PROGESTERONE

Progesterone is the predominant hormone produced during the second half of thc menstrual cycle. It is produced following the release of an egg by the corpus luteum to maintain the uterine lining until implantation.

Progesterone is also a precursor hormone for most of the other steroid hormones including cortisol, estrogen, aldosterone, and testosterone. It requires vitamin B6 and magnesium for its synthesis. Testosterone requires additional zinc. Since many women experience stress and are deficient in these vitamins, they will often experience symptoms from low progesterone during the second two weeks of their menstrual cycle,

If progesterone levels are very low there might also be a deficiency of estrogen and testosterone. This will lead to problems with sexual dysfunction regardless of age. Since the environment has so much estrogen-like substances present in our meat, dairy and poultry, a woman who is under stress and has a mineral poor diet will be exposes to high estrogen without the support of progesterone. When progesterone levels are low, women are susceptible to the symptoms described above.

To determine a woman's progesterone and estrogen levels, it is best to check the hormones during mid luteal phase. Levels are drawn at approximately day 20 to 24 of the menstrual cycle (using the first day of the menses as day 1). Looking at the relationship between the levels of estrogen, testosterone and progesterone is helpful in confirming the diagnosis. Replacing progesterone in the form of capsules, creams or sublingual drops or lozenges can alleviate many of these symptoms. It is also important to change the diet and give a good multivitamin with adequate B vitamins as well as calcium and magnesium.

Progesterone is usually supplied during the second half of the menstrual cycle, starting after ovulation around day 14 and taken until the onset of menses. For women  with long cycles, it may be necessary to take the progesterone for longer than two weeks each month. If the menses does not start after three weeks on progesterone, it is recommended to take a break for a week and then restart again. Symptoms from too much progesterone are lightheadedness, dizziness and feeling sleepy. If these symptoms occur, a lower dosage can be taken.

The following are symptoms from low progesterone:

Psycho-emotional: anxiety, depression, suicidal thoughts, difficulty with concentration irritability, mood swings, fuzzy thinking Headaches Weight gain, bloating, fluid retention Food cravings Painful joints and muscles Low libido Insomnia Menstrual cramps, heavy bleeding, shorter cycles (less than 28 days) Acne, Fibrocystic breasts, painful breasts Ovarian cysts Fibroids.

Since progesterone levels decrease under stress due to the increasing need for cortisol, reduction of stress with rest, meditation and decrease in physical activity might me necessary. Since progesterone requires vitamin B6 with magnesium for it's synthesis, a supplement of these may be helpful(see below). Herbs such as vitex, bupleurum and peony combination.

Recommended supplements: Multivitamin mineral With adequate B complex Vitamin B6 100-300 mg daily (increase dosage for water retention) Magnesium 250 mg two times daily (too much can cause diarrhea) Vitex 20 mg daily or tincture 20 - 30 drops twice daily talcen from day 14 until menses Can be combined wih Bupluerum and PeoDy combination (available in the office).

Progesterone is also available as a supplement in over the counter creams, tablets and by prescription. Most over the counter creams contain about 20 mg per 1/4 teaspoon. Progon B tablets from Bezwacken also will raise pro,gesterone . The dosage is 2 to 4 tablet twice daily. Depending upon the level this may be adequate or a prescription can be made with 50 to 100 mg of micronized progesterone. A prescription for progesterone can be made in a 10% cream giving 100 mg per 1/4 teaspoon, sublingual drops with 50 mg per 8 drops, or a sublingual lozenge with up to 100 mg of DroQter.Acne- Problem ,

Instructions for Progesterone

Since progesterone is produced predominantly during the second 14 days of the menstrual cycle, it is usually begun on day 14. Take the pills or use the cream twice daily until the start of menses. Stop when the menstrual bleeding begins. If you have severe cramping, you may use some progesterone on the first few days of the cycle.

For progesterone cream, use the spoon to measure the amount to be used, spread on to palms and then on inner arms, inner thighs and abdomen. If the cream takes a long time to absorb, you may be using too much for your body. Try to rotate the areas, using different surfaces.

Symptoms of excess progesterone are dizziness and fatigue. They are transient but could be alimenting. They should resolve within 30 minutes. Please contact me if they don't.

If you use the progesterone for 3 weeks without any bleeding, take a one week break and then restart again. If you go for more than 3 weeks without a cycle please notify me.

If you are not having regular cycles, use the progesterone for 3 weeks out of the month unless we have discussed another protocol.

