The hormone dance
Jul. 18th, 2015 13:09![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
torquillThings have gotten kind of complicated.
I was diagnosed with a thickened uterine lining, in a follow-up after visiting the ER for OMG HEAVY BLEEDING. I've now had two bouts of very heavy bleeding. I've also gotten constant spotting despite a Depo-Provera shot, and since stepping up my BCP dose (to help stop the spotting) I've been getting uterine cramping and nausea.
My gynecologist doesn't seem to sure about what's going on, so I decided to try to unravel it myself. Figuring that the uterine lining is built up by estrogen, and since my mom has a history of high estrogen levels, I thought I'd look up the symptoms. I don't have most of the common ones, but in an expanded list I found:
Acne (I've been breaking out for months)
Heavy bleeding (check) and thickened uterine lining (check)
Irritability (check)
Depression (I remarked on depressive mental patterns just yesterday)
Mid-cycle bleeding (check)
Nausea (check)
Fatigue (I'm more sluggish than I'd expect, all other things being equal)
Pelvic cramps with or without uterine bleeding (which has mystified my gyno)
Weight gain (which I've been attributing to lack of exercise, but this might not be helping)
A few could be from other causes, but some of these are pretty definitely high estrogen. (No, I'm not pregnant.) What's causing it?
Estrogen is produced by the ovaries, but as my mom never noticed menopausal/low estrogen symptoms even after getting hers removed, I think it's likely that at least some of it is coming from elsewhere. It's also produced by adipose tissue, skin, and the hypothalamus, at least primarily. I do have a high body fat percentage even when I'm fit (thank you subcutaneous fat genes), and I already know there's something a little weird with my brainstem, so all of that could be contributing.
What to do about it? Losing weight would be an obvious, but very difficult, option. Especially when nausea, cramps, and fatigue make it hard to manage basic daily stuff. My body really doesn't make weight loss possible without vigorous exercise, diet notwithstanding.
Another option would be to find a way to block estrogen production. When I looked up estrogen receptor antagonists, the names there made the hair raise on the back of my neck -- Tamoxifen is not something to play around with. So I started looking at herbal versions, and didn't find much. However, estrogen production is another target in breast-cancer treatment (which is where most of the research is), and it turns out there are a couple of logical targets. Aromatase is an enzyme which converts androgens to estrogens in various tissues, and inhibiting it fully can drop blood-estrogen levels almost to nothing -- at least in women who have had their ovaries removed. One assumes inhibition is less effective with ovaries present.
Given that I don't want zero estrogen, however, partially inhibiting aromatase might be worth a shot. There are a few biologicals that have been studied -- there's an excellent review article on aromatase inhibition -- and the one that stands out to me as both effective and widely available is grapeseed extract. It has various other health benefits, of course, such as antioxidant activity, but it is reportedly quite effective at downregulating aromatase expression. I'm still hunting for suggested doses, but it's a start.
What's bothering me right this moment is the sense that my current treatment is actually exacerbating the problem. BCPs help regulate my bleeding, at least so that I don't bleed uncontrollably for a week or more (I was losing up to a pint per day, which is kind of prohibitive even for a large person). But the estrogen in those pills is adding fuel to the fire, and potentially making my uterine lining even thicker, even in the presence of progesterone. It's certainly showing up in symptoms like worse acne, nausea, and cramping. It makes BCPs a temporary measure at best, and I'm going to have a hell of a time coming off them if they've exacerbated the uterine lining issue.
I've been champing at the bit to have a hysterectomy over this, which would certainly remove some of the worst symptoms... but it wouldn't deal with nausea or hormone-induced depression and fatigue. I think that addressing the root cause may be better overall -- and I might be able to enlist my doctors' help by citing things like increased breast cancer risk (which doesn't run in my family, but I do have other risk factors like never having had children).
The uterine cramping, even more than the bleeding, has also been poking at my gender dysphoria. The gender part of my identity is in favor of getting rid of my uterus (at least), but I don't want it my doctors to see it as "the solution" to the medical issues I'm having, task done, the end. I'd rather continue living with a uterus which is quiet and well-behaved because I've dealt with the real problems.
My gynecology appointment is next Thursday. We'll see what I can come up with by then. for right now... I think it might be time to switch back to the lower dosage of BCPs and just cope with constant spotting.
Edit: it looks like I'd start in the low hundreds of milligrams (100-400). Adding resveratrol might help as well, as it can act as an estrogen mimic and receptor antagonist at 50 microM doses.
