Low progesterone, estrogen dominance, thyroid and other

[Symptomatic]

I've seen many posts in various threads on these topics, but would like to consolidate a discussion here.

I found out last year that while my estrogen is fine, my progesterone is off the charts low. That's after coming off ~27 years on the pill...

I started taking 100mg oral progesterone/day (bioidentical), on Day 8 through Day 1. After about six months, my progesterone number was still low. Granted, my periods are starting to get wacky (e.g. I've already had 11 so far this year, yikes!), so it's hard to tell exactly when Day 19/20/21 is, and sometimes I don't even make it that far before my period starts.

I upped the dose to 200mg a few months ago.

Since my sister has Hashi's, I've had regular thyroid tests for many years. I do not have Hashi's myself; however, I have had elevated rT3 (at times, highest number at the top of the range), and on my most recent testing, low free T4. And have had low body temps for as long as I can remember.

I was thinking my low progesterone was causing the thyroid issues, my doc thinks it's the opposite (thyroid causing low progesterone). He wanted to start me on Synthoid, but I demanded Armour (and later found papers suggesting that there is a certain SNP (for which I'm hetero), folks with it do better on T3+T4 than plain T4.

Now that I'm on 200mg progesterone, I'm starting to get up over 98.0, even to 98.6 some days. I've noticed that my temp seems to track with the progesterone, regardless of whether or not I'm taking Armour.

I'm interested in hearing whether folks think low thyroid leads to low progesterone, low progesterone leads to low thyroid/low thyroid symptoms, or something else.

 

[Ema]

Dr John Lee contends that low progesterone leads to estrogen dominance and that estrogen can block the action of thyroid hormone causing functional hypothyroidism even with normal thyroid hormone output from the thyroid gland.

Estrogen can increase levels of thyroid binding globulin so that more thyroid hormone is bound and less is "free".

Have you tested your thyroid frees - FT3 and FT4?

Most everyone does better on a mixture of T3 and T4 whether Armour or a mixture of Cytomel and Synthroid.

200 mg of progesterone is a fairly large dose. I wonder if changing forms to a sublingual or a cream might work a little better for you? Do you feel fatigued or "hung over" in the morning?

You're taking it from day 8 to day 1??? Does this just mean you stop it for 7 days when you get your period?

Ema

 

[L'engle]

Symptomatic: Are those temps basal (early morning) or daytime body temps? I'm currently trying to increase progesterone with vitex tincture but haven't tried progesterone yet. I wasn't able to tolerate armour thyroid and wouldn't go near the synthetic ones. If I can improve even a small amount by addressing the imbalance I will be pleased. Low 98s is the highest temperature I've attained in the daytime with my early morning temperatures being in the 96-low 97s. That is interesting you've been able to raise your temps. Do you feel any improvement in symptoms with the higher temps?

I hope you can find some improvement.

 

[Symptomatic]

Dr John Lee contends that low progesterone leads to estrogen dominance and that estrogen can block the action of thyroid hormone causing functional hypothyroidism even with normal thyroid hormone output from the thyroid gland.

Estrogen can increase levels of thyroid binding globulin so that more thyroid hormone is bound and less is "free".

Have you tested your thyroid frees - FT3 and FT4?

Most everyone does better on a mixture of T3 and T4 whether Armour or a mixture of Cytomel and Synthroid.

200 mg of progesterone is a fairly large dose. I wonder if changing forms to a sublingual or a cream might work a little better for you? Do you feel fatigued or "hung over" in the morning?

You're taking it from day 8 to day 1??? Does this just mean you stop it for 7 days when you get your period?

Ema

I'm familiar with Dr. Lee's work and theories. I'm just confused since my Dr. thinks it's the other way around...was wondering what folks here real-life experience has been.

I'll post my thyroid numbers in a separate post in a minute.

Funny you should mention that 200mg is a fairly large dose. Last time I had my Labrix salivary hormone testing done (when I was taking 100mg), the report came back with a note stating: "Progesterone to estradiol (Pg/E2) ratio is consistent with residual estrogen dominance and the progesterone level is below the therapeutic range. Dosage adjustment may be warranted. It may be worthwhile considering topical bio-identical progesterone supplementation as it is better absorbed than the oral route".

I've been trying to avoid the cream, as I think I'd be non-compliant. I take so many other pills that adding this one seemed like a no-brainer.

You are correct, I stop only for 7 days when I get my period.

 

[Symptomatic]

Symptomatic: Are those temps basal (early morning) or daytime body temps? I'm currently trying to increase progesterone with vitex tincture but haven't tried progesterone yet. I wasn't able to tolerate armour thyroid and wouldn't go near the synthetic ones. If I can improve even a small amount by addressing the imbalance I will be pleased. Low 98s is the highest temperature I've attained in the daytime with my early morning temperatures being in the 96-low 97s. That is interesting you've been able to raise your temps. Do you feel any improvement in symptoms with the higher temps?

