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estrogen is helping (and I'm only 31)

Posted by katekite on July 17, 2002, at 11:32:27

This is long. A description first of my response to birth control pills, then of peri-menopause, then of other ovarian conditions that can also cause or worsen psychiatric problems.

So, me --- I started a pack of old birth control pills two days ago out of desperation and can't believe the positive difference. Went to an obgyn yesterday and got an even higher estrogen dose. This obgyn listened to my symptoms and response to the Pill and confirmed that I am in very early menopause at 31.

My situation up till now was that after lots of medical tests the only thing wrong was high cortisol (seems to fluctuate normal to abnormal -- next appt July 25). I used to have anxious depression treated by meds years ago, but Prozac had pooped out, several things didn't work, neurontin worked for a while then seemed to have sided effects, things just seemed to be getting worse and worse. ADD got treated with Ritalin, that was good for a while, then couldn't tolerate Ritalin any more due to blood pressure probs.

Here's a run down of my symptoms: mostly moodiness and anxiety and insomnia to begin with. I was diagnosed with GAD, then BP II, then I was normal for a few months, then recently changed to ADD. In the last few months mostly physically sick with wild mood swings. Physical symptoms: things like weird hot sensations mostly in my legs that don't seem to meet the description for hot flashes as they last too long, have over a year now progressed more towards true hot flashes. (anti-convulsants impair cooling so can make hot flashes not the classic flush). Also a bizarre twitchy skin sensation here and there, like a rubber band snapping or a bug crawling (yeah imagine the look on the doctors face). Also weird scalp sensations on and off that have turned out to be a type of migraine without headache. Eye dryness, acne, no libido, no tolerance of caffeine, weird runs of racing heart, odd fluctuations in blood pressure, joint pain, breast tenderness and swelling, feeling bloated now and then, occasional nausea, crippling fatigue. Miserable.

I had been holding off on experimenting with any meds due to having testing done and not wanting to screw it up. The only med I've been on is klonopin. But I was feeling like I couldn't make it till the next appointment -- so I broke down and tried my old BC pills. Within an hour I felt so much more like 'me', and most of the physical symptoms were better, after 2 days now they are really improved, as is my energy level. Many things are just gone completely. It seems like early to post, 2 days, but the difference is really remarkable. Life isn't fantastic, but I'm suddenly functional again. If I had a job I'd be able to go.

In retrospect my periods have been getting lighter for the last year, now last around 3-4 days instead of 7. I am still having them, usually slightly sooner than I expect. But still every 26-27 days. Some women will actually have heavier or longer periods.
Basically what one is looking for is a change... not any particular kind of change.

I probably have some cortisol problem too, but it seems that many of my actual symptoms are due to low estrogen or maybe just wildly fluctuating estrogen. Menopause can progress at any pace it wants to: mine started just with insomnia and moodiness and anxiety. It probably could have stayed like that for a year rather than progressing.... so maybe there are other women out there who's ovaries work slightly better and are just stuck at the mood/insomnia stage.


After reading, I've found out the following:

1 in 100 women go through menopause before 40 (I'm 31). 1 in 1000 go through it before 30. Menopause is usually defined as an entire year with no period at all. "Pre-menopause" or "peri-menopause" is approximately the 3-5 years before menopause. Probably many many women in their late 30s are in this without knowing.

Women may experience all, none, or one of the menopausal symptoms due to decreasing ovarian function. They may have completely normal periods and show only moodiness, insomnia, or anxiety. They may have only an exacerbation of a pre-existing problem. Since it takes years after pre-menopause starts to actually stop having periods altogether, there are a lot of women younger than 40 with pre-menopause who have no idea why their mind and body feels so wrong.

Women who have ovarian problems at a younger age often have a more difficult time with it, since younger bodies are more used to estrogen and it isn't decreasing gradually but probably fluctuating wildly. This is not to say that a percentage of women who go through it at a normal age don't also have wild mood swings and unbearable symptoms. And many lucky ones have very few symptoms.

Statistically, women with psychiatric problems go through menopause earlier than others (chicken or egg?)

Anyone with any other hormonal issue (thyroid etc) is more likely to have premature ovarian dysfunction.

