Please Help -- Need An Explanation Of Hormones!!!

[Hoosierfan]

I posted this on another thread and didn't get a response, so hopefully some one will chime in so that I can have an effective doctor's appointment later this week....

Ok, I need a kindergarten explanation of this. Is estrogen a vasodialator or vasoconstrictor or neither? And the same for progesterone?

My hormone tests just came back and I am off the charts estrogen dominant, and a little low on progesterone. My bp tends to tank right around when my estrogen peaks and continues until my period. So, my thought was that estrogen was a vasodialator and that the best treatment for me was the progesterone only pill ---- but then when I research it seems it is the other way around (estrogen is a vasoconstrictor and progesterone a vasodialator). I'm totally confused!!!!

I'm meeting with my OB and my holistic doc to go over my test results next week and I was inclined to say "hey, let's try and stop my cycle with the mini pill or MIrena," but now I'm confused -- would this make my bp LOWER??

I have NMH -- hypotension -- not POTS -- so if we do anything with my cycle I need something that will bump me up. Thanks all!!!!

[arizona girl]

I can't answer the hormone question, but I do know that these kinds of conditions are flared by the female mentstrual cycle. This is well documented. Don't think the imbalance would cause the hypotentsion, but anything is possible. I'd wait and see what your docs have to say.

[misstraci]

Hi, I'd also like to know this information. Sorry I'm not replying to your question, I'm just hoping someone else writes you and describes this. I do know, like arizona girl says, that menstrual cycle and dysautonomia don't mix. I've got it bad right now. This is my week after and it is horrid. I'm not sure what the hormones are doing exactly but whatever it is, feels terrible and like I'm dying.

[firewatcher]

• Basic Science Reports
  

Chronic 17β-Estradiol Replacement Increases Nitric Oxide–Mediated Vasodilation of Guinea Pig Coronary Microcirculation

1. Loren P. Thompson, PhD;
   
2. Gerard Pinkas, BS;
   
3. Carl P. Weiner, MD
   

"The incidence of coronary artery disease is lower in premenopausal women than in age-matched men.^{1 2} After the menopause, the risk of coronary artery disease rises to levels equivalent to those of men.^{1 2 3 4} Epidemiological and clinical evidence suggests that estrogen is cardioprotective, because hormone replacement therapy reduces the risk of coronary artery disease in women.^{2 5 6 7} However, the mechanisms by which estrogen is cardioprotective are incompletely understood. Although estrogen lowers LDL cholesterol and increases HDL cholesterol,^{3 4} these changes account for only 25% of its cardioprotective effect in women.^{3 4} The remaining 75% is accounted for by alternative mechanisms.

Estrogen may be cardioprotective by enhancing vasodilation of the coronary circulation. Functional estradiol receptors are present on both endothelial⁸ and vascular smooth muscle cells.^{9 10} Acute infusions of estradiol increase coronary blood flow in the open-chest dog¹¹ and the nonpregnant sheep.^{12 13} Several mechanisms have been proposed to mediate the direct effect of estradiol on the vasculature, including membrane-altering properties and/or calcium channel blocking,¹⁴ stimulation of the NO/cGMP pathway, and activation of K⁺ channels of the coronary vascular smooth muscle.^{11 15 16} Although it is important to understand how estradiol relaxes vascular smooth muscle directly, it may be independent of the genomic effect chronic estradiol administration has on the coronary vasculature.

Chronic exposure to estradiol has been shown to upregulate gene expression of endothelial NO synthase^{17 18 19 20} and thereby can increase NO production...."

[flyingsquirrel]

You are correct that estrogen leads to vasodilation (actually estrogen causes an increased release of nitric oxide which causes vasodilation).

As far as I can recall, progesterone doesn't have much effect on blood vessels one way or another (but don't quote me on that one).

[firewatcher]

better explanation:

http://pharmrev.aspetjournals.org/content/60/2/210.full

[Hoosierfan]

Fire, thanks for the articles...taking these to my docs tomorrow. And squirrel, thank you to. Now I get it, estrogen = more NOx = more vasodialation. In my case, b/c I'm estrogen dominant, my bp goes down and the florinef just isn't enough to counteract it.

So, it seems like progesterone only pill is the way to go and maybe regulate my cycle. I have a couple of books on hormone health and am reading them this morning -- seems like natural progesterone compounded is the way to go. But they talk about it as a supplement, not as a way of stopping your cycle. Hmmmm....

I have appointments with my OB tomorrow and my holistic doc on Thursday, so I will report back on what they tell me about estrogen, progesterone, stopping my cycle, options, etc. so that everyone can have this information. Thanks again, this board is invaluable!!!

[Hoosierfan]

I should also note that right now the only thing my holistic doc has me doing to counteract the high estrogen is eating cruciferous veges every day, eating whey protein, and taking a supplement called methylguard (basically a whole lot of Bs) that is supposed to help my body process through the excess.