I hope you can find some improvement.

Not really doing a true basal temp, but I take it three times a day: 8 am, 2pm, 8 pm - same time I take my meds (just 'cause it's easier for me to remember to do it then). For a long time I was below 98 at all three times (and for a time I was dipping below 97 pretty regularly). Now, generally I'm up above 98 at least at the 2pm timepoint. Today at 8 am I was 97.4 at at 2 pm was 98.1.

I've just started getting back up above 98 in the last month or so, so not sure what if anything will come of that. I know temperature is tied to thyroid, which is tied to progesterone, so just trying to make some sense of it all.

 

[Symptomatic]

Do you feel fatigued or "hung over" in the morning?

Ema

Nowadays I am sleeping pretty hard, so although I wouldn't say I feel fatigues or "hung over" per se, since I'm in such a deep sleep, it takes a bit to come out of it.

I'm taking LDN (which is supposed to help with sleep), but a few months ago bought a Spoonk acupressure mat ("bed of nails") which is supposed to help release endorphins. Since starting its use, I sleep like a rock. Which is a huge change for me, I've always been what I refer to as a "Princess and the Pea" type sleeper - meaning any teeny tiny thing will wake me up. Need it to be very dark, cold, and quiet to sleep. Any noise, light, etc. would wake me. But the Spoonk has me out totally - I hope that's good and not bad!

 

[Symptomatic]

OK, here's the thyroid info. The reference ranges for rT3 were different each time I tested (in 2011 the range was 90-350 pg/nL; in 2013 it changed to 9.2-24.1 ng/dL):

Here's sex-hormone bloodwork, I was on the pill for all but the most recent testing:

And salivary estrogen and progesterone (2012: after 4-6 weeks off pill; 2013 was on 100mg oral Progesterone, but pretty sure it wasn't actually Day 19/20/21 due to wacky cycles). I have a kit right now, and if I make it to Day 19 this cycle, will retest. That will be with a 200mg dose of progesterone, plus Armour thyroid (which Dr. thinks will make a difference).

 

[L'engle]

Symptomatic. I think the idea of testing around day 21 for progesterone is to get it about 7 days after ovulation. So if you are ovulating earlier then you might not need to wait to see if you get a day 21. If you track your early temps, which I guess would the 8am ones for you or before you get up and do anything, you can get a sense of whether and if so when you ovulate. There is a rise in basal body temperature after ovulation. If you don't have that rise you might not even be ovulating which wil throw off progesterone readings, as far as I know.

When women are on synthetic hormones for a long time they often don't go back to ovulating for some time after stopping.

If you are ovulating, you can get a sense of how long the second phase of your cycle is, and whether it is even 7 days long. Progesterone should help with both ovulating and lengthening the luteal phase.

 

[Symptomatic]

Symptomatic. I think the idea of testing around day 21 for progesterone is to get it about 7 days after ovulation. So if you are ovulating earlier then you might not need to wait to see if you get a day 21. If you track your early temps, which I guess would the 8am ones for you or before you get up and do anything, you can get a sense of whether and if so when you ovulate. There is a rise in basal body temperature after ovulation. If you don't have that rise you might not even be ovulating which wil throw off progesterone readings, as far as I know.

When women are on synthetic hormones for a long time they often don't go back to ovulating for some time after stopping.

If you are ovulating, you can get a sense of how long the second phase of your cycle is, and whether it is even 7 days long. Progesterone should help with both ovulating and lengthening the luteal phase.

I believe the note on the first testing from Labrix stated that the numbers were indicative of an anovulatory phase.

When you say, "When women are on synthetic hormones for a long time they often don't go back to ovulating for some time after stopping", how long are we talking? Months? Years? I think I stopped the pill in July '12 or so...I'd have to double check.

 

[L'engle]

Symptomatic. I'm not sure how long but in my recent research on hormone balancing supplements, it seemed one person after another was missing their cycles for months after stopping hormone pills. Most of them were people trying to improve their fertility, not dealing with chronic illness, but some of the same problems seem to apply. The length of time you were on them, age and individual conditions would affect how long it took to get back to normal, I would think. I haven't had this problem personally but it seems to be very common.

 

[Ema]

OK, here's the thyroid info. The reference ranges for rT3 were different each time I tested (in 2011 the range was 90-350 pg/nL; in 2013 it changed to 9.2-24.1 ng/dL):

View attachment 5549

Here's sex-hormone bloodwork, I was on the pill for all but the most recent testing:

View attachment 5552

And salivary estrogen and progesterone (2012: after 4-6 weeks off pill; 2013 was on 100mg oral Progesterone, but pretty sure it wasn't actually Day 19/20/21 due to wacky cycles). I have a kit right now, and if I make it to Day 19 this cycle, will retest. That will be with a 200mg dose of progesterone, plus Armour thyroid (which Dr. thinks will make a difference).

