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A woman with PCOS, well any woman for that matter on Diane35 is exactly the same as me whilst we are all taking that pill. There's no underlying hormonal activity when you are taking the pill. It totally blocks the release of gonadotropin hormone, so it is ONLY the progetstins and EEs inside your body. All other female hormones are 100% suppressed, so his opinion there is very valid. It wouldn't matter if i had normal hormone production whilst taking the pill. It would be wiped out anyway. There's simply no such thing as having protective natural hormones underneath synthetic hormone replacement.
I do see where you are coming from. I have been doing a lot of research about bodily tissues requiring particularly 17B in order for oestrogen receptors to be properly activated. It's part of why i tentatively decided to try a topical 17b.
I have to apologise as i have been wrong about something. Indeed, prometrium is a low androgen index progesterone, and shouldn't elevate levels of 17-OP. I did read a few studies where women with both adrenal and ovarian androgen over-production took this micronised version of progesterone and saw no negative elevations in serum dheas or 17op. This may indeed be an option for me.
I worry about what cycling the hormones will do to me. I believe that the dosage recommendation is 12 days continuous use 200mg within the 28 day cycle. I remember when i began bleeding again in 2015, my hair would shed EVERY SINGLE TIME it happened. I feel like my body is now just totally ruined and can't respond to hormonal fluctuation normally. It just freaks out. I don't know. There's also the issue of the very minimal dose of oestrogen that i would be taking - 2mg. My gyn said that would be that max i could take, and i would be afraid to go against his word because well quite frankly i don't want to get cancer.
For now, i only have a prescription for progynova and prometrium. I would need to get prometrium from somewhere if i did want to try this, because there's no f*****g way in hell that i am ever touching provera. Else i just come off the pill and let the chips fall where they may, perhaps just use a topical estrogen.
First off that's not entirely true about estrogen levels on the birth control pill. Yes natural estrogen levels will go down, but they will not completely disappear, and should in fact stay in the normal range.
Here is the best research I can freely find available illustrating this:
"Estradiol levels in women receiving oral contraceptives were low, usually in the range of 20-30 pg./ml., similar to those found in the early follicular phase in ovulatory cycles, and significantly higher than levels found in postmenopausal women"
https://www.ncbi.nlm.nih.gov/pubmed/4645131
This study used mestranol which is an old estrogen apparently but equally potent to ethinyl estradiol:
"Indices and dosages showed ethynylestradiol and mestranol to be essentially equipotent under these experimental conditions"
https://www.ncbi.nlm.nih.gov/pubmed/1146928
In the first study, they were using 100 mcg/day of mestranol, which is then equal to 100 mcg/day of ethinyl estradiol, ie. Almost three times as much as you're getting from your Diane 35. (From what I read, back in the 60s and 70s the doses on birth control pills were insanely high.)
And yet despite these mega doses, the women still had levels of their natural estradiol within the normal monthly range for healthy women.
So normal women who take birth control are NOT the same as you. You have NO natural estrogens. And that is the problem. NO natural estradiol. NO natural estriol. NO natural estrone.
You are relying completely on ethinyl estradiol while other women who are not menopausal will still have all their regular hormones as well, just in lower baseline levels.
If your gyne has told you "Diane 35 will 100% suppress natural estradiol/estriol/estrone" and that "you are the same as any girl with PCOS taking the pill" your gyne is giving you bad info because that's not true.
As for your concern about cancer, you'd have to clarify what exact type of cancer you are worried about getting. If it is endometrial, that's only a risk if you don't bleed or use a progesterone (IUD or prometrium) to keep the lining thin. If you're talking about breast cancer, or just general cancer in the body being induced by the estrogen, again, the goal is not a given # mg to take a day or to megadose. The goal is to have normal blood levels for your age and gender. Once you have normal blood levels, you are taking the proper amount, and you are at no higher risk of "cancer" than you would have been if you had never gone through menopause already.
The dose conversions for bioidentical hormones can easily be done to compare to 2 mg estradiol. I did them before for you and can do them again. The total dose (# mg) for bioidentical hormones will be higher, because estriol and estrone are so weak, but the total estrogenic effect can be standardized to 2 mg estradiol easily enough if that makes you comfortable as a starting point.
If you don't want to cycle and want the safest approach with the lowest effective systemic progesterone levels, go for bioidentical estradiol/estriol/estrone tablets with the Skyla/Jaydess IUD. Keep the topical antiandrogens if you're worried about the 1.2% of risk of hair loss with the IUD from the very weak androgenicity of the progesterone. Any topical antiandrogen should be able to block something that weak easily.
Again, titrate the dose of the estrogens to NORMAL BLOOD LEVELS that you SHOULD HAVE ANYWAY and you will just be back to being a normal girl hormonally, ie. How you were before menopause. You aren't going to grow tumors all over your body just for putting the hormone levels back to where they were 4-5 years ago. That's where the levels belong.
The fact that your natural hormones are all missing and you are not replacing them properly is almost certainly why you're such a mess.