![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by dusty rhoads on July 9, 2010, at 2:45:06
I'm a 35-year-old woman who's had PMDD for about 5 years. It seems to have gradually gotten worse over the years, and I now only have about one good week per month. I've found a bunch of things that help (B vitamins, exercise, fish oil, grapefruit juice, calcium, magnesium, vitamin d, meditation, yoga, getting plenty of sleep, etc) but still have pretty bothersome symptoms (irritability, anxiety, depression, bloating, etc). I've tried SSRI's, anxiolytics, birth control pills, etc and they were all either ineffective, or the side effects made them intolerable.
Anyway ... I recently went to a naturopathic doctor and got my hormone levels tested. Turns out my estrogen is on the low end of normal, and progesterone and testosterone are on the high end. This jives with what I've been reading on PubMed about women with PMDD having low estrogen levels. I've also read on PubMed that grapefruit can increase estrogen, and after drinking grapefruit juice I noticed that I felt calmer and happier.
So, my question is ... has anyone out there with PMDD tried estrogen therapy? All the doctors I've seen so far are very reluctant to give me estrogen, but I'm not giving up because I have a strong feeling that it would help me. Supposedly estrogen by itself can increase the risk of endometrial cancer, but I read in a book on menopause that endometrial cancer is really only a risk for women who aren't shedding their endometrial linings every month, i.e. postmenopausal women. I probably have at least another decade of PMDD torture before menopause, so I'm ready to try estrogen now. But it's frustrating that it's so difficult to get estrogen therapy by itself, without progesterone, which I already have too much of.
Any thoughts or anecdotes would be very much appreciated! :o) Or if anyone knows of any studies that I can print out and show my doctor, relating to the safety of estrogen therapy for pre-menopausal women. I did find one enterprising doctor in the UK who touts estrogen therapy for women under 60 (Dr John Studd), but I can't access his journal articles for some reason.
Thanks for reading!
Posted by morgan miller on July 9, 2010, at 9:02:16
In reply to PMDD and estrogen therapy?, posted by dusty rhoads on July 9, 2010, at 2:45:06
Your naturopath should have plenty of natural supplement suggestions.
A few that come to mind are black cohosh and soy isoflavones.
Have you tried evening primrose? I don't think it raises estrogen but it is known to be helpful for some of your symptoms.
Do you take fish oil?
Does moderate to intense exercise help you feel better? Have you tried this?
I would do an extensive google search and talk more with your naturopath.
I would also exhaust all options before trying estrogen therapy. I would have concerns over breast cancer risk.
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.
Posted by janejane on July 9, 2010, at 17:09:46
In reply to Re: PMDD and estrogen therapy? » dusty rhoads, posted by janejane on July 9, 2010, at 11:31:07
Correction: I misspoke about black cohosh. It's supposed to be estrogenic. Angelica is trickier since some sources say it increases estrogen, and others say it increases progesterone. I also found conflicting reports on what licorice does. Very confusing. (Sorry for being so sloppy about this, by the way. It's been a long week.)
Posted by ihatedrugs on July 10, 2010, at 22:22:33
In reply to Re: PMDD and estrogen therapy? » dusty rhoads, posted by janejane on July 9, 2010, at 11:31:07
Hi,
I'm so glad this topic is being discussed in this forum. I too am suffering from PMDD and have been trying to understand how to manage it. I went to a gynecologist who advertised his expertise with menstrual disorders, only to find out he was a jerk and dissed my condition as purely emotional. I left his office in tears. I have tried the ssri route but with minimal benefit. I am now increasing my intakes of B vitamins and especially B-6. Your explanation about the different types of PMDD makes so much sense. I too believe suffer from type D. My main complaint during the 10 days before menstruation is severe depression that disappears a couple days after my flow starts. When I asked the "jerk GYN doctor" about checking my hormone levels, he dismissed it as an inconclusive test and a waste of time.
I am also leery of hormone treatment as I had a transient ischemic attack a couple of years ago. However, I was tested by a hematologist to see if I was having a clotting problem and she found absolutely nothing wrong and came to the conclusion that the ischemia may have been an isolated incident. But I am still afraid to even consider any hormone treatment as it could potentially create a cardiovascular situation. So at this point, I'm exploring any options but not much is out there, at least in the mainstream medical community. I'm curious about green tea since I just purchased some Matcha tea, which is touted as a super antioxidant and has neuro-protective properties. I hope it doesn't lower my levels. I also wanted to add that the low estrogen theory makes so much sense to me because I remember feeling amazing during both of my pregnancies when estrogen levels were at an all time high.
I'm still going to look into having my hormone levels checked. I need to find someone who believes in it as a diagnostic tool.
Please keep us posted about any new information you may find or websites I can look into.
Posted by SLS on July 11, 2010, at 5:45:07
In reply to Re: PMDD and estrogen therapy?, posted by janejane on July 9, 2010, at 17:09:46
What about Yasmin?
