to thebabydoc...help please?

[evilqueen]

Hey there...

I was reading the bcp thread and saw your very interesting contributions to it, so I'm hoping you might be able to answer some questions about Depo-Provera. I have a thread on here, and the women who answered were very helpful, but none of them described my situation.

(My apologies for being so persistent about this topic. But I'm telling you, there is absolutely NO information out there. This will be the last post on this, I promise!)

Here's the situation: A month after refusing my last Depo shot (should have gotten it March 11), I am having severe symptoms, namely terrible breast tenderness, water retention, abdominal bloating, and extreme irritation. (I snapped at my boyfriend for eating pretzel sticks too slowly.)

My ob/gyn suggested a pregnancy test. Took one three times, all negative.

Just got a book by John Lee, M.D., who coined the term "estrogen dominance." He asserts that when a woman doesn't have enough progesterone, her estrogen takes over and causes all sorts of hormonal mayhem, including the symptoms I've described above. Maybe now that the Depo is leaving my system, my estrogen is running rampant.

My questions:

1. Now that the Depo is leaving my system, is it possible that my hormonal balance is screwed up and my progesterone is too low?

2. Have you ever heard of/seen women go off the Depo shot and get these type of symptoms?

3. If so, do you ascribe them to estrogen dominance?

4. If so, do you recommend the use of progesterone cream?

Any idea what may be going on with me?

A million thanks if you could help...my ob/gyn is useless.

 

[The_Monster]

Ok, no one has responded so I'll give it a shot...

By your question numbers:

1. Yes, its almost certainly screwed up, but its to be expected more or less.

2. Not depo in particular (that I can think of) but it makes perfect sense that this would happen.

3. No. Not strictly. I would attribute this to coming off of the DepoProvera, not systemic imbalance (it is an imbalance, but it has an outside cause)

4. No. I would recommend (as sucky as it might be) to wait it out and let your body attempt to find a hormanal equalibrium. When you have had adequate time to see that your endocrine system has returned to "normal" you should reassess where you are at. Only then would I consider any sort of imbalance as being permanent.


Basically, just hold on and let your body try and return to normal. Then you can see whats going on. Odds are youll balance back out naturally, since thats what your body wants to do anyway!
It definatly sounds like an influx of estrogen (how about acne??), but like I was saying, it should correct itself. The same thing kind of happens when men come off of gear.

(Well, if that doesnt help, someone else will now. There is no surer way to get someones attention than to express an opinion they dont agree with! )

 

[evilqueen]

Thanks for thanking the time to reply--I appreciate it! (What DOES happen when men go off gear?)

And to whomever might be reading this, I say again: If you're considering Depo as a form of birth control, don't do it. You might be one of the many unlucky ones.

 

[wilson6]

The depo issue has come up with some of my clients. One in particular would lose control of herself coming off Depo. Go from crying to laughing to pure evil in minutes.

My guess is that because depo is a time-release agent, as it half-lives itself out, there are probably releases of just enough Depo to cause a state of hormonal chaos/confusion but not complete suppression of endogenous E and P. As we all know, estrogen because it crosses the blood-brain barrier can play mental havoc in both men and women when concentrations bounce around and there are probably surges of E occurring while coming off Depo causing the emotional chaos.

The problem guys have coming off is that their own T is shut down. We know that guys with low T are irritable, depressed and lack energy and that is reversed when they are put on T. With guys it is different. Their problems are a function of low T, not high E at least coming off, but their T:E ratio is screwed up and that may also cause problems. In guys, most of the post-cycle blues can be avoided with prudent use of hCG then Clomid. In women, there is no easy way out.

 

[thebabydoc]

Tough question.

First off, no, I have never had a patient with quite the symptoms you are describing post-depo.

Second, there are many things about your history that I would need to know that MIGHT help me. For instance, why did you go on the depo in the first place and why did you discontinue it? Are you on any other meds/substances/herbs? Do you have children?

Third, and let me be honest, anything regarding exactly what is happening is PURE SPECULATION; there is no solid evidence or literature (that I know of) on this topic.

Lastly, progesterone cream is too poorly absorbed systemically to be of any benefit. Might as well try Yam extract in menopause.

As for Dr. Lee, I have many, many patients with PCOD (PolyCystic Ovarian Disease) Now THAT is an "estrogen dominant" condition. And other than obesity (not all), hirsutism, and infertility, they don't suffer from any of the symptoms you have described.

Progesterone, not estrogen, CAUSES breast tenderness.
The progesterone component CAUSES water retention as well as many mood changes, particularly depression. During the menses, progesterone is withdrawn from the system (hence WITHDRAWAL bleeding). Sarafem (Prozac) has been clinically shown to be of benefit in reducing the symptoms of PMDD (PreMenstrual Dysphoric Disorder)

I would check a fasting prolactin level; this may explain some of the menstrual/breast symptoms.

I would usually recommend just waiting it out; usually within 3 months it's gone but you could go to regular OCP's to rapidly restore regulation to your cycles. Or you could just use micronor (progestin only) pills and if that helps, then you know your problem.

hope this provided some good insight.

 

[evilqueen]

Thanks for your reply, babydoc.

