Potential Side Effects

1. Allergies: Seasonal and Asthma

Without rhythmic hormones, immune reponse can soar, activating mucous membranes causing an increase in allergies. Adoilescents, for example, are more allergic than children are because their hormones are in flux. Once adolescence is over, allergies often stabilize. In my office, I often see allergy symptoms return in peri and post menopause women.

2. Bleeding Out of Rhythm: Bleeding longer than 5 days or before Day 28

Premarin or Depo Estradiol is the standard of care emergency use to stop excessive bleeding (or a hysterectomy). More estrogen always means less bleeding. Incompetent shedding effect is also due to fibroids due to not having normal cycles with normal amounts of progesterone. Should early or heavy bleeding (longer than 5 days) occurs, you do not need to start the cycle over but you may need to increase the estrogen dose and decrease the progesterone dose. Brown tinge is usually old blood and old uterine lining. Periods should be red.

3. Breast Tenderness

Until progesterone receptors have assembled in full compliment, there will be edema (cortisol receptor driven) in the breast causing swelling, heat and discomfort or breast tenderness, just like the first trimester of pregnancy. When progesterone is received at its own receptor by cycle 3-6, apoptosis and subsequent debris is cleaned up by the immune response. I find it takes anywhere from 3-8 months before progesterone is accepted fully.

DIM is Di-Indol 3 Methyl Carbinol, which is an enzyme found in cruciferous vegetables (like cabbage). It speeds up the cleavage of E1 (estrone) to E2 (estradiol) and the estrogen reversal back to its original precursor. How fast estrogen moves through the breast is part of the cascade creating the progesterone receptors.

Iodine is a fascinating necessary mineral that we used to pick up as humans from the dirt, by walking barefoot. Breast tissue has thyroid receptors and iodine uptake portals. There is some early research that iodine influences estrogen metabolism. It has been cited to successfully treat fibrocystic breasts.

4. Confusion (Brain Fog)

Differentiate from memory loss - losing keys is memory loss; not being able to prioritize, getting lost, not knowing what to "do" with the keys is "confusion." Lowering progesterone by 2 lines or increase estrogen might be needed. Sometimes confusion is really exhaustion.

5. Constipation

High serotonin controls gut mobility. As E2 goes up seretonin goes up. Sleeping will convert serotonin into melatonin and lower it. Progesterone slows down smooth muscle, slowing down gut motility. If this happens during the luteal phase (the last two weeks of the cycle) increase the progesterone by 1 or 2 lines to block the estrogen more fully. If it is in the follicular phase (the first two weeks of the cycle), lower E2 by 1 or 2 lines depending on the last Day 12 labs (was it in the normal range 350-500 pg/ml). Can add 500-1000 mg magnesium or talk to your physician for other options.

6. Cramps - Uterine

Fibroids may exacerbate cramps, but cramps are usually just not enough estrogen to block prostaglandins. Non-uniform shedding of the endometrium and low pain tolerance is due to low estrogen in the previous follicular phase. Low progesterone receptor complimennt is due to an inadequate peak on Day 12; increase estrogen by 2 lines twice daily and recheck a Day 12 in 1 to 2 cycles. Optimal level of fractionated estradiol should be 350-550 pg/ml.

7. Diarrhea

Diarrhea during menstrual cycle is normal in young cycling women, because when you are not reproductive (low estrogen state), the symbiotic bacteria in the gut is looking for a new host. So more E2 - or if progesterone is blocking too much E, lower progesterone by 2 lines. Can also try unsolidified Jello. The jello (sugar) feeds the bacteria and the pectin solidifies gut liquid. Cortef slows down the auto-immune response in IBS/inflammation. Prostagladin activity used to start the menstrual process (cramps) can also cause a secondary diarrheal response.

8. Edema

When there's not a full complement of progesterone receptors, the progesterone we put in fits into the cortisol receptors creating a "prednisone-like" response. During the luteal phase, the progesterone can cause joint swelling, painful breasts or abdominal distention. Once progesterone is properly received at the progesterone receptor site, progesterone will act as a diuretic. Estrogen needs to be increased by 2 lines to make a progesterone receptor.

9. Emotional Issues

Weeping and depressive states can be addressed by raising the estrogen every time. If you see a more "bipolar" picture, it could be from drinking alcohol. Low estrogen is characterized by irritability and lack of patience. More sleep is needed so take two tylenol PM two hours after dar and melatonin and go to bed within 45 minutes with the lights off, covering up all blinking and leaking ambient light.

10. Fibroids

Leiomyomas overexpress both progesterone and estrogen receptors. Muscle-wall tumors that appear at a time in a woman's life when she is dysrhythmic can, logically, behalted or regressed by restoring rhythmicity. Smaller fibroids can shrink, while larger ones either will stay stable or grow. Cortisol replacement may further re-model receptor (E2 and P4) response with the 4-peak-a-day release of E2 at the cortisol pulses. Reducing stress (blood sugar) which is the insulin response at the muscle wall can also help. Fibroids are a compensatory mechanism that occurs as hormones fluctuate and fall off in mid life. Many decrease when testosterone is added in a normal rhythm.

