Form and Function

Warning, long post ahead. I have a lot to say on this subject.

Unfortunately my "real world" hormone experience and my conventional medical experience of same have been less that what we might call awesome. Just thinking about it makes me want to drag out the trusty soapbox for a good old-fashioned rant, but I'll try to stick to the physiology as best I understand it (not well) and minimize the ranty side-notes.

Once upon a time and for quite a few years I took hormonal birth control in the form of a monophasic combined estrogen and progesterone pill and had few complaints. Side effects were limited to the occasional hot flash: real deal I-will-either-die-or-cook-my-internal-organs-by-being-this-hot hot flashes. Not too bad compared to what was to follow. At some point I decided to change pills to try and combat my chronic skin issues and was prescribed a triphasic with a much different formulation. Big, big, huge mistake.

Old Rx
progesterone - high
estrogen - low
androgen - moderate

New Rx
progesterone - low
estrogen - moderate
androgen - low

Some of the resulting side-effects are easy to explain. For example, the low androgen level that was supposed to improve my acne totally bottomed out the old sex drive (irony - my skin never did improve). Other side-effects are commonly attributed to BCP's with this particular hormone profile¹ but I can't seem to find any physiological explanation of exactly how these effects come about. In this category we have moodiness and migrane-type headaches (both supposedly due to higher estrogen). I even had some side-effects that were directly opposite what one would expect with this formula¹ - major depression and extreme nausea despite lower progesterone, and weight loss despite higher estrogen.

Also on the list of side-effects I experienced during this time (a whole year this went on):
extreme anxiety
insomnia
memory problems
difficulty focusing on a task
unusual glucose sensitivity, swinging from hyper- to hypo- states
poor immune function/frequent respiratory infections
feeling jittery, "amped up"

I finally went off BCPs altogether and many of these issues improved; some resolved within months, some over the course of several years, some remain at lower levels even today (I've been off for five and half years). After stopping the Pill, however, one new symptom emerged: tremendous, bone-crushing fatigue. I initially suspected thyroid issues and saw more than one doctor for thyroid testing but the results always came back normal and no alternative theories were ever suggested. I finally, finally, after a few years came across what I believe to be an explanation for everything: the adrenals. I came across some information indicating that changing sex hormone levels can impact adrenaline and cortisol levels². And why not? The adrenals produce them all. In 2007 I diagnosed myself as having had adrenaline/cortisol overproduction during the Year of Hell (explaining many of those symptoms), followed by hypoadrenia/adrenal fatigue after I stopped the Pill, explaining the overwhelming fatigue. Since I'd gotten nowhere looking for a solution with conventional doctors, I found a licensed naturopath (not covered by insurance) who would send in my saliva for hormone testing (also not covered), and validated my own theory. Lab results from July 2007:

Cortisol
7am 18 normal (range 13-24)
11am <1 depressed (range 5-10)
4pm <1 depressed (range 3-8)
11pm <1 depressed (range 1-4)

I wont' go into the treatment protocol I've been following (lots of effective but "not approved by 'real' doctors" stuff there) and I'll try not to be too bitter about all the time it took to get it sorted out and how profoundly unhelpful so many medical professionasl were throughout the process, but I think there are some good take-home lessons to be found here:

1. Hormones are inter-related. You can't go banging away at one (or more) without affecting something else. Hormone interactions are often poorly understood and related functional conditions may be denied altogether (just ask Wikipedia).
2. If you don't get an answer from the expected sources, that does not mean no answer exists. Expect to have to do all the work yourself to find it.

Sources
1. Family Practice Notebook Online, oral contraceptive pages: http://www.fpnotebook.com/Gyn/Pharm/OrlCntrcptvSdEfctMngmnt.htm
2. Schwarzbein, M.D., Diana. The Schwarzbein Priciple II: The Transition. 2002.