Posted 07 August 2004 - 01:34 PM
I am posting in holistic beacuse I think you probably spend most of your time in this forum, and I'm reeeeaaaaaallllly needing your help!
I have researched Progesterone, Estrogen, Testosterone, Androgens, Hormonal Imbalances, Acne, PCOS, and meds. used to help certain hormonal disorders....UNTIL I AM BLUE IN THE FACE!!!!
My confusion is regarding the med. Spironolactone, which I know you are familiar with. My questions are regarding the actions of the pill, how by blocking the androgen receptors, thereby decreasing the amount of testosterone taken up and used, how does this effect menstruation?? Is our progesterone decreased by this action as well? How is estrogen effected and how? How does the mechanism of this particular drug, cause increased menses in some, and ammhenoria in others?? And some may not have their menses changed at all! It is driving me crazy with figuring out the entire connection, and primarily how Spiro. is effecting my hormones, as I am concerned about short-term and long-term effects. I knew if ANYONE could help me understand the mechanism of action of Spiro., you could!
Thank you soooo much!
Posted 08 August 2004 - 03:31 AM
Wow so many questions you have ;-) Honestly I really don't know. I found this article below though so you can check some numbers
What Is It?
Spironolactone has been widely used for over 50 years to treat fluid retention, mild high blood pressure, and a few rare hormonal problems. It was subsequently found to be highly effective in the treatment of certain hormonally-related conditions in women, including (1) Adult acne, (2) unwanted facial or body hair, and (3) "pattern" hair loss of the scalp. It is common for a woman to have two or even all three of these (hormonal) problems. They are almost never caused by abnormally high or low hormone levels. In fact, hormone levels are usually normal. The problem is not with how much hormone is made, but how much hormone is used at its destination; in this case your oil glands and hair follicles. If your oil glands and/or hair follicles are too sensitive to normal fluctuations in your hormones, you "overreact" to those fluctuations.
THREE IMPORTANT POINTS:
1. Adult acne is NOT the same as teenage acne, and does not usually respond to teen acne treatments
2. "Pattern" hair loss is as common in women as baldness is in men. However, women do NOT go bald the way men do; their hair just becomes thin in the same, central area of the scalp.
3. The same hormones can cause hair loss on the scalp and Abnormal Hair Growth elsewhere. How can that be? Because different hair follicles have different hormone receptors.
Spironolactone does not change your hormone levels because hormone levels are not the problem. It works by preventing hormones from binding to your hair follicles and oil glands, blunting the unwanted effect. Since your hormone levels remain the same, hormone-associated side effects are avoided. Of course, no drug is completely free of side effects, but in our years of experience with this therapy, side effects have been quite rare, and those we have seen have been quite mild. Less than 5% have noticed irregular or frequent menstrual periods, which can be easily controlled with birth control pills or other methods. Breast Tenderness, Mood changes and Fatigue are other possible side effects.
The package insert also mentions reports of "tumors in laboratory animals." This is outdated and misleading information. Spironolactone has been prescribed for over 50 years, with many people taking it daily for years at a time, yet there is no evidence that it has caused a single tumor in a human, even after many years of continuous treatment. The present consensus is that any such risk is negligible.
If your blood pressure is normal, spironolactone will not affect it. If you are being treated for high blood pressure now, please tell us. However, if you are taking any other blood pressure medicines, spironolactone may increase their effect. You may have to substitute spironolactone for one or more of your present medicines. Please ask your physician about any potential problems with blood pressure medicines (or any other medication you are taking).
Do not take Spironolactone if you are pregnant.
Spironolactone should NOT be taken with drugs known as ACE inhibitors. Most people must take spironolactone regularly for a minimum of 4 months to have a beneficial effect. If it proves to be effective, you can count on remaining on spironolactone for 6 to 12 months. While taking spironolactone, do not eat LARGE AMOUNTS of whole-grain cereals, chickpeas (hummus), bananas, potatoes, tomatoes, carrots, celery, orange or grapefruit juices, clear broths, or salt substitutes such as "Nu-salt". REASONABLE AMOUNTS of any of these foods is not usually a problem.
