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Menopause Matters magazine ISSUE 53 out now. (September 2018)

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Author Topic: Estrogen dilemma - too much or too little?  (Read 1048 times)

AndieKC

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Estrogen dilemma - too much or too little?
« on: July 10, 2018, 02:38:27 PM »

Hi
I was wondering if anyone can shed some light on this apparent contradiction I seem to be coming across in my 'research' into menopause and HRT.

On the one hand, a lack of oestrogen in peri/menopause causes symptoms like hot flushes, cold shivers, palpitations, vaginal dryness etc,
On the other hand, even the lowest dose like Elleste Duet 1mg sequential causes/contributes to endometrial thickening, hyperplasia, polyp etc. - all signs of too much oestrogen, unopposed by adequate progestin.

My early menopause came suddenly at 44, no surgery, no chemotherapy, no illness of any kind, perimenopause was very brief - a couple of missed periods, and that's it, ovaries shut shop. The advice usually is to start HRT as soon as possible to protect the heart and bone strength (there is a window of about 2 years when without HRT there would be a sudden deterioration in bone strength, then the decline slows down).

Despite my low dose Elleste Duet, after a few months of heaven, the bleeds started, all those invasive procedures to investigate post menopausal bleeding etc, and the traditional doctors recommend to stop HRT because the oestrogen is 'causing or contributing' to all these endometrial changes, which could turn them cancerous. The fairy tale is over, and I am still only 47.

If I go off HRT, life will be unbearable again, my bones will start deteriorating very quickly, thermostat remains broken (hypothalamus will make me sweat every few minutes, then freeze, and again) and the palpitations will probably give me a heart attack as it's not normal to have a resting heart rate over 100 bpm when resting (on HRT my resting HR is 60-70). Also sleep deprivation will cause all sorts of other problems... but hey, I'll have a low risk of oestrogen related problems, and I can take a lovely thin endometrium with me to my early grave (from lack of sleep/heart attack/hip fracture/going nuts - take your pick).

If I stay on HRT, I'll continue to feel great, look young, sleep well, stay calm, have no flushes, live my life and think clearly, have no joint pain, but the oestrogen will continue thickening the endometrial lining, growing polyps, trying to turn them cancerous...

So I'm screwed if I do, and screwed if I don't...

Too much oestrogen is bad, too little is no good either. Seriously, which one is it? I get that after a certain age - like past 70 for example, the body is not meant to  have levels of oestrogen like the HRT provides, but in the 40s? 50s?

If the progestogen is meant to be balancing the oestrogen, (in my case it failed) then what is the point of sequential HRT? If I remember correctly, approx 50% of women on sequential HRT will develop these problems.

I am aware that patches contain a lower dose, but they are better absorbed, so the total circulating oestrogen is the same as the 1mg tablet.


P.S. Never smoked, never drank alcohol, never been obese or overweight (until the 2 years of sleep deprivation before HRT made me put on a stone, but still normal weight).

We can send a man to the moon, so can scientists now please please please come up with something? I know al the ladies here know what I mean when I say that until you experience how hot flushes, cold shivers, palpitations and lack of sleep can slowly be killing us, it is hard to understand. But sleep deprivation has been used as a method of torture all over the world for centuries. Why? Because it breaks even the highly trained soldiers in the end. Yet, half of the population is expected to somehow just simply get on with life... Grrrrr! Rant over, I'm going to weed the garden now - brilliant anger management by the way.

AndieKC xx
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AndieKC

Dotty

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Re: Estrogen dilemma - too much or too little?
« Reply #1 on: July 10, 2018, 03:10:12 PM »

Hi I'm afraid that I can't answer your questions as I'm not medically trained and I'm sorry if you've already stated the following elsewhere, but have you thought about seeing a menopause specialist like Dr Louise Newson who would be able to answer your questions?

Oestrogel and Utrogestan have solved all my problems.  A year ago I was in horrible place and very ill with what turned out to be menopausal symptoms.

I really feel for you x
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SueLW

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Re: Estrogen dilemma - too much or too little?
« Reply #2 on: July 10, 2018, 04:15:12 PM »

Oestrogel and Utrogestan have solved all my problems.  A year ago I was in horrible place and very ill with what turned out to be menopausal symptoms.

I'm sorry, I can't answer Andie's questions either.

But Dotty, can I ask how you take your oestrogen and Utrogestan?  What's your schedule and quantity?  I'm going to try switching to this method but don't want progesterone all the time.
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Dotty

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Re: Estrogen dilemma - too much or too little?
« Reply #3 on: July 10, 2018, 04:18:23 PM »

Hi SueLW I take utrogestan orally for 25 days out of 28. I use 4 pumps of gel every morning on shoulders and outer arms. X
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Milamam

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Re: Estrogen dilemma - too much or too little?
« Reply #4 on: July 10, 2018, 04:24:48 PM »

Hello Andie,
I read your post and felt I have to respond as I have been struggling with such a dilemma myself and trying to find an answer for myself. You are describing all my thoughts at present to the dot.