Instructions for Progesterone

Since progesterone is produced predominantly during the second 14 days of the menstrual cycle, it is usually begun on day 14. Take the pills or use the cream twice daily until the start of menses. Stop when the menstrual bleeding begins. If you have severe cramping, you may use some progesterone on the first few days of the cycle.

If you use the progesterone for 3 weeks without any bleeding, take a one week break and the restart again.

Symptoms of excess progesterone are dizziness and fatigue. They are
transient but could be alarming. They should resolve within 30 minutes.
Please contact me if they don't.

If you use the progesterone for 3 weeks without any bleeding, take a one
week break and then restart again. If you go for more than ~ weeks without a
cycle please notify me.

If you are not having regular cycles, use the progesterone for 3 weeks out
of the month unless we have discussed another protocol.

 

The HRT Question: Another perspective
Weigh issues, examine lifestyle and
decide with doctor what to do…

Cynthia Watson, MD, a Santa Monica physician specializing in women’s health and author of Love Potions, A Guide to Aphrodisiacs and Sexual Pleasure and All About Lipoic Acid, is a family practitioner in Los Angeles specializing in integrative medicine. She is a graduate of USC and is on staff at Santa Monica-UCLA and St. John's Hospitals. Her in-depth knowledge of hormonal functions in sexuality and female physiology has brought her many national media appearances.

By Cynthia Watson, MD
Special to OurGyn.com

For the past 20 years, the medical community has been prescribing hormone replacement for women in menopause to protect against osteoporosis, heart disease, dementia and vaginal atrophy. Approximately 38% of postmenopausal women were using hormone replacement in 1995. Estrogen was the miracle drug that was going to keep us younger and healthier and prevent us from aging.

It was known as the “youth hormone.” Despite the fact that many women had concerns about risks and side effects from HRT, the benefit was thought to outweigh the potential risks. When the results of the Women’s Health Initiative study were released on July 9, 2002, it sent shock waves through the medical community and the millions of women taking hormones. The study reported that in the women taking estrogen plus progestin, there was an increase in breast cancer, stroke, and blood clots compare to placebo. The study was discontinued after 5.2 years as a result of these findings.

Many women under their doctor’s recommendation stopped taking HRT immediately and suffered from terrible withdrawal symptoms. Some women continued therapy, but decided upon lower dosages or they switched to bio-identical hormones. Now the FDA has decided to put a black box warning label on any estrogen product. All of these concerns make it difficult to know what the best choices are for women, which estrogen to take, and for how long.

The most important issue to explore is that any decision about hormone replacement, from whether or not to begin therapy to the form it takes, must be decided on an individual basis for each woman based on her own family history, life style and personal risk factors. Each patient needs to work with her physician to decide what is best for her based on her biochemical individuality.

Physicians are trying to do the best for their patients to protect them from serious illnesses and help maintain quality of life. Since estrogen can help protect against certain illnesses and at the same time can increase the risk of others, it is often a difficult decision about whether or not to continue hormone replacement. We also do not have adequate research on all the different forms of hormone replacement to predict the long-term consequences of using HRT. Many studies group estrogen therapies together and yet there are differences between the different forms of hormones.

First, let us look at the Women’s Health Initiative research study itself. This study only involved two of the many different forms of estrogen available to women: Premarin® and PremproTM. These estrogens are conjugated estrogens from pregnant mare urine. In the study there were 38 cases of invasive breast cancer per 10,000 women in the group taking PremproTM, the combination of estrogen and progesterone. The control group had 30 cases per 10,000 women. With eight more cases compared to the control, the rate of increase was 26%, which is significant. A separate continuing study is looking at the risk of cardiovascular disease in women who have had a hysterectomy and are using Premarin® only.

The other important outcome of the study was that there was an increased risk of stroke and formation of blood clots causing pulmonary embolism. There was a 42% drop out rate with women discontinuing the hormones due to side effects. Another difficulty was that 3,444 women had vaginal bleeding; 248 of these women required a hysterectomy compared with 183 in the control group. On a positive side there were five fewer fractures per 10,000 and six fewer colorectal cancers. There was no statistical analysis on Alzheimer’s disease or dementia.

This study was limited to only these forms of hormones and only with one dosage. The authors reported in the comment section that the results do not necessarily apply to lower dosages of estrogen or other forms of hormone replacement. This raises a number of questions, especially since the group that had an increase in breast cancer used the synthetic progesterone in PremproTM. The progesterone used in the study, medroxyprogesterone, has been known to have many side effects. In fact, many women have not tolerated the side effects from medroxyprogesterone, which include bloating, breast tenderness, headaches and depression. It is also not clear if other forms of progesterone, either other synthetics or natural progesterone have the same increased risk.

