Low Estrogen & Progesterone: Symptoms, Causes & Treatment Options

Question
Hello Dr. Rappaport:

Age: 35/Married
Children: 2
Cycle Day 7 of Menses
Height: 5'3"
Weight: 110 lbs.

My estrogen levels are low and I'm having several side-effects: thin endometrium, near constant headaches, decreased libido, and most recently, lackluster changes in my skin and nails. It's been suggested that I consider estrogen supplementation. Curiously however, my FSH levels are excellent. Although, it's possible certain hormones have not been tested on the ideal day of my cycle.

This menstrual cycle was induced with Prometrium 200mg per day for 7 days. I will resume the Prometrium when my luteal phase begins. Sometimes my progesterone is normal on CD21, sometimes it's not. I also had a transvaginal ultrasound and my eggs/follicles, uterine blood supply, etc., were in excellent condition, with the exception of my endometrium at 4mm.

How does someone who is trying to conceive take Estrogen and Prometrium safely together? Do I take Estrogen during my Follicular Phase and Progesterone during my Luteal Phase? I don't understand the protocol.

Thank you so much,
Christine

Answer
If your endometrium is too thin, estrogen therapy may increase the thickness of the endometrium. Usually birth control pills (combination) work quite well in "priming" the endometrium. However, Estrogen taken for 25 days each month will also increase the thickness of the endometrium. Progesterone is then taken from cycle day #16-25 each month and you should get a normal period after that. I would discuss it with your doctor and follow the regimen your doctor suggests.