46 years old - spotting and pms mid-cycle (usually have regular periods) just started progesterone cream (High estradiol AND high progesterone lab results luteal phase)

by newtoprogesteroneagain
(usa )

Hi, I'm 46 years old. Not on birth control (only once for 6 months 25 years ago). I take thyroid medication for 10 years (hypothyroid) and was diagnosed with peri-menopause 10 years ago. I used to be on natural progesterone and estradiol, but got off estradiol years ago when my hormones leveled out and took progest cream for like 5 years after - and have been off all (natural) hormones for at least 5 years.

I have been having symptoms of: sore breasts 10 days before my period, which recently changed to all the time. PMS, moodiness and hormonal emotional feelings, bloating, night sweats and hot flashes (sweating out of nowhere) and most recently - spotting (which I never have - I have regular cycles that I track with an app that are not late and are very regular). I've been spotting for almost 2 weeks now - (varies from very light brown discharge to light red spotting) and I'm worried.

My labs from 4/11/18 show (23rd day of cycle so in luteal phase): estradiol: 215 (range is 56-214 for luteal phase) and
progesterone: 22.9 (range is 2.6 - 21.5).

I started taking DIM in May, per my naturopathic doctor - to see if that would resolve the issues. It didn't. It did help with the night sweats (still get them but less often), but the mood and pms type symptoms got worse.

I read here yesterday about taking 100-200mg minimum of progesterone cream/ day (I Ordered the Natpro yesterday) and started taking about 240mg of progest yesterday (up from probably about 80 mg / day before) .

I have a few questions: since I'm still spotting and my period is set to start in 6 days according to my cycle tracker - do I stay on the progesterone cream through my period? As in - do I not get off the progesterone cream / take it daily for 6 months as I read here?

I believe this is what I've read here - but haven't seen this elsewhere. (my doctor is not communicating very well at the moment due to holiday and her moving cities / her office and her family, and she has no assistants so I'm looking for external support while I wait for instruction from her). I'm also getting headaches and very bloated.

Also - I started panicking that I have cysts or endometriosis or something since this is very new for me (the spotting is not normal nor are my raging pms cramps / emotional state) - so would love some insight on whether or not I need to freak out about the spotting and other symptoms.

Any guidance and insight would be helpful. I am told I have estrogen dominance - but my lab results showing BOTH high progesterone AND estrogen are very confusing to me.

Thank you!

Comments for 46 years old - spotting and pms mid-cycle (usually have regular periods) just started progesterone cream (High estradiol AND high progesterone lab results luteal phase)

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Jul 07, 2018
46 years old - spotting and pms mid-cycle (usually have regular periods) just started progesterone cream (High estradiol AND high progesterone lab results luteal phase)
by: Joy

Hi newtoprogesteroneagain

I am pleased that you stopped taking estrogen as no women should take extra it adds to Estrogen Dominance symptoms which you are now experiencing. Your progesterone:estrogen ratio is 107:1 it should be around 600:1. Please read the Hormone Testing page. Your tender breasts could mean that you are deficient in iodine. Try rubbing some Natpro on your breasts to see if that will help, progesterone is a good anti-inflammatory.

Peri-Menopause can be a difficult time for most women. Usually between 100-200mg progesterone cream is needed but night sweats and hot flashes often require 400-500mg for 4-6 days or until they clear, please read Hot Flashes. Once they clear you can slowly start to reduce to no less than 100mg. I suggest that you use Natpro every day until your adverse symptoms clear and your cycle returns to normal, often in Peri-Menopause they don't but the use of progesterone helps with other adverse symptoms. Please read How to use Progesterone Cream.

If you feel that you have Cysts or Endometriosis please see your doctor. Spotting during peri-menopause is normal but pain could mean endometriosis or Fibroids.

Vitamin D3 is very important as a deficiency reduces the benefits of progesterone, optimal range is between 70-100ng/mL. Nothing less than 5,000iu's is needed daily. Co-factors are needed when taking D3, magnesium and vitamin K2 with no soy are the important ones.

Jul 07, 2018
46 years old - spotting and pms mid-cycle (usually have regular periods) just started progesterone cream (High estradiol AND high progesterone lab results luteal phase)
by: newtoprogesteroneagain

Hi Joy -

thanks so much. I actually needed the estradiol at the time - but was on it for maybe less than a year.

I'm confused about my progesterone to estradiol ratio - what does this mean for me specifically if my ratio is 106.5? I read that the range is 100-500 for 'healthy.'

Since mine is getting close to the low end, does this indicate a need for progesterone? What else does this indicate? I saw you said that my ratio should be 600:1 so this indicates a need for progesterone, correct? (if so - PHEW. I am so relieved).

I spoke to my naturopath and we are going to test my labs again, even while on the progesterone cream. I have gone up to 240mg / day of progesterone (still also taking DIM) and ordered Natpro (waiting for it in the mail).

