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[BrightLight]

Out of curiosity really (I feel shamefully lacking in my awareness of my hormones until now).  Perimenopause is the period of time where ovulation and hormone production become erractic.  Progesterone declines quicker than estrogen, most symptoms experienced can be assumed to be because of this lack of balance between the two.  Mostly I read that estrogen is the presumed culprit of hot flashes etc

Does hormone replacement therapy stop this process or does it 'sit' on the top of it, as it were and top everything up to levels where they are not low and thus alleviate symptoms?  Is that the aim of the game?   Will natural hormones continue to decline 'underneath'?

What I am wondering (because my jury is still marginally out on HRT as an option for me) is this - if estrogen levels are raised higher than ever during perimenopause and you add estrogen, aren't you going to create more symptoms or at the least very high levels of estrogen? I understand replacement when estrogen has started it's journey into true decline as this seems fairly obvious to replace it then, along with progesterone to get the balance that was there pre perimenopause.

[CLKD]

We need Hurdity here  ………. the HRT is to top up what our bodies should be making.  We take HRT to lessen symptoms of hot flushes etc. as well as to protect heart and stave off osteoporosis.

[honorsmum]

I'm going to watch the replies with interest.

Oestrogen dominance seems to be a buzz word on the US forum I follow. The emphasis seems to be largely on boosting progesterone, with one member saying that her doctor came close to killing her by prescribing oestrogen without realising she was already oestrogen dominant.2 years on and she's still not fully recovered.

I was wondering how HRT is prescribed, if the relationship between levels of oestrogen and progesterone isn't established by blood tests? Is this what makes trying HRT such trail and error for some women?

Does oestrogen really "fight back", when progesterone is introduced, as I've read? Is this why people feel worse before they feel better?

[CLKD]

The relationship between oestrogen and progesterone is 'natural'.  Because hormone levels vary on a moment-to-moment basis and not only sexual hormones, then blood tests are reliably un-reliable! which is why my Gynae won't do 'em.  He goes on symptoms.

As we age we don't need as much oestrogen  ……. no longer required for child bearing etc. …..

[BrightLight]

The more I think about this, the more I am interested - even if there is no easy answer and it is just theories.

I do believe in the concept of estrogen dominance - much as I believe some women have hormonal balance issues for a lot of their lives and also that menopause might just be a great opportunity to resolve them once and for all

I have always wondered if my body was operating in an unbalanced way and didn't pursue it with my Dr's because as they put it "unless you want children it doesn't matter" or "no there is no link to these things" - I am refering to several ovarian cysts, fibroids very young, cervical polyp and mild melasma for years.  None of these issues caused me major hassle so I didn't pursue anything, but these are signs of estrogen excess I believe.

I really am wondering or perhaps hoping that my body will eventually be happier with less estrogen - just a theory

[BrightLight]

The relationship between oestrogen and progesterone is 'natural'.  Because hormone levels vary on a moment-to-moment basis and not only sexual hormones, then blood tests are reliably un-reliable! which is why my Gynae won't do 'em.  He goes on symptoms.

As we age we don't need as much oestrogen  ……. no longer required for child bearing etc. …..

These doctors are clever because when I look up my symptoms some of them overlap and are said to be caused by either of the hormones - I guess if you are out of balance a good doctor can tell from your symptoms - I wish we could

[honorsmum]

The relationship between oestrogen and progesterone is 'natural'.  Because hormone levels vary on a moment-to-moment basis and not only sexual hormones, then blood tests are reliably un-reliable! which is why my Gynae won't do 'em.  He goes on symptoms.

As we age we don't need as much oestrogen  ……. no longer required for child bearing etc. …..

These doctors are clever because when I look up my symptoms some of them overlap and are said to be caused by either of the hormones - I guess if you are out of balance a good doctor can tell from your symptoms - I wish we could

BrightLight, that's what I'm thinking. Whenever I look at my symptoms online, they are indicative of both low oestrogen AND low progesterone. I'm guessing that these symptoms checklists are not particularly sophisticated, and a specialist/experienced doctor can differentiate more accurately.

[BrightLight]

The relationship between oestrogen and progesterone is 'natural'.  Because hormone levels vary on a moment-to-moment basis and not only sexual hormones, then blood tests are reliably un-reliable! which is why my Gynae won't do 'em.  He goes on symptoms.

As we age we don't need as much oestrogen  ……. no longer required for child bearing etc. …..

These doctors are clever because when I look up my symptoms some of them overlap and are said to be caused by either of the hormones - I guess if you are out of balance a good doctor can tell from your symptoms - I wish we could

BrightLight, that's what I'm thinking. Whenever I look at my symptoms online, they are indicative of both low oestrogen AND low progesterone. I'm guessing that these symptoms checklists are not particularly sophisticated, and a specialist/experienced doctor can differentiate more accurately.

Yes and that's why I wish you well with Annie Evans - definately pays to have someone who has detailed knowledge and experience, many GP's just don't.  The private GP I visited last week to talk through things did suggest my progesterone could have been very low in relation to estrogen and that if I do try HRT she suggested low estrogen as a start but she would need baseline bloods levels - I know they fluctuate but she wanted a guide to see if they were ok ish or 'in my boots' as she put it   My regular GP will not give me blood tests, so I still have to decide whether I will pay for these - this journey is excruiating - just want to get on with things and stop working out the mystery.