- Scott
Posted by janejane on July 11, 2010, at 6:30:00
In reply to Re: PMDD and estrogen therapy?, posted by SLS on July 11, 2010, at 5:45:07
It's a good suggestion, Scott (especially since it's FDA-approved for PMDD), however, as I mentioned above, the problem with yasmin (and yaz) from my experience (I've taken both), is that there are blank days (no hormones so you can have a period). Those were always the worst days, for me. Depending on which week is dusty's good week, it might be a problem for her, too. She did mention trying BC pills, so it'd be interesting to learn whether she took yasmin/yaz or some other brand. It might make a difference.
Because of my own experience, I think that continuous birth control might be better for PMDD than traditional pills like yasmin. I'm sure it's possible to take any brand continuously, but I'm not sure how it works with insurance coverage since they usually only allow one 28-day pack per month. I do know that seasonique is marketed for continuous use, but I don't know what the estrogen-progesterone ratio of that one is, whether it'd be appropriate for PMS type D or not.
Of course, there is always risk associated with using synthetic hormones. This is why I recommend bioidenticals, and why I think dusty was looking into them.
Posted by janejane on July 11, 2010, at 7:25:14
In reply to Re: PMDD and estrogen therapy? » janejane, posted by ihatedrugs on July 10, 2010, at 22:22:33
I'm glad this topic is being discussed too. :-) If you haven't already, try doing a search of the archives here. I remember reading through a bunch of threads when I started looking at this stuff last spring. Google of course will bring up a lot of info too. (Just remember to be a critical reader and don't necessarily believe everything.)
Have you had a chance to read more about the different PMS types yet? (Sorry I don't remember which sites were better than others. If you find good ones, be sure to put links for others, though.) I wouldn't automatically assume you have D since A is apparently so much more common, and can be associated with depression and moodiness too (not just anxiety). It's important to know which kind you have because if you try to raise the wrong hormone, you may get a worsening of symptoms.
As for getting tested, I do think your best bet is to try googling "bioidentical hormones" and your zipcode (or town, whatever) to see what docs come up. It took me a while to find someone who I felt I would be comfortable with who also took my insurance. (It turned out that she was less experienced than she claimed, though.) You might also want to just search for holistic/integrative docs generally because they are usually more open-minded and will probably be at least familiar with bioidenticals. Another option is online sites that sell saliva testing kits. (You'll have to research which ones are most reputable because I don't know.) I would think it'd be hard to get reimbursed by insurance for those, but I haven't looked into it. Many experts say saliva is better than blood, but others seem to disagree.
I love matcha tea too. I really do feel that it calms me and helps me to focus. (I tried taking a theanine supplement and didn't get the same effect.) I used to drink matcha every day (sometimes twice a day) for a while, in addition to drinking a lot of iced green tea (it was like water to me). Then I came across a study that found that women who are heavy green tea drinkers have 13% lower circulating estrogen than non-tea drinkers. The caveat is that those women were post-menopausal, so it's possible that the results are not be relevant to us. (Interestingly, they theorized that Asian women have a lower incidence of breast cancer because of tea drinking.) I quit drinking green tea for a while to see if it helped, and didn't feel any better, so I'm not sure it makes a difference, for me. (I mentioned green tea in my last post since it's a possible issue, but I probably should have been more thorough in my discussion of it.) If you like matcha, and don't have a worsening of symptoms, I say go for it. I've been drinking more green tea again lately, though not as much as before. I might try drinking grapefruit juice during my down times as dusty suggested, to see if it makes a difference. (I'm not on meds right now.)
You mentioned B vitamins, but are you taking other supplements, such as magnesium? As you probably know, magnesium been known to help with PMS, anxiety, constipation, and a bunch of other stuff. (It's supposed to be involved in over 300 biochemical reactions in the body.) Most Americans are deficient, and because it's bulky, multis typically don't have 100% of the DV, so it's something you'd most likely have to take separately. If you want to add it, avoid magnesium oxide since it isn't well absorbed. If you have heart problems, magnesium taurate/taurinate, I believe is often recommend. I take glycinate myself, though I used to take citrate. It (citrate) seemed to help with my sleep at one point, but doesn't seem to anymore. Not sure why. Citrate is apparently more likely to cause diarrhea than others, but whichever kind you take, start low and titrate up slowly to avoid having an unpleasant reaction. I know others prefer different types (e.g., malate, orotate), and if you do a search of the archives here, you'll find a lot of posts about preferences, and many examples of people touting the benefits of it.