The only adverse effect seen with any sort of regularity -- is irregular menses, and that's easily rectified with oral contraceptives. (Spironolactone + OrthoTricyclin or OrthoCyclen is an excellent combination treatment for androgenic acne.) The only other adverse effect listed in the insert as "relatively common" is breast tenderness, it is only rarely of any concern. Mood issues have been listed as a problem. Acne itself causes significant mood issues, especially when you are 35 or 40 and wondering what you did to deserve it!
OK, so based on the above info, irregular menses is quite rare (5%)...yet I've heard more women around here complain of irregular menses on Spiro, than not.
Another thing it mentioned was that acne, etc isn't caused by excess hormones, but by an oversensitivity to normal levels. Well, that is true for about 90% of acne patients....lucky me, I'm apart of the 10% that actually overproduces too.
Furthermore, Spironolactone is touted as not affecting your hormone levels, but it does. Yes it has the ability to bind to DHT/Androgen Receptors so that DHT won't, I suppose that's enough for people with "normal" hormone levels. Yet, it also happens to be a Type I 17-beta hydroxysteriod dehydrogenase inhibitor. What that means is that it helps maintains more of your active Estrogen (estradiol) and androgen (testosterone & DHT) and a progesterone in the blood stream. Some studies I've found shows that it boosts estrogen more than the others, which means that it should theoretically reduce your Free Testosterone levels (as my test results have shown) as a result.
Now, how would a boost in estrogen affect our cycles? Well, ever heard of women taking those phytoestrogens only to find that their periods come on a week early? Well, I did a search one time and it basically found that you can not have a birth control, with only estrogen. We need the progesterone in order to maintain the uterine lining. So if Spiro is boosting 2 out of 3 of these steriod hormones, that may be the reason...lack of sufficient progesterone.
My former endocrinologist told me that I have normal progesterone levels, but I went ahead and ordered a saliva test from Body Balance anyway. Well according to those results my Estrogen is in the low normal range, but both my Progesterone and Testosterones are above and BEYOND the high end of the range! LOL and this was 7 months into my dietary changes, but while I was still on 150mg of Spiro. So who knows, maybe that's why I can manage having regular periods even while on Spiro.
Of course it could be something other than a progestrone imbalance as to why it messes with your cycle. It's late though so I'll give it some more thought and see what else I'm able to find tomorrow.
Bye for now
Posted 08 August 2004 - 04:23 AM
Generally, PCOS women can't menstruate because they lack progesterone, so maybe having multiple periods or spotting is due to having too much?
Oral progestational activity of spironolactone.
Schane HP, Potts GO.
Spironolactone has progestational activity in the rabbit and rhesus monkey. It produced glandular development in the endometrium of the estrogen-primed immature female rabbit over the dosage range of 50 to 200 mg/kg and, at 400 mg/monkey, it delayed estrogen-withdrawal bleeding in ovariectomized monkeys and it inhibited menstruation in regularly cycling monkeys. These data are consistent with the menstrual irregularity and amenorrhea seen in women during treatment with spironolactone.
Furthermore, with PCOS Luteinizing Hormone (LH) is higher (boosts testosterone) while Follicle Stimulating Hormone (FSH) is lower (boosts estrogen & progesterone).
Low dose spironolactone in the treatment of female hyperandrogenemia and hirsutism.
Vetr M, Sobek A.
Department of Obstetrics and Gynecology, Medical Faculty, Palacky University, Olomouc, Czech Republic.
