Is Estrogen Dominance for real?

I am just wondering what everyone thinks about the concept/theory/whatever of estrogen dominance. The two sides of the issue are definitely at opposite ends of the spectrum and proponents of both sides make some salient points.

I just wonder how it fits in with surgical menopause, hrt, etc. When I look at the list of 'symptoms', it seems I fit the bill as a textbook case...but then again....

Confused, as ever,
Laura

Hi Laura Two sides of the issue? And those would be....?

"Estrogen dominance" just means that the ratio of estrogen to progesterone is higher than it ought to be. The confusing part of it is that that can happen even when estrogen levels are dropping - in fact, it often does in perimenopause, when progesterone levels are dropping even faster than estrogen levels.

Perhaps you could fill us in on which proponents you meant and what points they make by giving us links so we can look up their comments? That might help.

s,
-Linda

Linda,

I certainly didn't mean to sound ignorant. I just meant to convey that, from my reading about the subject, it seemed that there were two sides of the issue.

Here is a link that would seem to say that 'estrogen dominance' as put forth by Dr Lee is too simplistic of a concept, especially for those of us in surgical menopause:

http://NoLinks.blogspot.com/search?q=estrogen+dominance

Here is one that seems to agree with the theory, a little:

http://www.womentowomen.com/menopaus...dominance.aspx

I am thoroughly confused because I have many symptoms of 'estrogen dominance' but they could also be symptoms of hypothyroid, which I am also being treated for....I have been told by you and the moderator of another surgical menopause forum that I should try increasing my estrogen replacement before adding progesterone. If I really have 'estrogen dominance', how can it make sense to add more estrogen?

I am just afraid of doing the wrong thing and wanted to get some thoughts about some of the things I have read. I am seeing my nurse practitioner today, mainly about a switch in my hypothyroid treatment plan, and I am wondering if I should also bring up my sex hrt stuff (she is my practitioner for both conditions). Sorry if I seemed stupid by asking the question.

Laura

(((Laura))) no need to apologize at all, and there is no such thing as a stupid question here

I agree it is confusing. There are a couple of things that make it hard to understand. One is that almost all the stuff we read about this subject is written about women with cycles or in natural menopause/perimenopause, rather than those of us with no ovaries at all. So, while the 'theory' may be the same, the application is quite different.

Also, it's this notion that one can be estrogen dominant (too much estrogen relative to progesterone) while also being low in estrogen. That is absolutely true and happens all the time. That's what is going on in perimenopause. Dr. Lee's solution was just to add progesterone to balance the estrogen. Well, that works for a while if all you're dealing with is perimenopause and you still have ovaries. It works for a couple of reasons. One is that still having ovaries means that women can convert some of the progesterone to estrogen if they need to - those of us without ovaries have a much harder time doing that. In other words, just because they supplement only with progesterone doesn't mean that only their progesterone level goes up -- both estrogen and progesterone can go up when women in perimenopause use progesterone. (!)

Also, in perimenopause, the drop in hormone levels isn't nearly as big as it is when the ovaries are removed, so the supplementation doesn't require the same kind of quantities as it does for us. That's why women in perimenopause can get by on a .025mg/day or .0375mg/day patch, for example, with a little progesterone cream, and most of us with BSO's would be miserable on that kind of regimen.

Unfortunately for us, getting balanced after a BSO is way harder than getting balanced in perimenopause. There is a sudden, large drop in all hormone levels. The logical thing to do is to first replace the estrogen. That may take quite a while to get the dose right, and then how do you know it's right when you still have all these symptoms? That's because maybe progesterone or testosterone is still needed.

Well, so why not add those to begin with? Two reasons: first, because it makes it that much harder to figure out what the right estrogen dose is. And second, because if your estrogen dose is too low, adding progesterone will make the symptoms get worse.

So, many of us end up going through a period of a few months or so where we are estrogen-dominant before deciding we've done the best we can on estrogen alone and must look to progesterone and/or testosterone to fill in the gaps. And without looking back at your old posts, I'm guessing that if you were experiencing symptoms of estrogen dominance and having hot flashes, I would suggest first adding some more estrogen and then adding progesterone to balance out the symptoms of estrogen dominance. That way you'd get your estrogen up to the right level for you and in proportion to progesterone. At that point, if your libido and energy level had disappeared, I'd suggest trying compounded testosterone to fill in that gap.

That's pretty much the approach I took in my own situation, with a couple of exceptions. First, I didn't really understand at first how much I needed estrogen and tried to wean myself down to a very low dose. When it didn't work, I essentially had to go back and start over. And second, when I first tried to add progesterone, it made my symptoms worse, and I didn't understand that it was because my estrogen dose was still too low. Once I went to a higher estrogen dose, and then tried progesterone again, well, now I can use it quite successfully.