My vitamin d3 levels are good (I take 10,000 IU daily) - last labs it was 89 (range of 30-100). I've also taken k2 recently as well and also take magnesium (I take like 100 vitamins / supplements a day at the moment - dealing with SIBO and gut issues at the same time as this :( ).

I would love some guidance on how much is recommended that I use (safely) to get my levels up to 600:1 ratio . Also is it suggested that I stay on the natpro through my cycle? for how long?

This helps a lot, since my naturopath wants me to re-test while on the cream - which date of my cycle should I re-test? I typically shoot for day 19-21 (luteal phase) but with the spotting that is happening I'm not sure how to proceed. I have to do regular blood tests as I cannot afford more out of pocket costs for urine tests (my doctors both prefer urine tests as well).

Do you recommend I try to go up to 400mg / day of Natpro for a week? My breasts are not sore anymore, but I do still have intense weight gain, water retention, headaches, extreme emotional fluctuations / anxiety, and night sweats are better but it's very hot where I am right now and I can't tolerate heat at all.

Thank you so much I really appreciate it.

Jul 07, 2018
thank you (re: 46 years old - spotting and pms mid-cycle (usually have regular periods) just started progesterone cream (High estradiol AND high progesterone lab results luteal phase)
by: newtoprogesteroneagain

Hi

I tried to comment earlier but don't think it went through. Thank you for your comment, I hope you can see that I have responded?

So from what I understood from your comment, I do have estrogen dominance with this ratio? (that would really help to confirm since I cannot lose the extra 10 lbs and bloating around my midsection,and I can't fit into my clothes anymore).

And you recommend I stay on the Natpro cream (200mg / day), through my upcoming period (in 5 days - without spotting my period would come in 5 days)??

If so, when should I stop the Natpro cream? I'm specifically asking about using it through my cycle this time, and then again next month?

This is the first time I've ever had spotting in between periods (or it's been so long since I have in the past that I forgot it ever happened) so I'm not sure exactly how to go about it right now.

I have read the pages you linked a bunch of times, thank you.

In my case, do you recommend I use more than 200-240mg for a few days right now? And then lowering from that high of a dosage, would I just lower by 20% a day in this case, or can I drop by 100mg at a time ?

Thank you so much

Jul 10, 2018
46 years old - spotting and pms mid-cycle (usually have regular periods) just started progesterone cream (High estradiol AND high progesterone lab results luteal phase)
by: Joy

Hi newtoprogesteroneagain

It means that you need to continue using progesterone only to help raise your progesterone level, it needs to be around 600 as explained on the Hormone Testing page. Stick with the 240mg a day and see how you get on, it does take time to raise the level. If you feel no improvement after a week, then increase to 300mg per day. This is something that you need to experiment with, what suits one does not suit another. Once you feel stable, use by following your cycle as explained. The best way to reduce is to reduce by 25mg, stay on the reduced amount for a week, then reduce again by another 25mg and so on. Reducing too quickly and too soon will see the return of your adverse symptoms. DIM does not reduce estrogen as we are lead to believe. If you are taking it to reduce estrogen rather try calcium d-glucarate.

As you have adverse symptoms, spotting etc, it is best to use the cream every day until you become stable with a regular cycle, then use cream at luteal phase. Remembering of course that you are in Peri-Menopause, a time when the cycle becomes erratic. There is no point in having a test done if not using progesterone, so it is best to test while using progesterone.

Your D3 level is good and I am pleased to see that you are taking the co-factors.


Jul 11, 2018
thank you (re: 46 years old - spotting and pms mid-cycle (usually have regular periods) just started progesterone cream (High estradiol AND high progesterone lab results luteal phase)
by: newtoprogesteroneagain

Thank you Joy!

This has been very helpful. I actually went up to 300mg today, as I have gotten some relief (no more spotting!) but my hot flashes returned last night.

I will look into the calcium d-glucarate. Do you recommend I stop taking the DIM, or what benefits does it have? I have been wondering if it has been giving me headaches (my headaches have returned since starting the DIM, but I did feel it was partially helping me. I'm not opposed to taking it as I don't eat very many greens at the moment / vegetables due to SIBO).

Re: me going up to 300 mg progesterone (through my next cycle which is supposed to start today), I went up because I had hot flashes last night. So I have seen quite a bit of relief from the 240mg/ progesterone, but since you / this site said to go up if I got more symptoms I did (hopefully I did this correctly).

I will re-test my labs while on progesterone cream in my luteal phase (aiming for day 21 - but if this cycle is not regular, what do you suggest? )

Finally, since my cycle has become erratic (it might return to normal - not sure), if I'm following correctly, you are recommending I stay on the daily cream at whatever dosage I'm on (300mg down by 25 mg/ week to go lower) am I correct in understanding that I stay on this cream until my cycle becomes regular, THEN go back onto the cream only for the luteal phase? That's the confusing part, as it sounds like I will need to stay on the cream through a couple cycles to make sure my cycle becomes stable?

Thank you so much again. With a doctor that still has not responded to me in 3 weeks about these questions, it is invaluable to get this information and resource.

Much appreciated.

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