Weird Period Symptoms

[Kaylin Kumiho]

Alright, so I'm not sure if this is the right place to post this... but frankly I'm out of options and I need advice, and this seemed as good a place as any.

So a little preface, I'm 25 year old trans girl, about 2 years on HRT, no surgeries of any kind, and I've been taking my hormones via pills. My issue is that since about the 1.5 year mark on HRT, I've been having periods. By that I mean, I obviously don't have the parts for the bleeding, however, every month around the same time (sometime starting between the 7th and the 10th of the month), I'll start getting symptoms associated with periods. Basically, I'll get intense headaches, cramping in my lower abdomen, uh... trouble using the restroom, in addition to having to use the restroom more frequently then normal, intense nausea, body aches all over, and loss of appetite. My temper will shift pretty badly, I'll also get pretty bad breast pain around this time of month, and my dysphoria will peak. Furthermore, pamprin and midol will ease the symptoms I'm experiencing, but typically not enough to make me feel 'well'.

I've contacted my endocrinologist, and she rather helpfully just said: 'your pills shouldn't be doing that', and offered nothing else. My current primary physician is an idiot and has no idea about trans healthcare, so I'm in the process of looking for a new one. Obviously this is not a common occurrence for trans women, i've tried googling and got nothing. I'm missing work for this damn thing, and while I'm a girl, I did not sign up for this ->-bleeped-<-. Any suggestions as to what this might be and what I can do about it?

[Laura_7]

You might use a diary and note what you did and what you digested those days.

Do you go someplace to eat ?

Are you sensitive to moon phases ?

Do you do certain things a few days before ?

Do you cycle other hormones, like progesterone ?


*hugs*

[Kaylin Kumiho]

I've logged what I eat, and it's pretty much the same stuff I eat throughout the rest of the month.

As for moon phases... idk? Can you even be sensitive to that? Like, to the point that it makes you want to throw up for a good four-five days straight?

As for certain things the days before... maybe have sex a bit more than usual. I tend to get hornier than normal about the week before. I mean, I've gotten a migraine from sex before, but that was a one time thing.

Nope, I don't take progesterone. I used to take my estrodial sublingually, but I got switched to a manufacturer two months ago where that apparently doesn't work with the new pills, so I switched back to swallowing normally. Before before the manufacturer shift, and before and after I stopped taking sublingually my symptoms remained the same though.

Oh, also it's been a long time since I was in to the endocrinologist (they rescheduled me so it's been about 9 months since my last visit), but last time I was in, I was in the 'normal female range'

[Eva Marie]

I've heard of trans women having these kinds of symptoms. I tend to experience re-occurring headaches that usually begin the week before I start my progesterone cycle.

The symptoms you describe are reminiscent of the female monthly cycle and they make me think that you might be intersex - have you ever had a pelvic examination/MRI/ultrasound to see if there are undeveloped female reproductive organs there?

[Kaylin Kumiho]

Nope, not really sure how I'm supposed to go about getting that requested to be honest. Would I go to an urgent care facility, or would I need a general practitioner? Or could I ask my endocrinologist to arrange that?

[Laura_7]

Nope, not really sure how I'm supposed to go about getting that requested to be honest. Would I go to an urgent care facility, or would I need a general practitioner? Or could I ask my endocrinologist to arrange that?

Well all of the above I'd say ... what you feel is most convenient ... and covered 


*hugs*

[Kaylin Kumiho]

So I had dinner at my mom's tonight, and I brought up my symptoms and the fact that I could be intersex. Apparently I had a karyotype done when I was a kid, because my mom was older when she had me... that said, it came back clean. No chromosomal anomalies, standard XY. *shrugs*

[Dena]

I have some questions. Was your body somewhat feminine before you started HRT? If they were tested, what where your hormones levels like before HRT? Without mentioning dosage, is the doctor able to produce normal feminine blood levels with a relatively low dose?

It is possible that you are intersexed and are still XY. There is a possibility that something in your body is causing a menstrual like cycle and if so, there may be signs of it before you started HRT.

[Obfuskatie]

I'd recommend getting an allergy test, a more thorough blood panel to check your liver and kidneys, and a prostate exam.  It could be all of them, or something else. Oral estrogen is hard on the liver, and it could be buildup accumulating each month or there could be more things going on like intersex symptoms.  A sonogram is one relatively easy exam that'd help check for unexplained masses or growths in your abdomen.


     Hugs,
- Katie
Sent from my iPhone using Tapatalk

[Kaylin Kumiho]

I have some questions. Was your body somewhat feminine before you started HRT? If they were tested, what where your hormones levels like before HRT? Without mentioning dosage, is the doctor able to produce normal feminine blood levels with a relatively low dose?

It is possible that you are intersexed and are still XY. There is a possibility that something in your body is causing a menstrual like cycle and if so, there may be signs of it before you started HRT.

I was a bit androgynous before hrt i guess. Im not sure what a low dose would be, hrt meds tbh... i mean i think i could be higher. Ill try and look up my blood work tomorrow and post it

[Kaylin Kumiho]

Alright, got my portal, last time I was in was 4/20/15:
I had a testosterone serum 70 ng/dL
Estrodial Serum, MS 158 pg/mL

Now when I went in for my original blood work on 1/13/14, before I started HRT, I had:
Testosterone serum 342 ng/dL
Estrodial Serum 17.6

Does that help any? I can look up more levels like prolactin if you need that.

It's also worth noting that my testosterone did spike back up to 482 ng/dL 4-5 months after I started HRT, when I had my blood work run again, before it started to drop.

