Full Transcript Intro: Signs Estradiol May Be Too High 0:00 That is one symptom is spotting, uterine bleeding. That could be a sign that your 0:04 estradiol level is too high. >> Your dose is too high. If you're having 0:08 consistent, erratic, or irregular consistent bleeding. 0:14 >> What symptoms mean my estradiol dose is too high? Hi, I'm Dr. Valarie Davidson 0:19 from the Progressive Health Podcast. >> And I'm Dr. Mackey from the Progressive 0:22 Health Podcast. Uh so, as you already mentioned, so today we're going to talk 0:26 about how to know when your estradiol dose is too much. 0:29 >> Exactly. So, a lot of women will talk about, you know, dosing, maybe you do 0:33 labs, maybe you don't, but what symptoms physically or emotionally can you find 0:40 that would show that your estradiol dose would be too high? 0:44 >> Yeah, I mean, you know, I I can tell right now once we get into this episode, 0:47 there's a paradox there. Um when you're talking about, you know, the dose being 0:51 too high or too low. Uh and sometimes it can be a little 0:54 challenging. Now, sometimes it's very obvious. We'll talk about what some of 0:57 those are. Um but um the subtlety of HRT can also 1:02 be a little bit confusing to know if it's too much or not. 1:05 >> Well, I think it also has to do with your progesterone dose, too. So, you 1:09 have your estradiol dose or your bias with estriol and estradiol, and then you
Breast Tenderness and Sensitivity 1:13 got your progesterone, which will do the next podcast we'll do on if you if your 1:18 progesterone dose is too high. But, definitely if the estradiol is too high, 1:21 you're going to have some breast tenderness. Like, that's probably 1:23 classic. I'm sure a lot of you already know that that there's going to be 1:26 breast fullness, there's going to be breast tenderness. Sometimes there can 1:30 be almost like even little lumpies cuz if your estrogen's a little too high, it 1:34 can actually aggravate women that have a tendency towards fibrocystic breast um 1:39 conditions. >> Yeah, and usually those things appear 1:41 like if you're new to HRT, uh especially on the estrogen side, you might have 1:46 that for a little bit, and then it usually goes away. 1:48 >> Right. So, her body can get used to it. I've even backed it off a little bit, so 1:52 we're going to kind of titrate up a little bit slower cuz some women and way 1:55 more sensitive to the estrogen. >> And is pretty remarkable uh when you 1:59 look at the different types of dosing 2:02 and how different women are. Like there is not one one dose, one form, one 2:07 anything that fits all women. There is There is as many responses as 2:13 there are dosings in some respects. So you can't really go based on what what 2:18 the what the standard prescriptions are available are. 2:21 >> Yeah, you have definitely have to tailor it to the patient cuz everybody's 2:24 different and there's never going to be a forever dose. Like this is my perfect 2:27 forever dose. Life just doesn't work that way. Same with the breast 2:31 tenderness. Some women more susceptible and some are. But it definitely is a key 2:35 is if you're having breast tenderness that continues and continues, your 2:38 estradiol dose is probably a little bit too high or you need to do some things 2:43 to help bring down those estrogen metabolites. One other thing that I find 2:46 that's interesting when the estradiol level is too high is headaches.
