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[elia]

Has anybody experienced drowsiness, fatigue and depression as intense side effects of estrogen (not progestogen) therapy? Whether at the beginning of treatment or later?

I am prescribed 200mcg of Estrodot patches (twice a week). So far it's only been 6 weeks - and I have yet to take the Utrogestan to get a withdrawal bleed - but what I've been experiencing so far is this intense drowsiness (along with fatigue & brain fog) from the 2nd week onward. The last two weeks have also been horrific with severe depression and crushing fatigue ontop of the drowsiness - the depression has abated as of a few days ago (tho I'm still super emotional and easily weepy) - the drowsiness and fatigue, however, are still strong as ever and have not lessened.

Of course I'm gonna give it the full 3 months - but I am now at the halfway point with 6 weeks in and need to know: has anybody else experienced this drowsiness/fatigue with estrogen therapy (patches, gels, oral)? Did they lessen with time for you? If so - how long did it take before these side effects started to go away?

Of course I'm not asking about progestogens (we all know progesterone/progestins are notorious for causing drowsiness) - what I'm asking is purely in regards to estrogen therapy. And estrogen therapy, as we all already know, is meant to increase energy, mental clarity and boost mood - so these side effects (drowsiness/fatigue, brain fog, depression) are paradoxical to say the least, especially when persisting into the 6th week of treatment (only depression has abated moderately for me in the past couple of the days - the drowsiness is still strong).

I tried to do a search in the forum for women who've experienced something similar but all the posts I find are by women who've never come back to let us know if or when these side effects improved...or they were so bothered by them that they don't stick with the estrogen therapy long enough to find out if these side effects were temporary.

My current theory is that it is because I was given a high dose (200mcg) in one go right off the bat and that I should just "wait and see" my way through this. But it being 6 weeks in...I'm starting to worry this is abnormal and question whether estrogen therapy is right for me. My doctor btw is cluless (aren't they always?).

[Dancinggirl]

Why such a high dose? The normal
Oestrogen dose given is 50mcg. To start on such a high dose without gradually increasing seems bonkers to me!!!
 Your poor body is being bombarded - so it's no wonder you are feeling strange.
What symptoms are you trying to control.
DG x

[elia]

Why such a high dose? The normal
Oestrogen dose given is 50mcg. To start on such a high dose without gradually increasing seems bonkers to me!!!
 Your poor body is being bombarded - so it's no wonder you are feeling strange.
What symptoms are you trying to control.
DG x

Oh wow, so you think the high dose is to blame?? It was Dr. John Studd who prescribed the 200mcg of estrogen to me. The reason for the high dose is my osteoporosis and history of severe PMDD. My regular doctor is helping me monitor my blood levels etc - but he is clueless about treating PMDD (hence my consult with Studd), and I can't get another appointment with Studd until November so I'm left trying to make sense of these side effects on my own.

[Dancinggirl]

I haven't been to Studd but I know he is the pioneer in treating women with hormonal problems, however, he does seem to have a rather cavalier approach these days and doesn't offer a good back up service fro his patients.  Maybe contact his clinic and see if you can see one of his associates - I believe it can be better to see them these days as they tend to listen more??!!!
I assume he is shutting down your own cycle with this high dose to try and stabilise your hormones, however this does need to be monitored better. How old are you and where are you in your menopause journey??

I could be completely wrong but you don't think you need such a high dose to prevent or treat the osteoporosis. If you are getting severe depression and/or anxiety due the the menopause then I still think a gentler approach would be appropriate.
However, I am not a doctor, so I am only speaking from 25 years of HRT treatment due to premature menopause and some years of reading and responding to women on this forum.   
The gynaecologist I saw privately recommended introducing oestrogen more gradually to allow the body to adjust.
I really think you need to contact Studd's clinic for advice and support - You shouldn't be getting so many side effect with no benefits.
 Good luck. DG x

[elia]

Thanks DG for your generous replies and help. It's truly kind of you and confirmed to me that I am simply adjusting to this high estrogen dose.

I turned 30 a month ago. I'm not menopausal but suffer severe PMDD - hence the Studd treatment of shutting down my cycle with 200mcg of estrogen patches (twice a week), testosterone cream (Androfeme) 0.5ml daily, and the Mirena which will be inserted in two weeks time. My osteoporosis has been the result of hyperparathyroidism (HPT) which I am still in the midst of investigating whether it is Secondary HPT or Primary HPT (benign tumor).

