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Emily54

Progesterone Cream And Breaking Out

This is my first post. I love these forums, and some of you are so knowledgeable about hormonal acne. Sorry for the length in advance.

I have struggled with acne on my face (whiteheads, clogged pores, cysts) and body (big cysts on back, neck, scalp and chest) since I was 11. I'm now 34. I have tried tons of antibiotics, topicals, etc. and none have cleared me. I did two courses of Accutance in my 20s, which cleared me for a few years. I was been on a bunch of birth control pills on and off for years and none really helped my acne, except the evra patch. I am not on any birth control now and don't need to BCP to avoid pregnancy because my husband had a vasectomy.

I think I have hormonal acne caused by excess androgens. The last few years, I have developed had some hirsutism on my face and hair thinning on my head. But my libido is fine and I have regular-ish periods (cycles are 26-36 days long). I got pregnant easily every time we tried to conceive. I am thin and don't have trouble with weight but if I gain weight, it is around the mid-section. I have been tracking acne during my menstrual cycle, and it seems I break out around ovulation through to the beginning of my period.

I eliminated dairy for several months years ago and it made no difference. My diet is fairly clean but I don't notice that diet has much impact on my acne either way. No other allergies at all. I don't take any medication or supplements right now. I am overall quite healthy with no complaints except acne.

I am using Dan's regime and his AHA, but even when I used it religiously, it doesn't stop my breakouts. Salt water and sun do seem to help a lot but I live in Canada, so that window is short.

So, all this to say, I have made an appointment in the new year with my family doctor to talk about my acne and PCOS. I will ask her to test my hormone and thyroid.

In the meantime, I started using NPC 22mg daily from days 12-28 of my cycle. I also starting taking DIM. On the first month, my skin looked less oily and clogged and I seemed to have fewer cysts. I have no other side effects at all, except a weird feeling of 'let down' in my breasts (the feeling of breastmilk starting to flow) but no lactation. But this month (second month), I broke out like crazy on my back from days 1-11 (when not taking NPC), which is usually when I am mostly clear, and on my neck near my jawbone/under my ear and on my cheeks along the jawline. I am on Day 15 (and back on NPC) and my face and back are erupting way more than usual.

Here is my question: if I am not low in progesterone, would using NPC cause me to break out? Using NPC was really a shot in the dark. Should I solider though and hope to get clear over the coming months, or should I go off NPC until I get some testing done?

Also, what exactly should I ask my doc to test?

Any insight would be appreciated.

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DIM can actually increase free testosterone, which doesn't help if elevated androgens / androgen sensitivity is your issue. DIM also made me break out.

I had normal periods, am very thin, no libido issues either, yet anti-androgens are what cleared me.

I think I have hormonal acne caused by excess androgens.

Edited by Green Gables

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Green Gables is very smart and her route has worked for some. However, I disagree and I think there are other options.

I think you should continue taking DIM — it is a strong anti-androgen like spironolactone, but also helps balance estrogen. Your acne sounds exactly like mine was and birth control (I tried many) and accutane didn't help me either. Even though spiro cleared me (since it was an androgen problem) it also gave me estrogen dominance symptoms (weight gain, massive hair shedding, etc.) I fixed the estrogen excess with NPC but I think what really cleared my skin for good was DIM. I barely use NPC now and I am still clear as long as I continue DIM.

I'm not saying you need to keep using progesterone cream, even though it shouldn't break you out at all and it still could help in other ways. Since you know you have an androgen problem, DIM should help but it will take a few months. This is just my opinion though, so you can take it or leave it! Good luck! (:

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I have EXACTLY the same hormonal acne pattern as yours. Breakouts during ovulation and during my period. Anti-androgens will not work for everyone, or will work but at a cost. My approach is to also target other hormones, like progesterone. Look up inositol or read my thread on it. It worked for my acne, and since you have the same pattern it might work for you too. It reduces testosterone and boosts progesterone, so you get a 2 in 1.

I'm not sure that increased estrogen is the way to go, as greengables suggested. Personally, anything that reduces my estrogen, like vitex, helps my acne. The hope is that, by increasing the "happy hormone" progesterone, it will be able to regulate your estrogen and balance your prog : estrogen ratio without the need of extra estrogen supplementation which has been linked to cancer.

Other things you can do:

- If your acne gets better with regular sun exposure, consider supplementing with vitamin D. Get your vitamin D levels tested (both D2 and D3) to see if you are deficient.

- Consider using NPC without a break, like hearts was doing. It seems like your body can't adjust well to the sudden drop in progesterone. Either continue all of your cycle on the same dose, or decrease a bit on those days, but don't completely stop NPC at any point during your cycle.

And to answer your question, if you do not need NPC, you can break out. I think you should have started using either NPC or DIM, not both, because it's hard to tell which one might be breaking you out. In my opinion, ovulation breakouts are not simply an androgen problem, they have to do with estrogen, FSH, and progesterone. Acne during ovulation means that your body either can't ovulate properly (which for you, if you are fertile, might not be the case) or that your hormones spike too much compared to other times of your cycle. I'm taking inositol to help me achieve a healthy ovulation, anti-androgens won't help you do that and will mess up your cycles. If you are regular, why mess that up?

Edited by WishClean

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I agree with WishClean... I forgot to mention that I did take NPC daily because when I didn't and took a break, I did break out and symptoms would return. I am also the same way — any increase in estrogen made my acne worse. When you first start progesterone you are stimulating estrogen receptors and it can cause a worse imbalance temporarily until progesterone is more of a dominant hormone.