[BrightLight]

What are the symptoms for being estrogen. Deficient and the symptoms  for protesterone deficeint.?

That's the thing Julie, I am not quite sure. Most of the symptoms of menopause like hot flashes are reported as estrogen deficient symptoms but in truth it's just a symptom of estrogen and progesterone being out of balance but we tend to focus on estrogen as deficient and I don't know why.  For some women things like anxiety are said to be from falling estrogen but progesterone is a calming hormone too, ?

Here's a list of what each do in the body which :

Estrogen has many benefits. These include:

    Preventing of heart disease
    Stroke prevention
    Osteoporosis prevention
    Decreased Alzheimer's risk
    Preventing urogenital atrophy
    Preventing macular degeneration
    Reducing menopause symptoms such as hot flashes, depression, and mood swings
    Reducing memory loss
    Reducing tooth loss
    Reducing colon cancer

Progesterone has a number of physiological effects, usually to counteract the effects caused by estrogen. The effects and benefits of progesterone include:

    Increases breakdown of fat
    Protects against endometrial cancer
    It is a natural diuretic
    It is a natural anti-depressant
    It exerts a calming, anti-anxiety effect
    Increases libido (sex drive)
    Helps prevent osteoporosis (when combined with estrogen)
    Decreases PMS Symptoms
    Decreases carbohydrate cravings

[BrightLight]

Both play a part in everything as far as I can see - progesterone is good for heart health for instance and estrogen too.  The thing is - it is definately reported that high estrogen can be damaging but I can't see the same for progesterone, so I wonder why estrogen is the priority to replace and the main focus???

[Dancinggirl]

Hi Brightlight - You need Hurdity for your questions - she has a biology background and is very good at explaining these types of questions.
I think this idea of oestrogen dominance is a bit of a red herring.  You are wondering about the balance of progesterone with oestrogen to control meno symptoms but if progesterone was key then women who have had a hysterectomy would need progesterone as well to relieve symptoms - they usually only need oestrogen to control their symptoms.
My understanding is that through the peri stage our hormones are fluctuating and declining and this will usually happen over some years.  Whether with early ovarian failure the ovaries suddenly stop functioning and therefore stop producing oestrogen or whether there is a slow decline, I suspect that will vary from women to women. Even in post meno we still produce some oestrogen and I think this can depend on body fat - this is why women who have had a breast cancer that is oestrogen sensitive are given drugs to strip the body of as much oestrogen as possible to reduce their risk of the cancer coming back.
One of the main problems with the peri stage is the fluctuating of the hormones and this will give rise to symptoms kicking in and out.  If you use HRT through this stage I'm sure there is going to be some dominance of oestrogen at times and I certainly found that I didn't feel good when I tried too high a dose of HRT when I was peri. BTW I think my peri stage lasted about 6 years.
One must bare in mind that through our reproductive years our hormone levels also fluctuate constantly and through pregnancy levels can be very high indeed - in the first 3 months one can feel sick and headachy as the body is producing extra hormones to keep the baby where it should be, then after that you start to feel really great because a different hormone balance kicks in.  I believe the tendency toward girls being rather overweight these days actually increases the amount of oestrogen they produce - I could be wrong on this but I'm sure I read about this somewhere. One of the symptoms of anorexia is the cessation of periods due to lowered hormone levels - so body weight has a significant effect on hormones.
When I was given the Oestrogel with separate progesterone this was so much better.  Oestrogel allows you to adjust your dosage to the amount that keeps symptoms under control - so in a way is ideal for the peri stage.
Interestingly women who have had a hysterectomy and take oestrogen only are actually less likely to get breast cancer!!!!
Hopefully Hurdity will be along with some science for you.  DG x

[dahliagirl]

Oestrogen dominance seems to be the thing at Cemcor in Canada http://www.cemcor.ubc.ca/, where it is asserted that the theory that you need oestrogen during perimenopause is wrong, because oestrogen is actually at a higher level than normal.  This should be treated with progesterone.

I am sceptical, myself.  From what I remember of my human biology lessons, many years ago, there are complex feedback mechanisms.  We only produce progesterone after ovulation, from the ovary where the egg has been released, so it is not in your system all the time, unless you are pregnant (or on the pill).  And anyway, it gives me terrible constipation, so I do have a personal aversion to the idea 

Normally, you would produce oestrogen in the first half of your cycle, while the follicle is ripening in the ovary.  This peaks as you ovulate.  Progesterone is produced by the corpus luteum, which is what is left in the ovary when you have ovulated, and this produces a spike just after ovulation (you can measure this as a small temperature rise, if you chart your cycles).  After a couple of weeks, this degenerates and the ovaries stop producing progesterone and oestrogen, their levels crash, and you have your period.  (unless you are pregnant, then hormones from the fertilised ovum keep this going until the placenta takes over)

During perimenopause, the follicles in the ovary are a bit knackered.  So sometimes, the FSH will be stimulating the ovaries to produce oestrogen and the follicle does not ripen, the levels go up and eventually crash and you might get a bleed, without ovulating. Or not get a bleed and start another cycle. Sometimes, it might be more prolonged, or shorter.  Sometimes, the ovaries might not respond at all for a while, then start up.  You might ovulate, but the egg is a bit past it, and the corpus luteum and bit past it and you get a sort of progesterone rise, or you could get a big one! Or you could ovulate normally for a while.  So your oestrogen levels can fluctuate from very high to nothing, and progesterone levels are intermittent.

