumps, but she has continued to feel bad but is determined to continue for the remaining couple of months due to the money and time she's already invested.

We were trying to work out what had actually occurred, considering how great she felt at the beginning and now I'm wondering if this makes sense - also for some women on here who have also been struggling with getting the dose right:

If it's a fact that 3-4 pumps will trigger ovaries to stop natural production (like the pill is meant to) to stop any volatility and control things better, and that this occurs after a month or so, perhaps it can create a deficit where 3-4 pumps on top of zero natural oestrogen isn't enough, compared to, say, 1-2 pumps + natural. The Utrogestan will then make things even worse as that lowers circulating oestrogen, which is already too low.

She had tried lowering to 1 or 2 pumps, but only sporadically to see if she felt better for a few days - and nothing changed. This would make sense if it will take at least a month or so for the brain to detect lower levels in order to start to produce its own oestrogen again.

In which case, it may be best for those in this situation to try going back down to 1 or 2 pumps for over a month to see if this allows ovarian production to restart (or stop if for a month to let everything reset and then just try 1 or 2 pumps). I suspect, upping to 6 pumps might achieve the safe but surely our own oestrogen will feel better than the external stuff - even if natural.

Anyway, just wanted to share this in case it makes sense to anyone else who is having problems with the dose and also finding the maths don't add up.

[CLKD]

Could it be that her own hormones kicked in …………

[dangermouse]

Well she felt great initially but then felt worse than when she wasn't on the regime, so I don't think it's her body getting used to it and then reverting back.

Obviously don't know for sure though.

[Milamam]

DM, interesting hypothesis! Is there a way it can be discussed with Studd - I wonder what his view would be - all in all it is his regime that he has tried on so many women, I doubt that he hasn't thought of what happens if you are in peri and then go up to 4 pumps/day. Does he have any clinical observations in this regard?
Milamam

[CLKD]

Maybe send an e-mail to Professor Studd's secretary and ask?

[Blue Kingfisher]

I think this is a very interesting hypothesis Dangermouse & I entirely follow the logic. Even if any specialist wanted to investigate this response in a patient.....how would they be able to differentiate natural production from applied therapy? Surely they can't....can they?

I think unfortunately with hormones, once an expert has recommended a treatment regime we are then individually our best monitors of how it actually works in practise. I've had experts tell me exactly how much & what type of thyroid hormone I need (backed up by very convincing bloods) yet my body doesn't agree with the hypothesis & for me I'm sure it has something to do with applied versus natural production.

Anyway, I've just started using Oestrogel myself (very early days) & am seeing one of Studd's consultants later this month so thank you for sharing your thinking, very interesting 

[dangermouse]

Yes, I suspect without hooking someone up to a constant oestrogen monitor it comes down to trial and error, as even if they found that 100 women had their ovarian production reduced at, say, 3.4 pumps, there maybe another 100 who would reduce at a completely different level. Plus the varying amounts of natural oestrogen between women and at the stages they're at would vary it further.

Just trying to find the logic as, despite the complexity of hormones, there should be some logic for one individual doing so well and then having the opposite occur, which seems to be an issue with some women on here.

If my friend finds this helps (or anyone on here) then would be happy to email Studd about it in case it hadn't been considered, although it seems quite a basic theory and maybe as its all so hard to measure and second guess he might just find upping the dose will eventually get everyone there in the end.

[Hurdity]

Dangermouse - I don't understand what you are saying? We never have zero natural oestrogen even in post-menopause. Also progesterone does not lower circulating levels of oestrogen - not sure where you heard that? If this were the case we would be in trouble in pregnancy! Both oestrogen and progesterone levels are extremely high. Our reproductive hormones are controlled by a very complex feedback mechanism involving the hypothalamus as well as the pituitary gland and ovaries - and several other hormones such as luteinising hormone, inhibin, anti-mullerian hormones etc.

Once ovulation is suppressed through high levels of oestrogen - there will no longer be the extreme surges as at ovulation but levels will still be much higher than during eg early follicular phase (not sure what they might be though - but presumably very variable in different women.). So if levels are high enough to suppress ovulation then they are high enough to eliminate flushes and sweats.

Lower than this ie 1 or 2 pumps - if you are having regular periods - will give very high levels at ovulation but will prevent the extreme dip to low levels that occur just as the period starts so should prevent the monthly extreme mood dip and associated anxiety. The whole point about the 4 pumps is to suppress ovulation but give enough oestrogen to prevent depression/anxiety. If it wasn't high enough then ovulation would not be suppressed.

That is my understanding anyway!

Hurdity x

[dangermouse]

Thanks. I'm probably explaining things badly as I meant that oestrogen and progesterone are antagonistic, so when one goes up, the other goes down - not necessarily to drastic levels though but this does also happen in pregnancy as its just the nature of these hormones (and testosterone is also antagonistic against oestrogen). The effect may be minimal though.

