Posted by janejane on July 9, 2010, at 11:31:07
In reply to PMDD and estrogen therapy?, posted by dusty rhoads on July 9, 2010, at 2:45:06
I'm sorry about the PMDD, dusty. I'm 39 and am going through a bad spell right now, myself.
According to one school of thought, low progesterone is the most common cause of PMS (type A for anxiety), but there is also a rarer type that's due low estrogen (type D for depression). There are other types too, but you obviously fit into the type D category if your estrogen is low. Whether the typology is useful or not in the real world, I don't know, but the distinction makes a lot of sense to me.
I do remember finding a meta-analysis on pubmed that suggested that the jury was still out on whether progesterone helps with PMS, but I don't believe that either of the studies that ended up counting tested for levels beforehand, which I think is a major design flaw since if some of the women had type D instead of A, that may have confounded the results. I don't recall finding any studies on estrogen supplementation, but it's been a while since I did the research.
It's good to hear that you've found some relief with vitamins, minerals, fish oil, exercise, etc. (I totally understand meds not working or having unbearable side effects, too.) I'm a little curious if you've ever tried herbs. If so, how did they work for you? Did you get worse? I would actually caution you against taking any of the usual progesterone-enhancing PMS recommendations like vitex (chaste tree berry), angelica (dong quai), black cohash, licorice, etc. Since you have the unusual PMS type D, what works for most PMS sufferers (things that increase progesterone) would theoretically make your type of PMS worse. (They say that the last thing you want to do if you have low estrogen is to increase progesterone since that'll just exacerbate the problem.) Sometimes you read reviews of PMS supplements and there will be a ton of thumbs up, but then a few where the women say they got much, much worse. That's when I think they might have the rare type D, like you. I recently took some herbs that I think backfired on me in the same way, which makes me think I might also be type D.
As for supplements that increase estrogen, they might be something to consider. Soy comes to mind, but there are so many conflicting arguments about whether it's good or not, that I never bothered to sort out. Of course, it does make the most sense to try raising your low estrogen directly through estrogen therapy, as you're considering, rather than trying to do it indirectly. I understand your concerns about risk, but it might be worth it to get 3/4 of your life back.
When you tried birth control, did you do the continuous kind, where you don't have any periods? I ask because I noticed that when I took yaz, I tended to feel the worst on the blank pill days, when I wasn't getting any hormones. If I went back on oral contraceptives, I would definitely want to try the continuous type to see if it makes a difference. (Currently have a non-hormonal IUD.) I do know of one woman doing this, and it seems to help.
I looked into hormones a while ago, and from what I could gather, most of the risk of estrogen therapy is associated with use of synthetics. (This is something that makes me shy away from going back on the pill.) There was a pretty big French study that suggested that bioidenticals are safer, though people of course caution that more research is needed, etc. As far as I know, there are no studies suggesting that bioidenticals aren't safe, actually. From what I can tell, they are just tainted by association because of the research with prempro. If I were going to try hormone therapy long-term, I'd definitely go with bioidenticals, which is I'm sure what your naturopath would recommend.
If you're having trouble getting a prescription, I know there's an OTC bioidentical estriol cream. (I don't know why estradiol is not available.) Maybe you can ask your naturopath whether it might be something to try. You could also google bioidentical hormone docs in your area or ask your naturopath if she knows someone who could prescribe it for you if she can't.
When you got your hormones tested, did you do saliva or blood, and how far from the reference range were your numbers? The first time I did the blood tests, I was at day 14 and my integrative doc interpreted the results as low progesterone and prescribed prometrium for days 7-28 (I think) and I felt really bad after three days. Like I felt really irritable to the point of wanting to be violent. I looked at the results more closely and realized that she had probably misinterpreted them (since I was right at ovulation rather in the luteal phase) so we retested after day 21. That's when she decided I was in range and recommended I try other things. I was at the low end of normal for estrogen, though, so I do wonder if supplementation would help. I'm sort of tempted to try ordering a saliva test online and seeing where my numbers are when I'm feeling my very lowest.
Oh yeah. That reminds me of another question. I know you've got three bad weeks out of the month, but when are your symptoms the worst? Mine are when I'm spotting before the blood starts flowing (usually a couple days), and then for the first few days of menstruation. I've wondered whether my odd timing might be a clue to what my problem is since it seems like most women with PMS/PMDD start feeling bad a week or two before menstruation and get relief once the flow begins. Is that the case with you? I wish I could find more info on the timing issue, but I keep coming up empty. I guess I really should do a day 1 test to see whether low estrogen then is an issue for me.
That's interesting about the grapefruit juice (and thanks for the tip), by the way. I remember reading a theory once that the magnesium content in it induces calm (I kind of doubted it since I don't think there's a huge amount in it), but I didn't know about estrogen. (A note to anybody else out there who might be thinking of trying this... remember that grapefruit juice can alter the concentration of meds, so be careful using it with ADs and other drugs.)
I do know that green tea reduces estrogen, so that's something you might want to avoid.
I'm sorry I can't be of more help, but please keep us updated on what you decide to do.
PS: I just checked the availability of OTC estradiol, and it seems like there is now an OTC product available that is 80% estriol and 20% estradiol at iherb. I'm pretty sure it wasn't there a few months ago so it must be pretty new. There is only one review, but it's positive.
poster:janejane
thread:953868
URL: http://www.dr-bob.org/babble/alter/20100703/msgs/953886.html