Fwd: Q: progesterone supplementation and breast feeding women

[Guest guest]

Hi there, I have a difficult case and would very much appreciate any input. I have a 26 year old breast feeding woman. Her daughter is 15 months old (and was a surprise because of history of mom's irregular menses (see below). Mom's chief complaint is debilitating anxiety. She also presented/has g.i. symptoms of gas, bloating and constipation. She has not had a period since the pregnancy. She has a history of irregular periods starting with menarche. She was put on oral birth control and also given lupron injections when she was 16 (I'm not entirely sure why). This sent her into chemical menopause but then the birth control brought back her period. She was also treated for anorexia shortly after (4 years anorexic). She has a history of anxiety as a child

and being sexually molested. Her main anxiety as a child centered mostly around the dark and the unknown. Now it is a free-floating anxiety, worse when her husband is away at work or out of town. It also tends to be worse in the evening. She describes it now as a 2-4/10 (10 is worse) although she has reported being 11/10. She has a spiritual life and practices prayer and meditation. She has a social life with other mom's. Her husband is supportive, for the most part, except has financial concerns which causes her more anxiety in relation to the cost of supplements and tests she has had. She had a Vega test which showed problems with cow milk, butter, cheese, cottage cheese, cornmeal, wheat, wheat bran, lactose, MSG, formaldehyde, nutra-sweet, sulfites, goat's milk. We did remove carrots from her diet because her palms and soles of feet were orange, that has

resolved with elimination of the carrots and yams. She didn't eat that many but she did eat 1 or 2 everyday. She now eats them very moderatly (because she likes them). Before she was pregnant she had the g.i. symptoms and eliminated by trial and error, most dairy and gluten because of the symptomology. She has eaten ground flax seed everyday for years. She did the flax/epo protocol for 4 months before the hormone testing (see below). She is now studying nutrition. She is not anorexic or losing weight. She is in weekly therapy with a therapist who also does Emotional Freedom Technique, which she reports is helping. Anxiety-wise, she is doing a lot better. However, symptoms have not fully resolved and the anxiety remains her biggest complaint. We ran a Diagnostechs female hormone panel (11 sample, saliva).

Her progesterone is as follows: (Day 3, 5,9,10,13,15,16, 21, 22, 26,28 respectively): 68,53,65,53,72,72,46,55,65,56,62. Reference ranges are: follicular 20-100 and luteal 65-500. Estradiol is 7,8,13,10,13,13,10,12,13,11,11. Reference ranges are follicular 5-13, preovulatory 10-30 and luteal 7-20. Progesterone interpretation: anovulatory or weak ovulatory Estrogen interpretation: normal timing of preovulatory estradiol peak but blunted estradiol output. Estradiol peak dys-synchronized with luteal surge, suboptimal hypothalamic pituitary ovarian pacing. Overall recomendations: progesterone augmentation. In blood tests from 4/2007, pre-treatment, the out-of-range results were as follows: BUN 23 (range: 7-22) Alk phos 143 (range: 30-125) cholesterol 119 (range: 140-199) Everything else was within optimal range except

for thyroid which was not tested. (She is scheduled to have more comprehensive blood test after the first of the year) A Doctor's Data 3 sample stool test 8/2007showed imbalances with gamma strep 3+, Alpha Haemolytic strep 3+, Mucoid E.coli 3+ (DD did not recommend any treatment) . In beneficial flora the stool showed bifidobacter 4+, E. coli spp 4+, lactobacillus spp. 0+, enterococcus spp 1+. Her stool showed moderate vegetable fibers. Everything else was great including yeast, which was not isolated. (She did an HCl challenge test after this and her bloating became worse. She uses the HCl as needed now.) She also had a CT scan of her abdomen and reproductive organis in July 2007. Everything was normal. We are treating her with several herbs(rhodiola, melissa, dgl licorice, and Wise women's liquid serenity formulation as needed) in addition to theanine and B vitamins, calcium,

magnesium, nutri-enzyme vitamin, probiotics (HMF intensive and now Super) and fish oils (Nordic Naturals Balanced Omega). We just started Iodine (low dose: 225 mcg qid) and Phosphytidyl serine (Seriphos). She is also taking a daily low dose of dopamine/seratonin homeopathic. She was given homeopathic sepia 30c and one dose of homeopathic phosphorous. Her diet is awesome--mostly fruits and vegetables and quality protein, although we are suspecting she is reacting to something she is eating (sulfites?) but we will not do a cleanse or any elimination diet until after the child is weaned. She receives weekly Activator adjusments (www.activator.com) from me and massage because of her back and neck pain from carrying her daughter and stress. She tried vitex for 3 days, that is when her anxiety spiked to an "11/10" (which on the saliva test

