This is the story of my patient Kindle. When she first came to see me she was 52 years old. She had had a long history of PMS and two miscarriages (both signs of low Progesterone). At age 48 she had a hysterectomy because she was having heavy menstrual bleeding every 3 weeks due to endometriosis (sign of too much Estradiol (E2) and too little Progesterone) and having lots of cramping and large clots (sign of high Estradiol).
The hysterectomy did not stop the cramping because it did not correct the hormonal imbalance that caused the problem. She still had too much Estradiol and too little Progesterone. The endometriosis tissue that remained in her pelvis and abdominal cavity continued to cause cramps but were misdiagnosed as gallbladder attacks, so 14 months after her hysterectomy Kindle’s gallbladder was removed. During the surgery the doctor noticed something unusual on her ovaries so he referred her back to the Gynecologist to check it out.
Kindle’s Gynecologist tested her blood for CA125, which is a marker for ovarian cancer and the level was high. By now Kindle’s anxiety level was higher than her CA125 and she was scheduled for another surgery 5 months after her gallbladder surgery. Both ovaries were removed and sent to the pathologist. Fortunately, there was no cancer just endometrial tissue on the ovaries. Endometriosis would have caused the heavy bleeding that led to the hysterectomy, the stomach pains and the suspicious looking lesion on the ovaries. She didn’t need any of those surgeries, she just needed more Progesterone and less Estradiol, but now Kindle was in surgical menopause
So what did the Gynecologist do? She prescribed more Estradiol in the form of a patch. This did not stop the hot flashes. Now Kindle was really miserable. Three months later she decided to try the Sotto Pelle surgical hormone implants. She had heard that these implants were natural, bio-identical hormones containing Estradiol and Testosterone. What she didn’t know was that although they were biologically identical to the body’s own hormones, Estradiol was increasing her risk of breast cancer. Estradiol is used in the surgically implanted pellets, like Sotto Pelle and Amor Vie, becaue it is 1000 times more concentrated that Estriol, the safe estrogen. This high concentration allows the pellet to last a long time in the body, but it greatly increases the risk of cancer. For more information about the different estrogens please see my article: Estrogens: Are they safe to take?
The Sotto Pelle pellets did stop her hot flashes and raised her sex drive. Although she was not fond of the idea of getting a minor surgery every three months she did like the idea of not having to swallow a pill or apply a messy cream every day. However, after a year and a half and 7 surgical implants later she felt moody and irritable. Her sex drive went up for about 6 weeks after every implant, but then it went back down the next 6 weeks. She was tired of the mood swings and the ups and downs. She was fatigued, irritable and just didn’t feel like herself any more. Normally she was cheerful and happy and upbeat, but no longer.
First Office Visit with Dr. Hansen
On her first visit in my office I reviewed her entire history and medications. Based on her history and symptoms I could tell that the cause of her past PMS, Endometriosis and most of her other symptoms had been caused by too much Estradiol and too little Progesterone.
Estradiol is one of three estrogens the body makes. It prepares the uterus for implantation of a fetus and the breasts for milk production by increasing cellular proliferation, but too much Estradiol causes too much proliferation, heavy cramps and increased risk of ovarian, uterine and breast cancer. Progesterone, on the other hand, does the opposite; it activates Tumor Suppressor Protein and decreases cellular proliferation. The body works to keep these two in balance when it is functionally optimally.
What Kindle needed all along was more Progesterone and Estriol (E3) the safe estrogen. An excess of Estradiol and a deficiency of Progesterone can lead to PMS, Endometriosis, Uterine Fibroids, Infertility, Miscarriages, Ectopic Pregnancy, Pre-Term Births, Post Partum Depression, Osteoporosis and Cancer of the breasts, ovaries and uterus.
Date: 11/10/10 Summary of Finding from First Office Visit
Chief Complaints:
1) Hot Flashes with night sweats
2) Moodiness: irritability, depression
3) Heartburn; Bloating
4) Hypoglycemia; Lightheadedness
5) Hypothyroidsim (Taking Synthroid since age 21)
Medications: 1) Sotto Pelle (Estradiol + Testosterone Pellets) Harmful Long-term: Estradiol is associated with significant increased risk of Cancer, heart attacks and strokes. I planned to immediately switch her to the safer sublingual (under the tongue) Bio-Identical Estriol and wait for the test results to see how much Testosterone and Estradiol she had in her body from the pellets.