How about fish or krill oil? It seems to help a lot of people with mood, and I do find them useful for menstrual cramps. If you happen to cholesterol problems, it might help that too, as you probably already know. (A McGill study showed krill to be very effective for reducing LDL and triglycerides and raising HDL.) I don't tolerate either one very well, but I think I'm an anomaly. Just one gelcap is enough to give me stomach problems and make me anxious. They say that the SEs go away after a while, but if I take either one for more than a few days, my face turns into an oil slick and I get acne. I also have unusually high HDL ("good" cholesterol), and there was a Swedish study that suggested super high HDL might be bad so I'm cautious about taking something that might raise it. (Most docs think over 60 is great, but mine is over 100 which is kind of freaky, I think.)
When I have cramps, I take a product by now foods called super omega 3 6 9 that includes a little fish oil as well as borage and flax. I don't take it at other times since I don't think it does much for me otherwise. Borage of course is supposed to be good for PMS too, as is evening primrose, if I recall correctly. I just found a bottle of borage in the cupboard that I forgot I bought (luckily hasn't expired yet) so I might try it plain next month. I will have to look up whether it affects hormones.
If you haven't already done a trial of fish or krill oil, I'd recommend you try that first (before taking the supplement that I do), because there is a lot of good evidence that it helps with mood. (As I said before, I think I'm a bit of an anomaly in my reaction, though I've seen anecdotal reports of others with similar experiences.)
Krill is a bit more expensive than regular fish oil, but you wouldn't have to take as much of it, and it contains something called PS (sorry too lazy to look up the full spelling) in addition to EPA/DHA that's supposed to improve cognitive function, and possibly mood. I really wish I could tolerate it because there is so much good stuff that it's supposed to do, but I just don't. Everybody's different, though. Oh yeah, fish/krill can apparently thin the blood, so if you think clotting might be an issue, it might be good for that, too.
I assume you're taking a daily multi that includes zinc? If not, it might be something to start since you'll get your other bases covered that way. Zinc in particular is often touted as good for PMS. You'll want to balance it with copper, though, so I think a multi is the best way to get it. Lots of people just take extra zinc, but I'm a bit more cautious since I've got this weird serum copper deficiency so I can't take too much zinc without worrying about my copper going lower (apparently it's rare, but it doesn't hurt to be careful about megadosing in any case).
Posted by janejane on July 11, 2010, at 7:32:06
In reply to Re: PMDD and estrogen therapy?, posted by SLS on July 11, 2010, at 5:45:07
By the way, Scott, it's good to see you on the alt board! We could use your expertise. I don't have much of a biology or chemistry background so I get lost in all the sciency stuff. What do you think about the PMS typology?
Posted by dusty rhoads on July 11, 2010, at 15:31:42
In reply to PMDD and estrogen therapy?, posted by dusty rhoads on July 9, 2010, at 2:45:06
Thanks for all the great postings! Janejane, thank you so much for your thoughtfulness in taking the time to provide a lot of useful information that I didn't previously know about. I feel for all of us PMDD sufferers, and can honestly say that the more I've doggedly pursued effective treatments, the more I've found. Sharing info and ideas with others going through similar symptoms is invaluable.
So I looked into over-the-counter estrogen creams, and ordered a bio-identical estriol cream that I found on amazon.com. From what I've been reading, estriol or E3 is the gentlest of the three types of estrogen (it's the type that peaks only during pregnancy) and taking it through a skin cream makes the cancer risk much lower than taking it orally .. it is even associated with a reduction in the size of cancerous tumors, and also improvements in skin tone, mood, sexual function, bone density, and all the other things that estrogen is good for. It is usually taken by postmenopausal women so I'll do a bit more research and perhaps talk to my naturopath to make sure it's safe for a woman who still has a monthly cycle and would like to have kids one day. I ordered "bio-identical" instead of "natural" estriol because I read in that book on menopause that natural hormones can come from all kinds of animal sources and can differ chemically from the hormones found in the human body. Janejane, I'm sure you know this already, but the "bio-identical" ones are usually derived from plant-based sources and are safer and more effective because they're chemically identical to the hormones that our bodies naturally produce.
To answer a couple of your questions ... I have tried Yaz and Yasmin. Yaz made me feel better and worse at the same time, if that makes any sense .. I felt happier and more confident, but got angry and cried at the drop of a hat, like a little kid - which became a problem at work, not to mention life in general. These effects were throughout the month, and then I'd actually feel slightly relieved during the week when I stopped taking it. I stuck with it for 3 months to see if my body would adjust, but ended up just feeling a different kind of crazy than before the pill, so I switched to Yasmin, which gave me less of the happy/volatile feeling and actually made me feel more depressed. I then researched birth control pills that have lower progesterone levels (I think one was Lutera or Mircette) but those also made me feel depressed, so I just gave up on birth control pills entirely.
I have tried a handful of herbs. Herbs that help: evening primrose oil (calming), chamomile tea (calming), schisandra (calming, energizing). Herbs that did not help: vitex (more irritable), rhodiola (tired, depressed), st. john's wort (sunburn after 10 minutes of sunset). My jury's still out on dong quai .. I think it calms me, but upsets my stomach. Are there other herbs that folks would recommend? Janejane, thanks for the word on black cohosh .. I picked up a bottle and am going to give it a try.
