Hot Flashes vs. Hell Flashes

Here’s my story and I’m sticking to it.  Really I am.

Once upon a time I had hot flashes intermittently throughout my late 30s to late 40s.  It took THREE attempts to get off the combination hormone Estrogen/Progesterone, but I did!  After the third and final attempt, I was hot flash free after just over six weeks.  This final time I stopped hormones my mindset was different.  I embraced the burning ember feeling in my face, the formation of beads of sweat with the burning up sensation at night with cold shivers to follow.  I felt the heat rise and fall, reassuring myself this was a normal process when adjusting to being not so hormone-augmented any longer, hoping this feeling was transient.  The bothersome perimenopausal symptoms slowly faded, with the hot flashes and facial flushing being the last to go.

After this reprieve I decided to have my thyroid tested.  My TSH level (thyroid stimulating hormone) was barely elevated above the normal range of high — I was (still am?) sub-clinically hypothyroid.  I had some hypothyroid symptoms so my general partitioner put me on a low dose of Levothyroxine — 25 mcG to be exact.

For better or for worse, hypothyroidism is largely not under our control, [my emphasis] says Dr. Daniel Einhorn, M.D., an endocrinologist at Scripps Memorial Hospital La Jolla., who notes the disease is primarily genetic. Family history may be the greatest indicator of troubles ahead, but since so many people are undiagnosed, you could have a family history of thyroid disease and have no clue about it.

Full article

After four weeks of Levothyroxine I felt like I had more energy.  Then just about six weeks into this medication regime I started to have WEIRD hot flashes — more like HELL flashes — periods where it felt like ice was dripping down my neck covering my back and upper arms while simultaneously feeling an inner burn. Nighttime became its own hell.  I couldn’t sleep through the night because I was sweated profusely. I was hot and freezing at the same time.  How was this possible?  I thought maybe these symptoms were from drinking coffee in the daytime and wine at night.  Ha ha ha!  Cute  me and my hypotheses!  These symptoms were different than those related to coming off the hormones.

I thought these problems instead could be from the Levothyroxine. 

If your thyroid is out of control, all of your efforts to curb perimenopausal and menopausal symptoms, like hot flashes, insomnia, weight gain, hair loss, and achieve hormone happiness will be for naught [my emphasis]. What’s more, your symptoms might not be perimenopausal or menopausal at all. So talk to your perimenopause and menopause specialist about your symptoms and when you’re experiencing them. It’s a great first step in determining if your so-called menopausal symptoms are really symptoms of an underactive thyroid.

Ellen Dolgen

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From The Awkward Yeti comic — Check it out!

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I broke the scored thyroid tablet in half and tried taking a lower dose daily for four weeks … the chest pain and palpitations stopped with this decreased dose.  Oh, did I forget to mention I was having those too — the chest symptoms?  Oh, and the hyperacusis  … read below:

Individuals with hyperacusis have difficulty tolerating sounds which do not seem loud to others, such as the noise from running faucet water, riding in a car, walking on leaves, dishwasher, fan on the refrigerator, shuffling papers [husband’s voice, his breathing or even his heart beating … possibly the sound of any new hair growth on his beard as well]. Although all sounds may be perceived as too loud, high frequency sounds may be particularly troublesome [good thing I am not married to a canary!].

By this time I’d had enough experimenting on my body and said “F-you Levothyroxine!” and stopped it.

I am sub-clinically hypothyroid and many people aren’t even medicated at the TSH level I had!  (I don’t recommend anyone stop their medication without consulting a real life professional … just so you know!)

Subclinical hypothyroidism, also referred to as mild thyroid failure, is diagnosed when peripheral thyroid hormone levels are within the normal range, but thyroid stimulating hormone (TSH) is mildly elevated. It is common, occurring in 3-8% of the population, and carries a risk of progression to overt hypothyroidism of 2-5% per year. There is no absolute consensus on which patients to treat, although there are some clear recommendations.

It took another four weeks until the weird hellish symptoms went away. In the meantime I kept drinking coffee in the daytime and wine at night — you know, a healthy balance!  I’m no longer having hot flashes or night sweats.  Hallelujah!  I feel fine and am off any routine medication.  So happy.  Hormones are just plain weird and their effects REALLY linger.

I have concluded that hot flashes from Levothyroxine’s thyroid-hormone effects are much, much, much worse than any hormonal perimenopausal symptoms — a very interesting comparison and an experience I don’t wish to re-experience.  On an interesting note, the Levothyroxine lowered my cholesterol though!

How Does the Thyroid Cause Cholesterol Problems?

Your body needs thyroid hormones to make cholesterol and to get rid of the cholesterol it doesn’t need. When thyroid hormone levels are low (hypothyroidism), your body doesn’t break down and remove LDL cholesterol as efficiently as usual. LDL cholesterol can then build up in your blood.