2) Synthroid (112mcg) one tablet daily.
Female Symptoms: Irritability (due to low Progesterone); Breast Tenderness (due to high Estrdiol); Sex drive up and down (due to large release of Testosterone initially from Pellets then decreasing amount over time)
Mental: Moodiness, Irritability (due to high Estradiol and low Progesterone – the cancer causing estrogen)
Skin: really dry (due to low thyroid)
Hair: Ok, not thinning or falling out
Sleep: Ok, not disrupted
Digestive System: Bloating, heartburn (due to stress à too much acid dumped into stomach);
Adrenals: fatigue, hypoglycemia, fasting à shakiness, lightheadedness, headaches, ravenous hunger, must eat often (these are all symptoms of low adrenal cortisol that regulates blood sugar levels; cortisol is produced by the adrenals when stressed and initially raises the blood sugar à weight gain and fat abdomen, then the adrenals “burn-out” and cortisol levels drop significantly causing all the symptoms listed above)
Physical Exam: BP 130/70; TMJ (Jaw Joint) tension/pain/misalignment +2
Note: Kindle’s story is not too untypical. The cause of her problems was hormone imbalance not a defective uterus, gallbladder or ovaries. The good news is that we can now test her hormone levels individually and create a specific and individualized plan just for her unique biochemistry – a plan that will restore hormone balance, and reduce the risk of breast cancer and osteoporosis.
(For a more detailed description of each hormone and hormone testing, see my article entitled “Balance Your Hormones, Balance Your life.”)
Prescription
RX 11/10/10 First Office Visit:1) Progesterone 25mg once daily under the tongue at bedtime; 2) Estriol 2mg per day at bedtime; 3) Naturethroid 1 grain once per day (this natural thyroid contains both T3 and T4 and will replace the Synthroid (contains only synthetic T4) she is currently taking; 4) Isocort: Adrenal support with Cortisol (5mg) once daily in AM (for symptoms of lightheadedness, fatigue and hypoglycemia) (The Adrenal gland often needs supplemental support just like the Thyroid does) ; 5) Peak Advantage Multi-Vitamin: 2 capsules 3 times per day; 6) Pepteal (herbal support to heal the mucous membranes of the stomach) 2 capsules twice daily (for GI pain, heartburn). I did not prescribe DHEA or Testosterone at this time because I did not have Kindle’s hormone test results yet.
Date: 11/23/10 2 Weeks later
We received Kindle’s lab tests and she came back to review the results and to get a comprehensive and updated prescription based on her specific individual lab results and her response to my initial prescription.
Subjective Assessment: Kindle says she is feeling more positive; No longer having the lows she was having before, but still not sleeping soundly, she feels like she can’t relax; still a bit irritable.
Patient Labs:
| Lab Test | Reference Range | Optimal Range | 11/10/10 | 12/08/10 | 01/19/11 | 4/20/12 | 9/7/11 |
| Estradiol | 5-65 pg/ml | 10-40 | 321H | 223H | 132H | ||
| Estriol | 10-80 ng/dl | 40-80 | 37L | 48L | 94 | ||
| Progesterone | 10-80 ng/dl | 150-400 | 10.1L | 135L | 206 | ||
| DHEA | 10-500 mcg/dl | 200-280 | 65.2L | 54.6L | 254 | ||
| Testosterone | 6-82 ng/dl | 35-75 | 52.8 | 10.8L | 29.6L | 83.5 | |
| Thyroid (fT3) | 2.5-4.8 pg/ml | 3.4-4.8 | 2.3L | 3.8 |
RX 11/23/10: Increase Progesterone to 50mg once daily at bedtime; Indoleplex (Contains Indole-3-carbonole) 2 caps, 2 times daily; Plan to retest Thyroid hormones in 30 days.Lab Test Review: Kindle’s labs show an extremely HIGH Estradiol 11.5 times higher than it should be. It has been 3 months since her last Sotto Pelle hormone implant. Her body must not be processing Estradiol(E2) efficiently nor converting it into Estriol (E3) like it should. She will need the broccoli extract known as Indole-3-carbinol to help improve her liver function to get it to process the Estradiol and convert it into Estriol (E3). Her Progesterone and DHEA levels were all low. Her Testosterone level was still within the normal range. While on the Sotto Pelle pellets, her Testosterone levels ranged from 11 to 278, with an average of about 90ng/dl at the end of 3 the months after the pellet was implanted.