It's very interesting to hear about the PMS types. I'll have to look more into that. Although it seems that I'd fit into PMS-D (Depression) because of my low estrogen, I feel like my worst symptoms are irritability and anxiety. Maybe I'm a rare type of a rare type. :)
As for soy, I did find some articles on PubMed that found that soy could either raise or lower estrogen levels. I've decided to steer clear of it.
To answer your question about my hormone test, it was a saliva test around day 24. (Because my cycle ends around day 30-32.) My estradiol was 2.9 and the reference range was 1.2 - 8.4. My progesterone was 267.2, reference range 99.1 - 332.6. I got the test through my naturopath, and none of it was covered by insurance, unfortunately .. but I'd gotten to the point where I wasn't going to let cost stand in the way of hunting down my lost sanity.
On a tangent about doctors ... the vast majority of doctors out there haven't a clue about PMDD, and even the specialists have limited knowledge, at least in my (perhaps unlucky) experience. My naturopathic doctor (N.D.) has been so much more helpful than any of the gynecologists, psychiatrists, and endocrinologists I've seen. In my view, PMDD is one of those whole-person problems that can't be addressed through a single discipline .. it's hormonal, emotional, nutritional, lifestyle, energetic, cognitive, etc. I highly recommend that anyone with PMDD look for a well-reviewed naturopathic or holistic doctor. Definitely get your hormones checked as well as your neurotransmitters, and ask them ahead of time if they'll do hormone and neurotransmitter testing, so you're not wasting your time. My norepinephrine was high, along with some other neurotransmitter imbalances which my N.D. explained was directly related to my irritability, anxiety and depression. Based on this, she recommended that I try taking taurine, L-theanine, and fenibut .. all of which have been pretty calming, but they're still in the trial phase with me. Taurine gives me a headache and might make me more depressed, and fenibut can cause withdrawal symptoms if taken habitually. However, I've noticed that since trying them, I do feel calmer - less anxious/irritable. My N.D. also gave me a pretty amazing liquid herbal concoction that is calming and energizing at the same time .. I have to ask her what's in it exactly, and will post her answer.
Did I mention melatonin? If you think you might have PMS-D and don't have an autoimmune disease, you should consider melatonin - you can buy it over the counter. It made me feel noticeably happier and calmer, and improved the quality of my sleep. However, I have an autoimmune disease (a mysterious type of arthritis which may be fibromyalgia) and the melatonin made my arthritis worse, so I had to stop taking it.
Sorry for the super-long response! I'll close with a few links that I've found interesting:
Soy can have an anti-estrogenic effect: http://www.ncbi.nlm.nih.gov/pubmed/19235040
PMDD women have low estrogen (depending on how they define PMDD, they may be talking about PMS-D): http://www.ncbi.nlm.nih.gov/pubmed/17956950
PMDD women produce less melatonin, and later in the sleep cycle (another reason to get a full night's sleep every night!): http://www.ncbi.nlm.nih.gov/pubmed/9104690
Posted by ihatedrugs on July 12, 2010, at 0:25:21
In reply to Re: PMDD and estrogen therapy? » ihatedrugs, posted by janejane on July 11, 2010, at 7:25:14
Thanks for your reply. I do take Krill oil and tolerate it pretty well and also take a calcium-magnesium formula in liquid form which I believe has helped some. I had my vitamin D levels checked and it was very low 16 ng/ml, so my doctor put me in supplements and it went up to 34ng/ml, however according to various studies, optimum levels should be closer to 50-100 ng/ml. The irony is that I live in Florida and my brother who lives in South Beach, Miami also had very low levels of vitamin D. So we may have an issue with absorption more so than intake. I also take B complex, and a good multivitamin. This month I am attacking PMDD with Lexapro, and all the vitamins and supplements recommended and I'm going about it faithfully, so I will see if I see any improvements. I am looking for a doctor who would test my hormone levels and have found several in my area. I did find this website http://www.premierhormonebalance.com/dr-michael-borkin.html but how legitimate this guy is I don't know. Anyways we will continue on our quest and try to find some answers. Thanks so much for your time.
Posted by SLS on July 12, 2010, at 5:34:52
In reply to Re: PMDD and estrogen therapy? » SLS, posted by janejane on July 11, 2010, at 7:32:06
I don't know where you got the idea that I had any kind of expertise, but I'll take that as a complement. You ain't too shabby yourself.
:-)
> What do you think about the PMS typology?
From your explanation, it would seem to make sense to make a nosological distinction between the two types of PM disorders, so long as the Anxiety and Depression subtypes should be so consistently associated with their respective hormonal abnormalities.
