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Questions on Estrogen and Progesterone

Agatha M. Thrash, M.D.
Preventive Medicine

What exactly is natural progesterone, and how does it differ from synthetic progesterone?

Natural progesterone, a cholesterol derivative, comes from Mexican yams or soybeans. It matches exactly the chemical composition of the body's own progesterone. Synthetic progesterones, or progestagens, were designed to simplify any treatment that called for progesterone. Dr. Niels Lauresen, author of "PMS and You" says of synthetic progestagens, "Progestagens are chemically formulated from progesterone, but rather than duplicating the properties of progesterone, these synthetic hormones react differently when a woman is treated with synthetic progestagens, her body becomes confused and produces less natural progesterone, causing salt build-up, fluid retention, and hypoglycemia.... Synthetic progestagens generally make PMS symptoms worse, so if a woman is about to be treated with progesterone, she should be sure that it is NATURAL progesterone."

Are there any side effects from using natural progesterone?

Most frequently, any side effects from natural progesterone are associated with usage, and can be easily alleviated by changing the amount and frequency of the dosage. In the PMS age group, using too much progesterone over a protracted length of time (one to four months) can delay the period a day or two. Discontinuing the progesterone will cause the period to start, and progesterone use can be resumed after 7 days, but at a lower dose. Also, women with irregular periods might notice some spotting at ovulation upon beginning progesterone treatment. What's indicated here is that the period is trying to regulate on a 28-day cycle. With continued usage, the period will become regular and the spotting will be alleviated. Women who are beginning menopause might also notice some spotting when they begin using natural progesterone. This too should be alleviated with continued use. The post-menopausal and osteoporosis age group should not have any side effects at all.

Do I need a prescription for natural progesterone?

No. Natural progesterone in a cream or oil base comes from a Mexican yam, which is technically a food product. All of the other ingredients, aside from a trace of some cosmetic ingredients, are natural.

Can I use natural progesterone without estrogen for the prevention of osteoporosis?

Absolutely. Some feel that supplemental estrogen is not generally necessary for menopausal and post menopausal women who still have their ovaries. If vasomotor flushes "hot flashes" are occurring, the natural progesterone is usually adequate in relieving them. It is generally recommended to use natural progesterone daily and then every fifteen minutes during a hot flash. If after 1 month, hot flashes are still occurring, some natural estrogen is suggested always accompanied by natural progesterone. Estrogen use should continue until the hot flashes have ceased completely; then natural progesterone by itself can continue indefinitely.

How long will I have to use natural progesterone before I see any benefit?

In the case of PMS, some women will have immediate benefit - within minutes. Some might not notice a relief from symptoms for 2-3 months. Women who experience dysmenorrhea (cramping upon menstruation) or migraine headaches should continue to use natural progesterone during their period in order to get relief; whereas use of natural progesterone should normally be stopped with the onset of the period. Menopausal women who are experiencing hot flashes are advised to use natural progesterone every 15 minutes until the hot flash has ceased. On an average, menopausal symptoms will be relieved, or at least significantly decreased in 2-3 months. There are many exceptions here though; one being, a woman who has had a complete hysterectomy (removal of uterus and ovaries), and may need to use some estrogen in addition to the natural progesterone to relieve her symptoms. Every woman's body is different, and there is no exact way to predict when benefits will be noticed. In a study done by Dr. John Lee on women with osteoporosis, bone scans indicated that 5% new bone density occurred in a period of six months after each woman used natural progesterone daily and followed a specific nutritional regime.

Can natural progesterone help with endometriosis or fibrocystic breast disease?

There are many factors that affect both of these conditions, one common factor being a higher level of circulating estrogen, indicating a hormonal imbalance. Progesterone is the precursor hormone, and it helps to normalize all other endocrine and hormonal activity in the body. It will make or block estrogen as necessary—in this case, assisting to lower the level of estrogen in the body and thus possibly helping to clear these conditions.

Does natural progesterone help with vaginal dryness?

Vaginal dryness can occur in women of all ages for various reasons, but it is primarily present in postmenopausal women. Natural progesterone in a cream base can be used intravaginally and has been very successful in treating vaginal dryness and vulvar dystrophy associated with aging.

In the case of hysterectomy, doesn't some form of estrogen need to be used?

Not necessarily. If the hysterectomy involves removal of the uterus only, natural progesterone alone should be adequate in controlling menopausal symptoms and helping to prevent osteoporosis. In the case of a complete hysterectomy (removal of uterus and ovaries), it is recommended to start by using natural progesterone only. If no relief occurs within 2 weeks to a month, some estrogen is probably necessary.

Can estrogen be used without natural progesterone?