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Thanks all. I have stopped taking everything for the moment (I took DIM and NPC until my supplies ran out). Even off the NPC and DIM, my hair is shredding much less than it was before. Hmm. I have no idea what hormonal imbalance (if any) is causing my acne. the symptoms seem to overlap. I think it must be something about the hormonal spike around ovulation, but I also have heard that acne forms under the skin days before it surfaces, so I wonder it it is actually something happening early in my cycle?

I have my annual physical in Feb. I am debating whether to experiment until then or just wait it out and talk to my doc and do a blood test when I am not on anything. I think I should spend a couple more months tracking my breakouts to get a better picture of the hormones in flux.

anyway, thanks for the replies!

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This is my first post. I love these forums, and some of you are so knowledgeable about hormonal acne. Sorry for the length in advance.

I have struggled with acne on my face (whiteheads, clogged pores, cysts) and body (big cysts on back, neck, scalp and chest) since I was 11. I'm now 34. I have tried tons of antibiotics, topicals, etc. and none have cleared me. I did two courses of Accutance in my 20s, which cleared me for a few years. I was been on a bunch of birth control pills on and off for years and none really helped my acne, except the evra patch. I am not on any birth control now and don't need to BCP to avoid pregnancy because my husband had a vasectomy.

I think I have hormonal acne caused by excess androgens. The last few years, I have developed had some hirsutism on my face and hair thinning on my head. But my libido is fine and I have regular-ish periods (cycles are 26-36 days long). I got pregnant easily every time we tried to conceive. I am thin and don't have trouble with weight but if I gain weight, it is around the mid-section. I have been tracking acne during my menstrual cycle, and it seems I break out around ovulation through to the beginning of my period.

I eliminated dairy for several months years ago and it made no difference. My diet is fairly clean but I don't notice that diet has much impact on my acne either way. No other allergies at all. I don't take any medication or supplements right now. I am overall quite healthy with no complaints except acne.

I am using Dan's regime and his AHA, but even when I used it religiously, it doesn't stop my breakouts. Salt water and sun do seem to help a lot but I live in Canada, so that window is short.

So, all this to say, I have made an appointment in the new year with my family doctor to talk about my acne and PCOS. I will ask her to test my hormone and thyroid.

In the meantime, I started using NPC 22mg daily from days 12-28 of my cycle. I also starting taking DIM. On the first month, my skin looked less oily and clogged and I seemed to have fewer cysts. I have no other side effects at all, except a weird feeling of 'let down' in my breasts (the feeling of breastmilk starting to flow) but no lactation. But this month (second month), I broke out like crazy on my back from days 1-11 (when not taking NPC), which is usually when I am mostly clear, and on my neck near my jawbone/under my ear and on my cheeks along the jawline. I am on Day 15 (and back on NPC) and my face and back are erupting way more than usual.

Here is my question: if I am not low in progesterone, would using NPC cause me to break out? Using NPC was really a shot in the dark. Should I solider though and hope to get clear over the coming months, or should I go off NPC until I get some testing done?

Also, what exactly should I ask my doc to test?

Any insight would be appreciated.

Acne is caused by elevated free testosterone and exacerbated by insulin.

Diet is the easiest to address theoretically, but the most difficult to implement. I noticed no correlation between my acne and diet until I cut all dairy and carbs. It takes a while for your insulin levels to normalize. When that happens, you could notice a decrease in breakouts. If it helps and you start to clear, adding dairy and sugar in significant amounts will cause problems. It's completely obvious to me now. I went hog wild over the holidays and now have a breakout on my back. This is something I haven't experienced for months. The last time was for the same reason.

I suggest you stop the progesterone.

When you consider the effects of any hormone, you must also consider the hormones that increase or decrease the effects of the hormone in question. For example, elevated free testosterone is the primary cause of acne. This means that we need to also evaluate the levels of any hormone that stimulates or inhibits testosterone.

In women, 90 percent of testosterone is generated from DHEA. When DHEA is secreted from the adrenal system, your body also secretes cortisol in equal amounts to balance (inhibit) the effects of elevated DHEA. When under stress, you release cortisol, and DHEA is also released to inhibit the side effects of elevated cortisol.

DHEA and Cortisol balance

Estrogen and Progesterone balance

Estrogen balances testosterone

There are many others as well.

Women that have large breasts and hips, generally have higher estrogen levels. On the other hand, women with narrow hips and smaller breasts have lower estrogen levels. If you are on the thinner side, your estrogen levels may not be elevated. Taking progesterone will inhibit the estrogen you do have and ALSO potentiate testosterone by neutralizing the hormone that opposes testosterone.

The latter half of your cycle is the luteal phase. This is when progesterone typically increases. You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense. Unopposed estrogen causes breast swelling and tenderness. If you only experience this during the latter half of your cycle, then it elevated progesterone that is neutralizing the effects of estrogen and causing the ptosis. Testosterone increases at ovulation. If you are neutralizing estrogen with excess progesterone, then you are simultaneously potentiating the effects of testosterone by neutralizing one of the primary inhibitors (estrogen).

The other piece is the elevated DHT. This is the only hormone that increases body hair and baldness. Estrogen neutralizes DHT.

One very important point to remember is you never take estrogen without progesterone.

