Hormone Review

47/W/F had my hormones done 6/20/07. Dr.'s nurse called to let me know I had hormone irregularities - did I "need help".  I expressed that I smoked, and that I felt "ineligible" for help.  I now feel that I do need some help, I am very, very fatigued and get crazed PMS the day before my period.  I have noticed hair loss, a bit more perspiration, but no other problems.  I am a stablized, medicated bi-polar, too...I would like to try hormones, is there a way with the smoking.  Yes, I should quit, however, at this time, it is more like cut back.  Estradiol day 10 was 190 (ref range 150-528) LH 46.8 (ref range 8.7-76.3) and FSH Serum 15.1 (ref range 3.4 - 33.4) Thanks for your advice.  

[Machelle Seibel, MD]

Try to reduce your smoking to a minimum. If your symptoms are severe enough, you can go on low dose estrogen, but there is a slight increase in risk of stroke if you smoke. That is a risk benefit that must be discussed with your doctor. There are other ways to help manage your symptoms. Exercising is one very good one. Walk daily or other regular exercise. Drink lots of water - 8-12 glasses daily. Low doses of progesterone can help with PMS symptoms and the risk is lower than with estrogen. Other medications such as SSRI antidepressants can help with these symptoms as well but you must talk with your doctor about how they might interfere with medications you are taking for bipolar disease. Also, stress reduction and relaxation techniques can be helpful in reducing your symptoms. Look into programs near you.
Machelle M. Seibel, MD