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Q. Progestin intake has resulted in variation in sex hormones. Kindly advice.

Answered by
Dr. Priyadarshini Tripathy
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 23, 2020

Hello doctor,

I am a 25-year-old female. I am taking 0.5 mg Dienogest orally twice daily. I am diagnosed with Hashimoto's thyroiditis, exercise-induced asthma, and suspected endometriosis.

I have had a lot of trouble talking to a doctor where I live who is knowledgeable about endometriosis. I thus have had multiple ultrasounds and an MRI that all come up showing nothing despite a plethora of symptoms (chronic pelvic pain, especially in the lower abdominal region and lower back), chronic fatigue, dysmenorrhea, pain during or after sex, extreme bloating, issues with bowel movements, issues with weight, etc. I got the prescription for Dienogest, to begin with.

That said, I recently had my hormone levels for estrogen and progesterone checked. My estrogen levels appeared normal at around 56 pg/mL, and my progesterone levels were 0.09 ng/mL. My question is, is this to be expected on a daily dose of 1 mg Progestin? And is it possible to be estrogen dominant even on Progestin?

I have not uploaded the photos of my blood work because they are written in a different language. Also, I do not have copies of my ultrasounds or MRI scan. I am also aware that endometriosis, more often than not, does not appear on such scans and that laparoscopic surgery is required for diagnosis. It is impossible to get diagnosed here, so I am just trying to manage things as best I can and arm myself with as much information as possible.

I began menses at around the age of 14 and began taking birth control at age 16 due to my symptoms (heavy, prolonged bleeding, severe cramps, nausea, etc.), which I often missed school. I am now 25 and have used multiple pills. I had a Nexplanon implant for a year, and I tried the Skyla IUD once but had it removed after only four months due to discomfort and worsening periods. I have also struggled with my weight since adolescence. Please help.

#

Hello,

Welcome to icliniq.com.

I went through your query. The symptoms you have described are typically suggesting of pelvic endometriosis. Dienogest is a hormone that suppresses the symptoms and prevents excess endometrial growth.

Thank you doctor,

Would you say such low levels of progesterone are expected while taking Dienogest?

#

Hello,

Welcome back to icliniq.com.

The estrogen levels you have described is a normal thing. Do not worry. The progesterone levels vary in the menstrual cycle. At the start of the menstrual cycle, it is less than1 ng/mL or under, and in the middle of their menstrual cycle, it is 5 to 20 ng/mL. So it is essential to know at which day of the menstrual cycle you did the progesterone levels.

Progesterone suppresses estrogen levels, so you will not expect estrogen levels to be higher.

Sorry that you did not have a good experience post menarche. Let me inform you that endometriosis is a chronic condition. You need to continue Dienogest for a longer period or undergo laparoscopic endometriotic tissue ablation for better outcome.

I hope this helps.

Thank you doctor,

That makes sense. I have been on Dienogest for around two months so far, so it is hard for me to say where in my cycle, I am now. The blood tests were performed last week, however, and my last period was at the end of the previous month, just before I began taking Dienogest. I am not sure of the length of my cycle as there was always a bit of variation when the bleeding would start and end even while on the pill.

At the end of next month, at the 3-month mark, my doctor said they would consider increasing my Dienogest dose as it has not done anything to improve my symptoms at this dose. Given the difficulties in diagnosing endometriosis here, I do not expect to get the surgery for quite some time.

#

Hello,

Welcome back to iclniq.com.

Do not worry. I can understand your concern. Dienogest could be given up to 2 mg per day. Apart from Dienogest, there are other options like aromatase inhibitors, gonadotropin-releasing hormone analog. It is worth having a chat with your doctor in the next meeting regarding other options as well.


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