Does that make sense? Now, don't ask me about thyroid stuff because I have zero personal experience with that (other than that both of my cats are hyperthyroid, and I really don't think you want me giving you advice based on that ).

in there! Sometimes it can be a really long process to get balanced, but it's worth it when you do get there.

s,
-Linda

Thanks Surferbabe, I often wondered about the same progesterone questions as Laura. Your info answers lots of questions for me!

I have noticed that Linda has a way with words and explains things to make them easily understood. Good job!

Thank you for your compassionate and thorough reply, Linda! I think the way you explained things is the most reasoned and well-put answer I have seen on the subject...especially in regards to those of us in surgical meno!

Now, here is another one for you...I am on the highest dose of Vivelle dot (.1) and have been since my BSO in Jan 07. I have no hot flashes and haven't since I found the Vivelle after much trial and error with oral estrogen, etc... At my appt with my nurse practitioner yesterday, she looked at my low testosterone level (on both blood and saliva test results) and prescribed a compounded testosterone cream for me. (I haven't picked it up yet, so don't know the dosage, etc) From what I have read, and what you said in your reply, I should be trying progesterone first, right?

Testosterone scares me a bit as I have a family history of heart disease (both paternal and maternal), high BP myself, and my HDL levels were low the last time I had my cholesterol checked (6 mos ago).

Can you give me your thoughts on whether I should try progesterone first?

Thanks!
LauraK

(((Laura))) Not necessarily... what's important is to start with estrogen and then only add one hormone at a time and give it plenty of time to work before adjusting the dose or adding another one, so you know what is making the symptoms better or worse.

I'm glad your DR checked your testosterone levels before prescribing it. Did she also run lipids (cholesterol) and liver function? Those two can be adversely affected through testosterone use, though the effect is stronger with oral testosterone than transdermal.

I know starting testosterone is scary... if you are using a very low dose, and not too much of it, then they would tend to come on very gradually and give you plenty of warning so you can back off. For me, the first thing to show up is oily skin and hair, then cystic acne (small amounts of regular type pimples are not a concern; that is normal temporarily when you first start it as your pores are clearing out stuff that's hardened inside). I found that if I backed down on the dose at that point, those symptoms reversed quite easily. It's if you don't listen to your body and just let the symptoms continue that you get to the ones that are much harder to reverse, if not impossible (lower voice, larger clitoris, hair loss) - now that IS scary.

Remember not to be impatient with it... using a very low dose, which is the best approach imho, it can take a few weeks to work. Some women think if a little is good, a lot must be better, but that's not the case. And you may find that once it starts working, you may need less and less of it. I hardly ever use it anymore, though I keep some around in case I'm feeling like I have no energy at all.

Good luck!
s,
-Linda

Thanks for your quick reply, Linda. I totally understand what you are saying when you recommend only changing/adding one thing at a time and giving each change time to take hold.

To answer your questions, my NP did not check my liver function (never has, in all the time I have been doctoring with her...) or my lipids before prescribing the T. She is famous for not running tests unless I specifically ask for them and she tends to forget the Big Picture when it comes to prescribing things for me. (ie - she put me on thyroid meds without checking my adrenal status, she put me on 2 antidepressants without realizing that an increase in thyroid meds may be necessary, etc...) I really have to be my own advocate with her and if I don't know something (like the above things she overlooked) until it's too late, I end up on meds I probably didn't really need in the first place if she would keep the Big Picture in mind. I think many people can, unfortunately, say the same of their practitioner, so I know I am not alone in this. I did have my liver function checked by a DO in June '07 and it was normal.

Some of things I failed to mention when I asked you about progesterone v. testosterone are that, according to recent saliva testing, my progesterone to estrogen ratio is only 7:1 (I understand it should be 20:1 to 100:1, right?); I have no real symptoms of low testosterone, aside from low libido; I have MANY symptoms of low progesterone, as listed on this site and others.

I do find things that I have read about testosterone scary, but I would be willing to add it to my regimen. I am just confused that if progesterone can convert to testosterone (at least that's what I understand), why I would add testosterone first.

It seems odd to me that I am just now realizing that I don't have to feel as crappy as I do, considering that I have really not felt well for years, but I think that is why I am finding myself in this learning curve. Thanks for helping me in it!

Laura

Thanks, Linda. You do have a great way of explaining things. You've really cleared up a lot of my questions.

Blessings, Lisa