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[Postmeno3]

Yes, the very mention of oestrogen dominance seems to cause the medical profession in this country to get a bit flustered. In complementary health, it's well recognised, but, up against the taboo that seems to be attached to it, it remains unsubstantiated but without any evidence to prove otherwise. You're right, Sheila99, it is VERY sadly an area of medicine where we seem to know far too little.

[Wrensong]

You may find these threads interesting if you haven't seen them before.  They include comments from Hurdity. 
The last one goes off the rails onto thyroid but initially there's some interesting stuff.
Wx

https://www.menopausematters.co.uk/forum/index.php/topic,33124.15.html

https://www.menopausematters.co.uk/forum/index.php?topic=41277.0

https://www.menopausematters.co.uk/forum/index.php?topic=41454.0

https://www.menopausematters.co.uk/forum/index.php?topic=47412.0

[Scampidoodle]

Thanks Wrensong they’re interesting threads.

I see there is much debate over the term ‘oestrogen dominance’ - whatever we call it, it’s clear some people need progesterone in addition to or instead of estrogen. We’re all different I guess.

[Mary G]

When medics refer to oestrogen dominance I think they are talking about oestrogen spikes and generic hormone imbalance during peri menopause.

For example, progesterone goes west before oestrogen in peri menopause so it could be argued that too much oestrogen and not enough progesterone is oestrogen dominance.

I now know that it was the lack of progesterone that caused my silent migraines at the onset of the menopause - I had silent migraines which are caused by oestrogen spikes.  Progesterone gets a bad press for obvious reasons but I think most women need a small amount, just not too much of it.  Body identical progesterone has therapeutic effects but synthetic progesterone does not.

[Scampidoodle]

What did you do to combat that Mary? Or is it just with hindsight you now know that was the case? X

[LadyCC]

It's real and refers to the ratio of estrogen to prog. It can be either because estrogen soars in early Peri or because your Prog lowers and it makes the ratio off.

My first symptom of Peri was estrogen dominance (confirmed by rhythm hormone tests which are the same as the DUTCH test mentioned, rather than a random blood test which shows very little). My primary symptom was terrible swollen painful boobs from days 14-28 - I mean REALLY painful, to the point I sought medical help. This was because in the latter half of your cycle when Prog should rise as well as estrogen it wasn't for me so the ratio was off and I became "estrogen dominant".

When I stopped experiencing the terrible boobs / estrogen dominance was when my estrogen also began to fall... and that's when all the real trouble started 

Youve explained it perfectly (in a way that I couldnt lol).  As I understand it, even if both progesterone and oestrogen is low but progsterone is low in comparison to oestrogen then this can cause oestrogen dominance.  My experience is PMS symptoms and I have experienced the painful boobs too.

[Mary G]

Scampidoodle, the answer to that is with difficulty and with very little help I'm afraid.

I eventually established the cause of the silent migraines with the help of a hormonal migraine specialist but that was some time later.

Looking back, I now realise that I was suffering from progesterone drop off for about 10 years before my periods stopped.   I started having claustrophobia and panic attacks on the tube on the way to work but I didn't make the connection (I'm pleased to say my panic attacks have now disappeared).   It was in 2004 when the migraines began and a few years after that when I started sweating profusely and my periods suddenly stopped.   So I had two problems, progesterone deficiency which was causing the migraines (and the panic attacks) and oestrogen deficiency causing the profuse sweating.

My then GP was useless.  I had a Mirena at the time so I stated using patches but they were not very effective.   I consulted a specialist who prescribed three pumps of Oestrogel, testosterone and 7 days of 100mg Utrogestan every month and that worked well for a number of years but that high dose of oestrogen has a shelf life and is difficult to maintain long term.   That regime helped enormously and eradicated all menopause symptoms but I hated the Utrogestan phase and it often triggered migraines, probably because it caused hormone instability.  For me, a high dose of progesterone doesn't work, I need a slow steady dose.  I also found that the bleeds made me feel ill. 

The migraine specialist said I needed to keep my hormones as stable as possible and avoid a cycle.   By this time, I was several years post menopause so I no longer had the oestrogen surges.   She said that the reason I did not suffer with migraines during my reproductive years was because my own produced progesterone was acting like a hormone stabiliser and my oestrogen was not spiking.   Unfortunately, it's very difficult to achieve that kind of hormone stability with HRT.  She suggested I switch to a continuous combined regime to avoid the seesawing hormones of a cycle and that I reduce the oestrogen dose to one pump of gel.   Her thinking was that I should not need such a high dose of oestrogen at my age and at that stage of the menopause.