coorelated with the 7 estradiol and 68 progesterone spike, interestingly) So, we took her off that. With the saliva test results, I am interested in doing another trial of vitex inspite of the coorelation. She wants to do the progesterone augmentation with sublingual drops or the topical hormone. We have tried many ways to balance her hormones to no avail. Because she is still breastfeeding, (and really doesn't want to wean her daughter if she doesn't have to,) there is concern about prescribing sublingual hormone (progesterone) to her. Dr. Kamal (sic?) at Diagnos-techs says "no way" on hormone supplementation with a breastfeeding mom and says that her saliva tests are physiologically normal. (I understand this but I am also sceptic given her history of irregular periods and chemical menopause at a young age.) He is also against

glandulars and vitex for a breastfeeding woman. I know this is not strictly UNDA (honestly, I don't feel like I have the experience to do a good treatment plan with the UNDA numbers; I plan to take another seminar 2008). However, any insight, opinion or help would be greatly appreciated. Thanks for taking the time, I know your time is VALUABLE! Sawhill, ND beaverton, or www.docsawhill.com This communication and any attachment may contain confidential and/or privileged information, which is intended for use only by the

addressee(s) indicated. If you are not an intended recipient, please be advised that any disclosure, copying, distribution, or use of the contents of this information is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete/destroy all copies of the original transmission. To safeguard your privacy, try your best to restrict the use of e-mail to general questions. E-mail consults can never take the place of a personal consultation. Please ensure that your care is overseen by a qualified professional with whom you have personal contact.

[Guest guest]

Hello Katheryn: I am actually specializing in Post-partum depression, since I suffered from it and I had t study alot about it. I am goig to tell you a little about the hormonal changes then my suggestions.

First, Progesterone during pregnancy increases like a 10 fold during the last trimester of pregnency, but in the post-partum time (1-2 days latter) it can fall even nearly zero. And estrogen goes down too very quickly by around 90 porcent. This can cause anxiety, depression and moodiness. Both hormones stay low until child begings to eat food. It is great that they will check her thyroid aince many mothers have a thyroid reaction were they make antibodies against thyroid gland. Usually they get better soon but is important to treat naturopathicly. Also adrenal gland can be affected, since during pregnancy in last trimester there is an increase of CRT by the placenta then after delivery ofcourse there is not as much cortisol. But if that mother's adrenals were low then she may have a hard time since sleep depravation, having to care for a small creature is very stressfull. Also progesterone is a precursor to cortisol so decrease progesterone may also mean low cortisol. Also You already know that she has had anxiety and anorexia so probably she has unbalance neurotransmmiters. You may want to test her which is the best to do when a mother is breast feeding. So you know exactly what she is low on. Or you can try giving some GABA begin with 100mg and can increase up to 700mg in the afternoon and at night. Or if she knows what time is the worse anxiety take them 30 hour before that time. Also is very important to have the vitamines that help the process of the conversion of glutamine to GABA. The nutrients are Mg, and B6 (pyridoxal 5 phosphate). Also you could add some product with GABA that has taurine and glycine.

It is important that she takes a multi that is easy to absorve since she has GI problems I would be concern of her absorption.

About Progesterone I would use cream and I woul begin with 10-20 mg per day (less or 1/4 tsp of cream) Since she gas not menstruated she would use it 3 weeks on 1 week off (SO RECEPTORS REST).

I HOPE THIS HELPS

ADRIANA AZCARATE-FERBEL ND

LA BOTANICA NATURAL MEDICINE

8512 SE 9TH AVE.

SELLWOOD, PORTLAND

To: unda_cases From: docsawhill@...Date: Sun, 18 Nov 2007 10:48:55 -0800Subject: Fwd: Q: progesterone supplementation and breast feeding women

Hi there,

I have a difficult case and would very much appreciate any input.

I have a 26 year old breast feeding woman. Her daughter is 15 months old (and was a surprise because of history of mom's irregular menses (see below). Mom's chief complaint is debilitating anxiety. She also presented/has g.i. symptoms of gas, bloating and constipation. She has not had a period since the pregnancy. She has a history of irregular periods starting with menarche. She was put on oral birth control and also given lupron injections when she was 16 (I'm not entirely sure why). This sent her into chemical menopause but then the birth control brought back her period. She was also treated for anorexia shortly after (4 years anorexic).

She has a history of anxiety as a child and being sexually molested. Her main anxiety as a child centered mostly around the dark and the unknown. Now it is a free-floating anxiety, worse when her husband is away at work or out of town. It also tends to be worse in the evening. She describes it now as a 2-4/10 (10 is worse) although she has reported being 11/10.

She has a spiritual life and practices prayer and meditation. She has a social life with other mom's. Her husband is supportive, for the most part, except has financial concerns which causes her more anxiety in relation to the cost of supplements and tests she has had.

She had a Vega test which showed problems with cow milk, butter, cheese, cottage cheese, cornmeal, wheat, wheat bran, lactose, MSG, formaldehyde, nutra-sweet, sulfites, goat's milk.