I have been a long term member of this forum but lately just read and don't have the courage to post. I have been struggling with perimenopause since I turned 43, now 47. At 43, an HRT therapy saved my life as I was at the verge of going mad - shakiness, agoraphobia, extreme anxiety, insomnia, night sweats, palpitations, gastric upsets to name a few. Within 3 months of starting on Femoston 2/10 I was a new person and regained my life.

I stopped the Femoston two and a half years later due to raised blood pressure and chest tightness and that I felt intuitively that the estrogen was too much for me. I managed a year without symptoms and then all hell returned. I am now struggling again with all of the above , with full force. I am still hesitant though to restart HRT as I have the same concerns as you have. Will have to decide soon as sleep deprivation is killing me and makes me unable to do my work and my duties. As well as anxiety and fatigue.

I have concluded that during perimenopause, it is not exactly a drop of estrogen that causes my  symptoms. It is rather the widely fluctuating estrogen (very high or very low, different each month), and the gradual lack of progesterone that causes women to be anxious. Surprisingly, through all this time, I have always felt better in the second half of my cycle, when there is presumably some progesterone produced. It has made me feel calm and contented, and not depressed as many women state it does. So for me, I have realized that in perimenopause I have experienced wild fluctuations which have caused my symptoms. Adding HRT to the mix may cause extreme highs in estrogen when your own is spiking, but also helps when there is a dip (which you don't know when can happen). So in itself, it helps to avoid the dips, but can cause highs that thicken the endometrium and can cause (for me) tension, anxiety and restlessness. Cannot win, can we!

I was also recently diagnosed with thickened endometrium, and all the gynies that I visited do not agree for me to take extra estrogen for that reason. All of them have advised me to wait until my estrogen drops steadily (i.e. when I enter full menopause) , and not have these peri fluctuations, before I restart HRT. However, I know that HRT helps me with my other symptoms at the times when I feel very down. It is a big challenge and I am sorry that there is no really good support from doctors who can look at the perimenopause in a holistic way, rather than just looking at the thickened endometrium and dismissing your other symptoms.

Some doctors prefer to use the contraceptive pill as it will even out the fluctuations and allow a true replacement of your hormonal environment. I don't want to go that route. I have never taken contraception in my life, and don't want to start at this age due to risks. I know that HRT is far safer at my age than the CP. So again, it is all about knowledge, personal decisions, and reading that will allow us to pass through this. Remember that in ancient times, women with menopausal symptoms were called hysterics. Hysteria was purely a woman's decease (now disregarded as such), and comes from the word "hysteria" which in Greek means Uterus. All ancient doctors believed that women's problems at a certain age came from the uterus , and proclaimed them as hysteria. Women were cured with dreadful and dangerous hysterectomies without anesthesia, or with opium. Or put in asylums and proclaimed witches. So the issues of the perimenopause and menopause are not new to mankind, just I hope now in modern times, we have to have more modern and scientific approaches on how to solve these struggles.

Sorry for the ramble, I hope I didn't bore you all. These are just my thoughts and my experience and I hope these are helpful.

Milamam
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Wilks

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Re: Estrogen dilemma - too much or too little?
« Reply #5 on: July 10, 2018, 05:54:24 PM »

Iím completely with you on the sleep thing. Iíve had years of sleep deprivation on and off and itís always the thing that cracks me. Thereís a huge lack of research into alternatives that might help us. Are there even any charities that fund menopause research?
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Dancinggirl

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Re: Estrogen dilemma - too much or too little?
« Reply #6 on: July 10, 2018, 07:17:09 PM »

Hi Andre - I think I have been responding to you on another thread?

Frim
The outset you had some bad advice from your GP who didnít know much about treating the menopause.
If you felt good on the Elleste and simply had a monthly bleed, then you should be able to go back to this. If I remember right the problems arose because you were put on a conti hrt and erratic bleeding is quite a common side effect of any conti hrt. However, if you can bring yourself to have the mirena fitted this would offer you some reassurance that you are less likely to develop hyperplasia, polyps etc and can safely use oestrogen at a level that suits you. You clearly did well with a low dose of oestrogen and if your periods stopped over a year ago then your natural oestrogen levels will be bottoming out soon anyway.
I think you are due to go back to have the polyps removed ? so if you can have the Mirena,  I think after a few weeks with this, together with using a low dose oestrogen patch or the daily gel, you will quickly get your life back on track.
Many of us share your view that menopause treatment still has a long way to go but try not to overthink things - you are not alone with these issues - there are thousands of women out there suffering as you are.
Keep us posted. DG x
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AndieKC