It may have the side effect of increasing testosterone levels slightly. I'll watch for that.
I was diagnosed with a thickened uterine lining, in a follow-up after visiting the ER for OMG HEAVY BLEEDING. I've now had two bouts of very heavy bleeding. I've also gotten constant spotting despite a Depo-Provera shot, and since stepping up my BCP dose (to help stop the spotting) I've been getting uterine cramping and nausea.
My gynecologist doesn't seem to sure about what's going on, so I decided to try to unravel it myself. Figuring that the uterine lining is built up by estrogen, and since my mom has a history of high estrogen levels, I thought I'd look up the symptoms. I don't have most of the common ones, but in an expanded list I found:
Acne (I've been breaking out for months)
Heavy bleeding (check) and thickened uterine lining (check)
Irritability (check)
Depression (I remarked on depressive mental patterns just yesterday)
Mid-cycle bleeding (check)
Nausea (check)
Fatigue (I'm more sluggish than I'd expect, all other things being equal)
Pelvic cramps with or without uterine bleeding (which has mystified my gyno)
Weight gain (which I've been attributing to lack of exercise, but this might not be helping)
A few could be from other causes, but some of these are pretty definitely high estrogen. (No, I'm not pregnant.) What's causing it?
Estrogen is produced by the ovaries, but as my mom never noticed menopausal/low estrogen symptoms even after getting hers removed, I think it's likely that at least some of it is coming from elsewhere. It's also produced by adipose tissue, skin, and the hypothalamus, at least primarily. I do have a high body fat percentage even when I'm fit (thank you subcutaneous fat genes), and I already know there's something a little weird with my brainstem, so all of that could be contributing.
What to do about it? Losing weight would be an obvious, but very difficult, option. Especially when nausea, cramps, and fatigue make it hard to manage basic daily stuff. My body really doesn't make weight loss possible without vigorous exercise, diet notwithstanding.
Another option would be to find a way to block estrogen production. When I looked up estrogen receptor antagonists, the names there made the hair raise on the back of my neck -- Tamoxifen is not something to play around with. So I started looking at herbal versions, and didn't find much. However, estrogen production is another target in breast-cancer treatment (which is where most of the research is), and it turns out there are a couple of logical targets. Aromatase is an enzyme which converts androgens to estrogens in various tissues, and inhibiting it fully can drop blood-estrogen levels almost to nothing -- at least in women who have had their ovaries removed. One assumes inhibition is less effective with ovaries present.
Given that I don't want zero estrogen, however, partially inhibiting aromatase might be worth a shot. There are a few biologicals that have been studied -- there's an excellent review article on aromatase inhibition -- and the one that stands out to me as both effective and widely available is grapeseed extract. It has various other health benefits, of course, such as antioxidant activity, but it is reportedly quite effective at downregulating aromatase expression. I'm still hunting for suggested doses, but it's a start.
What's bothering me right this moment is the sense that my current treatment is actually exacerbating the problem. BCPs help regulate my bleeding, at least so that I don't bleed uncontrollably for a week or more (I was losing up to a pint per day, which is kind of prohibitive even for a large person). But the estrogen in those pills is adding fuel to the fire, and potentially making my uterine lining even thicker, even in the presence of progesterone. It's certainly showing up in symptoms like worse acne, nausea, and cramping. It makes BCPs a temporary measure at best, and I'm going to have a hell of a time coming off them if they've exacerbated the uterine lining issue.
I've been champing at the bit to have a hysterectomy over this, which would certainly remove some of the worst symptoms... but it wouldn't deal with nausea or hormone-induced depression and fatigue. I think that addressing the root cause may be better overall -- and I might be able to enlist my doctors' help by citing things like increased breast cancer risk (which doesn't run in my family, but I do have other risk factors like never having had children).
The uterine cramping, even more than the bleeding, has also been poking at my gender dysphoria. The gender part of my identity is in favor of getting rid of my uterus (at least), but I don't want it my doctors to see it as "the solution" to the medical issues I'm having, task done, the end. I'd rather continue living with a uterus which is quiet and well-behaved because I've dealt with the real problems.
My gynecology appointment is next Thursday. We'll see what I can come up with by then. for right now... I think it might be time to switch back to the lower dosage of BCPs and just cope with constant spotting.
Edit: it looks like I'd start in the low hundreds of milligrams (100-400). Adding resveratrol might help as well, as it can act as an estrogen mimic and receptor antagonist at 50 microM doses.
It may have the side effect of increasing testosterone levels slightly. I'll watch for that.