Thyroid hormone levels don’t have to be very high to increase cholesterol. Even people with mildly low thyroid levels, called subclinical hypothyroidism, [that’s me!] can have higher than normal LDL cholesterol. A study in The Journal of Clinical Endocrinology and Metabolism (JCEM) found that high TSH levels alone can directly raise cholesterol levels, even if thyroid hormone levels aren’t high.

Full article

Why The Connection?

When thyroid hormone levels drop, the liver no longer functions properly and produces excess cholesterol, fatty acids and triglycerides. The liver, which metabolizes cholesterol, also has a key role in thyroid hormone metabolism. In addition, thyroid hormone serum level is very important for normal liver function. The liver in turn metabolizes the thyroid hormones and regulates their effects in the body. What’s more, thyroid dysfunctions are frequently associated with abnormal liver tests.

Another explanation for the thyroid-cholesterol connection is that hypothyroidism slows the body’s ability to process cholesterol. This processing lag occurs thanks to reduction in the number and activity of receptors for the bad LDL cholesterol. These receptors normally help metabolize LDL cholesterol. When the number of receptors decreases, LDL builds up in the bloodstream, increasing both LDL and total cholesterol levels.

Hypothyroidism also significantly changes the metabolism of steroids and other hormones that are made from cholesterol. For example, the hormone progesterone is made from pregnenolone, which in turn is derived from cholesterol. Likewise, vitamin D is produced through the action of ultraviolet irradiation on cholesterol in the skin. Hypothyroidism reduces the conversion of cholesterol into progesterone and vitamin D, contributing to total cholesterol load.

Full article

Let’s just say that stuff quoted above EXPLAINS A LOT!

I had vitamin D deficiency.  I am now in the normal range (at least my Vitamin D is) after taking 10,000 units of vitamin D3 daily for three months.  I am eating oatmeal intermittently to help improve my cholesterol.  I simply can’t tolerate the thyroid medication.  I feel OK … but my ankles still have a slightly swollen butterfly appearance on the outer aspects.

Hormones are simply weird and mysterious.  Cats are also mysterious and often weird as well.

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Why & how I stopped HRT

I never thought I’d be able to stop HRT (hormone replacement therapy).  I tried twice before without success.  My intolerance to hot flashes, night sweats, insomnia, headaches and brain fog kept me coming back to hormones the two times I tried to quit.

I had no real idea how any woman managed to stop hormones successfully.

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There are a lot of people who simply can’t relate to my life with this challenge.  They include and are probably not limited to:

• Any woman I know who is not taking and has never taken hormones
• Those women who have gracefully eased into menopause
• Any male — definitely my husband, father and father-in-law
• Those against many, most and / or all medications of all kinds

That list above is about every person I know.  I’m not sure why but it’s important for someone to me and vice versa when I’m experiencing challenging or upsetting experiences in my life.  I’ve had this feeling with innumerable issues — the desire to find others who are experiencing or have experienced what I’m going through.  Many people I talk to say they don’t need anyone else to relate to them; I wish I could be that resilient and nonchalant, but it doesn’t feel natural for me.  Emotionally, I get a lot from others who share their experiences with me and I don’t feel so alone.

Intellectually I know exogenous hormones can be detrimental to one’s health for various reasons.  I don’t like being on a medication that has to be taken daily.  It’s interesting what can make the final push to get one to start or stop something.

I hesitated writing this post because I wanted to make sure I was off my hormones (a low dose synthetic estrogen and progesterone combination) before I made the sweeping statement, “I’m off my hormones for good!”  It’s been over two months since I quit the Lo Lo Estrin … and I didn’t exactly quit because I wanted to — not like the other two times I didn’t succeed in stopping — I wanted to stop then simply for the sake of quitting.

I quit HRT because I started to get changes in my body that I had no idea as to what to attribute them to.  I stopped the hormones and any PRN (as needed) medications to see if it would make a difference.  I developed swelling in my ankles and I read many sources stating hormones can contribute to or cause this.

Some other medications can also cause swelling in the legs. These drugs mostly affect the water balance in the body or cause blood vessels to leak fluids.

Medications that can cause edema include:

• Vasodilators
• Calcium channel blockers such as nifedipine and amlodipine
• NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen
• Corticosteroids such as prednisone
• Steroids, both androgenic and anabolic
• Diabetes drugs like thiazolidinediones (say that fast with a mouth full of marbles!)
• Estrogens such as oral contraceptives and replacement hormones  BINGO!
• MAOIs (monoamine oxidase inhibitor) and TCAs (tricyclic antidepressants)

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I’ve NEVER had any problems with hormones — at least no obvious ones. The only problems I thought about hormones causing were heart attacks, strokes, blood clots and cancer.  While peripheral edema can be a side effect of hormones I never put much thought to it.  Sometimes you have to experience adverse effects personally vs. reading them on a list to visceralize what can happen in real life.