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Re: Estrogen dilemma - too much or too little?
« Reply #7 on: July 10, 2018, 10:24:11 PM »

Hi girls,
To Dotty,   
I have thought about Dr Louise Newson, I might still do that, but I have a feeling polyp removal and Hysteroscopy etc still needs doing on the nhs, but thank you xx

To Wilks,
Youíre right, we need a menopause charity- we kind of have it already, Menopause Matters, I understand is a charity set up for this purpose. And all those £25 fees we pay for email questions & answers with Dr Currie goes to support this charity and the work. My understanding is that Dr Currie and Menopause Matters is/has been in charge of educating GPs and gynos on all Matters menopause and hrt
Xx

To Milamam
From everything Iíve read, and what all the docs are saying, the Mirena Coil for progestogen with estrogen as patches/gels is the best combination due to lowers levels of hormones circulating in the body, especially estrogen. This means fewer side effects and itís better if hrt is to be taken longer term. I donít know what your stance is on Mirena, (I am totally irrationally frightened of it, even though in my head I accept it is the best, but Iím working on accepting the fact that Iíll havd to have it), everyone seems to think it is worth considering.

I am sorry you feel you donít have the courage to post - this forum has been such a great help for me, but I am currently on hrt and feeling great except for the worries re Hysteroscopy, polyp removal and Mirena fitting etc. I completely feel for you god awful it is when your body is ravaged by symptoms, I felt utter despair before hrt, symptoms were relentless and I didnít have the will to do anything.

I agree with you on the peri menopause and fluctuating hormones, move was extremely short, a couple of missued periods, and that was it. I was nearly 2 years post menopausal (at 46!) when I started hrt. Canít quite work out if I felt different on the oestrogen only two weeks, or the estrogen + progestin two weeks. I had all the side effects in the first few months but all settled, and I have even lost some weight (gained during those 2 years before hrt due to severe symptoms and no sleep). So I have no idea where my extra estrogen could be coming from as ovaries are completely dead (no activity on the scan) and body fat is the biggest producer of estrogen.

You know, regarding CP vs HRT, some of them contain exactly the same preparation - if it helps your concerns, look it up for ingredients and amounts - and some contain the same. For example, Dr Currie recommended for me a continuous combined Hrt with extra progestin to arrest hyperplasia and itís Kliovance (same estrogen and progesterone as Elleste Duet I had been on before) but plus Noriday for extra progesterone- exactly the same as in Kliovance, yet Noriday is Contraceptive pill.  Itís all about the type and amount... 

Have you thought about using Dr Currieís email service ? I found it amazing, just pay £25 through this website and email Dr Currie with your question, I did that a couple of times.

Donít suffer in silence, we are all here for each other, and remember itís anonymous xx
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AndieKC

AndieKC

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Re: Estrogen dilemma - too much or too little?
« Reply #8 on: July 10, 2018, 10:33:29 PM »

Hi Dancinggirl,

Thank you for your reply,

My problems started on sequential hrt, bleeds didnít settle into a neat monthly pattern, had spotting mid month, after intimacy etc. I should have been put on continuous combined hrt at some point, because I started the original sequential hrt when I was already 2 years past menopause, after periods stopped completely. I had a very sudden onset menopause, no warning, hardly any peri menopause.

My understanding is that sequential  hrt is more likely to lead to hyperplasia, Conti is better because on Conti progesterone is delivered every day, protecting the endometrium but a few months ago I didnít know any of this.

P.s. I really hate being a woman sometimes 😒

Thank you for your support xx

You are right about the mirena, Iíll have to overcome my reservations about it, am working on it...
« Last Edit: July 10, 2018, 11:47:23 PM by AndieKC »
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AndieKC

Dotty

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Re: Estrogen dilemma - too much or too little?
« Reply #9 on: July 11, 2018, 04:43:45 AM »

Hi Andie.  Have you got to have the Mirena ? Canít you stay on the Kliovance if that suits you? X
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Dancinggirl

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Re: Estrogen dilemma - too much or too little?
« Reply #10 on: July 11, 2018, 07:08:49 AM »

I personally donít think itís too much oestrogen that causes the hyperplasia,as some women take very big doses of oestrogen with on abnormal build up. Many women stick on sequential hrt ( well into post meno) because it gives a predictable bleed instead of erratic bleeding that so often occurs with conti hrts. We are all different and our bodies respond differently to hrt. I think itís just that for some women the lining wonít shed properly - I had this problem when I was roughly 15 years post meno and on the lowest dose of oestrogen. This is why the Mirena can be good. You are just unlucky that you need so much progesterone to stop the lining from building up. At least you arenít intolerant to progesterone - so many women are. DG x
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Hurdity

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Re: Estrogen dilemma - too much or too little?
« Reply #11 on: July 11, 2018, 07:43:53 AM »

Hi AndieKC - I also responded on your other thread about the balance between oestrogen and progesterone - in the New Members section. Yes that's all it is - endometrial hyperplasia is caused by too little progesterone in relation to oestrogen - and as Dancinggirl says this is very individual - some women won't get it at all but because there is a causal relationship between too much unopposed oestrogen and ultimately endometrial cancer (only in some women!) - we all have to take the right dose to keep the lining thin.

