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hormones and hep C
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hormones and hep C

I was dx 3 years ago with hep c, liver enz. low, liver biopsy grade II, no cirosis. Seems I have had the virus since 1974. No systems, no alcohol or drugs. Doctor said it would be OK not to do TX at that time, to wait and see if better tx available in the next few years. Every six months I go and have enzymes tested, always the same. In Oct. 04 they came back very elevated, 160/135 compared to 30/35. Waited 2 weeks, same thing. Now the doctor insist on tx, interferon. The only thing I have done differently is go on Bioidentical Hormone Cream in April 04 which I put on my skin once a day for menapausal systems. Are there any women out there who have experienced any relationship between elevated liver enzymes and hormones? Next I will be going off all hormones although my doctor says that the hormone creams could not elevate my enzymes. I also have now have a pain in my right side, a dull ache which comes and goes. I had a ultra sound 2 weeks ago, normal. They put me on Ursodiol and Colchicine, 2x a day for inflammation, anyone have experience with these drugs? Besides for the discomfort in R side, all else normal.  Thanks for your help.............
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Last year I had a frozen embryo transfer which required me to be on a number of hormones, including estrogen, to prepare my body for the procedure.  My liver enzymes shot up dramatically -- my ALT was over 300.  My numbers came down after the hormone therapy ended.  So, based on my experience, supplemental estrogen does appear to affect liver enzymes.  

Susan
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About 2 weeks before the end of my treatment, I started having horrendous hot flashes.  I wrote it off to treatment.  Then, when I finished treatment, I continued to have hot flashes.  Went to OB/GYN and found out I was staring menopause.  I was surprised as I am a little young to be going thru menopause based on family history.  I kind of thought that maybe the treatment triggered early menopause and called my GI doc.  He said he has never heard of the tx being related to menopause.  I asked him if it would be OK to take hormones to help the hot flashes and he said no problem.  My OB/GYN elected to use the hormone patches as she said it would help bypass the liver.  I am still holding out and not using the patches yet.  I am scheduled for my 3 month post treatment test in March and am still paranoid about doing anything that might affect that test, even though both OB/GYN and GI said the hormones won't affect it.  I did some research and couldn't find any med. literature on hormones and tx either, so I guess either no research or not enough research has been done on it to make a determination one way or the other.
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I have been on the patch for at least two years now, pre, during and post tx, enzymes have always been normal. never gave it a thought that it might raise them...but like I said, nothing has been elevated...and they work. ( I use Ortho Evra)
best to you
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Just a reminder about an excellent article that ran in the April-June 2004 issue of  Hepatitis magazine by Tina M. St. John, M.D., on "The Estrogen Connection: Women and Hepatitis--Gender Influences the Way Hepatitis Acts on the Human Body."   [Can be ordered directly from www.hepatitismag.com.]

St. John points out that estrogens and progesterone "are not only metabolized by the liver, they are also inactivated or conjugated there.  Conjugated estrogens are secreted into the bile."   Because a damaged liver has more difficulty in clearing these substances,  menstrual difficulties can be worse for those of us with HCV.  St. John writes:  "Impaired metabolism and inactivation of estrogens in a diseased liver lead to an accumulation of estrogens in the body and seem to be a likely mechanism for many of the menstrual symptoms with chronic hepatitis."  

As for the premenopausal and menopausal years,  St. John has this to say:  "Impaired liver metabolism of the sex hormones caues an even more intense and sustained variabilitiy in these hormones.  This appears to be the primary reason many menopausal women with chronic hepatitis report exagerrated menopausal symptoms such as hot flashes, night sweats, irritability and emotional lability."

One more interesting piece of information.  It seems that  the number of estrogen receptors (ER) present on the surface of liver cells decreases as liver disease becomes more severe.

Given the liver's importance in hormone regulation,  it is reasonable to assume that there could be a connection between hormone supplementation and enzyme behavior.   However, I would think you'd be okay with low-dose supplementation, especially with the transdermal sort.  