This ankle swelling has done it for me.  As soon as I read this as one of the side effects I went off Lo Lo Estrin cold turkey.  I am scared sh*tless as to what I may have done to my body with various medications over the years.  I’ve never had ankle swelling in my life.  Coupled with the unsightly appearance of lateral swelling to my ankles is a sense of shame and embarrassment that I caused this … making me feel very cautious with whom and when I divulge this problem.

It only took six weeks for me to stop having perimenopausal symptoms from being off the low dose estrogen-progesterone combo.  Those six weeks were no walk in the park though — I got restless sleep, sweated nightly (and daily) and hot flashed constantly.  My mindset was different in this third attempt to quit.  I actually accepted the hot flashes telling myself I’d get used to them, embracing each episode riding it out as each one waxed and waned.  This became my new normal.  And then one night I didn’t have any sweats during my sleep which progressed to a full week without them.  The daytime hot flashes became fewer and fewer to now where I might have one or two brief hot flashes every several days.

Yay for me!  I did it.  I got over the hump with the hot flashes, night sweats, headaches and insomnia.  And because I don’t have the hormonal headaches any more I don’t need the Fioricet (acetaminophen, caffeine and butalbital combo).  However, the swelling to my ankles has not improved and I’m in search of other causes.   On the upside, my ankles are now easier to shave without a fear of nicks due to their fluffiness and in the process of deciphering the ankle edema mystery, I’ve also successfully kicked hormones to the curb!

Now I have to figure out how to get to the bottom of this ankle edema before I have full on cankles! 

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No, no and no!

Reflecting on my last post, thinking about medications in general and suffering through hot flashes … all I can think of is NO, NO & NO.

NO I’m not going to start a new blog about my thoracic outlet syndrome and chronic pain.  What was I thinking?!  All the typing on a new blog is only bound to make my symptoms worse.  But even worse it would be soooooo boring to have to read someone’s blog about pain day #1, 2, 3 , 4 … 325 … blah, blah, blah.  I obviously wasn’t thinking that one through.  So, no, no, no new blog about boring pain.  My pain.  My boring pain.

NO I’m not taking the Trazodone any more.  I took it for about a month to help with pain-induced insomnia.  While it helped I was slowly developing swollen ankles.  YIKES!  WTF?!  I’ve never had swollen ankles in my life.  I’ve been off the Trazodone over a month  … and the swelling has gone down, but hasn’t gone away completely.  This is crazy.  Medications with their side effects blow.  Of course, some side effects are tolerable and some aren’t.  Right now I’m really pissed at medications.  Don’t worry I’m not going go all hippy green or something.

NO I’m not taking my Lo Lo Estrin anymore.  Say what?!  Yep.  I decided since my last medication failures I’ve decided to quit my hormone replacement too.  I am sweating with insomnia along with the shivers that come afterwards from the lovely perimenopausal symptoms … I knew what I was getting into having failed getting off hormones twice before.  Something is different this time.  I can’t put my finger on it.  Perhaps I got scared due to Lyrica giving me elevated blood pressure and now Trazodone giving me swollen ankles … I’m thinking about the potential of blood clots and stroke from the hormones.

I feel great about my NOs.

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PS: I have another “no” post in the works!

UPDATE: That other “NO” post.

PPS: There will never be NOs to cats … ever!

A site to check out!

Lots and lots and lots and lots of GREAT stuff about hysterectomy and women’s health can be found at Hysterectomy.org

Check out Hysterectomy.org

About 10 days after hormones …

About 10 days to hormonal turnaround … if you read my most recent post HORMONAL SADNESS then this post will make more sense.  In fact, if you read every single blog post I’ve written it will make the most sense of all.

But really, folks, I’m sure you have better things to do like get your “re-gift” closet ready for next year, get your tax stuff ready for 2016 (woo hoo!) … and on that thought, ignorant American here (AKA me) — you Europeans don’t have to pay annual taxes right ’cause you’re already taxed to death for your “free” healthcare and such, right?  … anyway, my digression (and global ignorance at it’s finest) … if you do want to read my entire blog, please, please be my guest.  I like comments too. ❤

Back to hormones … it has taken just about 10 days for my response to the  hormones to come around more or less. (Ironically I’m sweating as I write this. … and now I’m not sweating as I proofread this.)  I’m still having some hot flashies in the daytime, but the insomnia, drippy sweatiness and feeling super sad has been “fixed” by the low-dose synthetic progesterone-estrogen pill I’ve been taking.  This really is one of those times that there is better living through chemistry … at least for me!

What would you choose?

If I had a choice to feel sadness vs. anger, I would pick anger.  Grrrr!  Anger feels so much more energetic … although according to spiritual readings I’ve done in the past, anger is only a slighter false level of higher energy than sadness.  If it sounds like I’m some hippie dope smoker here I assure you I’m not … not that there’s anything wrong with hippie dope smokers except, well … that’s another soapbox for another day and probably NOT this blog.

Back to the energy thing … don’t worry this hysterectomy blog isn’t going to turn into some spiritual guru place where I take your money getting you to buy my books while we all practice shamanism in the heat of a New Mexican summer crowded into a seven-person tent with a fire pit blazing all while reading  The Law of Attraction or The Secret … definitely not going to happen.