Definitely not. It is very important that natural progesterone be used with any form of estrogen. Estrogen without progesterone can cause endometrial and vaginal carcinomas. Estrogen blocks thyroid hormones, causes water retention; and it can cause fibrocystic breast disease and even fibroid tumors & cysts in the ovary area.

I have already gone through menopause and have never taken hormones. Do I need to take natural progesterone?

Some women who haven't had any menstrual trouble will not have any menopausal symptoms, and thus probably would not need to use the natural progesterone. However, if there is a possibility of osteoporosis, it might be wise to use small doses of natural progesterone and follow a nutritional regimen for prevention of osteoporosis.

I am already using hormones from my doctor, why should I switch to natural progesterone?

Natural progesterone is simply an alternative to hormone replacement therapy. Synthetic progesterone has many side effects, and synthetic estrogen can be dangerous to your health, especially if taken without any progesterone. If someone is taking both synthetic estrogen and progesterone, a gradual step might be to at least substitute natural progesterone for the synthetic, then gradually back off of the synthetic estrogen and let the natural progesterone take over. If hot flashes or any other symptoms occur and the natural progesterone doesn't clear them up within 1 to 2 months, some natural estrogen might be added to the program.

Can men use natural progesterone?

If a young man under 45 uses very much, it will cause his testicles to shrink and his libido to decrease. However, older men 55 and up can use natural progesterone daily and it will cause the libido to increase. Older men with rheumatoid arthritis have gotten relief from the pain and swelling after rubbing natural progesterone in a cream base on their joints. Although a very small number, older men have actually been diagnosed with osteoporosis. In these cases, use of natural progesterone and a specific nutritional regimen is recommended as well.

I am trying to get pregnant. Will natural progesterone help me?

Progesterone plays a crucial role in reproduction. First, it prepares the uterus for the implantation of a fertilized egg. Without adequate progesterone in the uterine wall, the egg cannot attach itself and is expelled. So if a woman is having trouble getting pregnant, it may be a simple matter of what is called "luteal phase deficiency," which results when a woman produces an inadequate amount of progesterone after ovulation. In these cases, natural progesterone therapy would be very effective.

Adequate progesterone levels also allow an implanted fertilized egg to remain in place. Women who have had unexplained miscarriages in the first trimester might be suffering because of a shortage of progesterone. Here also, natural progesterone therapy could be effective.

How do I know if I am using enough natural progesterone?

Each woman's need for natural progesterone is different, as each one has specific symptoms that are affected by many different factors, including poor nutrition, stress, and physical illness. For menstruating women, natural progesterone is usually used for 21 days on and 7 days off—7 days being the menstrual period. Amounts used might increase in the 7-10 days before the period, if PMS symptoms occur. After several months usage, this will probably taper off, and natural progesterone will be necessary only 5-7 days before each period.

Menopausal women can use natural progesterone every day—increasing amount if hot flashes occur. Again, usage will probably taper off, as hot flashes decrease. After a woman has been free of hot flashes and menopausal symptoms for 1 month, she might be wise to continue using natural progesterone indefinitely for prevention of osteoporosis. Women who have osteoporosis can also use natural progesterone every day - especially if bones have already thinned and are starting to break.

I am post menopausal, will I start menstruating again if I use natural progesterone? What if I have some breakthrough bleeding?

Occasionally upon beginning use of a natural progesterone supplement, a post menopausal woman could experience some breakthrough bleeding, or a "period." This is a perfectly normal response and is nothing to cause alarm. The progesterone is simply causing the body to rid itself of excess stored estrogen, which can sometimes stimulate a uterine shedding - thus breakthrough bleeding. If this continues for longer than several months, one should consult with a health care provider.

What is the difference between natural progesterone in a cream base and in an oil base?

The oil is a 10% progesterone solution and is administered sublingually and is most effective in relieving severe symptoms more quickly. The body cream is a 3% progesterone solution and is applied topically for effective relief from most symptoms and for long range maintenance therapy. In some cases, it has proven effective to use the oil and the cream together for severe symptoms of PMS and menopause.

I have amenorrhea. Can natural progesterone and natural estrogen help with this condition?

Amenorrhea can be the result of prolactin-producing pituitary tumors, anorexia nervosa, or intense long-distance running associated with undernourishment. These conditions cause cycle irregularities and ovulatory disturbances, which in turn affect the levels of circulating estrogen and progesterone. If a woman is not ovulating, she will most likely develop an estrogen deficiency, which can be brought under control by natural progesterone and possibly some natural estrogen. If the time between ovulation and menstruation (luteal phase) becomes less than 10 days, a progesterone deficiency can develop, because during the luteal phase is when progesterone is produced. The use of natural progesterone and some sort of nutritional regimen should cause menstruation to resume. If it does not, it is strongly recommended that progesterone therapy be continued to prevent accelerated bone loss associated with estrogen deficiency.

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