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[CrispyChick]

I beg to differ bombshell.

I asked my private gynae (BMS accredited) if I could try prog only (cyclogest) before I tried chem meno. Now, to be fair, she did let me. But let's remember I was paying for this. But she made it clear she thought I was bonkers and that everyone needs estrogen. I'd never have got to try it on the NHS.

There is absolutely no mainstream support out there for woman struggling with 'estrogen dominance'.

I believe in it. 100%. I can't see how woman in other parts of the world suffer from it, but in the UK they don't!  .

Progesterone drops first. Lots of annovulatory  cycles. Yes, it's only meant to be high in luteal, but by becoming non existent, but with estrogen still high, and often surging, the whole thing causes imbalance. Which a bit of prog can solve, for some woman.

I for example, have never had low estrogen symptoms in my peri until this year. Now 49. But I've had a lot of symptoms. But I haven't needed estrogen...

[Pippi85]

I beg to differ bombshell.

I asked my private gynae (BMS accredited) if I could try prog only (cyclogest) before I tried chem meno. Now, to be fair, she did let me. But let's remember I was paying for this. But she made it clear she thought I was bonkers and that everyone needs estrogen. I'd never have got to try it on the NHS.

There is absolutely no mainstream support out there for woman struggling with 'estrogen dominance'.

I believe in it. 100%. I can't see how woman in other parts of the world suffer from it, but in the UK they don't!  .

Progesterone drops first. Lots of annovulatory  cycles. Yes, it's only meant to be high in luteal, but by becoming non existent, but with estrogen still high, and often surging, the whole thing causes imbalance. Which a bit of prog can solve, for some woman.

I for example, have never had low estrogen symptoms in my peri until this year. Now 49. But I've had a lot of symptoms. But I haven't needed estrogen...

Can I ask, when you used cyclogest, did you use it in luteal only? I'm with newsons and was told should only use it in luteal to prevent progesterone receptors to become less receptive. If it was me I'd rather take it continously but it seems to make sense to stick to luteal phaase when my body would naturally produce it.

[CrispyChick]

Hey pippi.

I'm afraid I only lasted 4 days  . I have some stange over reactive stuff going on I'm afraid. So I'm a bit of a lost cause.

But, I followed the ED route for quite some time and, at one point, I was under the Marion Gluck clinic. I've also read a lot about it.

Yes. The official line is luteal only. As that's when your own body produces prog. And many do cite the receptor issue - but plenty woman post meno take continues utrogestan and they'd receptors never seem to become tired. 

I was told I could take continuous. If I ever go back to it, I'll only do continuous as the stop /start is massively triggering for me.

Interesting you're with Newson and on progesterone only. It's good to hear the more mainstream private are supporting this, where needed. I think we're a long way off the NHS supporting it.

How did you end up in the position of taking progesterone only???

[joziel]

My issue with "estrogen dominance" can be encapsulated in how the term and the attitude of these people has made you feel, Pippi - in your own words "crippled with fear" to add estrogen into HRT.

WTF??

When people have high T4 and low T3, we don't say they have "T4 dominance". When people have taken zinc and not copper and have ended up with low copper as a result, we don't say they have "zinc dominance".

It is this demonisation of estrogen which is completely ridiculous. As if estrogen is some evil hormone, out to slay you, and it's all about how to get your estrogen levels down. Ridiculous.

There is no such thing as "estrogen dominance". If you have sufficient progesterone, you are fine whatever your estrogen levels. (Within reason.) You do realise that during pregnancy women have estrogen levels into the 30,000s+?? The levels are are talking about for HRT are incredibly low by comparison, lower than levels even in birth control pills.

Do yourself a favour and leave the fear mongering groups and get yourself on some estrogen if you are peri-menopausal. Of course, make sure you are taking enough progesterone too. You need balanced hormones.

[CrispyChick]

Joziel - I note Newsons have pippi on cyclogest only. There must be a medical reason for this. Low prog but normal or high estrogen I'd assume .

I totally agree that the slating of estrogen is wholly inappropriate. But so to is suggesting someone definitely needs estrogen. Newson will be all over pippi's levels so I'm assuming her estrogen levels are anything but low. As is common in early peri.

[Pippi85]

Hey pippi.

I'm afraid I only lasted 4 days  . I have some stange over reactive stuff going on I'm afraid. So I'm a bit of a lost cause.

But, I followed the ED route for quite some time and, at one point, I was under the Marion Gluck clinic. I've also read a lot about it.