A long time ago … I don’t know … about nine or ten years ago, I used to be more spiritual — whatever that means and during this exploration I came across a book called Power Vs. Force.  In this book, levels of emotions are rated as being higher or lower energy levels than others placed on a scale.  Through this book that I have no particular interest that you do or don’t read, I learned that different emotions have different consciousness levels of energy.  Ooooh!  Neato … or something.

Poor you, hysterectomy reader, you thought I was going to talk more about  hysterectomies or hormones … something female-related at least.  However, what I have come to feel is that the artificial hormones have helped moved me out of a sadness and now I can return to the regularly scheduled program of husband-wife anger Mars vs. Venus discussions in my house.  

Please don’t mistake me, I don’t enjoy being angry or feeling angry or being around others who are angry … it’s just a bit better feeling than that of sadness.

 

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P.S. Did I mention I’m getting back to yoga?  I think this helps a lot with hormones and moods and stuff …

The third chakra is called Manipura, which means “lustrous gem.” Located around the navel in the area of the solar plexus and up to the breastbone, it is a source of personal power and governs self-esteem, warrior energy, and the power of transformation.

Namaste

Hormonal sadness

Going off hormones can be a bad idea.

Of course, if you have a breast cancer that’s estrogen receptive or positive, then of course you need to stop those hormones.  Duh.

I wish I hadn’t tried going off my Lo Loestrin for 8 weeks.  While I have restarted the hormone regimen again, my body is taking a while to catch up, especially emotionally lately.  Hormones aren’t like instantaneous pain pills — like take a pain pill and feel better in about an hour.  It doesn’t work that way and I’m sure you know that.

I simply didn’t realize how hard the emotional aspect would hit me after stopping the Lo Loestrin.  I can’t wait until things are back on track emotionally-speaking. I’m not sure how long that part of this hormonal process takes to stabilize.  I really have no idea.

Easier said than done.

I don’t like feeling sad or crying easily — it reminds me of my teenage years and through the times when my hormones weren’t very balanced.  I hate being a sensitive person and having petty things upset me to a greater degree than they “should”.  I very much envy stoic people … not that I like to be around these unfeeling people much, but I do envy their lack of emotional responses and seemingly controlled cool-as-a cucumber outer appearance (perhaps facade).  And no, no, no I wouldn’t want to be an unfeeling psychopath by any means.

Why isn’t my skin thicker?  It’s a stupid unrewarding question only asked to torture oneself with no real logical conclusion that can only serve to spiral into more self-deprecating thought.  I can only think hormones, genes and past experiences combined play a part in this emotional downspin.

And I don’t want to become a man pumped full of testosterone with a sex change either simply to avoid female emotions.  I suppose the hormone balancing act is one that takes patience … and perhaps the tension of the Christmas season with all it’s various stressors don’t help either.

Where’s my cyber friend Wanda when I need her to tell me that depression is a lying asshole?  Wanda, Wanda, come out of the woodwork wherever you are. ❤ 

Anyway, physically my hormonal symptoms are greatly improving but this lack of estrogen and progesterone (whether synthetic or not) has me reeling into depths of being oversensitive and almost drowning in self-doubt.  It’s to the point that if you tell me I’m shit, I believe you without fight or question.

Sorry for the sad post folks … it’s usually not my style.

Then I feel guilty about being sad … like my sadness is stupid, selfish, a waste of time … I don’t have cancer, I’m not like the woman I saw in the grocery store today with only half an arm, my dad didn’t die, I didn’t lose a baby, I didn’t get fired … I feel like my sadness is all bullshit and trivial.  However, on the other hand I genuinely feel it … it’s not fake … the tears come, the lower lip and chin quiver, the thoughts grow, merge and a take on a life of their own.

No worries please, I know and hope too as the eternal optimist that I am that this too will pass.  It’s just so amazing how it feels like it won’t.  I’m nowhere needing the “suidcidal hotline”.  It’s simply sadness with undertones or rather overtones of unworthiness.

I also know I need to get myself to yoga tomorrow … yoga does something very special to me … more than words can explain.

I failed and I’m sweating

Sleep of the universe.

Hormones, hormone, hormones … can’t see them, can’t smell them but boy oh boy when they’re off you certainly feel it.

I decided to go off  my Lo Loestrin (my drug … er, hormone of choice) for the following reasons:

1. Maybe less hormones in my body will  help me lose weight (Ha ha ha — nice try!)
2. Maybe I don’t really need hormones.  (And maybe I don’t need air to breathe either.)
3. To see what happens again when I stop the hormones.
4. Going off hormones should help my heart right?  Because hormones (estrogen/progesterone) are purportedly bad for your heart, right?
5. I’m strong (mentally not physically) and don’t need another medication in my body!  (Wrong!  There IS better living through chemistry.)
6. Other women don’t need hormones and I should be just as capable of handling my peri-menopause as well as they do, shouldn’t I?  (Nothing like comparing yourself to others to heighten your expectations!)
7. Maybe the last time I had such a bad experience with going off hormones was because it was only my imagination and that I didn’t give it enough time.
8. I decided to fix things that aren’t broken.
9. Maybe sleep IS overrated?!