Headaches and Mood Changes 2:50 >> Oh, true. >> Which we'll do another podcast on this 2:52 in the future. You can get headaches from having your estradiol or your 2:56 estrogen level too high. You can also get headaches if it's too low. So you 3:01 want to find that right happy medium. So if you're having high, you know, having 3:04 the headaches, you want to pair that with the other symptoms you're having. 3:08 But I'm sure you're probably aware of headaches and 3:11 estradiol levels. And then did you know that your estradiol level if it's too 3:15 high, it can make you moody? I'm sure you all know that, right? But it it is 3:19 true. If your estrogen levels are too high, so you're on HRT and you're 3:24 finding yourself more weepy, more emotional, uh more irritable, it can 3:29 actually be because of that estradiol cuz estradiol has a huge impact on your 3:33 neurotransmitters in your brain. It can have an effect on serotonin, on 3:37 dopamine. It can actually raise up your glutamate which can make you a little 3:40 irritable. So if it's So that's kind of like the Goldilocks paradox with the 3:46 estradiol. You don't want it too hot, but you don't want it too cold. You want 3:50 it just right. >> Yeah, yeah. 3:52 And that's a subjective. Like there isn't a blood number that you can 3:55 determine what that number is. Um which is makes it 3:59 for the Yeah, for the mood. I I mean, a lot of those symptoms in general, like 4:02 the some of those numbers, you know, you sort of have to see where they end up in 4:07 a lot of cases. Uh so, what else besides um besides 4:11 headaches behind besides breast tenderness? What else would 4:15 >> Moodiness. Is fluid retention. So, you'll see that 4:18 when that estrogen at level goes up is even some of the changes and 4:22 fluctuations of estrogen if you're doing a rhythmic dosing, you can notice some 4:25 of the fluid changes, but but not so much I mean, sure, there's going to be 4:29 like some breast tenderness, maybe some breast fullness from the water retention 4:32 in the breast tissue, but you can also get it in the hips and the thighs and 4:36 the stomach. You can get that water retention. Estradiol doesn't directly 4:40 cause weight gain, but I do feel like, you know, you can have that water 4:44 retention. And then speaking of weight gain is sometimes when that estrogen's 4:47 elevated, you can get more munchy. Like you know, munchy or I just I'm not full 4:53 or I'm full, but I want to still keep eating. So, it can increase up your 4:56 appetite if it's a little too high, which that could increase up, you know, 4:59 weight gain. And I wish it was that simple of oh, my estrogen's too high, so 5:03 I'm gaining weight. Really has to do with the other hormones, too, like you 5:06 would mention about cortisol, your androgens, you know, testosterone, your 5:10 progesterone. But I have had some women where they they go on the estrogen and 5:14 then when I see them again, they're like, "Wow, you know, I lost 12 lb. I 5:17 feel fantastic." Is that because they're sleeping better? Because they don't have 5:20 hot flashes? Because their brain fog is gone? Maybe their motivation is better. 5:25 And then I've had other women that have gone on some, you know, estradiol levels 5:28 and they were too high or they come see me cuz they were put on some kind of
Fluid Retention, Appetite, and Weight Gain 5:32 estradiol and said, "Oh my gosh, I put on 20 lb in, you know, a little over a 5:36 month. Is this because of the estradiol?" And some women are 5:39 susceptible to that. So, you have to take that into consideration. Cuz I will 5:43 say in since working, you you with women with HRT since 2004, that I have run 5:48 across quite a few women that gained weight on estrogen. So, that's why I if 5:52 you're going to do the static dosing, I really like the biest where you have the 5:55 estriol and the estradiol. And I don't even sometimes do these ratios that, you 6:00 know, you can do ratios, but I'll even individually based on someone's symptoms 6:04 and their labs determine what dose of estradiol they should have to the 6:09 estriol or what dose of estriol to the estradiol so you can find that balance 6:12 there. I have some women on very low low doses of estrogen because that's what 6:16 they can tolerate or they might be I have some women on quite a good number 6:21 and good level of of estrogen because they feel really good. So, it does come 6:25 down to the individual, but I will say one symptom of your estradiol being too 6:30 high could be weight gain and water retention. 