I've searched high and low on the internet for a space where I can share my PMDD treatment experiences and get answers to some of my burning questions - but it doesn't exist. All of the available spaces that are designated for PMDD (Facebook, Reddit, etc) are rife with misinformation (the estrogen dominance fad is strong) and a scarcity of actual women who've tried Studd's approach of using estrogen as PMDD treatment. The shocking thing I've discovered is that this entire forum and all of your experiences with menopause are, blow by blow, identifical to the luteal phase of my cycle - for those two weeks I am struggling with hot flushes, insomnia, mood swings, depression, cognitive dysfunction (esp memory), loss of libido and fatigue. After heavy research into my PMDD condition, I've confirmed the nature of the beast: estrogen withdrawal. There's a fantastic paper by Olle Eriksson ("Studies on Premenstrual Dysphoria" 2005) that lays it out with such beautiful clarity. The brains of women with PMDD are highly sensitive to hormonal fluctuations (of any kind) due to an already constitutional, or somehow acquired, serotonin dysregulation - which explains why studies on SSRIs for PMDD have worked. Estrogen withdrawal, particularly in the late luteal phase, aggravates an already sensitive brain by further reducing its serotinergic activity. Hence...PMS.

The luteal phase, unlike the follicular phase, undergoes 3 major hormonal shifts in the female body (estrogen plummets from a high peak for 2 days after ovulation, then rises again alongside a looming progesterone, then both E and P plummet hard together) - these extremes are unmatched by the follicular phase, which only sees a rising estrogen (which in itself is energizing, libido-enhancing, mood-uplifting). It is no wonder these hormonal extremes leave us reeling. Studd's approach to shutting down the cycle is absolutely correct, but to do so with estrogen (rather than medical menopause) is brilliant.

[elia]

I haven't been to Studd but I know he is the pioneer in treating women with hormonal problems, however, he does seem to have a rather cavalier approach these days and doesn't offer a good back up service fro his patients.

You're absolutely correct - I only had a phone consult with him (I am based in Australia) and he was quite off-putting, had a dismissive manner of speaking, kept calling me "darling" and "sweetheart" which I found condescending, and if anything was discouraging about my asking any questions as to the hows and whys and was very withholding of explanations. I sent him a few emails with some questions and his replies have been so curt as to be comical. That said - his published papers and pioneering of estrogen as a treatment for PMDD might as well be the very thing that will save my marriage and my life.

Maybe contact his clinic and see if you can see one of his associates - I believe it can be better to see them these days as they tend to listen more??!!!

Definitely thinking of opting for Dr. Michael Savvas if it becomes more difficult to consult with Studd.

If you are getting severe depression and/or anxiety due the the menopause then I still think a gentler approach would be appropriate.

I absolutely agree - I just don't have the luxury of time to gradually go up slowly. My PMDD has put a stop to my employment and productivity of any kind, and so I need to get my life on track as soon as I possibly can. A horrific adjustment period seems to be the price to pay, but as long as there's light at the end of the tunnel, then I'm happy to push through the craziness until the hormones settle. I personally wouldn't recommend such a harsh route to anyone, however, it was a very very dark past 2-3 weeks.

I really think you need to contact Studd's clinic for advice and support - You shouldn't be getting so many side effect with no benefits.
 Good luck. DG x

The only consistent benefit I have experienced so far is an increase in libido. I have had no libido to speak of prior to the estrogen therapy, the only time I could muster any sexual activity was in the days leading up to my ovulation (days 10-14 of my cycle).

[Dancinggirl]

Your poor thing - what a tough time you are having.
You have clearly done some excellent research and pursuing a treatment route that could ultimately help you.
See if you can contact Savvas for advice and reassurance.
There is still so much that needs to be discovered about hormones and appropriate treatment for all hormonal problems - especially helping women with menopause - treatment is still far from good.
Do keep us posted with your progress. DG x

[NorthArm]

Hi Elia - I'm in Australia too lol.

Have you seen anyone here in Australia for help and advice? I'm someone who really suffered with PMDD myself, particularly after having had children.

In my late 20s I put myself on Diane 35, and was amazed at the difference...was quite a novelty (I remember feeling very wary when the time came for my first bleed) to get my period with no pmt!! Hindsight being what it is, and in the quest to do things ‘naturally' (WTF was I thinking!) I opted not to go back on the pill after having had my kids!

Anyway, the anxiety and mood swings became crippling so my gp put me on paroxetine when I was about 39 - that was successful for many years until it stopped working when I was about to turn 50, so I weaned myself off. Nine months later I was an unholy mess, and have been struggling trying to manage symptoms ever since 🙁

I'm so glad that PMDD is more recognised these days. My mother was affected, as is my daughter. She's 16, and just recently asked to go on the pill, so I went straight to Dianne 35 for her, bugger the expense (it's non pbs, so $115 for three months supply)....and I have certainly noticed a difference in her since she's started taking it. I'm so happy to have been able to guide her right, as I had no help from anyone. I managed mine by suppression mostly, with the odd moody explosion here and there.

I do hope you settle on this routine you're using - have you been keeping a mood diary with it? xx

[elia]

Your poor thing - what a tough time you are having.
You have clearly done some excellent research and pursuing a treatment route that could ultimately help you.
See if you can contact Savvas for advice and reassurance.
There is still so much that needs to be discovered about hormones and appropriate treatment for all hormonal problems - especially helping women with menopause - treatment is still far from good.
Do keep us posted with your progress. DG x

Thank you so much, DG. Really kind of you, truly. I will be sure to keep posting progress, the more information we can put out there the better to help others in similar conditions.