Date: 12/21/10 1 month after 1st visit
Kindle says, “I feel much better now: more even, my energy level is good and I’m sleeping well at night. I’m no longer having breast tenderness, which I was having with the pellets. My stomach feels much better: no more heartburn and I can no longer feel my thyroid gland when I swallow. It feels less swollen.”
Rx 12/21/10: Testosterone (5mg) 1 capsule poured under the tongue once daily; Continue the other items previously prescribed.
Date: 2/2/11
Feeling better: mood up; handling stress better; less emotional. Still having a few night sweats. (Estriol still too low) Energy still low. (Testosterone still too low)
Rx: Estriol (3mg) once daily under the tongue; Testosterone (10mg) 1 capsule poured under the tongue once daily; DHEA 10mg once daily; Mesotherapy treatment #1 of 3 (every 2 weeks for 3 treatments) for TMJ (See Mesotherapy)
Date: 2/16/11 Mesotherapy Treatment #2; Continue all other previously prescribed items.
Date: 3/2/11
“Female hormones feel much better!” No hot flashes. No more night sweats; Sex drive finally feels at a consistent good level: not too high and not too low. No breast tenderness. Sleeping fine. Jaw is getting better: tension /spasm much reduced; soreness almost completely gone.
Rx: Mesotherapy Treatment #3; Continue all other previously prescribed items.
Date: 4/20/11 About 5 months from 1st visit
“I’m feeling really good; sleep good; no hot flashes; no breast tenderness; TMJ better.
Rx: Repeat Female Hormone Panel today; Refill Naturethroid 1 grain; Retest Thyroid in 2 months. Re-evaluate everything upon receipt of labs in 2 weeks.
Date: 5/6/11 Report of Finding
Estriol, Progesterone and DHEA all within optimal range now. Estradiol is still too high and Testosterone is still too low.
Rx: Increase Estriol to 4mg once daily under the tongue at bedtime. Start Testosterone cypionate injections 20mg I.M once per week for 4 weeks, then 20mg I.M. oncer per two weeks, to boost and maintain Testosterone level at 50-82ng/dl (Optimal Range); Continue all other previously prescribed items.
Date: 9/7/11
Feeling much better now: Energy much better; No hot flashes; Testosterone level feels right now; healthy sex drive and interest.
Rx: Continue all previously prescribed items. Retest Hormones in 3 months.
Date: 9/21/11 Report of Lab Test Results Treatment Plan Re-evaluation
Kindle is now feeling great! She has absolutely no hot flashes any more during the day or night (Estriol). Her mood is more upbeat and consistent now than it has been in years (Estriol, Progesterone, Testosterone). She is no longer moody or irritable (Progesterone). Her sex drive is great without large swings from high to low (Testosterone). She has fewer aches and pains (Testosterone). She feels stronger both physically and emotionally (Testosterone, Progesterone, Estriol).
Kindle will continue to take her hormones and nutritional supplements as directed for the next 2 months, until her one year follow-up visit in November 2011 at which time we will retest her hormones to determine if her dosing is still optimal. Then once each year Kindle will return to retest her hormones to keep them at their optimal level.
I had a total hysterectomy. I have been on Vivelle Dot. I have had insomina since surgery and racing heart at night. May be adding progest. cream. Where do you get estriol who makes it? Any help at this point would be great.
Dear Vonda,
Vivelle-Dot is Transdermal Estradiol. Every woman should be given the Drug info and WARNING to read before receiving this prescription. Estradiol is a known carcinogen. It causes “increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis.” Most women have no idea how dangerous Estradiol is if it is not given in balance with Estriol and Progesterone.
As you can see from Kindle’s case above, the amount of hormones that you need depends on your individual lab analysis, but you need to supplement Estriol and Progesterone in balance. If your serum Estradiol is below below 20pg/ml you may need to supplement it as well, but it should never be given alone if you want to prevent cancer.
I prescribe sublingual Estriol and Progesterone supplements from a compounding pharmacy for my patients. For more information about how you can get a Rx filled for your individual needs please call my Clinic at 480-991-5092.
I now use the 1 mg patch 2 pumps of gel i have no ovarie or uterous i have had chronic insomina since the surgery and was put on klonipin and celexa due to extreme heart racing panick i dont have tender breasts or swelling the celexa seems to help with the panic, my hair is falling out no more sex drive ugh, i just want to sleep like a normal person