6:33 And I will say I probably should have said this number one is if you have a 6:37 uterus and you're doing HRT that has estradiol in it, if you're bleeding, 6:42 especially if you're doing static dosing, if you're bleeding or or having 6:45 spotting, that means that that endometrial lining has gotten too thick 6:49 and that's because that estradiol level could be too high. Now, well, could be 6:53 also that the progesterone needs to be needs to be balanced out where that the 6:57 progesterone might be too low, but we'll talk about progesterone in a different 7:00 podcast, but that is one symptom is spotting, uterine 7:04 bleeding, that could be a sign that your estradiol level is too high. 7:08 >> Yeah, yeah, yeah. Um but that, you know, that sort of tells you right away if 7:11 your dose is too high if you're having consistent erratic or irregular 7:16 consistent bleeding, you know, um any woman that starts HRT, okay, as the 7:21 practitioner, you might made expect there might be a little bit of that um 7:25 early on. Let Let's say they're newly into menopause, you put them on some 7:29 estrogen, and they might get a little bit of spotting right away. Whether that 7:33 was a remnant of their old old period or it was, you know, 7:37 as a result of the HRT, but it shouldn't be an ongoing issue. It shouldn't 7:41 continue It shouldn't continue. Um usually the body's going to acclimate, 7:45 it's going to change, and then the bleeding should short it should uh short 7:49 sort of stop. And if it doesn't, then you got to make some adjustments. 7:52 >> Uh so you said um breast tenderness, weight gain, um certainly bleeding or 7:57 spotting. >> Headaches. 7:59 >> Um definitely headaches or migraines. I would put that on the list for sure. 8:04 Um honestly, those are probably the big ones. Um you know, and based on the 8:08 timing of what what they're using or how much they're using and for how long. Um
Spotting and Uterine Bleeding 8:13 so there's quite a few factors that go into determining is just is this just 8:18 from your prescription or is this from something else? 8:20 >> And I feel like the moodiness kind of gets skipped over a lot when you're 8:23 talking about estradiol levels. Like people are thinking, "Oh, you know, my 8:27 estrogen is too low too low, brain fog, brain fog, brain fog." Which sure, um 8:32 estradiol levels are low, you can have a lot of brain fog, but when it's high, 8:35 you can be moody. And that's where people you know, one one day you might 8:39 feel a little teary or something that normally wouldn't tear you up would tear 8:42 you up. Or you could be even overstimulated because that glutamate is 8:46 too high and you're feeling um overwhelmed or your bandwidth is at its 8:50 length. Like you can have that, you can have the irritability, you can even have 8:54 you know, even some anxiety cuz estrogen can be stimulating. So you can even have 8:59 that So you can have all of that. Now granted, you 9:03 when I'm talking to a patient about their mood, there's so many other 9:06 contexts to it. You know, family members might be ill, there might be a situation 9:10 going on, or it's tax season, or something. So of course there's all 9:15 those factors that can influence your your mood, but I feel like when that 9:18 estradiol level is too high, it can just almost shorten that bandwidth where you 9:23 just can get irritated, overwhelmed, anxious, and upset and weepy really a 9:28 lot quicker than if it were in that right level. So I always talk to uh 9:33 women when we're talk when we're doing HRT regardless of their labs, is what is 9:37 your mood like? >> Well, yeah, I mean, if you think about 9:39 it, HRT really is supposed to increase a woman's bandwidth, give her more 9:43 tolerance to the stresses around her, not sort of make it, you know, worse. 9:48 Right? It's supposed to give her more um a resilience uh to those things. Because 9:52 if you think about it, you know, when a woman's, you know, finally in menopause, 9:56 um she's usually probably has a lots of things on her plate. Uh so, she has lots 10:00 of things to be doing. You know, she shouldn't have time to, you know, be 10:04 dealing with that. >> It's part of the one of the reasons why 10:06 women go on HRT in the first place. So, um that definitely gives you a red flag 10:10 whether if the dose is, you know, too much if her ability to cope has actually 10:14 gotten worse as opposed to better. >> Which kind of swings back with estradiol 10:18 and libido. Like estradiol is really good for sex drive. I know people talk 10:22 about testosterone. Testosterone can be helpful for libido, but the estradiol 10:27 level is For a female, that's really great for libido. But, if it's if your 10:31 estradiol level is too high, it'd be awesome if, oh, wow, my libido is really 10:35 high. It doesn't really work that way. If anything, if your estradiol level is 10:38 too high, you're going to feel moody, and that's going to do nothing for your 10:41 libido. Oh, absolutely. Yeah, for sure. I've had 10:45 blood tests come in, and they'll be, you know, like this one patient not