On sequi HRT it is perfectly OK for the lining to thicken and it will be at its thickest at the end of the combi part of the cycle ie the end of the progesterone phase. With the right amount of progestogen the lining should be shed so that it measures within the normal range just at the end of the bleed - that is the time it should be measured. On conti HRT it should remain unformly thin ( after 6 months) with no beleding - otherwise more progesterone will be needed.

If you want to remain on sequi HRT then you just need to take separate oestrogen and progesterone ( or take extra progestogen during the second part of the cycle) - but a slightly higher dose of progestogen.

As advised several times if you are prone to endometrial hyperplasia then the Mirena is ideal as Dancinggirl recommends.

Hurdity x
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AndieKC

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Re: Estrogen dilemma - too much or too little?
« Reply #12 on: July 11, 2018, 08:45:56 AM »

Hi Hurdity and Dancinggirl
Thank you for your posts.
 
Can I please ask you about the thickness of the lining - I have only been on Elleste Duet 1mg sequential for nearly a year (not Conti) so do you think this is what caused the thickness and the imbalance between the 2 hormones? I am literally only just now about to start the continuous combined hrt (Kliovance +
Noriday).

My 6mm lining was measured about 2 months ago - on Sequential HRT (16 white pills, 12 green pills) - when I was towards the end of the white pills (oestrogen only). A couple of days ago they measured the lining again - still on sequential as I am just finishing the green pills (estrogen + progestin) - so the result 8.7mm was 4 days before the end of green pills.

I keep reading that thickness should be measured after the bleed has just finished to see if the lining sheds properly but no one seems to know or care about that when they measure it! So itís never been measured just after the bleed. Is it possible that my lining could be normal if only they measured it at the right time?

As you say, Sequential HRT builds the lining up then sheds it, so now I will never know what mine is after shedding.
I am finishing the last two green pills of sequential Elleste (today and tomorrow), and then Iíll be taking the Kliovance + 2x Noriday combination (progesterone continuously) so bleeds will be different I guess.

I am trying to come to terms with the upcoming op now, I think Iíll go for GA, but gosh I really want it all to be over.

To answer DancingGirlís question- I could have progestogen treatment orally instead of Mirena but the polyp still needs cutting out and the oral progestin  is insanely high amount compared to Mirena so Mirena is better, I understand that... I really really hope the polyp is going to only benign (most cases) not abnormal because then they would take me off hrt and itís hysterectomy usually recommended. Apparently if there is postmeno bleeding and hyperplasia and polyp, itís more likely to be something nasty on the polyp... fortunately biopsy showed simple hyperplasia only without atypia but who knows what that polyp is... hope we get there soon and it will be over
Thank you for your support il. Keep you posted xx
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AndieKC

Dancinggirl

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Re: Estrogen dilemma - too much or too little?
« Reply #13 on: July 11, 2018, 01:07:31 PM »

Angie - the last time I saw a very good specialist gynae, he explained things really well. I was getting erratic spotting and bleeding and he insisted I have a scan right at the end of a bleed as this is the only way to tell if there is hyperplasia. It turned out I had a Ďpatchí that was clearly not shedding properly but he was not concerned. The chances of endometrial cancer are very small and polyps and fibroids are common when using HRT - they are usually benign. To be honest I really wouldnít be happy taking a lot of progesterone orally all the time, so the Mirena will be your easiest option and if you have GA they will be able to fit this after doing the polyp which is the ideal scenerio.
I really think you have been unlucky as I fear they have simply done your scans at the wrong stage in the cycle. The only way to be scanned at the right time is to have it done privately so you fix the date when you know itís the right time.
If the NHS has menopause clinics in all major towns that had scanning equipment, management of the menopause would be far better. Even without HRT, so many women get fibroids, polyps or excessive bleeding in the peri meno stage and this could be treated more efficiently with appropriate clinics in place.
Hope things work out ok for you.
DG x
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AndieKC

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Re: Estrogen dilemma - too much or too little?
« Reply #14 on: July 11, 2018, 09:28:55 PM »

You are so right, Dancinggirl, if only we could have the scan at the right time, it would mean less worry etc

Iíll hold on to the hope that itís nothing to worry about, iíd love to have it over and done with, and feel relief... hate this waiting

In the next life Iím coming back as a bloke, thatís a promise !
Xx
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AndieKC
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