- Scott
Posted by janejane on July 12, 2010, at 8:31:52
In reply to Re: PMDD and estrogen therapy?, posted by dusty rhoads on July 11, 2010, at 15:31:42
I don't have time to write more right now (darn work), but I did want to urge you to do more reading on black cohosh before starting it. Several sources I saw online suggested that it's estrogenic, but when I dug a little more deeply (not much), the picture got more complicated. I wish I could be more helpful, but biology was never a strong subject for me so I tend to get lost when it comes to the nitty gritty. Let us know what you find out.
Posted by Phillipa on July 13, 2010, at 0:16:18
In reply to Re: PMDD and estrogen therapy? » dusty rhoads, posted by janejane on July 12, 2010, at 8:31:52
I'm postmenopausal and using bioidentical hormone creams. I have blood work done twice yearly and the compounding pharmacy gives me the right dose of estrogen, progesterone, and testosterone. Google componding pharmacies in your araa. The ones I've google also provide a name of the docs that do hormone testing and a lot of the pharmacies that compound also do saliva testing with a script. So also google anti aging doctors as mine is one and he does the blood testing. I went from way low postmenopausal to pre menopausal. New studies I've read are now saying low doses of bioidenticals are safe or relately safe. Phillipa
Posted by janejane on July 14, 2010, at 13:16:12
In reply to Re: PMDD and estrogen therapy?, posted by dusty rhoads on July 11, 2010, at 15:31:42
Hi dusty. Sorry for the delay.
So an estriol only cream is OK, then? Is it converted to estradiol in the body, and if not, does it not matter? Since estradiol is the kind they usually test for, I assumed it was the most important, but I never read too much about the different types. What kind of dosing schedule are you using?
It's interesting that your naturopath considered your estrogen low even though you were within range. (My doc would not make that leap.) From what I remember anxiety and irritability can be part of type D so I wouldn't worry too much about them being bigger issues than depression. I would think it would make more sense to go by the numbers more than by symptoms, anyway, in determining what you should supplement.
High norepinephrine makes sense with your symptoms, from what I understand about neurotransmitters. (I've read mixed things about the utility of neurotransmitter testing so it's interesting to see that your results do seem to match your symptoms. How were your serotonin and dopamine levels?) I know I read something about how hormones affect various neurotransmitters but I don't remember the relationships. Oh darn, I just found the link I was thinking about, and it sort of contradicts the idea of estrogen helping you if your NE is high. See here:
http://www.digitalnaturopath.com/cond/C52281.html
Quote:
"Estrogens appear to affect mood by suppressing type A-monoamine oxidase (MAO) while enhancing type B-MAO. These enzymes are involved in the oxidation of biogenic amines - norepinephrine, epinephrine, dopamine, and serotonin - which have significant effects on mood and behavior. The net effect of estrogen on these MAOs is to increase the levels of epinephrine, norepinephrine and serotonin (all normally deactivated by MAO-A) and decrease the levels of dopamine and phenylethylamine (both normally metabolized by MAO-B).
The effects of these changes on mood and behavior are well documented: epinephrine triggers anxiety; norepinephrine, hostility and irritability; serotonin, at high levels, nervous tension, drowsiness, palpitations, water retention and inability to concentrate and perform. Dopamine is believed to counteract these three amines by inducing a feeling of relaxation and increasing mental alertness. It is of interest to note that a decreased dopamine level in the hypothalamus is also believed to be central to the hormonal imbalances found in polycystic ovarian disease.
Estrogens also affect mood by competing for pyridoxal-5-phosphate binding sites, stimulating hepatic tryptophan pyrolase (shunting away from serotonin synthesis), and decreasing glucose tolerance."
Hmm... I'm not sure it's a reliable website, but it sure stinks that it suggests that estrogen increase NEs. You'll have to ask your naturopath about that.
Oh, here's another article on estrogen I just found:
http://www.medscape.com/viewarticle/406718_2
Scroll down to see the section on mood. It confirms the idea that estrogen increases NE and serotonin. However, it also says it increases dopamine and opioid and endorphin production, which seems to contradict what the other site said. Lovely. (I give more credence to the medscape article since it has cites, though.)
Oh goodness. Looking at more articles just makes me more confused... there are a lot of contradictory claims. If were well enough, I'd try to take some biology classes to get a better handle on this. But of course, if I were well, I probably wouldn't care about trying to understand it anymore.
I'd definitely be interested to know what's in your herbal concoction so please do ask about that, too. As for the other supplements you're trying, I hope one or more of them work for you. I tried taurine a couple times and didn't notice much. Theanine, I think I already told you about (prefer matcha)... phenibut is familiar but I never explored it. Right now depression is more of a problem for me than anxiety, though dread and irritability are a big part of my monthly woes. My diagnosis is major depression on top of dysthymia, by the way. My symptoms appear to be exacerbated by PMS and SAD (winter blues, which I'm not looking forward to in a few months). I'm 39 and have lived with this since I was a teenager.
Have you not tried tryptophan or 5-HTP? I don't remember if you said you were a responder to SSRIs or ADs in general, just that you didn't like the side effects.
