The big explanation - why, what, who and how...

By now it's February 2005 and I know I have long cycles, LUFS (unruptured follicles) and low progesterone, so I decide to do some more research to see if I can sort any of this out myself.

I also know that rheumatoid arthritis tends to occur in teenagers, new mothers and menopausal women, and I've started to come across something called estrogen dominance over and over again, and the two seem connected somehow, so I get excited about finding out what the connection is.

First of all I research why rheumatoid arthritis goes into remission during pregnancy and find out that it is most likely because of huge increases in the amount of the sex hormone progesterone produced during pregnancy (up to 40 times the normal amount). I find out that progesterone not only preserves the endometrial lining, thereby sustaining pregnancy, but it also regulates the immune system, preventing one's own body from rejecting the foetus. (Many researchers erroniously think that raised estrogen is what regulates the immune system in pregnancy. They fail to find a link again and again, and I wonder why they keep focusing on the wrong hormone? I have yet to discover why this is?)

Progesterone, I find out, has many beneficial effects within the body, such as:

• Maintains the secretory endometrium
• Protects against fibrocystic breasts
• Helps use fat for energy
• It is a natural diuretic
• Natural anti-depressant / mood enhancer
• Facilitates thyroid hormone action
• Normalises blood clotting
• Restores sex drive
• Normalises blood sugar levels
• Normalises zinc and copper levels
• Restores proper cell oxygen levels
• Prevents endometrial (uterine) cancer
• Helps prevent breast cancer
• Simulates osteoblast for bone building
• Restores normal vascular tone
• Necessary for the survival of the embryo
• Precursor of corticosteroids and other hormones
• Modulates other hormones helping to restore balance
• Promotes sleep
• May help improve libido
• Contributes to reducing anxiety and panic attacks
• Reduces estrogen dominance symptoms

To give some context, I should explain that women have two phases to their menstrual cycle, the follicular phase and the luteal phase. In the follicular phase, estrogen is dominant and builds the endometrial lining of the womb in preparation for ovulation. The second part of the phase is the luteal phase and the dominant hormone in this phase is progesterone.

In the first half of the menstrual cycle, levels of estrogen rise and make the lining of the uterus grow and thicken. In response to follicle-stimulating hormone (FSH), an egg (ovum) in one of the ovaries starts to mature. At about day 14 of a typical 28-day cycle, in response to a surge of luteinizing hormone (LH), the egg leaves the ovary. This is called ovulation.

In the second half of the menstrual cycle, the egg begins to travel through the fallopian tube to the uterus. Progesterone levels rise and help prepare the uterine lining for pregnancy. If the egg becomes fertilized by a sperm cell and attaches itself to the uterine wall, the woman becomes pregnant. If the egg is not fertilized, it either dissolves or is absorbed into the body. If pregnancy does not occur, estrogen and progesterone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

The trouble is, menstrual cycles aren't always 28 days long. In fact, mine are somewhere around 60 or more days long. When cycles are longer than 28 days, it is the follicular, or estrogen part of the cycle that is extended in length. The luteal, or progesterone part of the cycle, is always about 10-16 days long, not longer or shorter. What this means for me is that when I have a 60 day cycle, my follicular phase is 46 days long and my luteal phase is 14 days long. This means that I am exposed to estrogen for 46 days instead of 14. This leads to a condition called estrogen dominance. It is not that I am producing too much estrogen per se, but that I am producing it for too many days in a row, without having it balanced out by progesterone.

To see the effects of the two hormones side by side, see the table below:

Physiological effects of Estrogen versus Progesterone

Estrogen effects Creates proliferative endometrium Causes breast stimulation Increases body fat Salt and fluid retention Depression and headaches Interferes with thyroid hormone Increases blood clotting Decreases sex drive Impairs blood sugar control Loss of zinc and retention of copper Reduces oxygen levels in all cells Increases risk of endometrial cancer Increases risk of breast cancer Slightly restrains osteoclast function Reduces vascular tone Increases risk of gall bladder Increases risk of autoimmune disorders

Progesterone Maintains secretory endometriun Protects against fibrocystic breast Helps use fat for energy Natural diuretic Natural antidepressant Facilitates thyroid hormone action Normalizes blood clotting Restores sex drive Normalizes blood sugar levels Normalizes zinc and copper levels Restores proper cell oxygen levels Prevents endometrial cancer Helps prevent breast cancer Stimulates osteoblast bone building Restores normal vascular tone Necessary for survival of embryo Precursor of corticosteroids

As you can see, being exposed to estrogen uninterrupted for months at a time can be very detrimental to a woman's health. Indeed, when I was a teenager, and before going on the birth control pill, I wouldn't have a period for four to six months at a time. I didn't think anything of it back then, assuming it was stress of exams or that my periods would settle down eventually, but I now think that this could have been instrumental in either the development or exacerbation of my rheumatoid arthritis.