The conclusion from the study is that the overall risks of taking this combination HRT formula is greater that the benefits. If you have a concern about heart disease and stroke, there is no reason to take this type of HRT for prevention. This form of estrogen and progestin can increase the risk of invasive breast cancer and does not reduce the risk of heart disease.

For many women now who have concerns about using hormone replacement it is important to keep several things in mind. We are aware that there are other issues in our environment that increase the risk of cancer, not only breast but other cancers. When you look at a study like this it is hard to know what other factors played into the increase in cancer, heart disease and stroke since these illnesses generally have more than one causative factor. It is not clear whether or not each patient was screened for life style issues, family history, etc., which makes it difficult when you are dealing with an individual patient.

When making a decision for yourself, it is important to weigh all the different factors and life style issues. We know that diet, lifestyle and family history play a major role in the development of cancer and heart disease. There are many other alternatives that are available to women for prevention of the symptoms of menopause and aging. Estrogen isn’t the only treatment. Some women will benefit from taking estrogen but perhaps have fewer complications when using lower dosages of the bio-identical hormones.

Here are some of the ways that I am trying to help my patients with this decision. If women want to stop taking estrogen, it is best for the body to do it gradually, not just suddenly stop the pills, creams or patches. Stopping suddenly will often cause a recurrence of the uncomfortable symptoms that a woman was having when she started HRT initially. If doses are reduced slowly, many women will find that they can use smaller doses or may not need to take hormones at all. For women who have been taking hormones for longer than five years, it may be time to see if lower dosages or stopping all together is an option.

It is important to look at the reasons a woman started HRT in the first place. Was it just to prevent symptoms or was there a more significant problem such as osteoporosis? Are there any other alternatives such as plant hormones or using other hormones besides estrogen? In my practice, I prescribe a variety of hormones including progesterone, testosterone, DHEA and pregnenolone when the levels are low. When using these other hormones in a “hormone cocktail” the overall dosage of estrogen can be lowered and many women feel better overall. In reality, for years the ovaries and the adrenal glands have produced these other hormones.

After menopause, the ovaries stop the production of high levels of these hormones, but the adrenal glands should be pitching in to pick up and produce some hormones. Unfortunately, most women by the time they reach menopause have exhausted their adrenal glands and the production of these hormones are often negligible. It is an easy blood test to have performed by your doctor. Measure the levels of these other hormones and see if they are low. DHEA and pregnenolone are available over the counter but I advise starting with small dosages.

Vaginal dryness is one of the bigger problems to occur when women stop taking hormones or enter into menopause. The vaginal tissues can often become dry and even painful when estrogen levels fall. This can be helped using topical estrogen or testosterone. The Estring is a small ring that sits in the vagina and releases very small amounts of estrogen. It is changed every three months. The amount of estrogen released into the blood stream is minimal and believed to be safe. Vagifem tablets are another low dose forms of estrogen that can help with vaginal dryness that do not release very much estrogen into the blood stream.

Many women are using natural progesterone creams in low dosages that are available over the counter. Most of these creams have between 25 – 30 mg of progesterone per dosage. These creams have been reported to reduce the risk of hot flashes and help with sleep. There is no data to suggest that natural progesterone has the same risk of cancer as the progestins in the study. Unfortunately, there is no information about the long-term safety effects of using natural progesterone. Many doctors including myself who use bio-identical hormones find that the natural micronized progesterone as Prometrium or from the compounded pharmacy is much better tolerated and has fewer side effects when compared to the synthetic. I have preferred to prescribe bio-identical hormones for my patients and have seen many women report that they felt more “ like themselves” compared to using other products.

In the end, whether or not to use hormone replacement therapy and in what form is a very personal decision. Each woman should look at her medical history, risk factors, family history and symptoms and decide how to approach the issue. Prevention of cancer, heart disease, Alzheimer’s disease and osteoporosis requires a lot more that just whether or not to take hormones. Lifestyle issues such as stress, diet, exercise and the use of various supplements can play a major role. (May 2003)

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Nelson, et al (2002). Postmenopausal hormone replacement therapy scientific review. Journal of the American Medical Association, 288 (7).

Nelson, HD (2002). Assessing benefits and harms of hormone replacement therapy clinical applications. Journal of the American Medical Association, 288 (7).

Writing Group for the Women’s Health Initiative. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Journal of the American Medical Association, 288 (3).