11. Hair Loss

It can take 6-9 months to see a difference in hair growth. Hair loss is a common complaint of menopausal women because as estrogen decreases, acute hair loss can be the result of some physical or biological stress or event 2-3 weeks earlier. TSH increases along with androgens. Hyperthyroidism in perimenopause culminates in frank hypothyroidism after menopause. Too much progesterone in relation to estrogen may also result in hair loss.

12. Hot Flashes/Night Sweats

Fluctuating levels of estrogen in perimenopause or rising levels of FSH precipitate vasomotor symptoms. Neurotransmitter response controls capillary dilation and constriction both internally and in the skin, hence the difference between flushes and flashes. Flashes end in a sweat.

Excessive sweating accompanies changes in skin color and temperature. Some women experience estrogen fluctuation only at the receptor level during sleep, when cortisol falls at night and estrogen is bound more thoroughly, hence night sweats. Since night sweats and hot flashes are caused by fluctuating hormone at the receptor level, sometimes women beginning transdermal hormones have hot flashes when they haven't before because the sudden surge of estrogen can deregulate receptors. Spreading out the daily dose for at least 3 days allows receptors to "catch up" or increasing Estrogen by 2 lines twice a day works too.

13. Incontinence

Incontinence is too low estrogen or fluctuating receptors. Raising estrogen dose is often all it takes. Sometimes it is progesterone blocking too much of the E2. Fluctuation is resolved by addressing 72 hour receptor rollover by spreading out the dose or by lowering progesterone dose.

14. Joint Pain

Most joint painis just the garden variety aging and sleep deprived "Old timers disease" Estrogen will usually fix it. If the pain is worse in the morning with stiffness, higher estrogen is indicated, if it is worse at night, cortef regimen may help. Rheumatoid or osteoarthritis is a different matter. More estrogen will not only block pain but increase progesterone reception to afford immuno suppresion of tumor necrosis factor alpha. In the autoimmune case of RA, progesterone's ability to immuno suppress is even more substantial. If viral titers are high, it is an endogenous virus creating the autoimmune state. Acyclovir might work.

15. Libido

Libido is the brains response to rhythmic estrogen in both men and women. Libido is lost in low estrogen states because pulsitility and feedback of Day 12 estrogen peak in a mammal's menstrual cycle feeds back to the pituitary, creating the characteristic leutinizing hormone surge on day 13 and 14 provoking theca cells to secrete testosterone in preparation for ovulation. Vaginal mucosa is engaged and lubricated when these pulsitile time points are made depending on the amplitude. Anorgasmic people usually have high serotonin, prolactin, are prone to headaches, high blood pressure, and high blood sugar because in order to have high serotonin and prolactin, insulin must be up. Headaches and high blood pressure often follow high insulin.

16. Memory Loss

The memory loss of dementia is classic in the aging process that it is termed "senile dementia." Memory loss is essentially the loss of D2 receptors made by E2. The same mechanism that leads to memory loss is evident in acute phase in extreme old age as Parkinson's disease. Much of memory loss is centered on sleep deprivation. The lack of sleep means that serotonin can't turn into melatonin. High serotonin inhibits short term memory storage. That's why you can remember the past, but not last week or two days ago. More estrogen is needed or lower progesterone. Memorize all your family's phone numbers to make more dopamine. Use your brain and play Chess, Scrabble, or Word Puzzles.

17. Migraines

Migraines are caused by fluctuating hormones. Migraine activity is a seizure disorder characterized by pain on one side or above one eye. In acute situations, there are visual/hallucination distortions. Olfactory/auditory distortions caused by fluctuating estrogen receptors. Some people are more prone than others to fluctuation disturbances. Allow the receptors to catch up. May need to raise the estrogen, or alternate estrogen and progesterone in the luteal phase by putting estrogen on and wait an hour and then apply the progesterone...etc. Consider Cortef four times a day between dawn and dusk.

18. Sleep Disturbance

Sleep is REM and N-REM. The REM is driven by the melatonin phase. Melatonin secretion also controls white cell immunity like macrophates, leucocytes, and lymphocytes. N-REM is driven by the prolactin phase provoked by the previous timing of melatonin and varies seasonally in duration. This prolactin phase controls neurotransmitters and t cells and auto immunity after midnight. A lack of sleep is characteristic of perimenopause and menopause, adolescence and pregnancy, and, classically, at times of hormonal fluctations. Melatonin blocks estrogen receptors, so teenagers tend to stay up all night to get, essentially, get "more bang for the buck" or to get more hormone response from what sex steroids they are secreting - to get through puberty. Menopausal women, as hormones fall off, find themselves back at the same strata hormonally as adolescents, trying to keep melatonin from blocking estrogen by being awake all night. Interval waking is the biggest complaint of perimenopausal women, usually at 1 & 3 am and 2 & 4 am. In those periods cortisol is down, estrogen levels drop and receptors are empty. Sleep is the biggest issue; and if we can resolve it, many other issues will resolve olso. Like Brain fog, Emotional issues, Joint pain, etc... Exercise will also help and be easier to do when you aren't sooooo tired!!

It is important to go to bed early, especially in the winter. In order for melatonin to pour you need 3.5 hours of sleep before midnight in the winter.

20. Tinnitis - Ears Ringing

Tinnitus can also be caused by hypothyroidism. More than likely, it's caused by low estrogen and fluctuating receptors. Thyroid hormones may be needed plus more estrogen.