To answer your questions:

Went on Depo because an ex-boyfriend whined about condoms and I was afraid I'd pay the price. Got my first shot in November of 1999. I discontinued it because after two years, I wanted to give my body a break.

Also, I'm 39, and there's a small chance I would want another child (I have a 5-year-old son.) I know this stuff takes a long time to work itself out of the system.

I take the antidepressant Wellbutrin and one or two ECA stacks a day. Oh, and I quit smoking in January. Not on nicotine products now.

THE MOST IMPORTANT THING--all of my symptoms occurred within a week of my not getting the last scheduled shot, in March.

More questions:

Exactly what the HELL is going on then? You didn't really speculate...or maybe I misunderstood.

How exactly would my prolactin levels be affected by the Depo?

Would water pills help get rid of the extra weight? (My bf is still low, so I'm assuming it's water.) If not, why not?

I cannot STAND how I feel--bloated, fat, uncomfortable, bitchy--and I will go mad if I have to wait 90 days, especially since I feel I'm still gaining weight, even on 1500 calories a day and 90 minutes of exercise a day.

I would consider BCP or the progestin but is there a possibility it would put more weight on me?

I so appreciate your taking the time to reply....

 

[wilson6]

I still think this is an estrogen rebound issue. Why not have your E2 levels checked?

A low dose E/P BCP might shut it down depending on where you are in your cycle, it there is one per se at this point. Have some bloodwork done LH, FSH, E2 and P. See where you're at.

W6

 

[evilqueen]

Thank you, W6. I raised the question of hormone testing with my ob/gyn, but he sez I don't need it, so he won't prescribe a test. Should I persist in getting tested, and if so, who do I approach? Another ob/gyn? An endocrinologist?

Also: If I go on even a low-dose pill, isn't there a chance of MORE weight gain, bloating, etc?

I have never been a whiner, but this situation is getting to me. I don't want to wait this out unless I have no choice. I'm afraid I'll keep gaining and gaining...while I lose more and more of my hair!

I truly appreciate everyone's help.

 

[wilson6]

Find another doc that will do the blood work. See where you're at. Depending on where your E and P are right now, a low dose pill even though you're putting E and P into the system will supress your own production. The end result may be less E and P in the system. But, you should still see what your E and P are relative to your menstrual phase and take it from there. Probably another OB/GYN or female endocrinologist that understands these issues.

W6

 

[thebabydoc]

Any low-dose pill will work to suppress your body's production of E2 and P.

If you were doing well previously, the depo was the way to stay; you might just want to go back to it. The only reason to "take a break" is after 4 or so years because of a possible effect on bone density but by lifting you pretty much negate that.

My point about prolactin was that it might be an independent CAUSE of some of your problems, not necessarily that it's related to the depo. Remember, we really don't understand 100% how the depo works. Don't get me wrong, we know the mechanisms, but the complex interactions in the brain with 5-HT (serotonin) receptors, estrogen, progesterone (produced by the ovaries), even FSH as well as SHBG (sex-hormone binding globulin, which primarily binds up free testosterone but also other sex hormones) are not completely understood. As physicians, we must rule out all possible/reasonable causes and PRL is one.

As for contraception. Try the IUD (search for my threads and responses on this), an awesome non-hormonal, rapidly reversible, cost-effective method!

As for speculating....like I said, there really is no good literature to support a conclusion. The symptoms do not, in my opinion support "estrogen dominance", but I know little/nothing about this and like I said, my PCOD patients DO NOT HAVE THESE SYMPTOMS. If I had to guess, I would say this is a progesterone WITHDRAWAL problem more than an estrogen dominant problem. My reasoning is this:

1. It happened 1-2 weeks AFTER you should have gotten your "booster" shot of progesterone.
2. PMDD, PMS- whatever you like to call it occurs when? When the body STOPS producing progesterone!
3. Your symptoms (bloating, breast tenderness, moodiness) are progesterone related, albeit usually from increased levels, the body is funny this way and may actually have an opposite effect.

These are the things I would try/do:

1. I am usually cautious with the shots in the face of mood disorders requiring SSRI's. Believe it or not, your dose of Wellbutrin may be too high now. Restart the depo if it was working for you without problems. Sorry to say, but yet another example of "If it ain't broke, don't fix it"

2. Micronor (progestin-only). May replace the progesterone your body is now lacking only in a lower dose so that you can taper it. Also, because it must be taken daily, when you stop it for good it might not be as abrupt a change as the level tends to taper itself every day.

3. Birth control pills (Yasmin is a new one which has nice anti-androgentic and mineralocorticoid action) will DEFINITELY shut down whatever your ovaries are making, whther it is estrogen or progesterone. Unfortunately, it will replace the E2 and P with higher doses of its own. You shouldn't have too much of a problem with weight gain/bloating either.

My GUESS is that any or all of these will give you rapid relief. My guess is that it will be the progesterone effect which will be the resposible party. Remember, the human menstrual cycle is 30 days, so it's difficult to do things "quickly".

It's mostly experimentation. You might even try a little premarin 0.625mg. or an estrogen patch. If it works, it would do so in 24-48 hours. Although this is estrogen only and you might not expect it to work, you might be surprised.

good luck.

-thebabydoc