It sound to me like you may need a moderate estrogen dose and mild progesterone dose. The hirsutism is all DHT, most likely caused by elevated DHEA converting to testosterone and then DHT. The best course of action to deal with this is to try the estrogen (with a lower dose of progesterone) first, and if that doesn't work, try adding dexamethasone. This will inhibit the adrenal system, lower DHEA and also have an anti androgen effect by blocking the effects of dht at the hair follicle.

The nice thing about dexamethasone is that it doesn't cross bind to aldosterone, so it won't cause bloating.

To make all this happen you will need a doc that is very familiar with bioidentical hormone replacement.

Good luck.

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thanks jlcampi!

You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense.

Edited by Emily54

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thanks jlcampi!

You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense.

I am not referring to sagging breasts - sagging sadly happened for me after carrying and breastfeeding two babies! What i mean is the feeling of "let down" which is when a woman is lactating, and ready to breastfeed the baby, there is a feeling (for some women) that accompanies the moment when the breastmilk starts to flow from the nipples. It is also called the milk ejection reflex. It is a very distinct tingling/pressure feeling for me. I get the feeling of let down, but have no milk to eject. Hormonally, let down is caused by oxytocin, but i believe that progesterone somehow plays a role in lactation so it makes sense this is a side effect of using NPC.

I am off everything right now, even topical BP. My back looks horrendous. I am going to keep a fairly detailed journal of food/stress/breakouts during my next few menstrual cycles so I can talk to my primary care doctor. i fear this is out of her depth and that she may not have good referral sources, but we will see.

Emily, I appreciate your sophisticated approach in addressing this problem.

I now understand what you are referring to with letdown and you are correct that oxytocin is involved in the process by stimulating the contraction of milk producing glands in the breast. Oxytocin is probably not involved directly with acne, although it can cause a decrease in cortisol levels if levels are excessive. This typically only occurs with exogenous administration. If ptosis occurred after having kids, then this is another indication of estrogen deficiency. The most commonly observed complaints/physical signs of estrogen deficiency are:

Complaints

Hot flashes with night sweating

Beast ptosis

Hypo or amenorrhea

Vaginal dryness/itching

Physical signs

Pale face

small breasts

breast ptosis (sagging or droopy breasts)

There are many others-these are the most common.

PCOS is usually more associated with a progesterone deficiency (estrogen dominance). A quick lab test will give you a good indication of the probability of PCOS. In premenopausal women. PCOS is probable if:

LH > FSH and E1 (estrone) > E2 (estradiol) on day 21 of your cycle.

It usually takes about 3 cycles to see the effects of any hormonal modifications on a menstral cycle. It will also be interesting to have a better idea if most of your cycles are short or long. When everything is optimized, then cycle length should be 28 days. The range you provided earlier is outside of the optimized cycle.

It's going to be very difficult to find a physician that will understand all this. My take is that your best approach is to try and find a doc that is interested in bio-identical hormone replacement. Ask around at your medical group.

Logging everything is a great idea while you are trying to sort this out. What helped me, was not giving up (I've been at this for about 25 years). Physicians are not really adept at solving chronic problems. If you are a non-responder to their usual algorithm, then a persistent, open minded approach to evidence based alternatives will eventually help you.

It's absolutely critical that your doc test for the correct hormones. If you don't know, then I can give you a list to consider.

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DIM can actually increase free testosterone, which doesn't help if elevated androgens / androgen sensitivity is your issue. DIM also made me break out.

I had normal periods, am very thin, no libido issues either, yet anti-androgens are what cleared me.

I think I have hormonal acne caused by excess androgens.

By taking NPC you are reducing estrogen, and since estrogen counters androgens, you are actually increasing the androgenic power...so I'm not sure why you took that route.

I find that most women with acne are helped by anti-androgens and also increased estrogen. Estrogen does all sorts of great things for the skin (thins out the sebum, increases skin's ability to retain moisture) and by itself is sort of a natural anti-androgen.

Especially since you are thin, I suspect you would do very well on a typical anti-androgen regimen that blocks androgens and increases your estrogen.

I would recommend that you stop the NPC and the DIM, and instead ask for a spironolactone prescription or take over-the-counter herbal anti-androgens such as saw palmetto and stinging nettle.

I decided to try NPC because I had had clear skin on the Evra patch, which has 20 of estradiol and 150mg of a progesterone. I wonder if it may have been the estradiol. But I am not sure how to recreate this without going back on the pill? Would an estriol cream work, along with an anti-androgen?

Weird thing was that my hair is shredding much less than before I took the DIM and NPC combo.

Also, if I go the OTC anti-androgen route, what doses/combos do you recommend? I found a prostrate health supplements with 160mg of saw palmetto, and stinging nettle extracts, lycopene, pumpkin seed oil and zinc (15mg). Does that sound like a good combo?

I have EXACTLY the same hormonal acne pattern as yours. Breakouts during ovulation and during my period. Anti-androgens will not work for everyone, or will work but at a cost. My approach is to also target other hormones, like progesterone. Look up inositol or read my thread on it. It worked for my acne, and since you have the same pattern it might work for you too. It reduces testosterone and boosts progesterone, so you get a 2 in 1.

I'm not sure that increased estrogen is the way to go, as greengables suggested. Personally, anything that reduces my estrogen, like vitex, helps my acne. The hope is that, by increasing the "happy hormone" progesterone, it will be able to regulate your estrogen and balance your prog : estrogen ratio without the need of extra estrogen supplementation which has been linked to cancer.