[elia]

Hi Elia - I'm in Australia too lol.

Have you seen anyone here in Australia for help and advice? I'm someone who really suffered with PMDD myself, particularly after having had children.

Hello hello! I've seen Dr. Colin Holloway at the Caboolture Clinic - he's highly recommended for menopause and is very familiar with Dr. John Studd's work. He is currently my prescribing doctor for the Estrodot and Androfeme. He has a bit of a wait list for new patients so I would try to book an appointment now, he also takes phone consults for those who are too far to travel to see him. I live an hour away by train and he suggested that I simply ring up for my consults rather than make the trip.

In my late 20s I put myself on Diane 35, and was amazed at the difference...was quite a novelty (I remember feeling very wary when the time came for my first bleed) to get my period with no pmt!! Hindsight being what it is, and in the quest to do things ‘naturally' (WTF was I thinking!) I opted not to go back on the pill after having had my kids!

That's super interesting how your PMT was resolved with the Diane35 - I had trialled in my late teens and it worsened my issues but I wasn't on it long enough to adequately judge its efficacy. And yes! It's funny how the "natural route" has screwed many of us all in the end. Ah this world is too complicated for the best of us.

Anyway, the anxiety and mood swings became crippling so my gp put me on paroxetine when I was about 39 - that was successful for many years until it stopped working when I was about to turn 50, so I weaned myself off. Nine months later I was an unholy mess, and have been struggling trying to manage symptoms ever since 🙁

I'm so glad that PMDD is more recognised these days. My mother was affected, as is my daughter. She's 16, and just recently asked to go on the pill, so I went straight to Dianne 35 for her, bugger the expense (it's non pbs, so $115 for three months supply)....and I have certainly noticed a difference in her since she's started taking it. I'm so happy to have been able to guide her right, as I had no help from anyone. I managed mine by suppression mostly, with the odd moody explosion here and there.

I do hope you settle on this routine you're using - have you been keeping a mood diary with it? xx

I'm so sorry to hear you've been struggling after the paroxetine - have you started any HRT yet? It is heartening to hear you've helped your daughter deal with her PMDD, it can be quite debilitating to live with.

[dangermouse]

Particularly as you've had endometriosis, would it not be the case that you're having volatile oestrogen levels currently, where it surges too high causing fibroids, breast pain, endometriosis etc.? This would then explain why Studd would want to override your cycle to bring the high oestrogen down.

As you have to override with high dose oestrogen or the comibined pill, you do have to go through an elevation of symptoms until your own hormones start to settle. It takes about a week with the combined pill but I suspect longer with bio identical oestrogen.

If you simply had low oestrogen then adding it would make you feel better from the off, albeit at a much lower dose to add to, rather than shut down your own hormones.

[elia]

Particularly as you’ve had endometriosis, would it not be the case that you’re having volatile oestrogen levels currently, where it surges too high causing fibroids, breast pain, endometriosis etc.? This would then explain why Studd would want to override your cycle to bring the high oestrogen down.

As you have to override with high dose oestrogen or the comibined pill, you do have to go through an elevation of symptoms until your own hormones start to settle. It takes about a week with the combined pill but I suspect longer with bio identical oestrogen.

If you simply had low oestrogen then adding it would make you feel better from the off, albeit at a much lower dose to add to, rather than shut down your own hormones.

Hey dangermouse! Endometriosis is not caused by high and/or volatile estrogen levels. Endogenous estrogen at normal physiologic levels throughout a woman's cycle is only theorized to "feed" endometriosis, if anything recent research reveals the disease makes its own estrogen - hence the discovery of endo in post-menopausal women. Medically induced amenorrhea or surgical menopause is at best proven to eliminate symptoms of endometriosis - it does not slow down nor stop disease progression. To think it does is a misconception that many endo-specialist surgeons are frusterated with. Hormonally treating endometriosis (ie. stopping the menstrual cycle) hits the mute button, so to speak, on the pain symptoms. Surgical excision, however, remains the only proven treatment and the closest thing to a cure today. That said - individual variation in disease progression/regression is still poorly understood - we don't know why some women get better, why some get worse, why some improve faster, why some worsen slower, etc.

Overriding a woman's cycle has many benefits for those suffering from PMDD and endometriosis. A state of amenorrhea will help her avoid the monthly endometriosis symptoms of pain while a hormonally consistent steady state (rather than fluctuating cycle) can help eliminate symptoms of PMDD.

I still don't know why I'm struggling with drowsiness from the estrogen patches, but it is improving day by day as I adjust to it. I'll keep coming back here to update my progress but if anyone has any questions, please let me know, I'm only happy to oblige.