This week was 58 miles of running, 1500 yards of swimming and 18 "miles" of pool-running -- training log is here.
Another jumbled up week - I did a long intervals workout on Monday in anticipation of another attempt at an IUD insertion on Tuesday. Fortunately, this time they were able to get it in. I felt an odd sense of accomplishment even though I literally did nothing but sit there.
Predictably the misoprostol (cervical dilation medication for the IUD insertion) made me feel lousy on Tuesday. But, I have to admit, I haven't felt great the last few weeks, independent of the IUD insertion stuff. This of course could be heat and humidity, or also the birth control pill changes. But since I have had past issues with low folate, Vitamin D, and/or iron, I decided to buy a blood test and check those again.
As it turned out, all of those were fine. But what was NOT fine was my cholesterol. My LDL (bad cholesterol) has jumped in the past 6 months from its normal 80-100 (which is acceptable) to 160 (which is bad).
From a strictly cardiovascular perspective, this isn't that concerning, since my blood pressure is low and my HDL (good cholesterol) is excellent. But it does indicate that something is going on, and one of the most obvious causes is menopause - the drop in estrogen results in a big jump in LDL.
[obvious question - wouldn't I know that I was in menopause? The answer is no - until recently I was on continuous birth control so I didn't have a period. And that same birth control pill meant that we couldn't do any bloodwork to look for indicators of menopause, since the birth control pill would alter the values.]
As it turns out, I was able to get in to see an ob-gyn who is a menopause specialist this Friday. We discussed, and she pulled some blood to see if there were indications of menopause while also starting me on supplemental estrogen, taken in the form of a gel that I apply once a day.
There are some obvious questions and answers here:
1) why did I have to go off of the estrogen/progestin pill due to the dangers of estrogen at my age, only to start using estrogen gel?
- Apparently the stroke risk of estrogen is associated with taking it orally; when you take it transdermally, it's absorbed in a different way that reduces the stroke risk.
2) won't you feel silly for going to all that effort to get an IUD if it turns out that you are menopausal?
- Actually the IUD is very useful. One of the risks of estrogen supplementation is uterine cancer, which is addressed by also prescribing progestin to protect the uterus. The preferred form of delivering the progestin to the uterus is an IUD - in fact the same one I just got (Liletta). So that worked out great.
3) isn't this hormone therapy violating the doping rules?
-not if I'm only replacing estrogen and progesterone - both of those are totally fine, with no TUE required. It's when you start adding in testosterone or HGH, or taking DHEA, that you get into trouble. Interestingly (and sadly) when I mentioned to the doctor that I suspected many of my competitive peers were taking testosterone and/or DHEA, she agreed with me. So that sucks. But it is what it is - I'm going to play by the rules.
4) wasn't there a study indicating that estrogen supplementation was very dangerous in menopausal women?
- yes, but that study was done on women who were sedentary and taking estrogen for the first time in their 60s. More recent research has shown that if you start estrogen replacement at or just before menopause, and you also take progestin, and you do not have a history of breast cancer, then it's fairly safe. Nothing's perfectly safe, of course, but I eat red meat and run by myself in the morning - this really falls into the same level of risk.
I started the estrogen supplementation on Saturday, so I'm only a few days in. I noted as of Monday morning that I felt fresher and less stiff, but of course that could just be the placebo effect. We'll see how this week plays out. I ended up skipping my planned marathon pace workout this weekend because I was feeling off and wanted to give the estrogen some time to start working. Hopefully I'll be able to do it this coming weekend.
Monday: 10.5 miles, including a track workout of 3x2400m in 11:04, 10:58, 10:47, each with about 2:50 jogged recovery. Followed with leg strengthwork and 500 yards recovery swimming. Foam rolling at night.