But, even with these measures I still had a lot of lows and lightheadedness right around days 19 - 25 of my cycle, which is when I get my estrogen peaks.

[Batik]

It's worth noting that anything provided as a form of contraception, such as the mini-pill, Mirena or Depo Provera, isn't actually progesterone. It's progestogen (progestin in the US). This is an artificial hormone, vaguely similar to progesterone, but actually more similar to the hormone androgen. For some reason it's incredibly common to say "progesterone" when people mean "progestogen", to the point where I've seen it on medical sites.

Don't assume that progestogen-only medication will cure oestrogen dominance. It's not that simple, especially since it's progestogen rather than progesterone. Progesterone is almost never used by the medical community these days. I can't remember why, it was quite popular in the seventies, but I think it didn't really do that much, or perhaps it's just one of those medical oddities. The "natural" progesterone cream you can buy online is very low-dose, and there have been studies on a few brands which showed that they didn't contain any progesterone at all. Some doctors will prescribe progesterone pessaries/suppositories, which do have clinically useful levels of progesterone, so it can be worth asking about those, though I don't think they're useful for more than a small minority of women.

I think the best thing is to learn as much as you can about this, have a good talk with your gynaecologist, and make sure they monitor you carefully with whatever medication they put you on. It's really hard to predict how people will react to hormonal treatments, so it usually boils down to trial and error.

[targs66]

Based on my experience going through sudden menopause at age 45 due to total hysterectomy, I understand your frustration! I spent a lot of time trying to come to conclusions from what seemed like a lot of conflicting information, and finally decided that (as Batik mentioned) different people may react very differently to hormonal treatments.

For example, I used compounded bio-identical progesterone cream to combat what was described as "estrogen dominance." When I did, I found that my worst menopausal symptoms were greatly exacerbated (insomnia, depression and anxiety). It made me feel like the estrogen stopped working. I spent some time online and on various forums, and found that I wasn't unique - one theory is that if the body is "using" the progesterone, it can't "use" the estrogen at the same time (apologies -there's a much more scientific way of explaining this, but I don't remember it!). Finally came to the conclusion that, in simple terms - progesterone makes me feel worse.

Unfortunately, this may just take some trial and error for you. Good luck and keep us posted.

[issie]

better explanation:

http://pharmrev.aspetjournals.org/content/60/2/210.full

I really liked this article. I have been thinking for years that estrogen is playing a role in our issues. I think they are with guys too. Guys can have an estrogen dominance issue too.

This article sort of explains why "maybe", some of us got and have more issues after hysterectomy. Estrogen is so important for us ---in balance with other hormones. This article is showing the connections with estrogen and NO production, vasodilation, migraines and so much more. It also mentions that a lot depends on how well we metabolize the hormones and use them and the way our body converts them. Some of us with issues in our liver --may not be breaking them down properly and therefore, not getting the benefit that we need from replacement. The article did say there were not many studies done showing if transdermal application would be better with this. (Most of my studies have indicated that with a transdermal application of hormones - it helps to bypass the liver and goes into the blood stream.)

One thing that may help with estrogen dominance in addition to progesterone is a product that I use called "EstroSense". It has things to help the estrogen from breaking down into the bad forms --that we don't want. (Word of caution ---some don't do well on progesterone. In some it will trigger hot flashes, tachycardia - etc. even with a estrogen dominance problem. It did with me, both before and after a hysterectomy. I can't use it.)

Thanks for the article. It confirmed my thoughts.

Issie

[Hoosierfan]

Thanks all for the good info.

Had a good appt w/ my OBGYN today and he suggested I try Necon .5 / 35, and take it continuously (no "dummy pills") so that we even out my hormone levels and my cycle stops.

Here's his theory....that I have such high peaks of estrogen (given my genetic issues that make me estrogen dominant) and then "crash" to a low level before my period, that it is directly connected to my bp tanking -- estrogen does bind and make florinef more effective, so his theory is that when I started florinef therapy 2 years ago, my adrenals started to downshift their aldosterone production. No problem except when I've tried to reduce the florinef and I have low bps right before my period....since there is so much less estrogen at that time in my cycle, the florinef is less effective. (I also get really severe PMDD because I'm coming from such a high estrogen level to low).

So, the two choices seem to be either adjust my florinef around my cycle, or try and even out the hormones so they are at the same levels all the time. The first is counterproductive to my long term goal to be off florinef (I'm usually not on it), and the second hits two birds with one stone -- PMDD and the low bp.

Going to meet with my integrative doc tomorrow to go over my OB's suggestions, because I don't want to upset the apple cart. But if this makes things better.....

