Women’s Health Ask Me Archives


Question:
I am 41, perimenopausal. I have regular, yet heavy periods. I have insulin resistance, which I treat with low-carb and exercise; therefore, I am no longer overweight. I am still having worsening of hirsutism and hair loss (itchy, oily scalp, graying and breakage). My nails have developed longitudinal lines. My TSH is 2.0 on saliva test. Progesterone cream was prescribed, but it only increased my insulin resistance, or at least my oily, loss of hair. My estradiol is high, but estrone and estriol are low. Giving me a luteal phase 0.18L for 24-hr urine level of estrogens total. My testosterone is normal-high and so is cortisol, DHEA low. I took Kenalog shot for allergies back in 1992 and I believe the side effect of ballooning out/water retention over entire body, set off the high cortisol that I can’t seem to lower—even though I quit my job 4-yrs ago and now go quite happily to college part-time. I am no longer stressed, in other words. Doctors suggest Estrofem (17-estradiol) tablets at .50, and estriol cream at 2mg, plus progesterone cream last week before period only. Any suggestions?

Answer:
Your doctor is trying to re-balance your hormones. When your testosterone is high, you can get the symptoms you mention. Estrogen has some testosterone balancing effect. You may wish to talk to your doctor about tri-est if estrogen is needed. Tri-est is the natural form and low in E2 while the drug is pure E2 which is not as natural. You need to normalise your cortisol level and the cortisol to DHEA ratio. Too high a ratio (high cortisol and low DHEA) indicates a catabolic state and a catabolic state can be associated with estrogen dominance (with heavy period, for example), insulin resistance, and excessive testosterone. Once your adrenals are balanced (normalization of cortisol and DHEA), it is likely that the rest of your symptoms will be reduced. The bottom line – don’t just adjust the female hormones without paying attention to the adrenals which may likely be the root cause.
Read my adrenal fatigue article here and you will know what I mean:
Adrenal fatigue
While your TSH is considered normal by conventional standards, I would caution you to look at other hypothyroid symptoms as any number 2 or higher is an alert. Get your doctor to do a free T3 and a Free T4 for more info. Read more here:
Hypothyroidism

I have given you quite a bit to read. It is imperative that you understand that in women, the thyroid-ovarian-adrenal axis is highly interrelated, and imbalance of this axis may be the root cause of your problem. You need to consider all three as a syndrome and not try to put a band-aid one at a time which will invariably fail.


Question:
What course of action do you recommend for large uterine fibroids?

Answer:
Large fibroids in and of itself is not bad. The problem arises when it starts pressing on the bladder or excessive bleeding etc, causing symptoms that becomes a medical problem. Depending on your age, the best way to handle asymptomatic fibroid, large or small, is estrogen reduction, and buy as much time as you can until you hit menopause, at which time the fibroid normally will spontaneously shrink. Surgical procedures should be reserved as a last resort. To read more about natural fibroid therapeutics, click here:
Fibroid


Question:
I’m in my 40’s and have large fibroids which cause heavy periods. My ob/gyn says surgery is the only thing that will improve the situation. I had consulted a specialist re: radiological fibroid embolization but decided to wait since all procedures/surgeries have risks and side effects. Besides, I’m scared of surgeries of all kinds. My ob/gyn mentioned taking prescribed progesterone will help with the heavy bleeding but the side effect is bloating and swelling of the breasts. What is your opinion or finding in taking progesterone reducing heavy menstruation flow? I’ve heard from another doctor that progesterone will cause fibroids to grow.

Answer:
I can sense your agony. Conventional medicine has little to offer when fibroid becomes too large, especially if it is compressing on your bladder. I am sure you have done your homework on surgical and non-surgical options. The key is to reduce estrogen and buy time until you are at menopause. I am personally against all surgical intervention unless there is no choice. There are nutritionals you can consider to reduce your estrogen as well as converting more of your estrogen to the good estrogen in the body. Of course the use of natural progesterone in small fibroid is highly successful. Progesterone comes in natural and synthetic forms. The synthetic form is not recommended in your case. The natural form can be helpful if you use it properly, but there is no guarantee. Some people can actually get worse, but generally speaking, it is more helpful than harmful. Excessive natural progesterone can have side effects, but that is rare if you monitor it closely. Natural progesterone can be helpful for heavy menstrual flow (an indication of excessive estrogen often, but not all the time).
Each person is different, and I would hesitate to make blanket recommendation without a full history which is best done by a naturally oriented medical doctor near you physically or by telephone consult.