As you probably know, colchicine is usually prescribed for inflammation of the bile ducts or biliary cirrhosis and ursodiol for dissolving gallstones. (i.e., bile salts).  Is your doc attributing the right flank pain to your gallbladder?
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Whoa.... little moey-mitt!! We ain
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Here, let me translate:   It's the hormones AND your liver.   The liver has to work hard to process them.
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Thanks for the info.  Very helpful indeed.
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some time back i read that the estrogen that your body produces appears to help protect the liver.   some of us with chronic HCV  had much worsening of our symptoms in our mid 40's as our natural estrogen levels declined.  also menopause symptoms started appearing along with it for many of us.  i use soy now as im 52 and it controls the hot flashes.  i also take calcium/magnesium  and a natural progesterone cream to help it all balance out.  even so, the mood swings i have  i feel are a big part hormone related.  ive been off tx. over a year.
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thanks all for help, califia, I am ordering the magazine. You were very helpful. I am cutting back hormone dose 1/2 to see if it helps, will wait 3 months then get enzymes tested again.
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Makes good sense to me!   And btw, I've always registered hormonal shifts in my liver as upper right quadrant pain.   (It's sort of like the old wound that throbs when the barometer drops.)  Hope everything resolves for you quickly.
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Hi everyone!  Was reading this particular thread with great interest.  I went into early menopause (40) before I knew I had hep C.  I was having hot flashes and night sweats, and my dr. perscribed ERT.  Immediately upon starting it (less than a week), I began having palpitations, all my joints felt like the tendons & ligaments had turned to rubber.  I kept feeling like all my joints were going out of place, and much pain, aching.  I went off the hormones, and it took over a year for my body to feel like it could hold all the joints together.  I told my dr., and of course NONE of them believed me.
  
A couple of years later, I tried hormones again, same result.  I was then diagnosed with cryoglobulins.  Had such alarming heart misbeats, that they finally did an EKG, stress test.  Nothing.  All fine.  I don't take hormones, although my GYN just told me about the patches.  I have terrible hot flashes, night sweats.

  I have not started treatment, although it has been 7 years since I first found out I had hep C.  My mother had it, and while on interferon, was dx'd with lung cancer and died within the year.  I found out I had it exactly one year later.  I still smoke, and am afraid to be treated with interferon.  I recently found an article about interferon induced granulomatous lung disease.  I know cigarette smoking causes lung cancer, but I can't get rid of the nagging feeling that my mother got it from the interferon.  Now you know why my doctors don't listen to me!! ha.  

I also had intermittent pain in my right side.  For 5 years the doctor said, it isn't your liver, as all the tests showed nothing.  This Oct., the ultrasound finally showed a gall stone in my common bile duct.  Had the ugly little procedure to have it removed, and they found two.  I don't think it accomplished anything, as I am still having gastrointestinal problems, most of which I did not have before the procedure.  Anyway, I am sure HCV has a big impact on how our bodies process hormones.  And probably not just the female hormones.  They have learned so much since I was first dx's, but still have so much to learn.  I just hate it that my doctors don't really pay attention to symptoms.  I guess they think if it was bad enough, I would take treatment.  Thanks to everyone for all the information posted on this board, and God bless.
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Hi Califia,
Boy I wish that article had been around when I was going through TX. I had a heck of a time with my cycle! Strangely, the upset of my hormones seemed to trigger a whole realm of sides one would not think were related. I guess it
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Actually, I read an article that showed that estrogen has a protective effect on the liver.  Think about it, men have a faster fibrosis rate than women and usually get cirrhosis sooner, etc.  If women go into menopause and don't replace that lost estrogen, then they are at the same risk as men and their fibrosis rate increases.  It makes sense to me.  That's what this study showed anyway.  All I know is I am not stopping my hormones.  I've been on them for years and I like the way they make me feel.  I've had a complete hysterectomy and ovaries taken out, too.  So, if I stop my hormones, then I'd have instant craziness, hot flashes and all the other menopausal problems to the nth degree.  I've tried the natural things before and they do not even begin to help the menopausal symptoms I experience.  I really don't care to ever stop my estrogen.  I know that some day, some doctor may tell me I have to and that will be a bad day in my book.
Susan
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Really interesting thread we have going.   Night sweats and hot flashes are such misery!   But two herbal medications helped me a lot in that department.  The first, and for me the most effective, is a Chinese patent formula called DA BU YIN WAN.   The second is a standardized black cohosh preparation made in Germany called Remifemin.   (I know, I know, am probably preaching to the choir here.)
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the rate has gone up a little 50%, and is higher if you have mild liver damage, low Viral load and other predictors. Tx extension seems to increase the chance for SVR also. 40% is the old school, before pegylation.
see if the patch works as well for you, it never affected my enzymes, even during treatment.
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Interesting how most doctors don't know anything about hormones and hep C! My enzymes have been normal even when on the estrogen replacement!  When I went off of it, the doctor thought I was nuts, then they found out that ERT might not be so good after all.