Other things you can do:

- If your acne gets better with regular sun exposure, consider supplementing with vitamin D. Get your vitamin D levels tested (both D2 and D3) to see if you are deficient.

- Consider using NPC without a break, like hearts was doing. It seems like your body can't adjust well to the sudden drop in progesterone. Either continue all of your cycle on the same dose, or decrease a bit on those days, but don't completely stop NPC at any point during your cycle.

And to answer your question, if you do not need NPC, you can break out. I think you should have started using either NPC or DIM, not both, because it's hard to tell which one might be breaking you out. In my opinion, ovulation breakouts are not simply an androgen problem, they have to do with estrogen, FSH, and progesterone. Acne during ovulation means that your body either can't ovulate properly (which for you, if you are fertile, might not be the case) or that your hormones spike too much compared to other times of your cycle. I'm taking inositol to help me achieve a healthy ovulation, anti-androgens won't help you do that and will mess up your cycles. If you are regular, why mess that up?

I totally agree that break outs from ovulation through the luteual period are not just an androgen problem. I am quite sure I ovulate most months and I am regular (give or take) so I think it is an imbalance in my hormones in the second half of my cycle. I had clear skin on the Evra patch, which has highly absorbed levels of estradiol, so I wonder an increase in estrogen and progestrone might be what I need. It is so hard to know. Hopefully hormone testing will elucidate my levels.

Thanks for the tip on Vit D - I will have my doc check.

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thanks jlcampi!

You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense.

I am not referring to sagging breasts - sagging sadly happened for me after carrying and breastfeeding two babies! What i mean is the feeling of "let down" which is when a woman is lactating, and ready to breastfeed the baby, there is a feeling (for some women) that accompanies the moment when the breastmilk starts to flow from the nipples. It is also called the milk ejection reflex. It is a very distinct tingling/pressure feeling for me. I get the feeling of let down, but have no milk to eject. Hormonally, let down is caused by oxytocin, but i believe that progesterone somehow plays a role in lactation so it makes sense this is a side effect of using NPC.

I am off everything right now, even topical BP. My back looks horrendous. I am going to keep a fairly detailed journal of food/stress/breakouts during my next few menstrual cycles so I can talk to my primary care doctor. i fear this is out of her depth and that she may not have good referral sources, but we will see.

Emily, I appreciate your sophisticated approach in addressing this problem.

I now understand what you are referring to with letdown and you are correct that oxytocin is involved in the process by stimulating the contraction of milk producing glands in the breast. Oxytocin is probably not involved directly with acne, although it can cause a decrease in cortisol levels if levels are excessive. This typically only occurs with exogenous administration. If ptosis occurred after having kids, then this is another indication of estrogen deficiency. The most commonly observed complaints/physical signs of estrogen deficiency are:

Complaints

Hot flashes with night sweating

Beast ptosis

Hypo or amenorrhea

Vaginal dryness/itching

Physical signs

Pale face

small breasts

breast ptosis (sagging or droopy breasts)

There are many others-these are the most common.

PCOS is usually more associated with a progesterone deficiency (estrogen dominance). A quick lab test will give you a good indication of the probability of PCOS. In premenopausal women. PCOS is probable if:

LH > FSH and E1 (estrone) > E2 (estradiol) on day 21 of your cycle.

It usually takes about 3 cycles to see the effects of any hormonal modifications on a menstral cycle. It will also be interesting to have a better idea if most of your cycles are short or long. When everything is optimized, then cycle length should be 28 days. The range you provided earlier is outside of the optimized cycle.

It's going to be very difficult to find a physician that will understand all this. My take is that your best approach is to try and find a doc that is interested in bio-identical hormone replacement. Ask around at your medical group.

Logging everything is a great idea while you are trying to sort this out. What helped me, was not giving up (I've been at this for about 25 years). Physicians are not really adept at solving chronic problems. If you are a non-responder to their usual algorithm, then a persistent, open minded approach to evidence based alternatives will eventually help you.

It's absolutely critical that your doc test for the correct hormones. If you don't know, then I can give you a list to consider.

I appreciate your emphasis on diet. Although my acne is a huge issue in my life, I don't want to change my diet so dramatically without a clear view that my acne will improve. Maybe that is short sighted of me, but I would rather commit to 3 months of a hormonal therapy than severe (for me) diet restriction. Especially when my breakouts are so closely tied to my menstrual cycle. I am now on Day 5 of my cycle and in keeping with past cycles, I have healing from my LP last cycle but no new acne.

I don't have any symptoms of estrogen deficiency. My breasts are not as firm before my kids but they are not super saggy. Changes in breast tissue are really common after pregnancy and breastfeeding (especially where one has children close together, as I did - I was pregnant and/or breastfeeding from July 2007 to January 2012 inclusive!) so I don't think it is that.

I track my cycles closely - my cycle length in the last year has been (in days) : 30, 27, 29, 32, 28, 28, 25, 26, 27, 26, 32. 36 above was a typo - it should have been 32 not 36 days.

I would really appreciate a list of hormones to consider testing. I have access to free blood and urine tests, but not saliva tests. My appointment will be around day 17 of my cycle but I can get the blood drawn on a different day (or multiple days). I know my primary care doctor will agree to test me for whatever I want.