She was right.   I have been on a low dose, continuous combined regime for nearly three years now and so far, so good.   My current regime would have been completely useless 10 years ago but I'm 60 now and very post menopause so my needs have changed and I can be symptom free on a much lower dose of oestrogen.  I think this is going to be as good as it gets.  In an ideal world, I really needed to replicate my own cycle exactly but that can't be done.

I think the menopause is an evolving situation and your needs change over time.   

I hope that helps.

[Lamplighter]

Hi Mary, reading your answer (and this thread) with interest, and was curious about this comment of yours:

I consulted a specialist who prescribed three pumps of Oestrogel, testosterone and 7 days of 100mg Utrogestan every month and that worked well for a number of years but that high dose of oestrogen has a shelf life and is difficult to maintain long term.

I wondered what you meant by a) three pumps being a high dose (I'm currently on three and am thinking of upping to four); b) that it has a shelf life and c) why is it difficult to maintain long term?

Would dearly love to hear an explanation as it worries me (for obvious reasons - as I have every intention of staying on HRT very long term!)

Thanks

LL

[Mary G]

Lamplighter, I'm sorry, it wasn't my intention to worry anyone, it's just my personal experience!

Three pumps of gel and a low dose progesterone gave me an oestrogen blood reading in the high 800s which resulted in heavy withdrawal bleeds.   I found the bleeds pretty grim 10 years ago but it is definitely not something I would want to endure at the age of 60.  That is what I meant when I said that this regime had a shelf life and is difficult to maintain.   If you don't have a womb, you are able to tolerate high doses of Utrogestan or you have a Mirena coil it might not be a problem and if three pumps of gel works for you there is no reason why you should not continue with it.

None of those progesterone options are possible for me because of my migraines but I'm am unusual case.   That aside, you are probably much younger than me (most people on here are now!) and you may also find that you can be symptom free on a lower dose of oestrogen when you get to my age.   Always be prepared to adjust your dose of necessary.

I'm also an HRT lifer but now it's just a maintenance dose to keep everyone well oiled as it were!

[Lamplighter]

Hi again Mary G, thanks for the quick reply.  Sorry to hear the reasons you couldn't maintain a high dose of oestrogen, it's all so fraught this HRT business.

I'm actually 65 (but don't tell anyone  ) and post menopause 12 years, seven of which I've been on HRT with varying degrees of success.  I'm not sure that I can tolerate high doses of progesterone (only been on the Oestrogel/Utrogestan regime for five months) but am on a continuous regime so don't get bleeds.  Still finding my way after having used a now discontinued HRT for the first five years with total resolution of all the awful post meno symptoms - it's such a frustrating exercise.

But thank you for explaining - any hint that I might have to stop HRT, regardless of whether it's working brilliantly or not really freaks me out 

Best of luck with your maintenance regime xxx

[Hurdity]

Ha!! This is a minefield! I'm just signing off for the day so no time to read or reply properly but had to make a quick comment. Thanks for posting the links Wrensong but I haven't seen what I said in them!!!

I've already commented in two other threads this morning about the notion of needing progesterone for anything other than womb protection.

As Gilla99 says - oestrogen dominance as such occurs in peri-menopause because of the extreme hormonal fluctuations and anovulatory cycles ( where you don't ovulate) and therefore no additional progesterone is produced. It doesn't mean that we need additional progesterone to balance the symptons of large spikes in oestrogen but we may need it to regulate periods and protect the womb. Progesterone doesn't balance oestrogen in terms of how we feel as far as I know.

Our natural menstrual cycle goes through phases of "oestrogen dominance" when oestrogen is rising and becomes high, and being less so - in the second half of the cycle. Most women feel at their best during the first part of the cycle when there is very little progesterone - and often worse during the second half when progesterone peaks, or during the progesterone withdrawal  just before the period (and this is a metabolic phenomenon - not an indication that we "need" progesterone to feel well).

It was a term invented as a problem (or perhaps developed), I gather to sell progesterone cream from which obviously a great deal of money is made.....

There is, I gather a minority of women that do thrive on additional progesterone, and also some women benefit from the sedative qualities of progesterone - but that's not because it is needed to "balance" oestrogen as such, as I understand - more that it is used perhaps a a sleeping aid? If you want to use it ike that - fair enough - but I would hate for women to feel they need to spend hundreds of pounds chasing an elusive treatmennt that may not be justified....


All for now 

Hurdity x

[Mary G]

Lamplighter, you are obviously taking enough Utrogestan to keep the dreaded bleeds away so that's great.   I should explain, I take 50mg progesterone every day so 100mg every day for me personally would be a high dose - I tried it but failed miserably.

I'm pleased you have found a regime that works.   What a pity your previous HRT was discontinued when it was working so well for you.

Always remember that you are in charge and the only person who decides whether or not you take HRT is you.