The possiblilities are endless.  If you take progesterone all the time, it might help reduce the bleeding, and proliferation of the endometrium, like taking norithisterone does, or mirena coils but minipills, which have less progesterone don't usually have much effect.  Smaller amounts may stop you ovulating when you are close to menopause, but I am not sure that helps.

I am sure that conventional hrt is fine - it has the progesterone which stops the endometrium proliferating, and the oestrogen which stops you hitting rock bottom.  I am sure this helps your body's feedback systems stop  levels from going sky high once you settle on it and help stabilise your levels.

This is just my take on it - hopefully someone will come along who can remember stuff 

[BrightLight]

Thank you DancingGirl - wow I didn't know that breast cancer survivors were stripped of estrogen! You explain the rise and fall and effects of estrogen really well and that you did feel an imbalance and have adjusted it.  Yes body fat is clearly related, that's why our bodies change shape shift I think

It isn't so much that I think progesterone is 'the answer' I just wonder about 'too much' estrogen in general and why are the benefits/symptoms of progesterone not considered when using hormone therapy. I guess if the current protocol works then it works.  Do some people need more progesterone than estrogen in their HRT - does it work like that?

[BrightLight]

Oestrogen dominance seems to be the thing at Cemcor in Canada http://www.cemcor.ubc.ca/, where it is asserted that the theory that you need oestrogen during perimenopause is wrong, because oestrogen is actually at a higher level than normal.  This should be treated with progesterone.

I am sceptical, myself.  From what I remember of my human biology lessons, many years ago, there are complex feedback mechanisms.  We only produce progesterone after ovulation, from the ovary where the egg has been released, so it is not in your system all the time, unless you are pregnant (or on the pill).  And anyway, it gives me terrible constipation, so I do have a personal aversion to the idea 

Normally, you would produce oestrogen in the first half of your cycle, while the follicle is ripening in the ovary.  This peaks as you ovulate.  Progesterone is produced by the corpus luteum, which is what is left in the ovary when you have ovulated, and this produces a spike just after ovulation (you can measure this as a small temperature rise, if you chart your cycles).  After a couple of weeks, this degenerates and the ovaries stop producing progesterone and oestrogen, their levels crash, and you have your period.  (unless you are pregnant, then hormones from the fertilised ovum keep this going until the placenta takes over)

During perimenopause, the follicles in the ovary are a bit knackered.  So sometimes, the FSH will be stimulating the ovaries to produce oestrogen and the follicle does not ripen, the levels go up and eventually crash and you might get a bleed, without ovulating. Or not get a bleed and start another cycle. Sometimes, it might be more prolonged, or shorter.  Sometimes, the ovaries might not respond at all for a while, then start up.  You might ovulate, but the egg is a bit past it, and the corpus luteum and bit past it and you get a sort of progesterone rise, or you could get a big one! Or you could ovulate normally for a while.  So your oestrogen levels can fluctuate from very high to nothing, and progesterone levels are intermittent.

The possiblilities are endless.  If you take progesterone all the time, it might help reduce the bleeding, and proliferation of the endometrium, like taking norithisterone does, or mirena coils but minipills, which have less progesterone don't usually have much effect.  Smaller amounts may stop you ovulating when you are close to menopause, but I am not sure that helps.

I am sure that conventional hrt is fine - it has the progesterone which stops the endometrium proliferating, and the oestrogen which stops you hitting rock bottom.  I am sure this helps your body's feedback systems stop  levels from going sky high once you settle on it and help stabilise your levels.

This is just my take on it - hopefully someone will come along who can remember stuff 

Thanks - you seem to have your head around this.  I have not really understood entirely the progesterone only approach, but I do think it might have a role, although from your description I can see that in the natural cycle of things it wouldn't be in the body because an egg hasn't been released. 

I can see that if someone didn't respond well to high estrogen that progesterone could treat some of the symptoms (?)  Presumably some people's feedback loop isn't working properly and my thoughts are about how hormone replacement might just continue the trend - thinking it through, it probably does, but then you would adjust it. Just as you found progesterone didn't suit you, if estrogen made me feel unwell I can adjust it. 

Beyond this balancing act in perimenopause progesterone as a medicine on it's own seems to have a lot of benefits - not just as an HRT.  Estrogen isn't looking so friendly to me   Seems to be one of those can't live with it, can't live without it to me.

[honorsmum]

Have you considered trying a bioidentical progesterone cream, BrightLight?
I've read mixed reviews, but lots of positives among them. Worth a whizz, for research purposes?