I have been off Lo Loestrin for almost eight weeks … yes, I’ve toughed it out that long.  The first three weeks off was no problem having no peri-menopausal symptoms at all.  I thought for sure I was in the clear and didn’t need the Lo Loestrin anymore. Then for the next couple of weeks I was getting hot pretty much all the time (and I don’t mean sexy hot), and being that the weather has been getting cooler I welcomed the internal warmth.  Then for the next two weeks I’ve had hot flashes, flushing, night sweats, day sweats and insomnia.  I might be a bit more emotionally sensitive and on edge lately too.  I cried at yoga twice recently and I’ve been doing yoga for years without tears!  I don’t want to be that emotional crying yoga lady!  People ain’t got time to hear that poor me sh*t.

DR. ROBERT BARBIERI HAS THIS TO  SAY ABOUT LO LOESTRIN FE:

One circumstance in which a low-estrogen [oral contraceptive] might be especially useful:

The peri-menopausal woman.

During the perimenopause, many women have cycles characterized by markedly abnormal hormone levels. For example, some cycles in perimenopausal women are characterized by excessively high estradiol secretion and very low progesterone secretion. Other cycles are characterized by low estradiol secretion for an extended length of time. These abnormal patterns of hormone secretion contribute to …  vasomotor symptoms. 

It used to be that my hot flashes and flushing were triggered by alcohol, especially red wine, intense emotions (especially those people who play the devil’s advocate), hot baths, coffee, spicy food and hot weather.  Now all of these hellish sensations, and yes, it is like the heat of hell, are now triggered by driving, sitting up straight, smiling, thinking, frowning, clipping my toenails, watching birds fly, looking at my black cat, looking at my grey cat, breathing, making the bed, contemplating making the bed, flushing the toilet, putting on lipstick, blinking … really anything and everything triggers these horrific sweaty, flushing, insomniac bouts of life sensations  for no frickin’ rhyme or reason.  In fact, I’m sweating it up right now just writing this!

Last night, after feeling like a hormone-addicted-failure, I restarted my Lo Loestrin and I’m sure it will take a week or two before I start feeling normal whatever the heck normal is.  I was so excited to save on the heating bill this year because I’ve been able to tolerate the temperature at 65F (18 C for all you metric freaks and foreigners reading this).  I was planning on saving so much money … but no, the heat’s going  back up because I’m going to get cold (and thermoregulated) when my exogenous hormone regime is back up to snuff.  Yeah, poor, poor me and my first world problems … but folks, first world problems are the only ones I really know!

For any of you women out there suffering from hot flashes and the like from this wonderful part of life, I get ya totally.  I read that hot flashes can last from several months to 15 years!  And there have been some women in their 70s and 80s still suffering from this BS!  

I am weak and I admit it.  I cannot tolerate sleeping in 20-30 minute increments every night. I cannot handle having about 40 and I’m not exaggerating, hot flashes and sweating episodes daily.  I can’t do this … I’m just not that strong (physically speaking).  So, Lo Loestrin, I welcome you back with my flushed face, sweaty crevices, moist mustache area and sleep-deprived mind!

And come to think of it … I have been eating more crap since I haven’t been sleeping well while also trying to distract myself from these peri-menopausal symptoms!  More coffee to wake up … more wine to wind down … but what really pushed me over the edge was not being able to pick up and love my cats — they were just too hot to handle!

Do you know how hot cats are?!?!

A cat’s normal body temperature can range from 100.5 to 102.5 degrees. Because 101.5 degrees is right in the middle, it’s often referred to as a “normal” body temperature.

More on those hot fur babies.

F*ck it!  I need Lo Loestrin!

PS: Regarding the graphic above … I’m not really concerned if my sperm count decreases … if it increased at all I’d be F*CK!ING alarmed out of my mind … guess that one is for men!  Not to be confused with menopause!

“The Book” is done.

Finally finished reading The Estrogen Errors: Why Progesterone is Better for Women’s Health.  FINALLY.  What. A. Long. Read. This book was only moderately slightly helpful for those of us sans uterus. 

What I learned from this book was:

• The author is a feminist.
• The author believes Big Pharma is evil and controlling.
• The author states there is an estrogen over-prescribing and over-manufacturing conspiracy.  Yes, conspiracy.
• The author had an incredibly hard time getting her studies published; she felt incredibly marginalized.
• The author believes estrogen has been totally overemphasized and glorified while progesterone almost completely ignored.
• The author states that the only good reason for menopausal hormone therapy is for early menopause starting before age 40 and/or night sweats chronically disturbing sleep plus low bone density (or fractures).
• The author has a sense of humor.
• The author is a REALLY strong feminist.