Thanks to calfia for the article.  I think I will order and give it to my doctor also.  I will not try the patches now, as Kaiser does not cover the cost. I guess I just live with the hot flashes, but as I think of it, i realize how much it effects the quality of life.  I sweat so terribly at times, I don't want to do things.

Terriri, I know what you mean about knee bone connected to hip bone kinda stuff!  I would wake up in the morning feeling like my hip joint was stretched out of place, then my knee etc.  It is comforting to know I am not the only one who has experienced these things, as my doctors make me feel like I am a hypochondriac, or just shrug it off.
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I am ssooo tired of doc's treating women like we don't know how we feel and then because they don't know, they make us out to be "nuts". I have been having joint pain for years plus now I have sweats so bad I can't stand it. But, it can't possibly be caused by hormones...thank you so much for this...I too will "train" my doc and make him see that I am NOT NUTS!!!
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It's interesting that you asked that question.  I started taking bio-identical hormones 3 months ago and last Thursday when I went to my Dr he asked me what I've been doing different in the last 3 months because my liver enzymes are going up and now they are high.  I told him about the bio hormones and he told me to stop taking them.  I guess I will see next month when I get my blood work done if it will make a difference and the enzymes will lower.
You're right, it's back to the night sweats and the hot flashes.  I've only been off of them a week this Friday so I haven't gotten any sides yet.
I will keep you posted on how my blood tests come out
Linda
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I was interested in your story. I don't have a gallbladder, removed 25 y.o. so that is not causing the pain. I cut back on my hormones and spent the night with hotflashes, sweats. This is so dissapointing, the hormones have been working so great!! Felt like I was 20 again when I started them. I also work with 3 doctors, a liver specialist,A Women ND who specializes in hormones,she is the one who perscirbed the estrogen, progestron, testostrone cream to "avoid" the liver,  a male ND who specializes in Hep C. NONE of these 3 think that the hormones are causing liver upset. amazing.....I hope that it works out that I can stay on hormones, I can't get myself to consider tx, (genotype 1), doctor says 40% chance it will work. Thanks to all you women for your support, I am sending the article to the three Doctors above!
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More anecdotal info:  I use a ring which secretes estradiol to local tissue but causes no systemic effects.    Normal LFT's !
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thanks for your response. I started the bio hormones in April with low ast,alt.s (30) had been for 30 years. In Oct, 4 months after starting my enzymes are around 200, my doctor said he thought I must have been on a drunk!! Don't touch alcohol. He still feels there is no relationship between the increase and hormones but thanks to all you great women now I know differently.
I must say that it is easy to get confused with Hep C symtoms (symptoms) and menapausal symtoms (symptoms). I do know that when I started hormones all my HA went away along with all my aches in joints, sweats, water retention, etc. From having 4 sisters in menapause also a clientel of women I talk with all day that these are menapausal systems. Going off hormones will be another true test. Thanks for the suggestions on  chinese herb and Rem. I am also back to my accupucturist.. will let you know how next test results comes out
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Love it Chevygal55!  "I GOT THE POWER"  When I was on hormones, the hot flashes, night sweats, restless legs went away.  But then the side effects I mentioned before were worse!  Has anyone else had adverse symptoms while on the hormones?  I also have cryoglobulins, and wonder if that mixed with the hormones caused the problems I was experiencing.  I was told by someone that hep C can make you go into menopause, because of the effect on the liver function.  I think I will research all of this soon.
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going on hormones made me sooo much better, mainly because I could finally sleep at night after to many nights of no sleep. I loved being on them but I had to cut back (been 9 days now) to half the dose then I will go to none for awhile to see if my liver enzymes come down. I hope it does the trick.  (i was using bioidential creams)
Good luck .
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