Lab Timing, Symptoms, and Individualized Dosing 10:48 recently, her estradiol level was in the 200s, and she had been saying, you know, 10:52 I'm feeling just really emotional. Um she had been spotting. Right? She'd been 10:58 bleeding. I'm feeling emotional, but, you know, weepy, and just not like my 11:01 usual self. And she ran some blood work, and it was like 208 or And I'm like, 11:06 yeah, that's cuz your estrogen's high. And I've had other women, too, where 11:09 I'll have a blood test, and we'll have an appointment, and I'll say, 11:13 "Feeling a little moody cuz your estradiol level is 168." 11:17 And they'll say, "Yeah, I have." Even if they're not spotting, or maybe they 11:20 don't have a uterus. So, I feel like that's a big context, and that's why I 11:24 wanted to do this podcast is I love estradiol. Estradiol's awesome. It's 11:28 like it's, you know, it it's the cake. It's 11:31 like everything else is just accoutrements or the frosting like 11:34 testosterone and DHEA, but estradiol is like the main hormone for females, but 11:39 sometimes too much of a good thing isn't a good thing. So, that's why I wanted to 11:43 do this podcast. >> Yeah. No, I totally agree. I know 11:46 granted like you said some of those numbers obviously the numbers too high 11:49 if they're having some spotting. Um, but just looking at the number itself um, 11:53 can be a little bit um, a little bit ambiguous sometimes. 11:58 >> And their levels are really high and I'll say, "Oh, they must have just put 12:01 it on and went and got their blood drawn." And then I ask them and they say 12:03 yes, they they did and then we and that's where those symptoms come in. So, 12:06 sure we want to see that that objective data. I'll say, "Yeah, you're definitely 12:10 absorbing it, but this level probably is not reflecting your true estradiol level 12:14 because you would just put on your cream and you just ran down to the lab and got 12:18 your blood drawn. So, you need to pair that all together." 12:21 >> The subtleties and the nuances that um, go into managing someone's HRT over 12:26 time. Uh, none of it's none of it's uh, an exact science. I mean, it's all sort 12:30 of uh, you know, pr- and definitely an art and a 12:33 person-by-person scenario um, because everyone's going to respond to whatever 12:38 hormone they're using, they're going to respond a little bit differently. Um, 12:41 but that uh, so what you're saying it it does come down to both the physical 12:45 symptoms, right? So, like I said over breast tenderness, um, their emotional 12:50 stability, uh, whether they're bleeding or not. 12:52 Those are all all all would be uh, sort of classic indicators that 12:56 their estrogen dose is too much. >> Sometimes when it's a little high, you
Histamine Reactions and Wrap-Up 13:00 can have a bit of a histamine reaction which can be part of that bloating or 13:03 that puffiness. Some women can feel like their skin is a little itchy or their 13:08 nipples are itchy because that's a little bit of a uh, histamine reaction 13:12 coming from the estradiol level being too high. So, I've seen that. I haven't 13:18 I I wouldn't say I've all I think only one person I can think of out of 20-plus 13:23 years of practice that the estradiol level being too high caused breakouts. I 13:27 you don't necessarily see the pimples from high estradiol levels. Sure, 13:31 estrogen does help with your skin and that moistness and the lipid membrane, 13:35 so it might cause a little congestion perhaps, but it wouldn't cause acne. 13:39 That'd be more with the androgens, but it can cause a little bit of a histamine 13:42 reaction in certain individuals that are susceptible to it. You know, that'll be 13:46 our next podcast. We're going to talk about progesterone levels being too high 13:50 and we'll probably circle back to different levels of the estradiol and 13:53 the progesterone, but I definitely wanted to do this podcast cuz people are 13:57 cuz I do like, "Hey, let's take some more estradiol. Let's take some more 14:00 estradiol." But like I said, too much of a good thing isn't always a good thing. 14:03 >> Yeah. Uh until next time, I'm Dr. Maki. >> And I'm Dr. Valarie. 14:07 >> Take care. Bye-bye.
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