What I found to be useful or interesting from this book is that:

• Bio-identical progesterone, not to be confused with progestin — a synthetic progesterone, can make you very sleepy so you need to take it at night.
• The author states that the bio-identical progesterone, like Prometrium, is not implicated in breast cancer.
• Progesterone can be stopped without withdrawal effects like those of estrogen (Although she contradicts herself when she says it can be used alone for hot flashes, night sweats and insomnia — if you stop the progesterone, won’t those vasomotor symptoms return?)
• Peri-menopausal women usually have high or inconsistently fluctuating levels of estrogen — not low estrogen like those of post-menopausal women.
• Ovulatory cycles throughout a woman’s lifetime are necessary for adequate bone density and any hormone that suppresses ovulation, like Depo-provera, can lead to premature bone loss.
• Estrogen is important in the prevention of bone loss, but should also be taken with progesterone.

What I didn’t appreciate about this book … well, many things … but chiefly that the author did not discuss any real negative sides of progesterone.  Just as the author accuses the Big Pharma industry, et al in regard to estrogen-glorification, she does the same with progesterone.  This book wasn’t very useful in the aspect that women with hysterectomies were barely mentioned … only a few sentences are mentioned in regard to hysterectomy.

The most useful comment in the entire book came on the 4th page from the end:

You ask, ‘What if I have had a hysterectomy?’  If taking estrogen, progesterone is still needed for the breast, brains, and bones of women who have no uterus. ~ Jerilynn C. Prior, MD

Was this book a waste of my time?  No.  Would I pick it up for a second read?  No.  Would I suggest YOU read this book?  No.  Will I mention this book to my Gyn, that he should read it?  No.  Will I be taking the suggestion of taking oral progesterone 300 mG orally at bedtime combined with daily topical estrogen?  Maybe.  Is the author a feminist?  Yes.

(Just so you know … I don’t think feminism is a bad thing.)

On the bright side, one book I do recommend, perhaps while you’re on the mend from your hysterectomy, or you simply like cats is: Dewey: The Small-Town Library Cat Who Touched the World by Vicki Myron.

THE BOOK REVIEW.  This book has nothing to do about hysterectomy. While reading, I laughed, cried, sighed and felt love for a cat I’ve never met.  This is definitely one of the best books I’ve ever read.

WHERE TO ORDER IT (used it only costs one penny!) or free if you check it out from your local library.  You can also get the audio CD so you can listen in your car.

(*** Spoiler Alert: Dewey dies and this is incredibly sad tearjerking, so if you’re driving while listening to the audio CD be careful!)

Don’t you want to kiss this little kitty? I know I do.

Hormone Confusion

I’m still reading The Estrogen Errors: Why Progesterone Is Better for Women’s Health.  It is not quite the book I expected. I was hoping for more information about progesterone, but am getting a rather lengthy history about estrogen studies.

So far I’ve learned that estrogen isn’t really good for the heart, especially for any woman who starts estrogen therapy after menopause.  Apparently numerous studies set out to detail and prove why estrogen was good for a woman’s heart only to find either no evidence to support this idea or that it was actually harmful.

Big Pharma is to blame, according to author Dr. Jerilynn Prior, is to blame for most of these erroneous studies and the push for estrogen to be the forerunner hormone.  Interestingly, Dr. Prior discusses the errors with the quasi-estrogen DES – Diethystilbestrol as being an estrogen that could save failing pregnancies, when in actuality it caused more miscarriages that it helped, gave the women taking DES and their daughters vaginal carcinoma.

In 1971, DES was shown to cause clear cell carcinoma, a rare vaginal tumor in girls and women who had been exposed to this drug in utero. The United States Food and Drug Administration subsequently withdrew DES from use in pregnant women. Follow-up studies have indicated that DES also has the potential to cause a variety of significant adverse medical complications during the lifetimes of those exposed.[1]

The United States National Cancer Institute recommends[2] women born to mothers who took DES undergo special medical exams on a regular basis to screen for complications as a result of the drug. Individuals who were exposed to DES during their mothers’ pregnancies are commonly referred to as “DES daughters” and “DES sons”.

Source Wikipedia

Not only is estrogen, pharmacological estrogen, bad for the heart, but it plays no part in helping bone preservation or density either.

Personally, I’m not taking Lo LoEstrin, my HRT (hormone replacement therapy) with estrogen, for heart or bone health.  Those thoughts hadn’t even occurred to me, nor did my GYN tout estrogen as being helpful for either the cardiac or skeletal system when he prescribed it.  I am taking this HRT for hot flashes, night sweats and insomnia AKA vasomotor symptoms.

The next section in the book I’ll be reading is about breast cancer risks from pharmacological estrogens.