Yes. The official line is luteal only. As that's when your own body produces prog. And many do cite the receptor issue - but plenty woman post meno take continues utrogestan and they'd receptors never seem to become tired. 

I was told I could take continuous. If I ever go back to it, I'll only do continuous as the stop /start is massively triggering for me.

Interesting you're with Newson and on progesterone only. It's good to hear the more mainstream private are supporting this, where needed. I think we're a long way off the NHS supporting it.

How did you end up in the position of taking progesterone only???

Thanks for your reply and sorry you're having a rough time finding what's right for you.
I don't even know where to start but problems started six months after the birth of my second child so I wasn't initially connecting the dots it could have been hormonal because I thought I was out of the window for pnd but I basically woke up one day, on return of my periods whilst breastfeeding with the worst anxiety and nausea ever. I had a week in bed and couldn't function, cried a lot and thought I'd never get better. It was the scariest thing ever and realised I was experiencing a mental breakdown followed by years of terrible health anxiety and ocd. I ended up on Sertraline which has saved me and in hindsight wish I had taken it earlier. then reached out to private meno specialist who put me on the pill on which I lasted a week exaxtly. at that time symptoms were worse typical pmdd style before my period. then it became all muddled and symptoms were often more prevalent before ovulation. reached out to another meno doc and was put on continious utrogestan which stopped my still regular cycle. wouldn't get cyclogest from her so ended up with newsons and made it clear I want to try cyclogest. been on it for two months now, only in luteal. was also prescribed oestrogen but haven't touched it. doctor said ok, try cyclogest only but she thinks i'll have to add oestrogen too at some point. so yeah, i've got a follow up next week. things are still a very mixed bag. cyclogest clearly calms me down but sometimes to the point of no motivation and feeling very low which then in turn makes me anxious again. no idea if I could do with more cyclogest? currently on 200-400 / day depending on symptoms. re the receptor thing,since cyclogest is prescribed for post-natal depression too, surely you'd take it continously then? what are the receptors doing in that case? they don't know what you're taking it for, right? or if you're on it for ivf? sorry, I'm babbling now.

[Pippi85]

My issue with "estrogen dominance" can be encapsulated in how the term and the attitude of these people has made you feel, Pippi - in your own words "crippled with fear" to add estrogen into HRT.

WTF??

When people have high T4 and low T3, we don't say they have "T4 dominance". When people have taken zinc and not copper and have ended up with low copper as a result, we don't say they have "zinc dominance".

It is this demonisation of estrogen which is completely ridiculous. As if estrogen is some evil hormone, out to slay you, and it's all about how to get your estrogen levels down. Ridiculous.

There is no such thing as "estrogen dominance". If you have sufficient progesterone, you are fine whatever your estrogen levels. (Within reason.) You do realise that during pregnancy women have estrogen levels into the 30,000s+?? The levels are are talking about for HRT are incredibly low by comparison, lower than levels even in birth control pills.

Do yourself a favour and leave the fear mongering groups and get yourself on some estrogen if you are peri-menopausal. Of course, make sure you are taking enough progesterone too. You need balanced hormones.

thanks for your thoughts. I do very rarely use social media these days anyway so try and avoid these groups. like you said, making oestrogen the evil hormone simply didn't sit right with me. and the admins of those groups are not even medically trained and seemingly only quote dr ray peat and other sources not necessarily medically trained.

[joziel]

Pippi, I can't answer the stuff about cyclogest - but look up the Dr Louise Newson podcast, specifically this episode:

https://podcasts.apple.com/gb/podcast/the-dr-louise-newson-podcast/id1459614845?i=1000554056731

You'll see there 2 women interviewed whose issues began after having their babies and who needed estrogen....

[Pippi85]

Thank you Joziel, I vaguely remember listening to this years ago but can't remember the content so will definitely have a listen again. Thank you.

[bombsh3ll]

Pippi, the answer regarding whether to take progesterone continuously or sequentially depends on what works best for you as an individual.

There are advantages and drawbacks to both, and we all have individual physiology, challenges and priorities.

Conventional practice is to use cyclical progesterone in someone who is still menstruating, due to the belief that this will achieve or maintain a regular bleeding pattern. This is achieved some of the time, others bleed chaotically.

Cyclical is a closer mimic of natural physiology, and evidence is emerging of better long term health outcomes (irrespective of menopause status) when the progesterone is not used continuously. This is what Louise Newson means about estrogen receptor down regulation.

