Desperate - LPD & "Low" Estrogen - 2 Interpretations of Testing by Different Drs

  I have had 4 miscarriages and 1 live birth. A RE dianosed an LPD and I started on Clomid - took it for 4 mos (150 mg the last month) w/no pregnancy. We moved and I am seeing a new Dr - my period stopped for 10 mos. She gave me provera (nothing) then premarin(1.25 mg) and provera (still nothing) and finally premarin (2.5 mg) and provera and it came back. I want to get pregnant and my Dr was going to treat the LPD with just progesterone. I asked her to check my estrogen (in the 3rd cycle after my period resumed) because I have hot flashes, dryness, painful intercourse, no libido, etc (which have existed in vartung degrees as long as three years)and had noted that premarin relieves these (I took prematin while on clomid in addition to having taken it to help bring on a period). My day 3 estrogen was 19 which my Dr. characterized as "low" so she has sent me to a RE. He told me that if I get a period then I have enough estrogen (despite my bloodwork). He is focusing on establishing that I have an LPD (even though I have already had a FULL workup by another RE) with day 21 progesterone (my first day 21 was 0.9 and was 26.4 on day 28). I'll be having another progesterone in a few weeks. I know that I've always ovulated late (day 22 of 30) and previous biopsies have shown the lining to be out of phase so I don't have a problem with the diagnosis of a LPD. In the meantime I don't know what to think in terms of estrogen - my Ob/Gyn left her practice and I Have been unable to get in touch with her. I'm 33 and have such bad hot flashes I change my clothes at night and have vaginal discomfort such that I can't use tampons! This RE told my husband and me to use aspercreme to numb me and astroglide for lubrication. My LH and FSH are okay (my OB/GYN said "borderline"). Please give me your opinion - my OB/GYN told me I needed HRT and this RE says I have enough estrogen and is focusing on progesterone - I can't continue to live like this...
Dear Maureen:
Hot flushes and vaginal dryness are symptoms of low estrogen. Approximately 7% of women, around the time of menses, can have these symptoms. In a woman who only has menstrual periods in response to exogenous estrogen (Premarin 2.5 mg)priming of the endometrium and a serum estradiol level below 20 pg/ml, ovarian failure (menopause) is the most probable diagnosis.
Menopause is established by an FSH level greater than 30 or 40 mIU/ml. However, FSH values above 20 mIU/ml indicate low likelihood that any therapy will promote fertility. An estradiol level below 20 pg/ml is also strongly suggestive of menopause. Finally an FSH/LH ratio <1 also indicates a poor outlook for fertility.
There can be a 10-year interval, often called the perimenopause, during which there are wide swings in levels of estrogen and FSH. During this interval, a woman can appear to have fertility potential in some months and menopause in other months.
Keywords: low estrogen
This information is provided for educatin purposes and is not a medical consultation. If you have specific questions, please speak with your physician.