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I started an oral contraceptive (Zenchent) 7 months ago due…

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I started an oral contraceptive...
I started an oral contraceptive (Zenchent) 7 months ago due to severe menopause symptoms. I have dysautonomia with overactive sympathetic nervous system. Menopause started at age 44 and I’m 46 now. I had tried hrt prior but had symptoms at times despite high doses.
Just had blood tests done and my SHBG is 286!
I want to transition to hrt but I’m terrified of getting off the pill. I don’t want severe acne, but with SHBG this high, the drop coming off will surely cause excess testosterone/sebum effects. If these effects are as extreme as my SHBG I’m in for a problem.
Can you please recommend a transition plan to avoid acne and the rebound coming off the pill? My cortisol levels are up on the pill too.
Zenchent is chewable and can be cut, per the pharmacist. I don’t need contraception because I’m infertile - never able to have children due to endometriosis and now I’m menopausal.
I think some sort of taper would work best for avoiding acne and also creating worse dysautonomia symptoms.
Would switching to a different pill or to an oral form of Estrace or even adding in testosterone be of benefit? My menopause symptoms are so severe that I’m not sure how low I can tolerate the pill dose. I struggle when under 25 mcg of ethinyl estradiol.
I feel trapped. Why is my SHBG so high? I’m 46, 5’3” and 110 pounds. I eat a low-carb diet and work out. I’m battling fatigue, heartburn, insomnia, nausea, and persistent genital arousal disorder due to the dysautonomia which intensified with menopause.
I’m interested in starting bioidentical hrt. I’m open to any possible solutions.
Please help...
Submitted: 4 months ago.Category: OB GYN
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Answered in 42 minutes by:
3/7/2018
OB GYN Doctor: DocPhilMD, Doctor replied 4 months ago
DocPhilMD
DocPhilMD, Doctor
Category: OB GYN
Satisfied Customers: 59,661
Experience: Board Certified Internist trained in OB/GYN
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Hi, this is Dr Phil, here to assist you. I am Board Certified with over 10 years of experience. I will respond with my answer shortly. Thank you.

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OB GYN Doctor: DocPhilMD, Doctor replied 4 months ago

Do you still need help?

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Customer reply replied 4 months ago
I posted a question regarding my ridiculously high SHBG level of 286 on Zenchent oral contraceptive and wishing to transition to HRT. Can you recommend a way to taper (Zenchent is chewable and I do not need contraception) or to gradually reduce SHBG to avoid severe acne/testosterone rebound? Please note my menopause symptoms are severe and I have dysautonomia. Started menopause at 44 and I’m 46 now. Please help.
OB GYN Doctor: Dr David, Doctor replied 4 months ago
Dr David
Dr David, Doctor
Category: OB GYN
Satisfied Customers: 49,910
Experience: Experienced physican trained in ob-gyn and oncology
Verified

This is Dr. David

how has the Zenchent helped your menopausal symptoms? if it helps, you can stay on it for now and you don't necessarily have to go to HRT

it sounds like your liver is making too much SHBG. that is the most common cause of high SHBG

do you have bad anxiety symptoms? this can raise baseline cortisol levels.

do you have acne problems now?

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Customer reply replied 4 months ago
Hello,
The Zenchent has helped my menopause symptoms more consistently but I still get breakthrough symptoms that are moderate to severe about 50% of the time. My skin is sagging quite a lot and I am concerned about bone density. I thought the pillow was supposed to help with these things.It is hard to make a good decision with so many unanswered questions, misinformation and conflicting information. The pill is supposed to be stronger than HRT but one study I read showed that HRT even at low doses increased bone density while in oral contraceptive just maintained bone density. The study also indicated that 25 mcg of an oral contraceptive was the lowest dose effective at maintaining bone density. Yet an endocrinologist that I saw refuses to prescribe more than 20 mcg due to risks . Some say that the pill is more protective for younger women under 50 going through menopause. Others say HRT is better.I do have anxiety and my dysautonomia causes increased cortisol due to dysregulation of the stress response. I understand that the pill increase his court is all is well.I do not have any acne now but in The past I had bad acne when I came off of a different type of oral contraceptive pill. I want to minimize the possibility of that happening again. I don’t have a history of any acne except when I had discontinued the pill in the past.
OB GYN Doctor: Dr David, Doctor replied 4 months ago

the pill can help you. drinking more water and getting regular exercise and eating more fruits and vegetables and getting proper sleep can help your skin. exercise and diet are the best thing for your bone density.

have you had a bone density test recently? are you suffering from osteoporosis now or osteopenia or are you just worried?

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Customer reply replied 4 months ago
I exercise regularly and drink a lot of water. I also have a good diet. I’m quite thin and osteoporosis runs in my family which is why am concerned about that along with going through menopause early. I I’m concerned that the high SHGB level could put me at an increased risk of blood clots. Can you advise how to go about transitioning from the pill to HRT by reducing The pill gradually and also gradually increasing HRT So as to reduce SHGB gradually rather than abruptly?
OB GYN Doctor: Dr David, Doctor replied 4 months ago

it sounds like you are worrying about things which you don't have now

I would get a bone density test first

I bet it will show you don't have osteoporosis or osteopenia at this point.

I would not stress about increased risks for blood clots.

HRT has the same risks for blood clots as birth control pills.

you can stop the pill right away or taper the pill. most doctors don't taper patients off of birth control pills.

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Customer reply replied 4 months ago
Is there a way to reduce SHGB while taking the pill? Can testosterone be supplemented while on the pill?How can acne be avoided when coming off the pill?
OB GYN Doctor: Dr David, Doctor replied 4 months ago

testosterone supplements won't help.

do you have acne problems now?

how do you know you will get acne when coming off of the pill? you may not.

medications like spironolactone can help prevent acne in patients who have high

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