Progesterone And Aldosterone

[firewatcher]

I just received my recent labs and have noticed a trend in elevated progesterone levels. After a little digging, I found this:

"Progesterone exerts its primary action through the intracellular progesterone receptor although a distinct, membrane bound progesterone receptor has also been postulated.^[23][24] In addition, progesterone is a highly potent antagonist of the mineralocorticoid receptor (MR, the receptor for aldosterone and other mineralocorticosteroids). It prevents MR activation by binding to this receptor with an affinity exceeding even those of aldosterone and other corticosteroids such as cortisol and corticosterone.^[25]

Progesterone has a number of physiological effects that are amplified in the presence of estrogen. Estrogen through estrogen receptors upregulates the expression of progesterone receptors.^[26] Also, elevated levels of progesterone potently reduce the sodium-retaining activity of aldosterone, resulting in natriuresis and a reduction in extracellular fluid volume. Progesterone withdrawal, on the other hand, is associated with a temporary increase in sodium retention (reduced natriuresis, with an increase in extracellular fluid volume) due to the compensatory increase in aldosterone production, which combats the blockade of the mineralocorticoid receptor by the previously elevated level of progesterone.^[27]"

Perhaps this is why women of childbearing age are more effected by POTS than others? Could it be a hormonal glitch?

And this article using men:

Chronic potassium depletion increases adrenal progesterone production that is necessary for efficient renal retention of potassium

Boutaïna Elabida, Aurélie Edwards, Amel Salhi, Anie Azroyan, Heidi Fodstad, Pierre Meneton, Alain Doucet, May Bloch-Faure and Gilles Crambert

Abstract:

Modern dietary habits are characterized by high-sodium and low-potassium intakes, each of which was correlated with a higher risk for hypertension. In this study, we examined whether long-term variations in the intake of sodium and potassium induce lasting changes in the plasma concentration of circulating steroids by developing a mathematical model of steroidogenesis in mice. One finding of this model was that mice increase their plasma progesterone levels specifically in response to potassium depletion. This prediction was confirmed by measurements in both male mice and men. Further investigation showed that progesterone regulates renal potassium handling both in males and females under potassium restriction, independent of its role in reproduction. The increase in progesterone production by male mice was time dependent and correlated with decreased urinary potassium content. The progesterone-dependent ability to efficiently retain potassium was because of an RU486 (a progesterone receptor antagonist)-sensitive stimulation of the colonic hydrogen, potassium–ATPase (known as the non-gastric or hydrogen, potassium–ATPase type 2) in the kidney. Thus, in males, a specific progesterone concentration profile induced by chronic potassium restriction regulates potassium balance.

Of all the hormone testing that I have had, progesterone and cortisol always come back high.

So is the salt elevating my progesterone level or is the elevated progesterone causing me to shed the salt?

Has anyone else had hormone testing done and noticed a trend?

[firewatcher]

But then there is this article about progesterone and aldosterone and sodium which states that progesterone + high sodium increases aldosterone:

http://jcem.endojournals.org/content/91/10/3981.long

[sue1234]

That is interesting. Back before my POTS, I was having a decline in my usual energy, then I began bloating. After a couple of years, I started having low back pain that happened monthly, so I went to my gyn and said I must have something that grows around my uterus/ovaries monthly. Sure enough, I had a lemon-sized cyst on one ovary. It was promptly removed. I just thought my bloating would go away, but it never did.

When my POTS hit, I had been having the other ovary growing off and on cysts, but smaller. It got to the point that at anytime I would have an ultrasound, there was a cyst (2-4cm) sitting on it. That's when I began to wonder about progesterone. I knew from nursing school that the ovarian cyst that stayed on the ovary when one gets pregnant is to "calm" the body while this foreign "thing" grows. Progesterone is the hormone of pregnancy. I know I was sooo tired in each of my early pregnancies, with that elevated progesterone.