Anyone who has irregular periods or closer periods or lighter periods or more pain, moreso than in the past should look into this. Most regular docs and pdocs seem to be completely unaware. Or they think of it as normal with increasing age and don't think that it might worsen psychiatric problems. Women with premature ovarian failure tend to be undiagnosed for years.

I found several cases of women who'd been diagnosed as bipolar of some form. Usually it was a relatively new problem, not something they'd been dealing with since their teens.

FSH (the hormone that causes estrogen to be released from the ovaries) is often normal until periods stop altogether. Even after periods stop altogether it can be normal, because its taken at a point in time and it normally fluctuates over the day. Also, estrogen levels can be normal as it too fluctuates over the day. Having said that, if you do get an abnormal test result that will prove the issue beyond all doubt, so it is worth testing.

It seems to be that the only sure way to find out if low estrogen, or fluctuating estrogen, is a problem for an individual with some symptoms who still has periods, is to try estrogen supplementation (usually in the form of birth control pills for women under 40). Estrogen replacement therapy that is given to menopausal women is usually too LOW a dose of estrogen to see much of a difference. One has to evaluate the particular Pill carefully as some contain very little estrogen. The one I am taking has progesterone (norgestrel) and ethinyl estradiol 0.05 mg. (Ogestrol). I'm pretty sure that's a fairly high dose of estrogen.

There was a study once showing estrogen worsened symptoms for some women with psychiatric problems. Docs seem to have heard of this study, but not of others that show equal or greater numbers of women are helped by estrogen... so many docs will prescribe very low dose contraceptives to any woman with a history of mental illness. Or prescribe a progesterone only pill.

The bottom line is that since it seems to be so individual and also hard to predict, one might have to try several different combinations before deciding to give up on it. From reading, I recommend trying two things: first one with a lot of estrogen such as the one I'm taking, then if that seems to worsen things try a progesterone only version (or one with very very low estrogen). Either way, if taking the birth control pill changes your mood for better or for worse, that may be a clue that some hormonal factors are at work and need investigation.

I had taken the Pill as recently as 18 months ago and found it made no difference to my mild depression.... but things have apparently changed markedly in that time (as have my symptoms). So past response does not necessarily predict future response, especially if symptoms have changed.

Disclaimers: estrogen therapy can exacerbate some disorders, long term estrogen therapy in women over 50 is probably bad, and estrogen therapy does predispose to some types of cancers (as the current frenzy over HRT shows). Women who have an intact uterus must take progesterone too or uterine cancer can occur: progesterone pretty much prevents this.

Estrogen is thought to be required for serotonin to work properly, ie in PMS estrogen is low. People who have serious PMS sometimes use estrogen/progesterone therapy that goes for months at a time so as not to have to go through that as often. People with PMS bad enough to require meds, should consider this as an alternative or in addition to SSRIs if they have not tried it already.

There are some other conditions that are unique to women and can worsen or psychiatric problems: PCOS (polycystic ovarian syndrome), and endometriosis. Women with PCOS usually have irregular periods and have gotten hairier than they used to be, maybe gained weight. Women with endometriosis has increasingly painful periods, sometimes pain with intercourse -- anyone who has more than a day of cramps or who's pain isn't easily controlled with tylenol type things should look this up. As we get older both of these conditions are increasingly common.

SSRIs have been used in women who have had breast cancer (who can not take estrogen) to battle symptoms of menopause. SSRIs seem to help in many cases but at a lower effectiveness than estrogen (which works for most menopausal symptoms with upwards of 90% effectiveness).

Women have menopausal symptoms earlier than 40, ie premature menopause, or who have had to have ovaries or uterus removed for some reason, are more at risk of other hormonal situations like thyroid disorders.

And lastly, about female testosterone. Yes we have it and it is normally produced by the ovaries in significant amounts (although way less than men). It is directly linked to drive and to libido. Women who are in pre-menopause or who have gone through menopause or who've had surgeries almost all have low testosterone. It can be replaced. Women who use it say it makes them feel younger, have better libido and have more general motivation. Downsides are that too much will cause hair growth and predispose to irritability. So never wrong to get levels checked and replace if wanted.

Kate


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poster:katekite thread:112658
URL: http://www.dr-bob.org/babble/20020709/msgs/112658.html