August 5, 2009

Dr. Bird, a leading expert on hypermobility has written about the ‘Hormonal Aspects of Hypermobility.”  As always, we will only be quoting excerpts from this article, even though it is now available online (see link below)

“Although oestrogen tends to stabilise collagen, progestogens loosen it. Many hypermobile patients, though not all, noticed a worsening in symptoms, more pain in the joints, clumsiness or a greater tendency to dislocate in the five days leading up to menstruation and in the few days after menstruation. This is exactly the time when the progesterone compounds far exceed the stabilising oestrogen compounds…. ”

Women who have increased pain during menstruation usually notice this after their period has become irregular which means that the estrogen/progesterone ratio may be off.

His suggestion?

Avoid progesterone only pills or  “progesterone depo contraception preparations or … mechanical devices impregnated with progesterone.”  But he also points out that this is not a one size fits all answer. Some women cannot take estrogen contraceptives, in which case  he suggests trying a different kind of  progesterone. More importantly, you need to discuss the pluses and minuses of your contraceptive choices with your doctor. Handing your doctor a copy of Dr Bird’s article would be a good start.  If you live in the UK,  the article is part of the Hypermobility Leaflet Pack.

And what about post-menopause when estrogen vanishes and the potential for pain increases?  Will hormone therapy help in spite of the risks?  “Since the oestrogen amount [during HRT]  is very small…..[it] is often not enough to provide a protective effect for the joints.”

more here



  1. Dr Bird is wrong. Scientific studies and personal experience show that estrogen and relaxin increase together during the menstrual cycle. Estrogen inhibits new collagen formation. Relaxin increases collagenase activity in ligaments (breaks them down/lengthens them). Progesterone inhibits these actions. Postpartum 12 years ago and again last month, I didn’t ovulate (zero Progesterone on bloodwork) and both times my ligaments fell apart. 12 years ago when I started cycling regularly (ovulating) and adding progesterone cream, my joints slowly returned to normal. This time I’m adding oral progesterone because I’m not ovulating. Dr. Bird is correct in saying some of us hypermobile women don’t have problems until we have irregular cycles, but that’s because we are not ovulating. Aside from small amounts from the adrenals, ovulation is the only source of progesterone in the body. It can’t magically appear. Progestin only birth control inhibits ovulation 50% of the time. So one would expect to become worse. Protestin is not progesterone. I just wanted to caution those that may think adding estrogen is the key. It’s not and could doors harm than good. There is some good science out there. Google estrogen, relaxin, progesterone and ligament.

    • Kerch, thanks for your comment. It matches my experience. Depo injection hasn’t made my joints worse. But I was put on estrogen for other reasons & sudden everything fell apart. It felt like every joint in my body was affected. Most obvious were the SIJs but even joints in the hands & feet previously fairly stable became severely affected.

      Googling hormones & hypermobility, almost all of the comments about estrogen helping stabilise joints are a copy & paste of Professor Bird’s comments or cite him. The ones saying estrogen makes joints less stable are from a variety of sources (endocrinologists, studies of female athletes & pregnancy health professionals). If Professor Bird is right he needs to cite evidence. Meanwhile the opposite seems likely.

  2. I think maybe this is too complex for easy answers one way or the other? I am definitely more lax on bioidentical progesterone cream and before my period. No question about it. Have no clue how estrogen affects me.

  3. Also, there are many women with ehlers-danlos hypermobile type who refuse to take progesterone because it makes them worse.

  4. I suffer from hms, and have increased issues with my hips specifically. Especially during menstration. my physical therapist and I were seeing improvements in my condition until menstration hit and things fell apart so bad we were further back than step on. Now they put me on the depo prevera shot (progesterone) and things are a little better and a little more stable. so I would think progesterone is a good thing. Unfortunately we are at the stage of we either fuse my hips or shut down my ovaries to see what happens. Not sure what to think of the whole thing, but there are answers somewhere, and hopefully they bring a decent recovery. I know I will never be 100%, but any step towards normality works for me.

  5. I had just the opposite experience. My EDS hypermobility symptoms improved dramatically at menopause, but my progesterone dropped to almost zero and I decided to use a small amount of natural USP progesterone cream. Even with a very small dose, within a few days my shoulder, hips, knees and ribs were dislocating. My estrogen, testosterone and DHEA are all in normal range.

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