Endo cyst - surgery or progesterone treatment?

[AnnaHoe]

Dear Lara, dear community,
hello from Germany. I am 31 and planning on trying to conceive end of this year. I have two 5cm endometriosis cysts, my gyn suggests surgery. She doesn't know much about hormones or progesterone therapy. I read on Prof. Jerilynn Piors CEMCOR site, that you could use 600mg natural progesterone for 6 months. Should I try this first or do the surgery right away? Or does it suppress the cycle so much that I couldn't get pregant after getting back to cyclic prog therapy and it's only an option to suppress endometriosis instead of the pill? I made an appointment at an endo centre in six weeks, until then I wanted to use progesterone 200mg orally and 200mg vaginally according to the cycle, maybe that already helps?

It's pretty strange that I developed the cysts, last year in January there was nothing. I've already been using natural progesterone 300 mg for the second part of my cycle since August and noticed less pain and less sore breasts, better mood, less migraine, less PMS symptoms etc. so I was really surprised about the cysts.
I had been on the pill until I was 23, after I had five good years with no bad symptoms and then at 27, PMS and pain and acne started and got really worse. After two years I found Lara's book and real information so I've been trying to keep it in check with nutrients, progesterone etc. I guess it was connected to a leaky gut and taking antibiotics for years because of cystitis after getting off the pill, stress, partying a lot etc.

Thank you all so much for your advice!

[Lara]

Thanks for sharing your story. Just to confirm, when you say, "last year in January there was nothing," do you mean you had an ultrasound then? with no endometriomas?

If so, it is odd that they would develop so quickly, especially during a time when you were feeling better with your other symptoms. Any diet changes or other medication in the past couple of years?

As to what to do going forward, I don't recommend 600 mg daily progesterone as that would suppress ovulation. It probably makes sense to bring on board natural endometriosis treatments like zinc, N-acetyl cysteine etc. And maybe surgery... I'm happy to have others chime in here.

[AnnaHoe]

Dear Lara,
thank you so much for your answer, that means so much to me!

Yes, ultrasound, in January '22 at my check-up my gyn talked about my follicles which were easy to see and there was nothing covering them, I saw those black points. Now there are these huge light-shaded balloons (one on each side) in front of them. Maybe they were really small back then. I had some pain in autumn on the right side after my period but it went away, so I didn't have a check-up.

I was eating a cleaner diet until summer last year, no dairy sugar alcohol wheat, and then after July I was drinking a lot more (weddings etc.) and eating everything. I am back to the cleaner eating now because I want to shrink the cysts, hopefully it works. I read your info about mast cells, histamine, dairy, wheat etc. I probably should stick with it anyway. My endometriosis can't be so bad if the pain is manageable with progesterone, I guess, so I would not have done a laparoscopy just to diagnose it.

I also did have Covid three times, in Oct 21, March 22 and Okt 22, the first time I developed inflamed acne and my hair was falling out, maybe a bit of Post-Covid. I also took antibiotics for the massive inflammation in my face then. And I had the vaccinations against HPV last year.
A naturopathic doctor gave me a very low dose of T3 (a quarter of a pill each morning) in April 22 to see if I am fitter. Now I'm less tired and my metabolism is faster. Maybe this had an effect on estrogen? She also gave me DHEA for a while because that was low. And I take your recommended supplements for my PMS, magnesium 300mg, zink 30 mg, iodine 200 mcg and also vitamin D with K and A. I also supplemented iron for a while because I lost much blood and was very tired, but I read about iron overload and copper deficiency, so I don't know if it was a good move.

My own wild theory is that the progesterone "set free" the estrogen in my tissues, so it circulated and caused growth of cysts? Not sure if that is really possible though. Jessica Ash talks about estrogen in the tissues a lot. But my breast cysts didn't grow and are way better on progesterone.

I am a bit worried that surgery might hamper fertility because the cyst may not be easily removed next to the ovary. But generally I am not against it. It's just so annoying, now that prog helped me so much, I thought I would finally get back to normal life now. And I don't want to get off the prog.

Sorry for the difficult case and thank you for your time!