I have found a registered naturopathic doctor in my city that focuses on women's health. She is SO SO expensive ($215 for a 1 hour consult, $140 for a followup, $75 hereafter) (and for me, a Canadian who doesn't pay a dime out of pocket for routine care!) but I may make an appointment with her if my family doctor is not helpful or cannot refer me to someone who is.

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thanks jlcampi!

You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense.

I am not referring to sagging breasts - sagging sadly happened for me after carrying and breastfeeding two babies! What i mean is the feeling of "let down" which is when a woman is lactating, and ready to breastfeed the baby, there is a feeling (for some women) that accompanies the moment when the breastmilk starts to flow from the nipples. It is also called the milk ejection reflex. It is a very distinct tingling/pressure feeling for me. I get the feeling of let down, but have no milk to eject. Hormonally, let down is caused by oxytocin, but i believe that progesterone somehow plays a role in lactation so it makes sense this is a side effect of using NPC.

I am off everything right now, even topical BP. My back looks horrendous. I am going to keep a fairly detailed journal of food/stress/breakouts during my next few menstrual cycles so I can talk to my primary care doctor. i fear this is out of her depth and that she may not have good referral sources, but we will see.

Emily, I appreciate your sophisticated approach in addressing this problem.

I now understand what you are referring to with letdown and you are correct that oxytocin is involved in the process by stimulating the contraction of milk producing glands in the breast. Oxytocin is probably not involved directly with acne, although it can cause a decrease in cortisol levels if levels are excessive. This typically only occurs with exogenous administration. If ptosis occurred after having kids, then this is another indication of estrogen deficiency. The most commonly observed complaints/physical signs of estrogen deficiency are:

Complaints

Hot flashes with night sweating

Beast ptosis

Hypo or amenorrhea

Vaginal dryness/itching

Physical signs

Pale face

small breasts

breast ptosis (sagging or droopy breasts)

There are many others-these are the most common.

PCOS is usually more associated with a progesterone deficiency (estrogen dominance). A quick lab test will give you a good indication of the probability of PCOS. In premenopausal women. PCOS is probable if:

LH > FSH and E1 (estrone) > E2 (estradiol) on day 21 of your cycle.

It usually takes about 3 cycles to see the effects of any hormonal modifications on a menstral cycle. It will also be interesting to have a better idea if most of your cycles are short or long. When everything is optimized, then cycle length should be 28 days. The range you provided earlier is outside of the optimized cycle.

It's going to be very difficult to find a physician that will understand all this. My take is that your best approach is to try and find a doc that is interested in bio-identical hormone replacement. Ask around at your medical group.

Logging everything is a great idea while you are trying to sort this out. What helped me, was not giving up (I've been at this for about 25 years). Physicians are not really adept at solving chronic problems. If you are a non-responder to their usual algorithm, then a persistent, open minded approach to evidence based alternatives will eventually help you.

It's absolutely critical that your doc test for the correct hormones. If you don't know, then I can give you a list to consider.

Sagging breasts after breastfeeding are caused by estrogen deficiency? How about normal aging and loss of tissue elasticity due to all the physiological changes.

I generally agree that restricting carbohydrates can help with break-outs, at least it did with me, but I had to stop due to some health issues I thought might be related to the low-carbohydrate diet.

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thanks jlcampi!

You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense.

I am not referring to sagging breasts - sagging sadly happened for me after carrying and breastfeeding two babies! What i mean is the feeling of "let down" which is when a woman is lactating, and ready to breastfeed the baby, there is a feeling (for some women) that accompanies the moment when the breastmilk starts to flow from the nipples. It is also called the milk ejection reflex. It is a very distinct tingling/pressure feeling for me. I get the feeling of let down, but have no milk to eject. Hormonally, let down is caused by oxytocin, but i believe that progesterone somehow plays a role in lactation so it makes sense this is a side effect of using NPC.

I am off everything right now, even topical BP. My back looks horrendous. I am going to keep a fairly detailed journal of food/stress/breakouts during my next few menstrual cycles so I can talk to my primary care doctor. i fear this is out of her depth and that she may not have good referral sources, but we will see.

Emily, I appreciate your sophisticated approach in addressing this problem.

I now understand what you are referring to with letdown and you are correct that oxytocin is involved in the process by stimulating the contraction of milk producing glands in the breast. Oxytocin is probably not involved directly with acne, although it can cause a decrease in cortisol levels if levels are excessive. This typically only occurs with exogenous administration. If ptosis occurred after having kids, then this is another indication of estrogen deficiency. The most commonly observed complaints/physical signs of estrogen deficiency are:

Complaints

Hot flashes with night sweating

Beast ptosis

Hypo or amenorrhea

Vaginal dryness/itching

Physical signs

Pale face

small breasts

breast ptosis (sagging or droopy breasts)

There are many others-these are the most common.

PCOS is usually more associated with a progesterone deficiency (estrogen dominance). A quick lab test will give you a good indication of the probability of PCOS. In premenopausal women. PCOS is probable if:

LH > FSH and E1 (estrone) > E2 (estradiol) on day 21 of your cycle.

It usually takes about 3 cycles to see the effects of any hormonal modifications on a menstral cycle. It will also be interesting to have a better idea if most of your cycles are short or long. When everything is optimized, then cycle length should be 28 days. The range you provided earlier is outside of the optimized cycle.