I've thought about seeing a naturopath, but cost is definitely a concern. May I ask how much yours charges, including for tests and supplements? How often do you see her? (If you don't want to say publicly, you can send me a babblemail by clicking my username at the top of this post.)
Melatonin? I know I tried it and decided not to continue, but I can't remember why. I want to say it didn't help with sleep, and maybe me spacey or gave me a headache or something (guessing). I'm pretty sure I've read of some people complaining that it makes them more depressed. Maybe I should go find the bottle and try it again. Sunlight is also supposed to help with melatonin production, is it not? I do notice that I get really tired if I'm in the sun for a long time.
Is hypoglycemia a problem for you at all?
When you tried rhodiola, what brand did you use?
OK, I'm going to stop now before this gets even longer. ;-)
Take care,
jane
Posted by janejane on July 14, 2010, at 13:43:42
In reply to Re: PMDD and estrogen therapy? » janejane, posted by ihatedrugs on July 12, 2010, at 0:25:21
Sounds like a plan. Please keep us updated on everything you decide to try, and how each affects you. Thanks!
P.S. Have you just started the lex? Any side effects?
Posted by janejane on July 14, 2010, at 19:38:23
In reply to Re: PMDD and estrogen therapy?, posted by dusty rhoads on July 11, 2010, at 15:31:42
Found this reference that suggests that pomegranate reduces "depression" and bone loss in mice who had surgical menopause, presumably due to the estrogen it contains:
J Ethnopharmacol. 2004 May;92(1):93-101.
Pomegranate extract improves a depressive state and bone properties in menopausal syndrome model ovariectomized mice.Mori-Okamoto J, Otawara-Hamamoto Y, Yamato H, Yoshimura H.
School of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan. okamoto-junko@spu.ac.jp
AbstractPomegranate is known to contain estrogens (estradiol, estrone, and estriol) and show estrogenic activities in mice. In this study, we investigated whether pomegranate extract is effective on experimental menopausal syndrome in ovariectomized mice. Prolongation of the immobility time in forced swimming test, an index of depression, was measured 14 days after ovariectomy. The bone mineral density (BMD) of the tibia was measured by X-ray absorptiometry and the structure and metabolism of bone were also analyzed by bone histomorphometry. Administration of pomegranate extract (juice and seed extract) for 2 weeks to ovariectomized mice prevented the loss of uterus weight and shortened the immobility time compared with 5% glucose-dosed mice (control). In addition, ovariectomy-induced decrease of BMD was normalized by administration of the pomegranate extract. The bone volume and the trabecular number were significantly increased and the trabecular separation was decreased in the pomegranate-dosed group compared with the control group. Some histological bone formation/resorption parameters were significantly increased by ovariectomy but were normalized by administration of the pomegranate extract. These changes suggest that the pomegranate extract inhibits ovariectomy-stimulated bone turnover. It is thus conceivable that pomegranate is clinically effective on a depressive state and bone loss in menopausal syndrome in women. Copyright 2004 Elsevier Ireland Ltd.
PMID: 15099854 [PubMed - indexed for MEDLINE]
I dug further and found this, which talks about the different kinds of estrogen it contains:http://www.pomegranatehealth.com/blog/index.php/2010/03/should-you-be-scared-of-estrogen/
(Note: they're selling pomegranate supplements, but it was still an interesting read. They actually suggest that the type of estrogens in pomegranate protect against breast cancer. Sounds too good to be true, doesn't it?)
Can't decide whether to try pomegranate or estriol cream now. Pomegranate supplements (not from the site above) are cheaper, and seems to have other benefits.
Posted by janejane on July 14, 2010, at 19:47:15
In reply to pomegranate supplements as a source of estrogen? » dusty rhoads, posted by janejane on July 14, 2010, at 19:38:23
Dusty, I forgot to acknowledge that you already mentioned estriol being associated with breast cancer remission. The article also mentioned 17 apha-estradiol as being protective. I wonder whether cultures who eat a lot of pomegranates have a lower incidence of BC and menopausal symptoms.
Posted by ihatedrugs on July 14, 2010, at 23:49:49
In reply to Re: PMDD and estrogen therapy? » ihatedrugs, posted by janejane on July 14, 2010, at 13:43:42
> Sounds like a plan. Please keep us updated on everything you decide to try, and how each affects you. Thanks!
>
> P.S. Have you just started the lex? Any side effects?Yes, I started the Lexapro but I'm still apprehensive about it. I have taken so many meds, Lexapro included and although some provide mild relief, the side effects drive me crazy, especially the weight gain. So I may stop it and give L-Tryptophan (good quality non-contaminated) a try. I have been reading up on it and found a couple articles that sparked my interest. I know is a long shot but at this juncture, all I can do is try it and if it fails, I'll dump it in the wastebasket along with all the other failed trials of medications, vitamins, herbs, shakes, magnets and God knows what else. I included below the links to two interesting articles on L-Tryptophan.
