Saw a new doctor on Friday. Kind of scary but I went to a psychiatrist since I haven't slept since 5 weeks post op and the anxiety keeps building. Don't know how I get through the day without collapsing my body is so worn out. Turned out the psychiatrist had a hysterectomy and she thinks some symptoms may be tied into my liver and my body not having enough progesterone. She described a situation where the liver produces a substance, maybe a protein, that binds to the estrogen making it unavailable for use. MY gyn had checked estrogen levels and they were low normal but perhaps I'm not getting the benefit of what I am taking which is a high dose at 3 mg estrace. Everyone at the site seems to feel a patch is better so I guess I need to push for that. I also started using prometrium 2 weks ago. Can't say anything has improved. If I am low on estrogen is the prometrium of any use? Had heard the body will change the progesterone to estrogen? Would this help my levels. Wondering if my liver can't process the estrogen can it use the Progesterone? New doctor also mentioned a test to check free estrogen levels. Anyone familiar with it or had success? Keep telling myself to hang on but there are days I feel like I won't make it. Anxiety has always been an issue and thought it was related to years of health and infertility issues. Went into surgery expecting a better quality of life, never thought I could sink this low. Once you switch to a patch how quickly might you see an improvement.
As always, thanks to everyone out there for your feedback.
Hi Lisee Well, it's true that estrogen absorbed through your skin (patches, creams and troches) will not pass through your liver first as oral estrogen does. That's why a patch labeled 0.1mg/day is considered roughly equivalent to an oral dosage of 1.25mg/day, over ten times as much. I say "roughly" because it depends on things like how permeable your skin is and how good the contact is between your skin and the patch, and also how "efficient" your liver is. You sound like me in that I have the most efficient liver of anyone I know. It takes 5 or 6 drinks for me to feel any effect from alcohol (which is a great thing, since I'm never tempted to consume that much). Does that sound familiar? That is why I don't take oral estrogen -- I would have to take a large dose, and I'd worry that over a long period of time the breakdown products might damage my liver.
The relationship between estrogen and progesterone is complicated. It is true that there are pathways in your body by which you can make estrogen from progesterone. The presence of progesterone also seems to affect the binding of estrogen. At low levels of estrogen, progesterone (like your prometrium) can interfere with its absorption so you will get less estrogen than you would normally.
My own personal experience was that at higher estrogen levels, I found progesterone to be helpful in eliminating side effects of too much estrogen, but it was still too much estrogen; and when I got down to a low dose of estrogen, which was better for me, I had to stop taking the progesterone. Your body can also make progesterone from dietary cholesterol, so it's likely that at low estrogen levels, you make enough progesterone on your own without having to supplement with it.
The test for free estradiol has been around for a while, as has the test for free testosterone. Both are blood tests and are more meaningful to us than total estradiol or total testosterone. Many DRs don't appreciate the difference or don't believe in hormone level tests, period. If your DR is willing to do the free estradiol and testosterone tests, I'd encourage you to have them done to see where you are. I had the free testosterone test done and it was very helpful to me.
I started out on a patch so I can't really comment on how fast you might see an improvement, except that I know that for me, when I have switched patch strengths, I've seen an effect within a day and it's leveled out within a week or two. Some sisters have said it's taken much longer, however. Do allow at least a few weeks before deciding if it's going to work for you or not.
Thanks for the quick reply. Funny, I don't drink because one drink and I'm woozy. Does that mean my liver is handling the estrogen O K? Even if it is I guess switching to a patch wouldn't be harmful. Heard back from the new doctor I saw and she spoke to my gyn. She said he didn't think my current problems were related to estrogen levels since my bloodwork a few weeks ago showed 90 as a level. My understanding is that is a low level even if in the normal range. I'm waiting to hear back from my gyn and will let him know I'd like to try a patch. The new doctor also gave me the name of another gyn in my town and suggested I see her for a 2nd opinion since she likes to work with natural products and has done the free estrogen test. I know it is one step at a time but have a hard time making the steps when I am so run down and low in spirits. I'm willing to try an anti depressant but the side effects of anything I've tried makes the anxiety so much worse I hate taking it. Seems to be a cycle.
Guess I should stay with the prometrium if I change to the patch so I don't do 2 things at once.
Lisee I switched from oral to transdermal and noticed a difference in the first few days that gradually got better.
Is your doctor talking about Sex Hormone Binding Globulin? There is a test to check for that.
i would like to urge you to make an appt. for that second opinion. i know that feeling of being too tired and worn out to do anything, but this sounds like a dr that can help you. have your test results, that you've had so far, forwarded to the 2nd opinion dr. if your new appt. is far off they may even start you on something before. good luck hon and your doing a great job hanging in there.