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[dangermouse]

Language and accuracy aside, I thought this was a helpful diagram to show why hormonal imbalance is so hard to control between ages 45 and 55 (on average), before levels are consistently low. Progesterone drops off by 75% by the age of 50 and oestrogen only by 35% and, for me, this graph equates with my experience of when things became much worse as the gap became wider.

http://www.dramybrenner.com/images/estrogen_dominance_sm.jpg

It would suggest that progesterone only, or a higher ratio to progesterone to oestrogen, is more effective in perimenopause but it appears to be a difficult one to top up without side effects.

Just thought this may be helpful for those who are in the midst of the imbalance to see things will even up at some point. I suspect early post menopause may also sit inside the imbalanced area as periods may stop prior to the full on plummet of both hormones.

[Hurdity]

Oestrogen dominance is the theory that was originally developed in order to produce and sell progesterone cream.

The thing is - it is true to a certain extent - in the sense that in peri-menopause, women experience some anovulatory cycles - where the follicles start to develop, oestrogen is produced, but ovulation does not take place.  Therefore there is no corpus luteum ( from the ruptured follicle) and no progesterone. There is no menstrual bleed and the womb lining builds up - so the period is much heavier when ovulation does eventually take place.

So, if women's progesterone levels are measured then of course they will come out lower (on average) - due to the presence of these anovulatory cycles. Extra progesterone is only needed in large quantities to prepare for and to maintain a pregnancy and the balance is only important to prevent the womb lining from thickening. Once periods start to be skipped though, oestrogen levels may well also start to decline overall (after all there is no ovulatory peak or surge) so at this point a low dose HRT often helps both to top up the oestrogen and to give sufficient progesterone to keep the lining thin and regulate the cycle/bleed. Some gynaes suggest the BCP ( the ones with estradiol) at this point as giving better control - although these have very high dose of synthetic progrestogens which do not agree with some women.

It is explained very well in this article on peri-menopause:
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

What I don't know and haven't been able to find out, is whether the corpus luetum itself produces less progesterone as the ovaries start to fail during peri-menopause - which could compound the lack of progesterone and exacerbate the problem of over-thickening - but HRT/BCP would help if this were the case.

Progesterone does not plummet as such in post-menopause in the same way that oestrogen does over the next two years -  once you are post-menopausal extra progesterone will of just not be produced because ovulation has ceased - but there is no evidence that you need it at this point!!!

Hurdity x

[dangermouse]

Yes it's a shame these things can't be properly tested otherwise it is just theories and opinion.

The progesterone cream industry haven't helped matters but I have seen this statistic mentioned numerous times by gynocologists (like this one) and endocrinologists. However, as most of their menopause training would be from external companies it may all just be untested theory - but it would explain why it's so tricky to get balanced with HRT during perimenopause.

I have not had any annovulatory cycles yet but I have felt much worse in line with the graph so far and oestrogen supplementation has excacerbated all of my symptoms. I don't know if this is because of oestrogen surging very high in an attempt to offset the falling levels, or because there is this faster fall in progesterone upsetting the balance. Or maybe a bit of both.

I'm really hoping I've just left that middle line as I've had no nausea this month and I'm starting to feel how I did 18 months ago - which was generally rubbish but all the overstimulation (heart, stomach, eyes, ears etc.) has calmed right down and I no longer feel as if I'm on a boat in the middle of a storm!

Would be nice to feel good though so I will keep exploring HRT options.

[dahliagirl]

In theory, you should be able to chart your progesterone levels by taking your basal body temperature each morning, in the same way as natural family planning methods.  The body temperature rises a small amount in the presence of progesterone.  After ovulation, there should be sharp rise, as the corpus luteum starts to release progesterone.

I did this for 18 months.  I used to get a slow rise, after ovulation should have happened (by other symptoms) which usually collapsed after a week and resulted in yet another period.  I interpreted this as knackered follicles - giving out a lower amount of progesterone, then failing early.  Unfortunately there was nothing out there for me to find out more.  I did get one really good ovulation just before I started hrt though  .

I found it harder to measure temperature, as lack of sleep (staying awake, then falling asleep at 6am and crashing out, or waking at 4am and not getting back to sleep mean that you are not measuring the basal temperature because you are being more active.)  I did try POP for a short while and this gave a very clear rise in temperature. This gave me confidence in my measuring skills.

Also, I wanted to say that the graph shows an average level over a period of time, but in reality, it will be up and down all over the place, at all levels.  'Perils' is an appropriate word. 

[dangermouse]

Ah thanks! That's a coincidence as I've been charting my morning temps for the last 6 weeks on the Kindara app. I had a rise after ovulation last month but it crashed after 3 days and this month it's all over the place (day 17 at the moment) not going higher than 36.88, where last month it was 36.98 at peak.

Me and my sister have always been chilly people - to the point where she had to move to Australia She also had to have IVF twice to conceive (I never tried but suspect would have had issues too) so maybe we've always had low progesterone vs high oestrogen. Also never had period pains or PMT irritability like most of my friends but instead felt more low and lethargic.

I found the POP made me feel a bit aggressive and moody but I didn't try it for long to be fair.

[dahliagirl]

My temp line was more up and down, zigzag like, when I did not ovulate. It seemed to hold steady during months when there was ovulation of sorts. Which is why I was doubtful of my temperature taking. I even changed the battery in my thermometer. Interesting.😉

The pop just did not suit me any more in my altered hormone state, so I only lasted a week.