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[ThisIsAwful]

Hello all. I am 44 and have been going through two years of Perimenopause. During this time my problem has been low progesterone. My OBGYN has treated it with cyclic Prometrium. Last Summer we began to increase it to the point where I am taking 300 MG a night and still still having low blood sugar, exhaustion, bloating and other wonderful symptoms high estrogen brings.
Does anyone have an idea of what can help? We talked about the birth control pill, but I am leery because I had a heart attack at 29 due to a genetic defect. I've even asked for a hysterectomy to stop this nightmare.
I'm at my wits end.

[Dancinggirl]

Hi and welcome to mm

The oestrogen dominance theory is a red herring. Using such high doses of Prometrium (I sssume you are in the USA?) will give some nasty side effects.
If you are truly still peri menopause then a more standard HRT treatment that incudes some oestrogen and much less progesterone would probably get you more in balance. If you are deeper into menopause then your oestrogen levels will be dropping, even if they are still fluctuating, and this will cause your fluctuations if symptoms.
Prometrium has quite a strong sedative effect so I expect your feelings of low blood sugar levels are more to do with the high dose of progesterone.
If I were you I'd be dropping your dose of Prometrium and adding in oestrogen. I would also not take Prometrium daily but just on a sequential basis - so 12 days each month. DG x

[ThisIsAwful]

The OBHYN said my symptoms are textbook of low progesterone/high estrogen. So if I rook a low dose form of estrogen would it balance out my estrogen levels instead of increasing them?
I will try anything at this point to feel better. The funny thing about Prometrium is it puts me in a really good mood about things. I had horrible anxiety before taking it.
Thanks for replying. You ladies are amazing.

[BlueButterfly]

I'm similar to you in that I have low levels of progesterone in comparison to my estrogen. Progesterone definitely makes me feel better as well. My mood is so much better, it has squashed my anxiety. It's quite wonderful for me honestly. But it's not for everyone. Works for me though because I have endometriosis and a fibroid (things that are usually linked to higher estrogen) and a genetic clotting issue so need to avoid estrogen.

Did you have your hormone levels blood tested or did the GYN just go by symptoms? Have you had any other tests done? Vit D levels checked, blood sugars, thyroid, etc?

Maybe keep track of what you are eating...see if that helps/hurts your symptoms. My digestion has been wrecked by all this and I can't eat the same way I used to or I get awful bloating and feel so run down.

[ThisIsAwful]

I've had all sorts of blood work done and I take vitamin supplements. I've had vaginal ultrasounds. Everything seems to check out well.
I'm sorry to hear about your battle. For bloating I take probiotics. It doesn't completely take it away, but it has greatly reduced it.

[Dancinggirl]

Thisisawful - what were you oestrogen levels when they were last tested?  What was your FSH level?

All I know is that when I took even 100mg of Prometrium (called Utrogstan here in the UK) I felt spaced out and shaky - very much like low blood sugar. In the peri stage your hormones are fluctuating a great deal at times and this can make symptoms come and go. By using a balance of oestrogen and progesterone this can help to relieve these fluctuations. Here in the UK the oestrogen dominance theory is not accepted but if problematic bleeding occurs due to missed ovulation (which is what happens in peri meno) then taking a low dose of progesterone can stop this bleeding and some doctors recommend the Mirena as a good option as you can then simply add in some oestrogen as and when it is needed.

High oestrogen should not cause bloating and exhaustion but progesterone or the withdrawal of progesterone certainly can make you feel sedated and spaced out.

There is a birth control pill that might help you are is has bio identical oestrogen  - it's called Qlairi here in the UK - so look this up. 

As BlueButterfly has suggested - do look at what you eat and when you eat, as eating small amounts regularly through the day can really help with drops in mood and energy. Do cut out as much sugar as you can and all caffeine if possible.  DG x

[dangermouse]

Oestrogen dominance seems to be a misunderstood term. It simply means that you aren't producing enough progesterone whilst also having oestrogen surging high. For many women in perimenopause this can be higher than any time in their life.

I think the term comes from when birth control pills were known either as oestrogen dominant (like Brevinor) or progesterone dominant (like Loestrin), because the volume of oestrogen against the strengths of the different progestins can tip them in either direction. ‘Pill ladders' were created for GPs to start in the middle with Microgynon (slightly progesterone dominant) and then go in either direction dependent on oestrogen or progesterone dominant symptoms to redress the balance.

I also suspect that many newly post menopausal women still have surging oestrogen and the simplest way to know if HRT oestrogen can help you is if you take it initially on its own and then you'll know if it makes you feel better or worse. Blood tests aren't reliable as hormones are volatile and can rise or fall at any given moment, especially in perimenopause.

I've used progesterone cream successfully in peri, which does get your levels up and you feel energised, motivated and the anxiety goes. It's possibly a combination of it creating a smaller gap between oestrogen and progesterone (this causes the least symptoms) and progesterone's influence on GABA, the calming neurotransmitter. The micronised progesterone should also work but it may be a harder one to get the dosage right with, as it's oral and not transdermal. Vaginal may work better for you.

Some women also use high doses of oestrogen, or the combined pill, which both work to override the volatile cycle, where the brain down regulates its own oestrogen production due to consistently high levels of oestrogen in the blood.

There are many theories why oestrogen surges in perimenopause, it could be a dwindling egg supply causing more oestrogen to be pumped out or multiple attempts to release an egg in the same cycle. Who knows, but it's incredibly exhausting and, at times, very frightening.

[Conolly]

Hello dangermouse,


Very informative post, thank you.


Conolly X

[BlueButterfly]

Hello dangermouse,


Very informative post, thank you.


Conolly X

2nd this!

[ThisIsAwful]

I've used progesterone cream successfully in peri, which does get your levels up and you feel energised, motivated and the anxiety goes. It's possibly a combination of it creating a smaller gap between oestrogen and progesterone (this causes the least symptoms) and progesterone's influence on GABA, the calming neurotransmitter. The micronised progesterone should also work but it may be a harder one to get the dosage right with, as it's oral and not transdermal. Vaginal may work better for you.

I became aware of the effect progesterone on GABA two years ago when my symptoms spiraled into PMDD. Mixronized progesterone saved me from that horror.

I have an appointment with my GP on Monday. I don't feel my OBGYN understands perimenopause. He says if the 300 mg does not cure the symptoms,  then he will raise it again.
I'm going to take the information you ladies have provided with me and ask my GP to figure this all out.
Thank you so much for the help.

[dangermouse]

Glad my post helped!

It is tricky with hormone replacement as, like in the case of high dose oestrogen to override our own oestrogen, high dose progesterone could possibly lower our own dwindling progesterone.

I have also tried the mega high doses of progesterone and it didn't make much difference compared to a normal amount, which does make a huge difference. I have started to get the intense nausea migraines again (after 3 years of hardly any) at high oestrogen points in the cycle so I think I just have to hold out until the oestrogen will eventually bottom out, which I'm hoping will happen when my periods stop but know it could take a couple of years after that. My sea bands really took the edge off of the last few but I recently had a 7 day long one which the bands couldn't even control so I'm hoping it's all coming to a head!