What has worked, so far?

So many changes happened all at once that I am not sure of what has specifically worked and what is just along for the ride.

You saw in my last post that the consultant made a lot of suggestions and changes to my supplement routine and I added HRT. Basically, I have been taking: Vyvanse (for ADHD), Low dose Naltrexone (for anxiety), Progesterone, Estro-ease, Magnesium glycinate, and adrenal stress support (NOW foods supplement intended to support stress and cortisol). To be fair the only real additions to this since July of last year was the progesterone and the Estro-ease, so I guess any success can be attributed to the combination of the two.

In my last post, you saw that I tested as estrogen dominant and very low on the progesterone side.  My doctor prescribed the 40 mg/g topical bio-identical progesterone cream, and the pharmacist recommended the estro-ease to help my body process and get rid of excess estrogens.

Here is what I learned about estrogen and progesterone and how both are important for hormone balance:

"Progesterone does not directly provide or produce estrogen, but it can influence estrogen activity and balance in the body. Progesterone and estrogen are distinct steroid hormones with complementary roles in the body. Estrogen is primarily responsible for stimulating growth and development of female secondary sexual characteristics, regulating the menstrual cycle, and supporting bone, brain, and cardiovascular health. It is mainly produced by the ovaries, with smaller contributions from fat tissue, adrenal glands, and the brain.  Progesterone, on the other hand, is produced by the corpus luteum in the ovaries after ovulation and later by the placenta during pregnancy. Its main role is to prepare and maintain the uterine lining for pregnancy, support breast development for lactation, and modulate mood and thyroid function." (Healthline.com)

'If your body doesn’t make enough progesterone or if it makes too much estrogen, this can lead to what’s called unopposed estrogen. Some healthcare providers call this “estrogen dominance.” Without progesterone’s balancing influence, estrogen can work overtime in your body. This causes cell overgrowths, like tumors in your uterine lining" (clevelandclinic.org)

"While progesterone does not convert into estrogen, it helps balance estrogen’s effects in the body." (lifemd.com)

It is interesting to me that symptoms for estrogen dominance (which come to find out I have probably had for a good portion of my life) can be similar to symptoms caused by other hormone irregularities. This is probably why many women aren't seeing results with certain treatments. for instance, hot flashes are typically caused by a sudden drop in estrogen (mayoclinic.org) but "women can experience hot flashes even when estrogen is relatively high if progesterone is low." (schoolafm.com). So, if a woman is experiencing hot flashes, she is likely being treated for low estrogen, which could potentially make things worse if her progesterone is low.

Another great example is low sex drive.  This can be caused by unregulated estrogen or low testosterone. (clevelandclinic.org)

Gods dammit! why does this have to be so complicated?!

Ok so seriously, here is a full list of symptoms of estrogen dominance (sources are clevelandclinic.org and hrt.org respectively, I did pull this information from google AI for ease of sharing)

1. Sexual & Reproductive Symptoms

• Decreased sex drive

• Irregular or heavy menstrual periods

• Worsening PMS symptoms (mood changes, cramps, headaches) 

• Uterine fibroids or fibrocystic breasts in some cases 

2. Mood & Cognitive Symptoms

• Mood swings, irritability, anxiety, or depression 

• Brain fog or difficulty concentrating

3. Physical Symptoms

• Breast swelling or tenderness 

• Bloating and water retention 

• Weight gain, especially around hips, thighs, or waist 

• Fatigue or low energy 

• Headaches or migraines 

4. Additional Possible Symptoms

• Sleep disturbances or insomnia 

• Hair thinning or hair loss 

• Cold hands/feet, thyroid‑related symptoms (due to hormonal interplay) 

You can see from these symptoms that they probably all have multiple potential causes. With the exception of the fibroids and fibrocystic breasts, I have been experiencing some combination of these symptoms for probably the last 3 to 4 years, with symptoms getting worse as I have aged.

Here is the good news, since I have started the HRT and the estro-ease there has been a noticeable change in my daily symptoms.  My mood has been more stable, I am sleeping a little better, the amount of shedding my hair does has decreased, my concentration has improved (usually during the first half of my cycle), I have less breast tenderness, I have had less migraines and severe headaches, my sex drive is returning, and my PMS symptoms are less severe.

There have been some other notable changes throughout my cycle that may indicate that my estrogen is more regulated and the progesterone is doing its job. Namely, the effectiveness of my Vyvanse though my cycle and how my joints feel starting about a week before my period.  Coincidentally, as estrogen drops toward the end of the cycle, that drop will affect the joints causing (for me) hip pain.  That estrogen drop can also decrease the effectiveness of stimulants used for ADHD (in my case, Vyvanse).

"Estrogen directly boosts dopamine availability, and when it plummets in the days before your period, stimulant medications have less neurochemical fuel to work with. The result is a predictable window of worsening symptoms" (neurolaunch.com) That was a super fun discovery.

In addition to the changes I have made in my medications, I have also changed jobs. I left a retail pharmacy environment and moved to a job in large scale pharmaceutical manufacturing. There are some key life factors that go with this change.  I get paid way better now, but my schedule is rough.  At the retail pharmacy I was working Monday through Friday 9am to 6 pm +/-. My commute was about 17 minutes each way. It was fast paced and could be high stress depending on if the owner was in that day (and his mood, if I am perfectly honest). I also had to listen to my co-workers talk to some very toxic customers all day long. There was a fair bit of financial stress, because retail doesn't pay well. And the insurance was and HMO, so anything other than preventative was not covered...add more financial stress.

My new position is about a 35–40-minute commute, I work 6:30 am- 7 pm Friday-Sunday every week with rotating Thursdays.  That means I get either three or four days off every week!  It is a manufacturing job, so its low-ish stress as long as the work gets done correctly and safely.  The pay (with bonuses and overtime) is about 1.5 times as much as I was making at the pharmacy and the benefits are significantly better. The company even has dedicated menopause support! While the commute sucks and I am not a fan of working weekends, the job change has significantly helped with my stress levels overall.  I mention this because this change happened shortly after the addition of the HRT and supplement changes.  So, I can't say for sure that my mood changes are solely caused by the Progesterone and estro-ease. Although I am pretty sure they are a big part of it.

One more factor to throw in the mix, in regard to my sleep.  The person who takes care of my medication management (primarily for my mental health) suggested taking Gabapentin for hip pain during sleep. I started that I February. Previously I had taken the gabapentin for my back issues and nerve pain. after my last surgery I had a bunch left so I figured it was worth a try.  The gabapentin, I feel, has helped relieve some of the hip pain I deal with when sleeping and has helped me sleep, possibly better.  I still wake up groggy and tired but there is a noticeable difference from this time last year. Reflecting, it may just be time for a new mattress.

That's all for now.