It's going to be very difficult to find a physician that will understand all this. My take is that your best approach is to try and find a doc that is interested in bio-identical hormone replacement. Ask around at your medical group.

Logging everything is a great idea while you are trying to sort this out. What helped me, was not giving up (I've been at this for about 25 years). Physicians are not really adept at solving chronic problems. If you are a non-responder to their usual algorithm, then a persistent, open minded approach to evidence based alternatives will eventually help you.

It's absolutely critical that your doc test for the correct hormones. If you don't know, then I can give you a list to consider.

Sagging breasts after breastfeeding are caused by estrogen deficiency? How about normal aging and loss of tissue elasticity due to all the physiological changes.

I generally agree that restricting carbohydrates can help with break-outs, at least it did with me, but I had to stop due to some health issues I thought might be related to the low-carbohydrate diet.

It depends. Pregnancy has a significant impact on hormonal status. So does aging. One quick way to determine if you have optimal hormonal health is to look at your silhouette. If you are hard and in shape, your hormone levels are likely optimal. When you start putting on weight, things start sagging, wrinkling etc, hormones are not optimal.

Many women in their 30s after childbirth require hormone replacement.

thanks jlcampi!

You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense.

I am not referring to sagging breasts - sagging sadly happened for me after carrying and breastfeeding two babies! What i mean is the feeling of "let down" which is when a woman is lactating, and ready to breastfeed the baby, there is a feeling (for some women) that accompanies the moment when the breastmilk starts to flow from the nipples. It is also called the milk ejection reflex. It is a very distinct tingling/pressure feeling for me. I get the feeling of let down, but have no milk to eject. Hormonally, let down is caused by oxytocin, but i believe that progesterone somehow plays a role in lactation so it makes sense this is a side effect of using NPC.

I am off everything right now, even topical BP. My back looks horrendous. I am going to keep a fairly detailed journal of food/stress/breakouts during my next few menstrual cycles so I can talk to my primary care doctor. i fear this is out of her depth and that she may not have good referral sources, but we will see.

Emily, I appreciate your sophisticated approach in addressing this problem.

I now understand what you are referring to with letdown and you are correct that oxytocin is involved in the process by stimulating the contraction of milk producing glands in the breast. Oxytocin is probably not involved directly with acne, although it can cause a decrease in cortisol levels if levels are excessive. This typically only occurs with exogenous administration. If ptosis occurred after having kids, then this is another indication of estrogen deficiency. The most commonly observed complaints/physical signs of estrogen deficiency are:

Complaints

Hot flashes with night sweating

Beast ptosis

Hypo or amenorrhea

Vaginal dryness/itching

Physical signs

Pale face

small breasts

breast ptosis (sagging or droopy breasts)

There are many others-these are the most common.

PCOS is usually more associated with a progesterone deficiency (estrogen dominance). A quick lab test will give you a good indication of the probability of PCOS. In premenopausal women. PCOS is probable if:

LH > FSH and E1 (estrone) > E2 (estradiol) on day 21 of your cycle.

It usually takes about 3 cycles to see the effects of any hormonal modifications on a menstral cycle. It will also be interesting to have a better idea if most of your cycles are short or long. When everything is optimized, then cycle length should be 28 days. The range you provided earlier is outside of the optimized cycle.

It's going to be very difficult to find a physician that will understand all this. My take is that your best approach is to try and find a doc that is interested in bio-identical hormone replacement. Ask around at your medical group.

Logging everything is a great idea while you are trying to sort this out. What helped me, was not giving up (I've been at this for about 25 years). Physicians are not really adept at solving chronic problems. If you are a non-responder to their usual algorithm, then a persistent, open minded approach to evidence based alternatives will eventually help you.

It's absolutely critical that your doc test for the correct hormones. If you don't know, then I can give you a list to consider.

I appreciate your emphasis on diet. Although my acne is a huge issue in my life, I don't want to change my diet so dramatically without a clear view that my acne will improve. Maybe that is short sighted of me, but I would rather commit to 3 months of a hormonal therapy than severe (for me) diet restriction. Especially when my breakouts are so closely tied to my menstrual cycle. I am now on Day 5 of my cycle and in keeping with past cycles, I have healing from my LP last cycle but no new acne.

I don't have any symptoms of estrogen deficiency. My breasts are not as firm before my kids but they are not super saggy. Changes in breast tissue are really common after pregnancy and breastfeeding (especially where one has children close together, as I did - I was pregnant and/or breastfeeding from July 2007 to January 2012 inclusive!) so I don't think it is that.

I track my cycles closely - my cycle length in the last year has been (in days) : 30, 27, 29, 32, 28, 28, 25, 26, 27, 26, 32. 36 above was a typo - it should have been 32 not 36 days.

I would really appreciate a list of hormones to consider testing. I have access to free blood and urine tests, but not saliva tests. My appointment will be around day 17 of my cycle but I can get the blood drawn on a different day (or multiple days). I know my primary care doctor will agree to test me for whatever I want.

I have found a registered naturopathic doctor in my city that focuses on women's health. She is SO SO expensive ($215 for a 1 hour consult, $140 for a followup, $75 hereafter) (and for me, a Canadian who doesn't pay a dime out of pocket for routine care!) but I may make an appointment with her if my family doctor is not helpful or cannot refer me to someone who is.

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thanks jlcampi!

You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense.