Also I read in Prevention magazine that White button mushrooms prevent the synthesis of estrogen.
http://www.naturalmedicinejournal.com/clinical_janci_gaby_insert.html
Good luck
Posted by janejane on July 15, 2010, at 10:59:28
In reply to Re: PMDD and estrogen therapy? » janejane, posted by ihatedrugs on July 14, 2010, at 23:49:49
I think tryptophan (or even 5-HTP) is definitely worth trying, especially if you're an SSRI-responder and your depressive symptoms are more of the anxious type rather than the lethargic type (you'd want to look at tyrosine/phenylalanine for the latter).
Do you ever get side effects such as anxiety or headache on SSRIs? If so, I'd watch for those. (I think weight gain is a less of an issue, and in fact, you might experience less hunger and fewer carb cravings.) My problem with 5-HTP and tryptophan was that I developed anxiety and headache after a while, as well as loss of efficacy (probably because I lowered the dose to reduce the SEs). My theory is that after being on prozac for over 10 years, some of my serotonin receptors were altered enough that I now get SEs from really small doses of serotonergic substances and it's hard for me to find an effective, SE-free dosing schedule. I also think that it's possible that increasing serotonin availability in the brain globally might not always work well since there's a chance that you might unwittingly hit some receptors that are associated with SEs such as anxiety. (Again, it doesn't seem to happen to everyone, and I think mine are sort of messed up so I still encourage you to give it a go, especially if you haven't used the same SSRI for as many years as I have.)
From what I've read, it does seem that tryptophan is probably safer than 5-HTP, by the way, since it doesn't bypass the rate-limiting step that keeps serotonin out of the blood (the reason 5-HTP is given with carbidopa in Europe), and since the contaminated batch was just that -- contaminated -- and not typical of most production. It is also less likely to cause GI upset than 5-HTP. That said, I don't think the heart issues that were supposed to be a problem with 5-HTP ever really materialized and Americans have been taking it without carbidopa for a while now. Because some people seem to do better on one or the other, if tryptophan doesn't work, I wouldn't rule out 5-HTP, though I'd be more cautious with it.
You probably know this already, but remember to start modestly with tryptophan (like maybe 250 mg -- you can get tablets and a pill cutter, which is easier than opening capsules) and take it on an empty stomach. You can have a carb snack to try to increase absorption (like a small amount of fruit juice), but you want to avoid protein for at least an hour afterwards. The idea is that the insulin spike will clear competing aminos so the tryptophan can cross the blood brain barrier (it has the least affinity for the large neutral amino acid transporter). I read one article that said it doesn't help to do this, but a lot of experts recommend it, and I don't think it would hurt (especially if you've consumed other protein recently). I think competition with other aminos is less of an issue if you take it first thing in the morning, though some people like to take it at night to help with sleep. (Some take it up to three times a day, if I recall correctly.) Remember to dose any competing aminos at other times of the day. For example, if you also wanted to take tyrosine, you might do that in the morning, and tryptophan at night. (You don't have to worry about this stuff with 5-HTP which makes it a bit easier to take.)
Oh yeah, you might want to take P-5-P (active form of B-6), too. (Hopefully this will already be in your multi or b complex, but not all contain P-5-P so you'll want to check.) And make sure you're getting some B3 everyday so the tryptophan does not need to be converted into it instead of serotonin. (Something to think about... people who don't get enough B vitamins or other supporting nutrients might not have the other building blocks they need to make tryptophan work. Meaning that, for instance, Bs might be the deficiency rather than tryptophan, if the problem is low serotonin.)
Of course (and here I will bring this back on topic), you can also try to increase serotonin by using bioidentical estrogen or other supplements like SAM-e/TMG or herbs. Personally, I think that if low estrogen is the problem, it seems logical to try to take care of that first, since it's more upstream. Then again, the appeal of something like rhodiola is that it normalizes estrogen (according to some sources), balances the HPA axis, and increases depression-related neurotransmitters in different parts of the brain. (Too bad it wasn't enough for me; works for some, though.) I think the holy grail is probably different for each of us, but I'm glad that we have a place to come and compare notes.
Posted by morgan miller on July 15, 2010, at 23:09:22
In reply to pomegranate supplements as a source of estrogen? » dusty rhoads, posted by janejane on July 14, 2010, at 19:38:23
Isn't pomegranate extract an aromatase inhibitor, which would mean it could suppress the production of estrogen?
What about eating ground flax seed?
Posted by morgan miller on July 15, 2010, at 23:11:28
In reply to Re: PMDD and estrogen therapy? » janejane, posted by ihatedrugs on July 14, 2010, at 23:49:49
O.K. I just realized that you might be trying to reduce estrogen production. If you are, pomegranate extract might be a good choice.