Past research has highlighted potential risks of HRT. The principal results from the Women’s Health Initiative Randomized Controlled Trial was that hazard rate of invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits.[

Source Wikipedia

One of things that bother me about the book so far is how much the history of estrogen is talked about without addressing the current use of progesterone.  The authors also mention hysterectomy several times throughout the book but fail to clarify if this is a hysterectomy with or without cervical removal, or a hysterectomy with or without ovaries removed.  To me there is a huge difference among these operations.  A hysterectomy without a salpingo-oophorectomy isn’t the same as a total hysterectomy (cervix removed with tubes and ovaries kept intact).

Anyway, I’ll keep trudging though this book, learning what I can, applying any knowledge to my own real life.  So far, I’m leaning towards asking my GYN for topical estrogen (again), and requesting to take progesterone (the non-synthetic form) 100-300 mG nightly.  I hope I don’t have to make an extra appointment for this request but can to speak to one of his nurses who will relay the information to him.  I’m also trepidous about changing from Lo LoEstrin to the two aforementioned hormones because currently, my vasomotor symptoms are well-controlled.

Dr. Jerilynn Prior states that in the beginning of menopause — perimenopause — estrogen is actually not low, but elevated and/or fluctuating greatly.  She states there is widespread misconception that the perimenopausal symptoms are due to decreasing estrogen.

PERIMENOPAUSE:
The period of time before and for a year after the final menstrual period during which ovarian hormonal patterns, experiences and sociocultural roles change.  The average age at which irregular cycles develop is approximately age 47.  Perimenopause probably begins several years before that in women with regular cycles whose ovaries are making higher amounts of estrogen and tending to make lower amounts of progesterone.  Like menopause, this is a normal part of a woman’s life cycle.

Dr. Prior also goes on to explain the difference between symptoms and estrogen levels in perimenopause and menopause:

ESTROGEN’S LOW IN MENOPAUSE, AND HIGH IN PERIMENOPAUSE — WHY FLUSHES IN BOTH?

Hot flushes occur in both perimenopause and menopause, yet hormone levels are very different. Why? Hot flushes appear to be caused by dropping estrogen levels when the brain has been exposed to, and gotten “used to” higher estrogen levels. Therefore the hot flushes in perimenopause occur because of the big swings in estrogen from super- high to merely high, or even from high to normal. In menopause, hot flushes occur because estrogen levels have become low after the normal levels of the menstruating years and the higher levels of perimenopause.

Although previously hot flushes were thought to be caused by low estrogen levels, in their brain actions, hormonal associations and experiences, they closely resemble an addict’s drug withdrawal. CeMCOR attributes hot flushes to “estrogen withdrawal.” The key trigger appears to be a dropping estrogen level (from high to normal or normal to low). 

Regarding OHT (Ovarian Hormone Therapy), Dr. Prior has never advocated the wide use of hormones as an ongoing “replacement” for menopause. She does not think menopause is a medical condition that should be “fixed”, but is instead a normal stage of life.

According to Dr. Prior, there are only three main reasons to recommend OHT:  If a woman is experiencing early menopause (<45 with hot flushes and for sure < 40) hot flushes are interfering with sleep and for prevention of osteoporosis.  For hot flushes progesterone is equally effective as estrogen [my emphasis].

Dr. Prior also says that OHT should only be taken longer than five years if menopause came early. She has never advocated OHT for prevention of heart disease.

More at CeMCOR

While writing this post, and looking over Wikipedia information I’ve come across this piece of startling information:

A study [2006] where women [aged women] going through menopause using HRT with Progestin as a major component of the therapy showed a few negative effects on hearing, [my emphasis] which highlights the importance of choosing bioidentical progesterone instead of synthetic progestin. Not only does the Progestin decrease the functionality of many regions of the ear it also reduces the effectiveness in parts of the central nervous system used for hearing.

Yes, you heard that right!  Synthetic progesterone, progestin, has been show to affect hearing in at least one study!  Ay carumba!

I actually had to go to the website with research by Dr. Prior to find the information I’ve been looking for — so far, I haven’t found it in her book.  I could have saved some money and time by simply reading the CeMCOR site.

Here’s what I’ve been looking for:

The reasons I believe that progesterone is preferable to estrogen for menopausal women with hot flushes are detailed below.

Progesterone is probably similarly effective as estrogen for hot flushes.  The first reason I prefer progesterone to estrogen for hot flush therapy is that it has been shown to be effective for hot flushes [my emphasis].

However, progestins (synthetic hormones derived from progesterone) have repeatedly been shown to significantly improve hot flushes in randomized double blind placebo-controlled trials and with similar 85-95 percent improvements as estrogen.

Progesterone has a “side effect” that it significantly improves deep sleep  thus particularly helping night sweats and one of the major reasons VMS interfere with women’s well being. (Progesterone cream and progestins don’t help sleep).

Stopping estrogen therapy causes a rebound increase in the number and severity of hot flushes and night sweats to greater than they were initially. There is no evidence from clinical experience (although the definitive study has not yet been done) that stopping progesterone or progestin leads to a similar rebound increase in VMS.