[Hoosierfan]

Ooops, forgot to mention, Issie, that you are right about the breaking down, etc. One of the tests my integrative doc did to begin with was a detoxification profile....it showed that genetically, I lack certain enzymes that break down estrogens (so I get all the nasty oxygenated estrogens running around my body). And I think its CRUCIAL that I have that information prior to starting any hormone therapy because we know that IF I decide to add any estrogens, I need to up the things that help me dextoxify them (cruci veges, whey protein, B vitamins).

[DoozlyGirl]

Ooops, forgot to mention, Issie, that you are right about the breaking down, etc. One of the tests my integrative doc did to begin with was a detoxification profile....it showed that genetically, I lack certain enzymes that break down estrogens (so I get all the nasty oxygenated estrogens running around my body). And I think its CRUCIAL that I have that information prior to starting any hormone therapy because we know that IF I decide to add any estrogens, I need to up the things that help me dextoxify them (cruci veges, whey protein, B vitamins).

Hoosierfan,

Can you share with us more about your detoxification profile? Was it done through their office or was it a send out to Great Smokies Lab or whatever they are now called? Did it tell which genes and enzymes are impacted? I am trying to learn more about the detoxification process. I'be had my genes profiled and wonder which ones are related to breaking down estrogen.

I have used prescribed progesterone cream (bioidentical cream) with great success in diminishing my excess bleeding, once we got the doseage correct, to counterbalance my severe estrogen dominence.

Thanks, Lyn

[issie]

Ooops, forgot to mention, Issie, that you are right about the breaking down, etc. One of the tests my integrative doc did to begin with was a detoxification profile....it showed that genetically, I lack certain enzymes that break down estrogens (so I get all the nasty oxygenated estrogens running around my body). And I think its CRUCIAL that I have that information prior to starting any hormone therapy because we know that IF I decide to add any estrogens, I need to up the things that help me dextoxify them (cruci veges, whey protein, B vitamins).

The product I listed helps with that.

I tried what he is suggesting to you before my hysterectomy. But, mine was because of endometriosis. I did it for 6 months and didn't have a period for that length of time. It seemed that I felt worse (if I remember right) - I had more mood swings - In the end I had to have a hysterectomy. But, that didn't really completely fix the hormone problem, (but, it did the pain). There were still imbalances in how my body processed hormones and there still is. I have liver issues that are still indicating problems with hormone break down. This is years after a hysterectomy and only using estriol gel - transdermal only once a week. We can hold estrogen in our fat too and our body gets estrogen in our foods and in other ways. So, estrogen come from many different places -not just our bodies production. ( I can get on a soap box about all the ways we get estrogen and what it can do to our bodies. So, better leave that for another time.) Just be aware - that it might not "FIX" the problem. We have to make lifestyle changes and try to get the estrogen we do have to circulate better and not convert into the "nasties". I think this is important for guys to look into also ---environmental estrogen, not only in our foods - but other places too.

Issie

[Hoosierfan]

Issie, you are right about the detox and getting out the "nasties." I'll check out the EstroSense, but for now I'm going to cruci veges / whey protein / methylguard route to hopefully get the nasty estrogens out.

Started the pill two days ago so we'll see how that goes. Fingers crossed that taking out the fluctuations will get me feeling better!

Lyn, the detoxification profile I had done was done by Genova Diagnostics. I don't know all the genes involved in the detox of estrogens, but at least for me, they listed the CYP1B1 (detoxes the 4-hydroxylation of estrogen) gene. As for the enzymes, I'm deficient in the gene COMT which produces catchol-o-methyl transferase. COMT detoxifies catechol estrogens, as well as neurotransmitters. The methylguard that I take is supposed to help produce the COMT enzyme.

[roxie]

Hey hoosier, have you started the pill yet?

I see that you said you were trying to not have a period. I was at the obgyn recently &shes putting me on the pill for suspected endometriosis. The goal is to eventually have no period but she was telling me in the beginning its best to train the body to have less periods. She's given me three packs with a scheduled period. After that I'll do two in a row w/our a period and then try to go 3 months without & so forth.

I don't know I'd that'll help you at all? When I was a teenager I had cysts & tried continuous bcp but ended up breakthrough blessed every 2 weeks. So I stopped. Now my this obgyn is saying the approached it wrong back then.

Hope this helps.

[issie]

Cruif. vegs are in the EstroSense. A really good combo --works for me.

Bananas, I have EDS and had Endo. You know they are connecting Endo to mast cell issues. Newest theory. Also, appears to be a lot of us EDS/POTS people with MCAS.

Issie

[issie]

Oh, forgot to ask ---you have a COMT mutation --do you have a CBS or Sx mutation? If so, there are sulphate issues and cruif. veg may be a problem. Unfortunately, broccoli, cauliflower, cabbage, radishes and some more things are high in sulfur.

COMT mutations are pretty indicative of some issues related to POTS. Have you figured it out yet?