Posted by ihatedrugs on July 16, 2010, at 0:45:27
In reply to tryptophan » ihatedrugs, posted by janejane on July 15, 2010, at 10:59:28
Hi,
Thanks again for the great info. I think I messed up and took too much tryptophan. Last night I took 1000 mg which actually helped me sleep. Then this morning instead of Lex, I took 500 mg.
About 5 months ago my Psych dr put me in Nuvigil since I wasn't responding to anything. The last thing we tried was the Emsam patch and to be honest I don't feel like anything really works. I have been on this roller coaster for so many years, I'm at my wits end. My depression is the of the weepy, unmotivated, type. My personality however, is of the gregarious, go-getter, love people type. Throughout the years I was able to hide it but the illness caught up with me. Now nothing excites me. My husband and I are soon going on vacation and he makes such an effort to pick the nicest hotels, go to the best restaurants and I have to pretend I'm looking forward to it so he doesn't feel bad. My doctor decided to put me on Nuvigil and that worked for the first time in years but 12-14 days before my period I go back to the dark place. So I really enjoy a few days of normalcy. So I asked the doctor to try Lexapro again. Now my other problem is all the weight I have gained since this nightmare with meds began. I figured if Nuvigil was working, then perhaps I could try adderall to help with weight loss. So now I'm taking adderall, exercising, and of course not eating much but making sure I take my vitamins and what little I eat must be nutritious. I have lost a little weight but I have noticed that when I take the Lexapro the weight loss stagnates which is the reason I'm hesitant to continue. Also the crashes of Adderall are for the most part bearable but today was not a good one. This is why I think I may have messed up with Tryptophan and taken too much. I broke down crying and was so overwhelmed by everything... new meds, trying to figure out what to take and what not to take, exercising everyday, weighing myself everyday, trying to feel better by telling myself everything is going to be fine, reading up on anything I can to try to help my situation, getting ready for a dreaded vacation, going to doctors and coming out sobbing because they make you feel stupid...Anyways I think I'm not even making any sense anymore and I apologize for the rant. I'm just so frustrated. Hopefully, I will feel better tomorrow. Thanks again for all your help and kindness.
Posted by janejane on July 16, 2010, at 5:54:43
In reply to Re: pomegranate supplements as a source of estrogen?, posted by morgan miller on July 15, 2010, at 23:09:22
Morgan, did you read the abstract and article? The idea is that pomegranate contains weak estrogens, which could help with menopausal depression and bone loss (at least as demonstrated in rats), while also protecting again breast cancer. If I'm on the wrong track, please let me know. This sciency stuff confuses me, but that's the take-home message I got. Thanks!
Posted by janejane on July 16, 2010, at 10:01:23
In reply to Re: tryptophan » janejane, posted by ihatedrugs on July 16, 2010, at 0:45:27
I'm sorry you're going through a tough time. I do hope you're better today.
It's interesting that you had a weepy reaction to tryptophan because I had a similar reaction to DL-phenylalanine and my theory was that the increased dopmamine ended up making my serotonin plummet even more, when I needed it to be raised. I'm wondering if you had the opposite thing happen to you.
Have you considered the possibility that you're low on catecholamines, endorphins, and/or GABA rather than serotonin? That might explain the low motivation, weepiness, and feeling overwhelmed as well as the partial response to nuvigil. Does the lexapro help you with mood at all? Have you ever tried PEA or DPA? Do you ever self-medicate with chocolate? Do you ever have depression not associated with PMDD?
Have you ever taken one of those quizzes that help you try to assess what neurotransmitter deficiencies you have? If so, what did you find? I have to admit that I find it difficult to distinguish between some low serotonin and low dopamine/endorphin symptoms. Weepiness is why I thought DLPA might help me, but it clearly was the wrong thing to do on my worst PMS day. (I actually think I might be low in a number of NTs, but trying to do a balancing act with aminos was difficult. I got a partial response to tryptophan, but it was short-lived and I was unable to find a workable dosing schedule. That's why I started to look at other things.)
Hmm. It also occurs to me that you might be right about simply taking too much tryptophan. Julia Ross says that the time to stop taking 5-HTP (which as you know is related to tryptophan) is when your symptoms start cropping up again after you've felt well for a while. I could see a similar thing happening with taking too much at once since there is this idea of topping off too much, if you know what I mean. (I wish I had remembered that paragraph in her book when I tried 5-HTP because I got myself into a horrible state by increasing my dose in an effort to relieve worsening symptoms.) It's also possible that you indeed need more serotonin, but it's just not going to the right places in your brain to make you feel better, and may be going to some of the wrong places, especially with a too-high dose. (I think that was also part of my problem, which I think is the phenomenon Patricia Slagle alludes to when she lists paradoxical agitation as a side effect.)
I wonder if we should start a new thread since this is getting off the topic of estrogen. Speaking of which, are you going to do some testing?
Go forward in thread:
Psycho-Babble Alternative | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.