Estrogen or estrogen with low dose medroxyprogesterone increases the number of abnormal mammograms and need for further investigation. It is likely, although not proven, that progesterone alone would not do that.

Estrogen or estrogen/progestin increases the risk for many diseases such as blood clots and strokes, gall bladder disease, incontinence and dementia as well as the more publicized increased risk for heart attacks and breast cancer. By contrast, these adverse effects are not seen with progesterone or most progestins. In particular, progestins “caused only minor effects on coagulation and fibrinolysis” (Kuhl, Maturitas, 1996) meaning no risks for blood clots that estrogens, especially in a pill form, increase.

From CeMCOR

But … I don’t know about changing what I’m doing just because Dr. Prior touts the positives of progesterone.  I wonder what taking actual progesterone is like?  All hormones have side effects, whether synthetic or not.

THIS BLOGGER talks about her negative experience with progesterone.  Granted, she was taking an injection form to get pregnant … which is a whole other different colored bag of worms on why I’d consider taking it.  The bloated feeling, insomnia and constipation sound dreadful!  It reminds of the time when I was briefly pregnant and I attribute all those side effects to progesterone.

Have YOU fallen asleep yet?

THIS IS SO CONFUSING!!!!

Got my book!

I received The Estrogen Errors: Why Progesterone is Better for Women’s Health (2009) two days ago.  I’m still reading the introduction and overview section.

In this revealing work, a medical writer and an internationally-known physician team up to explain the controversy over medicine prescribing estrogen for perimenopausal women in North America, and to detail why progesterone is actually a far more effective, and a far less risk-ridden, approach. Citing long-standing and emerging research, patient vignettes, and personal experience, endocrinologist Jerilynn Prior and writer Susan Baxter tell us how false beliefs on estrogen became entrenched in North American medicine and culture, and why business and politics have played a role in this erroneous thinking.

Like most women in Europe, Prior’s patients find progesterone the key to dealing with a life cycle transition that, contrary to Western medicine, these authors do not see as a disease. Challenging medical orthodoxy, this work presents arguments and evidence both women and doctors will find compelling and useful.

In my internet searching, it’s been difficult to find information about progesterone. Estrogen seems to be ubiquitous, but progesterone seems to be largely ignored.  This has baffled me.  Apparently, one of the authors of the aforementioned book felt the same way.

All of these women were going through something similar, and none of them knew what to do, particularly because being told that low estrogen was the problem simply felt wrong.  Women know what high estrogen feels like — with birth control pills, for instance.  It’s sore breast and headaches, anxiety and bloating.  It made intuitive and physiologic sense to all of us that during perimenopause estrogen was high and we needed progesterone.  Various women asked me what to tell their doctors because most of them had gone to medical school at a time when it was all about estrogen, and it became patently clear that women needed a book on perimenopause and progesterone.  It took me a few years, but here it is.  ~ Susan Baxter, Ph.D.

This reminds me of when I went to see my gynecologist and there was a sub due to his illness.  The sub GYN wanted me to go off my Lo LoEstrin and only use either a low-dose topical hormone or nothing!  I was only 45, still had my ovaries and having the slew of perimenopausal symptoms.  There was no way I was going back to simply topical estrogen.  It has always seemed odd to me when women are taking only estrogen.

You can read more about that situation here: THE SUB GYN THAT ALMOST GOT RID OF MY PROGESTERONE!

I was hoping that my current gynecologist who has returned to practice would be able to provide more in depth answers to my questions about perimenopause and medication management.  I don’t feel like badgering him because, well, frankly, he is frail and has returned to his practice recently after dealing with serious recurrent head and neck cancer.  By no means do I doubt his intelligence, but in the same token I know he’s a man who will never personally go through menopause and his academic training occurred during a time period when estrogen was hot, hot, hot!

What do midlife women expect from their gynecologists?  Too much.  The average midlife woman believes that her gynecologist is familiar with the whole gamut of complaints associated with natural menopause and that he or she could (if only they would) explain exactly what is going on in that woman’s body right now, as well as what she might expect in the future.  Since it is impossible to predict the course of a natural menopause, this would call for unusual prescience on the part of her physician.  And it is no big secret that the training of gynecologists allots very little time to natural menopause.  ~ Janine O. Cobb

As the above excerpt suggests, I too expect too much.

Jerilynn Prior goes on to say:

Gynecologists, however, are trained in surgery, not hormone physiology, and too many of them respond to symptoms with a prescription for ‘HRT’ or a recommendation to have a hysterectomy — since, from the perspective of obstetrics and gynecology, the womb is no longer useful — as ridiculous as that might seem.

After starting this book I’m beginning to think I need a higher dose of progesterone, not the synthetic form and no more estrogen.  These are my early thoughts as I read this book.  We’ll see what conclusion I come to by they end.  Currently, my hot flashes are fairly well-controlled now that I’m back on the Lo LoEstrin regularly.  Some say, why fix it if it’s not broken?

Stay posted.