We did remove carrots from her diet because her palms and soles of feet were orange, that has resolved with elimination of the carrots and yams. She didn't eat that many but she did eat 1 or 2 everyday. She now eats them very moderatly (because she likes them).

Before she was pregnant she had the g.i. symptoms and eliminated by trial and error, most dairy and gluten because of the symptomology.

She has eaten ground flax seed everyday for years. She did the flax/epo protocol for 4 months before the hormone testing (see below).

She is now studying nutrition. She is not anorexic or losing weight. She is in weekly therapy with a therapist who also does Emotional Freedom Technique, which she reports is helping.

Anxiety-wise, she is doing a lot better. However, symptoms have not fully resolved and the anxiety remains her biggest complaint.

We ran a Diagnostechs female hormone panel (11 sample, saliva). Her progesterone is as follows: (Day 3, 5,9,10,13,15,16, 21, 22, 26,28 respectively): 68,53,65,53,72,72,46,55,65,56,62. Reference ranges are: follicular 20-100 and luteal 65-500.

Estradiol is 7,8,13,10,13,13,10,12,13,11,11. Reference ranges are follicular 5-13, preovulatory 10-30 and luteal 7-20.

Progesterone interpretation: anovulatory or weak ovulatory

Estrogen interpretation: normal timing of preovulatory estradiol peak but blunted estradiol output. Estradiol peak dys-synchronized with luteal surge, suboptimal hypothalamic pituitary ovarian pacing.

Overall recomendations: progesterone augmentation.

In blood tests from 4/2007, pre-treatment, the out-of-range results were as follows:

BUN 23 (range: 7-22)

Alk phos 143 (range: 30-125)

cholesterol 119 (range: 140-199)

Everything else was within optimal range except for thyroid which was not tested. (She is scheduled to have more comprehensive blood test after the first of the year)

A Doctor's Data 3 sample stool test 8/2007showed imbalances with gamma strep 3+, Alpha Haemolytic strep 3+, Mucoid E.coli 3+ (DD did not recommend any treatment) . In beneficial flora the stool showed bifidobacter 4+, E. coli spp 4+, lactobacillus spp. 0+, enterococcus spp 1+. Her stool showed moderate vegetable fibers. Everything else was great including yeast, which was not isolated.

(She did an HCl challenge test after this and her bloating became worse. She uses the HCl as needed now.)

She also had a CT scan of her abdomen and reproductive organis in July 2007. Everything was normal.

We are treating her with several herbs(rhodiola, melissa, dgl licorice, and Wise women's liquid serenity formulation as needed) in addition to theanine and B vitamins, calcium, magnesium, nutri-enzyme vitamin, probiotics (HMF intensive and now Super) and fish oils (Nordic Naturals Balanced Omega). We just started Iodine (low dose: 225 mcg qid) and Phosphytidyl serine (Seriphos). She is also taking a daily low dose of dopamine/seratonin homeopathic. She was given homeopathic sepia 30c and one dose of homeopathic phosphorous.

Her diet is awesome--mostly fruits and vegetables and quality protein, although we are suspecting she is reacting to something she is eating (sulfites?) but we will not do a cleanse or any elimination diet until after the child is weaned.

She receives weekly Activator adjusments (www.activator.com) from me and massage because of her back and neck pain from carrying her daughter and stress.

She tried vitex for 3 days, that is when her anxiety spiked to an "11/10" (which on the saliva test coorelated with the 7 estradiol and 68 progesterone spike, interestingly) So, we took her off that. With the saliva test results, I am interested in doing another trial of vitex inspite of the coorelation.

She wants to do the progesterone augmentation with sublingual drops or the topical hormone. We have tried many ways to balance her hormones to no avail. Because she is still breastfeeding, (and really doesn't want to wean her daughter if she doesn't have to,) there is concern about prescribing sublingual hormone (progesterone) to her. Dr. Kamal (sic?) at Diagnos-techs says

"no way" on hormone supplementation with a breastfeeding mom and says that her saliva tests are physiologically normal. (I understand this but I am also sceptic given her history of irregular periods and chemical menopause at a young age.) He is also against glandulars and vitex for a breastfeeding woman.

I know this is not strictly UNDA (honestly, I don't feel like I have the experience to do a good treatment plan with the UNDA numbers; I plan to take another seminar 2008). However, any insight, opinion or help would be greatly appreciated.

Thanks for taking the time, I know your time is VALUABLE!

Sawhill, ND

beaverton, or

www.docsawhill.com This communication and any attachment may contain confidential and/or privileged information, which is intended for use only by the addressee(s) indicated. If you are not an intended recipient, please be advised that any disclosure, copying, distribution, or use of the contents of this information is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete/destroy all copies of the original transmission. To safeguard your privacy, try your best to restrict the use of e-mail to general questions. E-mail consults can never take the place of a personal consultation. Please ensure that your care is overseen by a qualified professional with whom you have personal contact.

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