However the NHS is unlikely to ever support cyclical on postmenopausal women due to the small risk of endometrial hyperplasia, as there aren't the resources to scan women regularly to avoid this.

Continuous progesterone is conventionally prescribed to postmenopausal women to avoid withdrawal bleeding. Many are simply happy to be rid of periods and either don't know that cyclical has potentially greater health benefits, or frankly don't feel that something largely theoretical at this point warrants spending every 4th week bleeding.

Others who may prefer to use continuous progesterone even if they are still menstruating are those who don't sleep well unless they take it, those who only tolerate it at a lower dose, and those with conditions exacerbated by hormonal cyclicity eg migraine, endometriosis or mood disorders.

This group, if not yet menopausal, accept the trade off that they MIGHT experience a less regular bleed pattern than they otherwise would have done.

There is no harm in trying out both regimes and seeing which you prefer, as long as you ensure sufficient progesterone is taken overall to keep the endometrium healthy.

[dangermouse]

The dominance is about which hormone is overpowering the other, as O and P have an indirect lowering effect on the other.

The old menstrual cycle graph was also misleading as it showed both hormones as if their measures were the same, when in fact P would be off the scale higher. In peri this stops first and so the O can go out of control and cause very extreme symptoms like intense nausea and dangerous overgrowths.

The FB groups do often debate the use of O and it gets agreed that sometimes it’s needed for balance, but that as O gets stored in the tissue it can show as low on blood tests when in reality it is still higher than it should be. There are a lot of interesting discussions about such things as local oestrogen not existing as, any medic or scientist will tell you, it will all enter the blood stream as systemic as cannot be restricted to one area.

As asked above, yes I have used P only but P will always stimulate circulating O so I can only take it for a couple of weeks until O starts coming out of the tissue, then it acts like me taking O (too stimulating and I believe I do not have the methylators to break down O into its metabolites). High dose P (200-400 Utrogestan) pulls the O out after about 3 days so that’s also no good for me. Stopping and starting it means you have to go through P withdrawal which is even worse. Now and again I have some prog cream though to get a little relief from O build up or take some DIM. I would love to feel the wonderful effects of O that many here report but not happened yet and I am post meno for a few years now.

[Pippi85]

Pippi, the answer regarding whether to take progesterone continuously or sequentially depends on what works best for you as an individual.

There are advantages and drawbacks to both, and we all have individual physiology, challenges and priorities.

Conventional practice is to use cyclical progesterone in someone who is still menstruating, due to the belief that this will achieve or maintain a regular bleeding pattern. This is achieved some of the time, others bleed chaotically.

Cyclical is a closer mimic of natural physiology, and evidence is emerging of better long term health outcomes (irrespective of menopause status) when the progesterone is not used continuously. This is what Louise Newson means about estrogen receptor down regulation

However the NHS is unlikely to ever support cyclical on postmenopausal women due to the small risk of endometrial hyperplasia, as there aren't the resources to scan women regularly to avoid this.

Continuous progesterone is conventionally prescribed to postmenopausal women to avoid withdrawal bleeding. Many are simply happy to be rid of periods and either don't know that cyclical has potentially greater health benefits, or frankly don't feel that something largely theoretical at this point warrants spending every 4th week bleeding.

Others who may prefer to use continuous progesterone even if they are still menstruating are those who don't sleep well unless they take it, those who only tolerate it at a lower dose, and those with conditions exacerbated by hormonal cyclicity eg migraine, endometriosis or mood disorders.

This group, if not yet menopausal, accept the trade off that they MIGHT experience a less regular bleed pattern than they otherwise would have done.

There is no harm in trying out both regimes and seeing which you prefer, as long as you ensure sufficient progesterone is taken overall to keep the endometrium healthy.

when the progesterone is not used continuously. This is what Louise Newson means about estrogen receptor down regulation.

Thank you for this. I wasn't aware about the research pointing towards cyclical use being more beneficial over continuous. So that's food for thought. Regarding the Oestrogel, I probably just need to put my big girl pants on and give it a good go. Can I start this at any time in my cycle?

[joziel]

Yes, you can start it at any time. I would begin gradually and wait at least 3 weeks on 1 pump before increasing to 2. (1 is unlikely to be enough for anyone.)

If you get to 2 or more, you can also split it morning and evening so you get a more regular dosage.

[Pippi85]

Thank you Joziel!