[Wrensong]

Thanks for posting the links Wrensong but I haven't seen what I said in them!!!

  Ah, Postmeno3 posted she was hoping you'd be along to give your view & remembering the topic had come up before & you weren't around, the old threads seemed a good substitute 
Wx

[Alicess]

Estrogen dominance is a misleading expression. There a more estrogens like estrone which don't get enough attention while their influence on our welbeing and hormonal balance can be profound.

Simply put; estradiol is made from conversion from estrone.
Estrone is a weak estrogen with only 4 % of the potency of estradiol.
Estrone can act as a partial antagonist of estradiol. It counteracts estradiol
Estradiol, especially from HRT, can convert back to estrone. It is said transdermal estradiol will only convert partially to estrone in a ratio of 1:1
Estradiol in HRT gave me hot flashes, I had my levels checked while on transdermal estradiol (patches) and my ratio was estradiol 1: estrone 7. So most of the estradiol converted to estrone.

Normale blood levels for estrone:

Postmenapausal without estradiol therapy :  31 - 100  pg/ml
Postmenapausal with estradiol therapy:        51 - 488  pg/ml

The conversion of estrone to estradiol and vice versa is catalysed by 17 HSD or 17β-Hydroxysteroid dehydrogenase

https://en.m.wikipedia.org/wiki/17%CE%B2-Hydroxysteroid_dehydrogenase

17 HSD  type 1 converts estrone to estradiol  and androstenedione to testosterone
17 HSD type 2 converts estradiol to estrone and testosterone to the weaker androstenedione.

There is ongoing research into  inhibition of 17 HSD type 1 for breast cancer treatment and
inhibition of 17 HSD type 2 to prevent osteoporosis

Progesterone increases estrone- activating enzymes. More estadiol is converted to estrone.

Transgender(men to female) are already very aware of this conversion and have their blood levels checked for estradiol and estrone.

It's very difficult to know what our estradiol levels are, as bloodtests are unreliable but by also testing for estrone we, atleast, know if too much estradiol is converting to estrone or vice versa. It seems more prudent then wondering if our symptoms are caused by estrogen dominance.or not as that's almost impossible to know for sure.

Alicess

[LadyCC]

Ha!! This is a minefield! I'm just signing off for the day so no time to read or reply properly but had to make a quick comment. Thanks for posting the links Wrensong but I haven't seen what I said in them!!!

I've already commented in two other threads this morning about the notion of needing progesterone for anything other than womb protection.

As Gilla99 says - oestrogen dominance as such occurs in peri-menopause because of the extreme hormonal fluctuations and anovulatory cycles ( where you don't ovulate) and therefore no additional progesterone is produced. It doesn't mean that we need additional progesterone to balance the symptons of large spikes in oestrogen but we may need it to regulate periods and protect the womb. Progesterone doesn't balance oestrogen in terms of how we feel as far as I know.

Our natural menstrual cycle goes through phases of "oestrogen dominance" when oestrogen is rising and becomes high, and being less so - in the second half of the cycle. Most women feel at their best during the first part of the cycle when there is very little progesterone - and often worse during the second half when progesterone peaks, or during the progesterone withdrawal  just before the period (and this is a metabolic phenomenon - not an indication that we "need" progesterone to feel well).

It was a term invented as a problem (or perhaps developed), I gather to sell progesterone cream from which obviously a great deal of money is made.....

There is, I gather a minority of women that do thrive on additional progesterone, and also some women benefit from the sedative qualities of progesterone - but that's not because it is needed to "balance" oestrogen as such, as I understand - more that it is used perhaps a a sleeping aid? If you want to use it ike that - fair enough - but I would hate for women to feel they need to spend hundreds of pounds chasing an elusive treatmennt that may not be justified....


All for now 

Hurdity x

I can only go by what my practitioner has said only yesterday but I have been advised to increase utrogestan in this instance until pelvic discomfort aka PMS type symptoms abate so would say that it is for other uses.  These symptoms I am trying to manage came on when I re-introduced oestrogen in the form of Biest (Bi estrogen).  Whilst the 'cramping' feels the same as at the totm, it is different since I have been in perimenopause in that I can no longer address it just by taking paracetemol for example.  At the moment, instead of 1 capsule she is suggesting 2 every other day for a week.

I can see that I appear to have a different response to hrt than most on here - I have never got on well with oestrogen since embarking on hrt.  I would think that if my hormones are fluctuating as they should be at this time, that at some points using the oestrogen it would be providing me respite from other symptoms but that is not the case.  For me, it seems to build up in my system and not detoxify adequately hence using DIM to assist with detoxifying down the correct pathways.  And unless it is utrogestan causing me to retain this awful weight I have gained since onset of perimenopause, I have no other issues taking that and do find it helps at least with sleep.