I always wondered if my continual cyst was always putting out progesterone, thus making my body too "relaxed". We know that estrogen is the hormone that increases blood pressure, so maybe that's why mine was always low pre-POTS (90/60). If I would happened to have had a progesterone-dominance, maybe that's why I developed POTS at menopause time! I lost whatever estrogen I would have had to "balance" out some of the effects of higher progesterone. And, the few natural doctors that assume every woman will be fixed with progesterone cream, prescribed them for me and I always felt AWFUL on them. Needless to say, I would only take them for 1 or 2 days, and I felt like I was going to go into a deep sleep at any moment.

So, I was just thinking out loud here about my own thoughts on progesterone and that I agree, it could be an issue. I am overdue for my annual ultrasound to look at that ovary again, but now I think I'll get it done in the next day or two. I almost had a hysterectomy a few years ago. Now I'm curious if I had that done and got on estrogen, would I feel energetic?

[sue1234]

And to think we were talking about this two years ago!

http://forums.dinet.org/index.php?/topic/14185-thinking-again-about-progesteroneestrogen/page__hl__progesterone__fromsearch__1

Wow, I think I would still like to try the unopposed estrogen for a month or so and see what I'd feel like.

[brethor9]

I had a partial hysterectomy in 2008 ....kept my ovaries....but thats when I really crashed with POTS I have had hormones tested and the docs say they are within normal range.....but every women needs a different amount of hormones to feel great...not whats on paper....makes me wish I had a baseline done before surgery....anyways I too have been having issues with monthly cysts on both ovaries and wonder how much of a part they play in POTS

Bren

[issie]

I've never been able to tolerate even bioidentical progesterone - despite having had a full hysterectomy at an early age. I also had those cycsts but also had endometrosis and that is usually caused by too much estrogen (So, they think). So, I don't know. I do know that every time I've ever tried progesterone - I feel worse. I do use transdermal estriol - which is the mildest form of estrogen and is supposed to help prevent breast cancer. It does make a difference - but, I haven't been using it regular - because of fear of the possible estrogen dominance because of the endometrosis. I don't think that having your ovaries removed - necessarliy corrects the issues. I'm overweight and fat can also produce these type of hormones. I've always been told that and since being overweight - I thought well I must be producing some estrogens. Maybe, I'll start using the estriol a little more regular and see if that makes a difference.

Issie

[s-pot]

Delighted to see this discussion today I was actually gonna start one myself to see what pples opinions are.

Slowly but surely im pulling the full picture together of my own POTS and symptom associations...and without a doubt it is directly linked with hormone changes for me!

I cannot tolerate combined contraceptives at all and always believed this was the oestrogen. I started a progesterone only (Implanon) a year and half ago just after the onset of severe POTS symptoms so everything got kinda confused then. It took me a year from symptom onset to get diagnosed and I never associated a worsening of symptoms with this.

However since diagnosis I have noticed a definate cycle with POTS symptoms a cyclical changes. I have not yet been able to identify at what point/what hormone changes is kicking it all off.

I believe it is the build up in progesterone...I would go 10-12 weeks with no period(on implanon) and POTS symptoms would build in severity (to the point of hosp last time) once the cycle ended symptoms dissipated. I feel great for 2 weeks, no symptoms, and then the whole thing kicks off again !

I got the Implanon hormone bar removed just over 2 wks ago to see what happens wit my own cycle but here I am again 2 weeks into the cycle and POTS has kicked off again the last two days!

As mentioned above by others, my labs also always come back okay, but i am hoping i will be retested now without the hormonal influence of the Implanon. I also regularly get the lower right sided back pain mid cycle that was mentioned by you guys...im wondering if I also have some ovarian cysts that are causing Pots problems too.

A pituitary adenoma was found on an MRI a couple of months ago aswell but no heed is being passed on this either :/ .

Ive started keeping a POTS symptom diary with cycle details aswel in the hope if i write it down that some doc will see the full picture rather that me trying to explain it!!!

Its very frustrating to know your own body and be identifying these issues but dismissed at every avenue! There are so many different aspects to this its hard to find what applies to each individual case...i know im certainly struggling to suss it all out!!!

