What Hormones Am I Taking?
You asked and I’m answering - “Dr. Carrie, are you taking hormones and if so, what ones?”
The short answer is YES! I’m taking progesterone. I’m not yet taking estrogens or testosterone. I’m probably going to start DHEA.
The long answer is…
I am in my mid-40’s pushing into late 40’s. About 2-3 years ago, my sleep started to suck as did my mood prior to my periods. Given all my hormone training, I figured it was time for progesterone. My labs indicated that I did ovulate (release the egg); however, the resulting progesterone production was not that great anymore. I began taking 50mg of compounded oral micronized bioidentical progesterone from a compounding pharmacy. I wanted to dip my toe into the world of progesterone and see how I felt. After a few months, I moved up to 100mg of Prometrium (also oral micronized bioidentical) from my Walgreens pharmacy. I did these at night before bed from ovulation until my period started (luteal phase).
In the last year, I’ve switched to 100mg of extended release oral micronized progesterone from a compounding pharmacy since STAYING asleep is more problematic for me. I wanted that extended release to extend most of the night! Sometimes, in the days closest to my period, I take 2 pills or 200mg.
[Quick aside: Oral micronized bioidentical means a type of progesterone that has been made small (micronized) so that when I swallow it (oral) it’s easier and faster to absorb. Plus, it looks just like the progesterone my ovaries make (bioidentical).]
Earlier this year, I repeated my DUTCH Test (you can read about it here). My estradiol (E2) looked good, my testosterone was about the same over these last many years, but my DHEA had dropped down to a suboptimal range.
I still cycle regularly and still ovulate. I have some symptoms of perimenopause like brain lapses, itchy ears, the occasional phantom smell, and drier skin. I do not have hot flashes, night sweats, joint pain, vaginal dryness, etc. that would have me thinking I am ready for regular estrogen use.
However, I am considering DHEA to help with energy, and it can potentially convert into some estrogen. DHEA-S (the hormone) is 100% made in the adrenal glands. DHEA (no -S) is predominantly made in both the adrenal glands and ovaries. All DHEA declines with age. The supplements available are also called DHEA and they will convert into DHEA-S in the body. For women, DHEA dosing tends to range from 1-10mg. You can find it over the counter; however, I would talk with your practitioner before starting a random hormone!
Once my cycles start skipping or become farther apart (currently they are every 25-26 days), I will likely start estrogen topically.
The reason I will NOT wait for my periods to stop entirely for 12 months before starting estrogen is that I don’t want my body to go without decent levels of estrogen for that long.
I had the absolute pleasure of interviewing the badass, brilliant, brain researcher, Dr. Lisa Mosconi here. She recently wrote, The Menopause Brain. She told me that as women become more mid to later stage perimenopausal and start skipping periods, they are going more lengths of time WITHOUT good estrogen levels. This can negatively impact all 12 systems of the body, including the bone, brain, heart, immune system, and more over time.
I understand some doctors prefer to wait to put someone on estrogen until she is fully menopausal and has not had a period for at least 12 months.
I disagree with this stance.
It’s not uncommon for women to start with one hormone when they are early perimenopausal, such as progesterone, then move into the other hormones with time and changes. It’s also not uncommon for women to realize they need all the hormones NOW!
It simply depends where you are on your journey.