I am not referring to sagging breasts - sagging sadly happened for me after carrying and breastfeeding two babies! What i mean is the feeling of "let down" which is when a woman is lactating, and ready to breastfeed the baby, there is a feeling (for some women) that accompanies the moment when the breastmilk starts to flow from the nipples. It is also called the milk ejection reflex. It is a very distinct tingling/pressure feeling for me. I get the feeling of let down, but have no milk to eject. Hormonally, let down is caused by oxytocin, but i believe that progesterone somehow plays a role in lactation so it makes sense this is a side effect of using NPC.

I am off everything right now, even topical BP. My back looks horrendous. I am going to keep a fairly detailed journal of food/stress/breakouts during my next few menstrual cycles so I can talk to my primary care doctor. i fear this is out of her depth and that she may not have good referral sources, but we will see.

Emily, I appreciate your sophisticated approach in addressing this problem.

I now understand what you are referring to with letdown and you are correct that oxytocin is involved in the process by stimulating the contraction of milk producing glands in the breast. Oxytocin is probably not involved directly with acne, although it can cause a decrease in cortisol levels if levels are excessive. This typically only occurs with exogenous administration. If ptosis occurred after having kids, then this is another indication of estrogen deficiency. The most commonly observed complaints/physical signs of estrogen deficiency are:

Complaints

Hot flashes with night sweating

Beast ptosis

Hypo or amenorrhea

Vaginal dryness/itching

Physical signs

Pale face

small breasts

breast ptosis (sagging or droopy breasts)

There are many others-these are the most common.

PCOS is usually more associated with a progesterone deficiency (estrogen dominance). A quick lab test will give you a good indication of the probability of PCOS. In premenopausal women. PCOS is probable if:

LH > FSH and E1 (estrone) > E2 (estradiol) on day 21 of your cycle.

It usually takes about 3 cycles to see the effects of any hormonal modifications on a menstral cycle. It will also be interesting to have a better idea if most of your cycles are short or long. When everything is optimized, then cycle length should be 28 days. The range you provided earlier is outside of the optimized cycle.

It's going to be very difficult to find a physician that will understand all this. My take is that your best approach is to try and find a doc that is interested in bio-identical hormone replacement. Ask around at your medical group.

Logging everything is a great idea while you are trying to sort this out. What helped me, was not giving up (I've been at this for about 25 years). Physicians are not really adept at solving chronic problems. If you are a non-responder to their usual algorithm, then a persistent, open minded approach to evidence based alternatives will eventually help you.

It's absolutely critical that your doc test for the correct hormones. If you don't know, then I can give you a list to consider.

Sagging breasts after breastfeeding are caused by estrogen deficiency? How about normal aging and loss of tissue elasticity due to all the physiological changes.

I generally agree that restricting carbohydrates can help with break-outs, at least it did with me, but I had to stop due to some health issues I thought might be related to the low-carbohydrate diet.

It depends. Pregnancy has a significant impact on hormonal status. So does aging. One quick way to determine if you have optimal hormonal health is to look at your silhouette. If you are hard and in shape, your hormone levels are likely optimal. When you start putting on weight, things start sagging, wrinkling etc, hormones are not optimal.

Many women in their 30s after childbirth require hormone replacement.

>

thanks jlcampi!

You mentioned a let down during this phase. If you are referring to ptosis (sagging) that would make compete sense.

I am not referring to sagging breasts - sagging sadly happened for me after carrying and breastfeeding two babies! What i mean is the feeling of "let down" which is when a woman is lactating, and ready to breastfeed the baby, there is a feeling (for some women) that accompanies the moment when the breastmilk starts to flow from the nipples. It is also called the milk ejection reflex. It is a very distinct tingling/pressure feeling for me. I get the feeling of let down, but have no milk to eject. Hormonally, let down is caused by oxytocin, but i believe that progesterone somehow plays a role in lactation so it makes sense this is a side effect of using NPC.

I am off everything right now, even topical BP. My back looks horrendous. I am going to keep a fairly detailed journal of food/stress/breakouts during my next few menstrual cycles so I can talk to my primary care doctor. i fear this is out of her depth and that she may not have good referral sources, but we will see.

Emily, I appreciate your sophisticated approach in addressing this problem.

I now understand what you are referring to with letdown and you are correct that oxytocin is involved in the process by stimulating the contraction of milk producing glands in the breast. Oxytocin is probably not involved directly with acne, although it can cause a decrease in cortisol levels if levels are excessive. This typically only occurs with exogenous administration. If ptosis occurred after having kids, then this is another indication of estrogen deficiency. The most commonly observed complaints/physical signs of estrogen deficiency are:

Complaints

Hot flashes with night sweating

Beast ptosis

Hypo or amenorrhea

Vaginal dryness/itching

Physical signs

Pale face

small breasts

breast ptosis (sagging or droopy breasts)

There are many others-these are the most common.

PCOS is usually more associated with a progesterone deficiency (estrogen dominance). A quick lab test will give you a good indication of the probability of PCOS. In premenopausal women. PCOS is probable if:

LH > FSH and E1 (estrone) > E2 (estradiol) on day 21 of your cycle.

It usually takes about 3 cycles to see the effects of any hormonal modifications on a menstral cycle. It will also be interesting to have a better idea if most of your cycles are short or long. When everything is optimized, then cycle length should be 28 days. The range you provided earlier is outside of the optimized cycle.