View attachment 5551

Were you on thyroid meds for these labs?

 

[Symptomatic]

Were you on thyroid meds for these labs?

No - just started thyroid meds about two months ago, after getting the low T4 result and due to continued low progesterone. Even the high rT3 the time before had me thinking I was having some kind of thyroid issue, but I'm stuck in the chicken-egg merry-go-round: is the low progesterone causing low thyroid symptoms, or is there a separate thyroid issue (and if so, is that affecting progesterone)?

Or am I just totally screwed up due to 27 years of the pill?

 

[Symptomatic]

Updated to include new salivary hormone results:

So, improving, but not there. Doc has suggested Vitex (I'm currently on 200mg oral Progesterone + 45mg Armour/day), do any of you have experience taking it?

 

[WoolPippi]

have you started Vitex and how are you?

 

[Calathea]

Read up on the Fertility Awareness Method (FAM), and start practising FAM charting if it's at all possible. You need your basal temp, which should be taken first thing in the morning, at the same time, and before getting out of bed, eating or drinking, or talking. I set the alarm on my phone, and use a basal thermometer (they're more accurate than fever thermometers) with a memory function, since I don't write down the number until later. My sleep schedule is regular enough for this to work, and I find that once you're used to it, you wake up, temp, and go back to sleep quickly.

Now, this will show your basal temps, which may or may not follow a clear pattern. I've been doing this for years, and my temps show a clear pattern, so I stopped bothering with the cervical signs. I'm only doing this for health reasons, not for conception/contraception, so it doesn't matter if I'm occasionally wrong about my ovulation date. However, it sounds like you might need the cervical signs as well. They're pretty easy to learn. Taking Charge of Your Fertility is the book people usually learn from, and it's so popular that it's easy to find cheap second-hand. Once you are doing all this, you should be able to tell:

* if you are ovulating at all
* when you ovulate
* how long your luteal phase is
* how your temp range relates to the range indicative of thyroid issues
* how long your follicular phase is compared to your luteal phase, and what that means in terms of hormone balance.

The follicular phase is the first half of your cycle, and can vary. The luteal phase is the second half, should be pretty constant in length, and should ideally be 14 days long.

So to show what you can learn: my luteal phase is 9-10 days long, which means firstly that I couldn't get pregnant even if I wanted to, and secondly that it's only half the length of my follicular phase, instead of the two being about the same length. The follicular phase is dominated by oestrogen, the luteal phase by progesterone, so I'm getting a lot more oestrogen in my system. I also have a 21 year history of menstrual migraine and a 7 year history of PMDD (severe PMS), which is probably connected to this imbalance. (My temp ranges are fine, I don't personally have thyroid problems, although I do have dreadful circulation and can see the temps rise a bit when I'm on ginger supplements.) I get migraine on the day when my temperature plummets, as that's when progesterone levels are dropping. It used to be before my period when I was teenager, but now it's a couple of days into it, when the bleeding gets heavier. The temp drop means that I have warning and can work out pain meds. And knowing when I ovulate means I know when my period is due (mildly irregular cycle), and thus when the PMDD is due, and I can take a proactive approach to those as well.

In other news, this month I ovulated a few days earlier than average, and more to the point, had a 13 day luteal phase! So the two phases of my cycle were nearly equal, rather than one being twice as long as the other. With minimal PMS and no migraine. I've changed quite a few supplements recently, mainly improving the minerals and adding Vitamin C. I suspect it's the minerals. I'm taking them in better forms and getting more of them, and in particular I am now taking quite a bit of iron and slathering myself with magnesium oil every day. I'll be very interested to see how this progresses.

 

[Symptomatic]

have you started Vitex and how are you?

Yes, I started taking Vitex last fall. I was originally taking a brand that also contained Dong Quai, but have since switched to a brand called Linden's Apothecary which does NOT contain anything else (I figured I don't need any help on the estrogen side, LOL). I tried for months to get hold of the Full-Spectrum Vitex from Planetary Herbals, but they were on backorder and the date kept getting pushed out - not sure if that has been resolved, but I'm happy with the Linden's product.

I've been taking one of the Linden's (1000 mg) pills a day in the morning, and have also continued to take 200 mg Progesterone orally in the evening and 45 mg Armour in the morning. I am having less frequent periods with SIGNIFICANTLY less bleeding. It's almost tolerable at this point!

Haven't had salivary estrogen and progesterone levels checked since last fall as posted here, should probably do that here in the next few months. I did find out I have a rather flat salivary cortisol curve...