[janiedelite]

I took clomid for 4 cycles a few years ago when we were seeing a fertility specialist. I felt so great when I first started taking it! I almost felt normal. But I had less benefit with each subsequent cycle, until I didn't notice any difference in my symptoms whether taking clomid or not.

I can't tolerate any progesterone, and neither can my mom. It makes both of us violently nauseated.

[Elegiamore]

Well, fire, I was totally unable to take progesterone supplements when my early menopause started around 42. They just caused major flairups in all conditions (CFS/ME, POTS, fibro, etc.). Yet I had no trouble with estrogen.

And I have next to no aldosterone whenever tested. Or none period. FYI...Ellie

[L4UR3N]

I had done a lot of research on this a while back after noticing that I always felt worse during the luteal phase of my cycle when progesterone is highest. I now consume soy (which has an estrogen like activity) during that part of my cycle and I can say with 100% certainty that it has helped. **I am NOT suggesting that everyone go out and eat soy,...just stating an observation and what has worked for me.

Here are some of the articles I found. I have many more, but I have to get ready to go to work! haha

http://hyper.ahajour.../51/4/1203.full "NET inhibition was 4-fold higher during the luteal phase than during the follicular phase."

http://www.ncbi.nlm....pubmed/20479333

http://circ.ahajourn...02/13/1473.full

http://jcem.endojour.../87/4/1569.full ** this is a study on how it is how it is SUPPOSED to work--may give a clue to what's going wrong in POTS (read the conclusion). One interesting excerpt: "in menopausal women (low hormonal status), it was reported that estrogen supplementation caused a significant decline in systemic norepinephrine spillover and in sympathetic tone"

http://www.ncbi.nlm..../pubmed/9756551 (rat study on estrogen and the SNS)

http://www.ncbi.nlm..../pubmed/8794812 estrogen enhances nitric oxide release

and this one is important for anyone with SVT : http://www.ncbi.nlm....pubmed/10190518

**BTW I am not convinced that estrogen is helpful for both types of POTS. I would think that it may actually worsen POTS if you already have super low BP.

[issie]

Thanks Rissy, for the info. Good info. It seems that estrogen may be helpful for those of us that need to lower our noriepi levels and up our nitric oxide levels. (Those of us with high bp's HyperPOTS.) Is this what others have gotten from the articles?

Issie

[sue1234]

Issie, that's kind of my take on what the articles were saying too. I think in relation to this discussion, I'm going to start a poll. It will kind of reflect our hormone status, in a way. You know, estrogen makes us "womanly", as in wider hips and bigger breasts. You can kind of picture a women with alot of estrogen, the ones where the fat deposits more in the hips and thighs(the "pear" shape). I am assuming here, but I'm wondering if higher progesterone people either tend to put weight on in their abdomens(the "apple" shape) or maybe thin and no shape. I am like an apple myself. I know the poll won't be scientific, but it will tell us if we seem to have estrogen or not. Does anyone think this poll would be worth the time?

[firewatcher]

Sue, I don't think that body shape will give any idea of estrogen status. Maybe age at menarche or menstrual pattern.

Progesterone makes me NUTS! My OB/GYN tried me on it and it was nasty, so I stayed with estrogen only. Unfortunately, I'm off that now and having a hard time regulating my fluid status.

If you were to start a poll, maybe actual hormone testing and the info above. I know my migraines started two weeks before my first period, so it was definitely a hormone thing. My headaches were also much better when I was on the estrogen.

Men make progesterone too, but not to the same levels that women do.

[misstraci]

rissy..... what days are the luteal phase? is the the week before during or after? i notice an increase in my symptoms the week before during and after and the week after especially worse.

ALSO, after a complicated delivery, extreme blood loss, etc etc. my obgyn put the implanon in my arm and i kept it for only a few weeks because i thought that was what was causing the hemorrhaging but it was the retained placenta. so, i'm wondering if it was actually something to do with the implanon (hormones) that triggered my pots and not the blood loss/stress/trauma to my body like i thought.