I have been told (and read) that, like with the pill, taking large amounts of oestrogen causes FSH to stop stimulating oestrogen production, so high enough levels shut down the ovaries (or make them dormant). In which case, surely taking a smaller amount adds to but doesn't affect natural production. I just meant zero oestrogen relating to dormant ovaries where they are meant to go to sleep and produce only minimal amounts due to the negative feedback loop. Or is this only with the pill and not high amounts of gel?

Saying that, I could still feel my hormonal fluctuations whilst on the pill but it did curb my oestrogen surges in quite a dramatic way, so wondered if the gel could do the same.

[saffy123]

Hi Dangermouse, I am interested in your post as I have increased estrogel to 3 pumps and I am starting to get back symptoms I had prior to starting. Thankfully not the anxiety yet (I pray that doesn't come back), but I have dry eyes, my hips really ache at night... and pmt most of the time, all of which I had pre HRT. Also my periods are back to around 28 days and I'm not even using any progesterone???

My initial thought is my body is no longer absorbing the gel...I had problems previoulsy and I just googled different sites and that seemed to help. Now I am at a total lost as to why I am back at square one.

I am thinking of changing to a patch to see if that makes any difference.....if anyone else is reading this and can shed any light on the matter, I would be very grateful xx

[donnacrichton]

This happened to me and it was my own hormones kicking in. They then tried to shut ovaries down and have only estrogel but even after what we thought was shut down my own still kept creeping in our of the blue. Now been on a different medication for shut down and so far nobe of my own kicking in just trying to get a dose right. Hormone level is still 70 estrodose and having to up slowly x

[clare663]

Hi. I too had to increase to three pumps a day as the initial 2 didnt stop the flushes. After a couple of days on 3 my anxiety crept back but the flushes stopped so I have reverted back to the 2 pumps again to see what happens. I am also using utrogestan 100mg 1-25 virginally.

[Hurdity]

Thanks. I'm probably explaining things badly as I meant that oestrogen and progesterone are antagonistic, so when one goes up, the other goes down - not necessarily to drastic levels though but this does also happen in pregnancy as its just the nature of these hormones (and testosterone is also antagonistic against oestrogen). The effect may be minimal though.

I have been told (and read) that, like with the pill, taking large amounts of oestrogen causes FSH to stop stimulating oestrogen production, so high enough levels shut down the ovaries (or make them dormant). In which case, surely taking a smaller amount adds to but doesn't affect natural production. I just meant zero oestrogen relating to dormant ovaries where they are meant to go to sleep and produce only minimal amounts due to the negative feedback loop. Or is this only with the pill and not high amounts of gel?

Saying that, I could still feel my hormonal fluctuations whilst on the pill but it did curb my oestrogen surges in quite a dramatic way, so wondered if the gel could do the same.

Yes you're right re the oestrogen and FSH but I still don't get your comment about oestrogen and progesterone being  anatagonistic - I mean they are independent of one another to some extent.  Also they are sometimes produced together - eg during second half of menstrual cycle. Progesterone receptors become active in the presence of oestrogen but are different from oestrogen receptors. Testosterone and oestrogen do have some sort of relationship but I can't say I know much about their mode of action in detail.  This explains hormonal control of the menstrual cycle very well! (only just discovered this site!) http://geekymedics.com/the-menstrual-cycle/.

Yes high doses of gel should act to inhibit ovulation through FHS in the same way as the contraceptive pill ( which also has high doses of progesterone). Lower doses of oestrogen will add to existing oestrogen - as you explained.

Hurdity x

[dangermouse]

Thanks, will have a good read later!

I was told by an endocrinologist (many years ago) that oestrogen and progesterone oppose each other and that, because I had low oestrogen levels for my age, I should take an oestrogen dominant pill to counteract the imbalance. I think it's like calcium and magnesium where they fight for the same receptors but I don't know for sure the scientific explanation, so I may have misunderstood if that doesn't sound right.

I had assumed that the reason so many had problems with progesterone HRT was due to it lowering their already dwindling oestrogen, as well as the side effects from high progesterone levels as I know some take extra oestrogen during the prog phase. That part was pure assumption though, so apologies for confusing anyone if that's not correct.

Anyhow, the main point is about the natural oestrogen being hit more by the higher amounts of HRT oestrogen, so would be good to know if anyone else has any stories to share that might support this theory, especially if they had higher blood test results after lowering oestrogen, which I'm sure I saw someone mention who is under Studd.

[andius]

I totally get what you are saying dangermouse.  I think progesterone must be able to bind to estrogen receptors and block the estrogenic effect somehow.... but maybe not change the blood levels.  Certainly if my progesterone dose is too high, I get low estrogen symptoms back (like I'm not taking estrogen) even when my patch dose is the same. Too hi prog in me causes bladder irritability, hot flashes, vaginal burning symptoms, etc.