Thirty one women with hyperandrogenism, clinically divided into polycystic ovary syndrome (PCOS)--28 women and idiopathic hirsutism (I.H.)--3 women, were treated with low dose spironolactone (50 mg or 75 mg daily) for average five months. There was an excellent clinical response in 19 (61%), incomplete response in 8 (26%), no response in 5 women. Six of 18 patients with sterility became pregnant during the one year after treatment and delivered a healthy infant at term. Two patients dropped out of the trial because of intolerance of the therapy. Remarkable change of the menstrual pattern characterised as polymenorrhea was major side effect of the therapy. Other side effects were not problem. Spironolactone caused statistically significant reduction in testosterone, luteinizing hormone and prolactin values at the end of the treatment. Our results demonstrate that low-dose spironolactone is effective in the treatment of hyperandrogenism in women.
FYI: It may pay to find a way to have regular cycles:
Predictors of clinical response in hirsute women treated with spironolactone.
Crosby PD, Rittmaster RS.
Camp Hill Medical Centre, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
OBJECTIVE: To examine the clinical efficacy of low dose spironolactone in hirsute women. DESIGN: Retrospective. SETTING: Outpatient endocrinology clinic. PATIENTS: One hundred nine consecutive women prescribed 75 to 100 mg/d spironolactone for at least 4 months in whom adequate follow-up data were available. RESULTS: Hirsutism improved in 72% of the women. Women with regular menses, whether or not they used oral contraceptives (OCs), had the highest response rate to spironolactone (78%), whereas women with irregular menses who did not use an OC had the lowest response rate (55%). Favorable responses were associated with increased severity of hirsutism (P = 0.04) and lower serum dehydroepiandrosterone sulfate levels (P = 0.05). Responders and nonresponders did not differ significantly in age (P = 0.10), duration of hirsutism (P = 0.14), pretreatment serum testosterone (T) (P = 0.48), or body mass index (P = 0.11). However, when each parameter was divided into subsets, trends toward decreasing response were observed with increasing age, duration of hirsutism over 15 years, and increasing serum T level. CONCLUSION: Low-dose spironolactone improves hirsutism in a majority of hirsute women, irrespective of age, severity or duration of hirsutism, menstrual status, or serum hormone levels.
So perhaps it has something to do with reducing LH. Although there are other studies that again say spiro doesn't affect Testosterone, LH, and progesterone levels. So I don't know. I guess the best way to know what it's doing in YOUR body is to get blood work before and several months after spiro and compare results.
Posted 09 August 2004 - 10:55 AM
I am glad to know that I am not just an idiot going in circles with this, that the 'facts' DO seem to be somewhat contradicting in how much of out hormones are effected by Spiro. and which ones. I had VERY regular menses prior to Spiro. Interesting/confusing that your Progesterone level is high and you have regular periods, I would think high would decreased frequency in menses, due to the uterine lining being maintained longer with higher level.
I know everyone's body chemistry is different, and this is why we all respond differently. But why would two totally ends of the spectrum be possible with menses? Oh well.....
I will keep researching...everything I read fascintates me, but confuses me at times too. Thanks for your help!!! You are very well informed, and I really respect your insight!
Oh, and my doc. doesn't know I'm on the Spiro. She would not agree with me, it took me forever to get her to give me a script to see a Dermatologist because she insisted on prescribing me the meds.....but I knew there was more to it than "acne" and knew of the homonal side to it. I am 31, and have been free of it all my life, until I hit 30, and my life has completely changed.
Anyway, that was a year ago, and much money spent on her and derm. meds...and I decided to do this on my own, after much research. I am in healthcare and very familiar with anatomy, meds. and the effect on the body. I think that is why I want to be able to break down the fundamentals of Spiro on the body.....and it is driving me crazy to not be able to put the pieces together!!
And besides reading articles on how Testosterone level is NOT changed, which is somewhat false, I have also read it will NOT lower blood pressure if bood pressure is normal to begin with. My BP has always been 120/76ish, and at my MD appt two weeks after beginning Spiro., it was 88/58!!!!! Kinda scary....
I will continue to research.....I may just stop taking it all together, but it is the only thing that has helped my acne in the last 18 months!
Thanks again Sweet Jade....I hope everything works out on your end. I know you are dealing with so much more than I am....good luck to you.
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