I don't have a COMT mutation - but, do have a CBS mutation and also MTHFR. I don't know about Sx - haven't figured that part out ---yet. But, the supplement - doesn't seem to bother me and I don't eat a lot of these veggies --try to limit them. That's a hard one - cause I love all of them.

Issie

[roxie]

Issie, I didn't know that. Thanks for letting me know! Right now, endo is suspected but I'm also a little on the fence of whether or not I could have mast cell?

[Hoosierfan]

Issie, I don't have POTs, just NMH....and now my docs are pretty universal in that for me, it is some combination of a neurotransmitter issue and also a hormone issue. I don't know what you mean by a "CBS or a ***** mutation?" Can you explain?

[issie]

There are different genes involved in the methylation - I'll list them:

COMT and MAO-A processes neurotransmitter catabolism and estrogens

CBS processes hemocysteine and if upregulated depletes methyl groups, increases taurine

MTR/MTRR recycles B12 and processes B12 for methionine production

GSTM1 and SOD major detoxification enzymes

GAD transforms glutamate to GABA

HNMT process histamine (secondary enzyme for histamine primary is DAO)

QDPR recycles BH4

NOS processes ammonia forms nitric oxide from arginine

SUOX processes sulfites/sulfur and this mutation is made worse from CBS upreg

I have numerous mutations with this enzyme breakdown pathway. Since I have CBS and probably SUOX then the issues with sulfates have to be addressed before I can address the MTHFR pathway. I also have issues with MTR/MTRR and I really suspect GAD - because of my issues in regard to glutamates. (I still have a lot to learn in regards to this and reading of the genetic testing.)

So, the study of this may be one of the keys to figuring out why we are not getting better. This is a genetic thing and can have mutations. One can be pre-disposed to something and not have the issue - but, working WITH our genes and not against them - will give more positive results.

Issie

[DoozlyGirl]

Hoosier,

Thanks for the explanation of your detox profile.

Issie,

Thanks for your concise synopsis. We have some of the same types of issues. I have highlighted my +/+

(complete) defects in red and my +/- or -/+ (partial) defects in orange and suspected defects in blue.

COMT and MAO-A processes neurotransmitter catabolism and estrogens

CBS processes hemocysteine and if upregulated depletes methyl groups, increases taurine

MTR/MTRR recycles B12 and processes B12 for methionine production

GSTM1 and SOD major detoxification enzymes

GAD transforms glutamate to GABA

HNMT process histamine (secondary enzyme for histamine primary is DAO)

QDPR recycles BH4

NOS processes ammonia forms nitric oxide from arginine

SUOX processes sulfites/sulfur and this mutation is made worse from CBS upreg

VDR - Processes Vit D

SHMT - Synthesis of methionine

I read somewhere that CBS mutations lead to issues with sulfites and ammonia and can cause low doparmine, low serotonin, cardiovascular risks and multiple chemical sensitivity.

Have you looked at your CYC450 genes? I got the list from Dana's awesome spreadsheet from the third tab at the bottom.

http://danachronicallyliving.blogspot.com/2012/05/determining-your-yasko-methylation.html

I have 3 different +/+ defects and -/+ or +/- defects in this batch.

I just know that these defects are contributing to my ongoing issues and won't get better until I do something about them.

Lyn

[issie]

I had not seen Dana's blog with the listing there. She had helped me months ago to decipher some of my results. She is no longer looking into this. She has gone in another direction and doesn't want to discuss POTS theories. I hope that the new direction she is going will give her some peace and she will feel better. We all have tried different things ---looking for answers.

I do know a little about P450 pathways in the liver. I've known since I was in my 20's that I have issues with that pathway. A doc discovered this - over 20 years ago. I have not looked into the exact pathways. But, will be looking into the spread sheet that Dana put up and try to decipher some of it in more depth.

Thanks Dana for the help you have given me and others ---with your timeless research and in sharing it with others. It won't be in vain --I'm sure that some of us will find some answers we would have missed otherwise. But, due to your diligence and assistance - we are hopefully figuring out some very vital info on ourselves. I'm trying to honor your wishes --of not talking POTS theories. But, with your knowledge on this ---think it is sad that we can't utilize your brain and what you've learned. But, really appreciate what you have passed along.

Issie

[Hoosierfan]

Issie, thanks for the info. I checked with my holistic doc and he said that my CBS and MTHFR pathways were checked and were normal (phew!!). Actually, I got a 2 page explanation of methylation pathways, complete with a powerpoint presentation from him....he he he. So, I should be good on the methylguard and the cruci's.

On day #5 of the pill and so far it seems to be bumping up my pressure by about 10 points (whoo hoo), but it also seems to be making some of my symptoms worse (depression, jitters, anxiety) but I'm going to wait that out and see if it evens out. I should note that I'm going through a particularly nasty case of withdrawal from Ativan (stopped it 10 weeks ago), so its hard to know what is what.