[Laura_7]

Here were some comments :
https://www.susans.org/forums/index.php/topic,205886.msg1827645.html#msg1827645

70 ng/dl testo should be fine still ... some endos strive for values below 60 for better feminization ...

well as the others said ... a further examination for intersex might be a good idea ...

you might talk with your doc about micronized bioidentical estrogen ...
estrace is one example.
It can be dissolved under the tongue.
This way the liver is bypassed with intake, which lessens strain on the liver, and also lessens blood clotting.
If there is estrogen in the digestive tract the liver presumes a leak and raises clotting factors.

With sublingual intake levels rise fast, and drop after a few hours. So spreading the daily dose in a few small doses might be a good idea. There are small dose pills for example, or there are pills which can be seperated in half...


here is a graph showing that this indeed has an influence on levels:
https://www.susans.org/forums/index.php/topic,186946.msg1665088.html#msg1665088


You might talk about all of this with your doc.


*hugs*

[Kaylin Kumiho]

To be fair, that was nearly a year ago. I haven't been back to the endo, because the same day I was supposed to go for my new appointment, I had to fly down to florida for a funeral. So I'm like, nearly 6 months over due. X_X

That said, I'm on estrodial which is the generic form of Estrace apparently? Like there is no way I'll be able to afford switching to Brand. My insurance doesn't cover it. That said, super glad you had me look anyways~ I just went on GoodRx to look some stuff up about it, and found a coupon for my existing meds... so, yay! $6-8 back!

[Dena]

It doesn't look like your body was attempting to produce estrogen and you were in the normal male range before HRT and in the feminine range after HRT. I don't see anything to explain what is going on but I will keep thinking about it.

[Dena]

I found what I have been suspecting from the time I first saw this post. The menstrual cycle is controlled by the Pituitary gland. I am suspecting the Pituitary hormones may have something to do with what you are feeling but I don't know how it all ties together.
http://www.soc.ucsb.edu/sexinfo/article/menstrual-cycle

[KayXo]

Oral estrogen is hard on the liver

I haven't seen much in the way of evidence supporting the idea that oral BIO-IDENTICAL estradiol harms the liver. Perhaps, this was so with older forms of estrogen that weren't bio-identical but I have not personally come across any study indicating that this has occurred either.

The bigger concern is clots where when estrogen passes through the portal vein to get to the liver, factors and proteins get modified so that coagulation increases but this risk is much greater, again, in the case of older forms of estrogens. One must not confuse this risk associated with first pass effect with liver strain from oral intake.

it could be buildup accumulating each month

Older estrogens like ethinyl estradiol or conjugated equine estrogen did build up in the body because of their molecular structure and difficulty in being eliminated BUT estradiol, being native to the body, is much more easily disposed of by the body as it's familiar with this form and has been for millions of years, hence much less likely to build up.

Minerva Med. 2013 Apr;104(2):161-7.

"Estradiol itself has a lower impact on estrogen-hepatic proteins, and is more readily metabolized by the liver than ethinyl estradiol, the ethinyl group on which slows down that process. The structure increases the bioavailability of ethinyl estradiol compared with E2, but may also contribute to an increased likelihood of estrogen-related adverse events.40"

Obstet Gynecol. 1990 Apr;75(4 Suppl):9S-14S; discussion 15S-17S.

"Although oral conjugated equine estrogens have been used extensively, they introduce types of estrogen, such as equilin, that are not naturally found in humans and that can produce a pronounced hepatic response."

[Obfuskatie]

I haven't seen much in the way of evidence supporting the idea that oral BIO-IDENTICAL estradiol harms the liver. Perhaps, this was so with older forms of estrogen that weren't bio-identical but I have not personally come across any study indicating that this has occurred either.

The bigger concern is clots where when estrogen passes through the portal vein to get to the liver, factors and proteins get modified so that coagulation increases but this risk is much greater, again, in the case of older forms of estrogens. One must not confuse this risk associated with first pass effect with liver strain from oral intake.


Older estrogens like ethinyl estradiol or conjugated equine estrogen did build up in the body because of their molecular structure and difficulty in being eliminated BUT estradiol, being native to the body, is much more easily disposed of by the body as it's familiar with this form and has been for millions of years, hence much less likely to build up.

Minerva Med. 2013 Apr;104(2):161-7.

"Estradiol itself has a lower impact on estrogen-hepatic proteins, and is more readily metabolized by the liver than ethinyl estradiol, the ethinyl group on which slows down that process. The structure increases the bioavailability of ethinyl estradiol compared with E2, but may also contribute to an increased likelihood of estrogen-related adverse events.40"

Obstet Gynecol. 1990 Apr;75(4 Suppl):9S-14S; discussion 15S-17S.

"Although oral conjugated equine estrogens have been used extensively, they introduce types of estrogen, such as equilin, that are not naturally found in humans and that can produce a pronounced hepatic response."

This all sounds pretty true and accurate, be we don't know the particular pill she's taking either. The standard one I'm familiar with is sublingual, so  it could still be the older equine / Premarin one or some pharmacological phenomenon based on the type and manufacturing of her hormone supply.

My points are all based on conjecture and my own experiences as well as what I've been told by doctors and the NPA that oversee my HRT. But this isn't the main point, the main point is the OP is experiencing unexplained phenomena and wondering what could possibly be a cause and what to do about it. Not what is the cause. She needs a doctor to diagnose that for her in person.


     Hugs,
- Katie
Sent from my iPhone using Tapatalk

[Kaylin Kumiho]

I think I just have the generic of Estrace, but I'll confirm later. I'm getting more pills in a few hours anyways... but even if this pill talk isn't related to the symptoms I'm kinda glad you guys are talking about this. If I'm on something less than good, I can always confront my end on the 18th of April and get a med change.

[KayXo]

You are on bio-identical estrogen. This has been shown to be safest form of estrogen.

[Kaylin Kumiho]

Yeah, it's a generic of Estrace according to the pharmacy info.