It's going to be very difficult to find a physician that will understand all this. My take is that your best approach is to try and find a doc that is interested in bio-identical hormone replacement. Ask around at your medical group.

Logging everything is a great idea while you are trying to sort this out. What helped me, was not giving up (I've been at this for about 25 years). Physicians are not really adept at solving chronic problems. If you are a non-responder to their usual algorithm, then a persistent, open minded approach to evidence based alternatives will eventually help you.

It's absolutely critical that your doc test for the correct hormones. If you don't know, then I can give you a list to consider.

I appreciate your emphasis on diet. Although my acne is a huge issue in my life, I don't want to change my diet so dramatically without a clear view that my acne will improve. Maybe that is short sighted of me, but I would rather commit to 3 months of a hormonal therapy than severe (for me) diet restriction. Especially when my breakouts are so closely tied to my menstrual cycle. I am now on Day 5 of my cycle and in keeping with past cycles, I have healing from my LP last cycle but no new acne.

I don't have any symptoms of estrogen deficiency. My breasts are not as firm before my kids but they are not super saggy. Changes in breast tissue are really common after pregnancy and breastfeeding (especially where one has children close together, as I did - I was pregnant and/or breastfeeding from July 2007 to January 2012 inclusive!) so I don't think it is that.

I track my cycles closely - my cycle length in the last year has been (in days) : 30, 27, 29, 32, 28, 28, 25, 26, 27, 26, 32. 36 above was a typo - it should have been 32 not 36 days.

I would really appreciate a list of hormones to consider testing. I have access to free blood and urine tests, but not saliva tests. My appointment will be around day 17 of my cycle but I can get the blood drawn on a different day (or multiple days). I know my primary care doctor will agree to test me for whatever I want.

I have found a registered naturopathic doctor in my city that focuses on women's health. She is SO SO expensive ($215 for a 1 hour consult, $140 for a followup, $75 hereafter) (and for me, a Canadian who doesn't pay a dime out of pocket for routine care!) but I may make an appointment with her if my family doctor is not helpful or cannot refer me to someone who is.

Ok, here is a list of labs. All serum.

Test on day 21 of your cycle. Day 1 is the first day of bleeding.

Estradiol

Progesterone

Estrone

LH

FSH

Total/Free Testosterone

DHEA Sulfate

Total and Free Cortisol 8am

Transcortin (CBG)

SHBG

IGF-1

IGF-BP3

TSH

Free T3/Free T4

Sodium

Glucose (fasting)

Insulin (fasting)

Calcium

Parathormone

Pregnenalone

Probably also a good idea to ask for

Homocysteine

CRP High Sensitivity

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The imbedded quotes make this post challenging to read.

I have all the PCOS symptoms but NPC didn't work for me.

All my acne is on my chin and comes just before or during my period.

Spiro worked for me for years and then stopped in July.

I've also tried diet, bc, antibiotics, glucosmart and other supplements. Spiro worked best but is no longer very effective.

Is there no alternative to spiro?

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It's not uncommon to become immune to spiro from what I've read online.

Alternatives, if you stil have an androgen/DHT issue: inositol and DIM.

If you have low progesterone besides NPC: inositol, vitex.

Can't think of any others now.

If it all stems from liver issues, then no matter what you take orally, if your liver can't break it down into useable matter, then it's like trying to fill a leaky bucket with water.

The imbedded quotes make this post challenging to read.

I have all the PCOS symptoms but NPC didn't work for me.

All my acne is on my chin and comes just before or during my period.

Spiro worked for me for years and then stopped in July.

I've also tried diet, bc, antibiotics, glucosmart and other supplements. Spiro worked best but is no longer very effective.

Is there no alternative to spiro?

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Thanks WishClean,

So inositol's working really well for you then?

I'm nervous to try DIM based on the IB. :-S

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So I saw my lovely family doctor today and she was just great. We are doing a panel of hormonal tests, but only those that are covered by my health plan. She prescribed Clindoxyl (BP and Clindamycin phosphate) for now. I haven't used topical antibiotics for years, but I am willing to try it. Once my lab results come back, she will give me a rx for spiro. If my labs are abnormal, we will take a different route. I was happily surprised at how educated and sympathetic she was.

Yay!

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Thanks WishClean,

So inositol's working really well for you then?

I'm nervous to try DIM based on the IB. :-S

Yeah, inositol is still working well! I ran out and didn't take it for 2 days, and my chin hair started to grow back :/

I decided to start vitex again per the recommendation of an herbalist I saw in Europe...he thinks it can help with allergies too, so I'm on that as well but I don't want to take it long term.

I still have a bottle of DIM in my kitchen...I'm nervous about the IB as well, but I don't think everyone gets it. Some experience dramatic clearing within the first few weeks.

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I had the initial break out! Always start it slowly and I read that you should take it with a liver supporting herb like milk thistle or so.

Thanks WishClean,

So inositol's working really well for you then?

I'm nervous to try DIM based on the IB. :-S

Yeah, inositol is still working well! I ran out and didn't take it for 2 days, and my chin hair started to grow back :/

I decided to start vitex again per the recommendation of an herbalist I saw in Europe...he thinks it can help with allergies too, so I'm on that as well but I don't want to take it long term.

I still have a bottle of DIM in my kitchen...I'm nervous about the IB as well, but I don't think everyone gets it. Some experience dramatic clearing within the first few weeks.

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