Question:
Last year I had three miscarriages. The first in almost the fourth month, and the other two early on. I had very heavy bleeding during the first pregnancy that went on for almost three months. I have recently been diagnosed with 2 ovarian cysts, and possible endometriosis. I am undergoing a laparoscopy soon. Could endometriosis be responsible for the miscarriages, and is a healthy pregnancy and birth possible with this condition? I do have one child, and I had a normal pregnancy with him.

Answer:
Endometriosis per se does not cause miscarriage, but those with endometriosis do have a much higher chance of miscarriage as a matter of fact. The reason is under heavy investigation scientifically, but most in natural medicine field agreed that estrogen dominance plays a big part as the root cause of endometriosis, and if your estrogen is high, it is very hard to get pregnant because your progesterone will be low as a result of the estrogen dominance. Progesterone is the hormone that maintains your pregnancy, especially in the first trimester. With out a high level of progesterone, pregnancy cannot be maintained and miscarriage is common. This is often overlooked by even some of the best doctors. If you indeed have this problem, high dose of natural progesterone (not synthetic) may be helpful in the first trimester to maintain pregnancy. I would suggest you should explore this further with your OB, and seek 2nd opinion if you needed.


Question:
I hemorrhaged in August from large fibroids; received 5 units of blood transfusion as I was at 5.3., a D & C which concluded fibroids and helped to stop the bleeding followed by a Depo-Lupron (3 month shot). It is now almost five months later and I haven’t had a period, but I think the fibroids are growing as they now press uncomfortably on my bladder. My gynecologist recommends a hysterectomy, fibroid embolization or at the least continued Lupron. Another doctor suggested switching to Depo-Povera. I don’t want a hysterectomy and the fact that the poly vinyl from emboliztion stays in the body dissuades me from that procedure. I am 48 and have two children, son 20 and daughter 12. Is is possible to treat my fibroids with progesterone cream? They are large and I’m honestly scared to hemorrhage again. I have been eating more plant and vegetable foods, and have lost some weight. Also, are you in the New York City area and if so can I see you for an appointment? One more question, can acupuncture and Chinese herbs help manage the heavy menstrual bleeding and shrink the fibroids? What about homeopathy?

Answer:
You are quite far along the progression of fibroid and non surgical options are very limited, especially since it may be pressing on your bladder. The Lupron will do the job, but only temporary as you know. It induces artificial menopause which you are very close to. You need to buy time, but 2 -3 years is a long time if you are symptomatic. Natural progesterone cream may help, but at this stage, it can also make it worse as the "seeds" in the center of the fibroid may be sensitive to the progesterone which can worsen the fibroid. No one really knows, and the results vary with individual. I would not recommend any depo-provera which is synthetic progesterone that is totally different from natural progesterone. If you are adamant about staying off surgery for now, you need to follow an estrogen reduction protocol with good diet, exercise, and supplements that are properly blended and optimized. Read more here:Estrogen Dominance
You did not tell me your weight, but it is very important for you to be at or below your ideal body weight, as fat cells generate lots of estrogen.
Acupuncture can produce some temporary relief as far as symptoms are concern. No studies have ever been able to conclude that it helps to shrink fibroids. I am not familiar enough with homeopathy to give you my thoughts.


Question:
Do woman require more sleep than men? If so, then is it due to hormones?

Answer:
Very good question. I am not sure if sleep is gender specific. That is an interesting question and it is likely that someone in the world somewhere has done a study. Progesterone, an important female in women, does help sleep. Many perimenopausal or menopausal women are lacking in progesterone which can make falling asleep more difficult. They are therefore chronically tired and the perception is that they may need more sleep. If there is stress, then things get worse. You may wish to note that for the best sleep possible, always sleep in a totally dark room (no light nights, with curtains drawn) to enhance melatonin secretion which is critical for sleep regulation. If you are having problem getting to sleep, try some melatonin 0.5 mg to 3 mg. (dosage varies with people so you have to experiment). If you have a tendency to wake up in the middle of the night, that is usually reflective of stress. In that case, a time release form of melatonin may be helpful. Melatonin is such a wonder substance. Not only is it a sleep regulator. It also is a strong anti-oxidant. Concentration in the brain is much higher than in the blood, so it can cross the blood brain barrier easily. It is important to take melatonin every time each day, especially when you travel. If you normally take it at 10 pm, then you should take it at 10pm when you arrive your destination as well and not convert it back to your "home" time. Because of its ability to enter the tissues and maintain a high concentration quickly (much better than vitamin C and E), I suggest everyone who is heading for an Xray to take some melatonin 2 hours before the procedure to prevent radiation to attack innocent cells unnecessarily. Melatonin is also excellent for cancer prevention and treatment, but high doses of up to 50 mg at night plus 5 mg with each meal is needed. I am getting off the subject, but because melatonin is such an important nutrient, it is worth while for you to know how it may potentially benefit you.