FAQ's About Progesterone Cream
by John R. Lee, M.D. and Virginia Hopkins
Q: What is progesterone?
A: Progesterone is a steroid hormone made by the
corpus luteum of the ovary at ovulation, and in smaller amounts by the
adrenal glands. Progesterone is manufactured in the body from the
steroid hormone pregnenolone, and is a precursor to most of the other
steroid hormones, including cortisol, androstenedione, the estrogens and
testosterone.
In a normally cycling female, the corpus luteum produces 20 to 30 mg of
progesterone daily during the luteal phase of the menstrual cycle.
Q: Why do women need progesterone?
A: Progesterone is needed in hormone replacement
therapy for menopausal women for many reasons, but one of its most
important roles is to balance or oppose the effects of estrogen.
Unopposed estrogen creates a strong risk for breast cancer and
reproductive cancers.
Estrogen levels drop only 40-60% at menopause, which is just enough to
stop the menstrual cycle. But progesterone levels may drop to near zero
in some women. Because progesterone is the precursor to so many other
steroid hormones, its use can greatly enhance overall hormone balance
after menopause. Progesterone also stimulates bone-building and thus
helps protect against osteoporosis.
Q: Why not just use the progestin Provera as prescribed by most doctors?
A: Progesterone is preferable to the synthetic
progestins such as Provera, because it is natural to the body and has no
undesirable side effects when used as directed.
If you have any doubts about how different progesterone is from the
progestins, remember that the placenta produces 300-400 mg of
progesterone daily during the last few months of pregnancy, so we know
that such levels are safe for the developing baby. But progestins, even
at fractions of this dose, can cause birth defects. The progestins also
cause many other side effects, including partial loss of vision, breast
cancer in test dogs, an increased risk of strokes, fluid retention,
migraine headaches, asthma, cardiac irregularities and depression.
Q: What is estrogen dominance?
A: Dr. Lee has coined the term 'estrogen
dominance,' to describe what happens when the normal ratio or balance of
estrogen to progesterone is changed by excess estrogen or inadequate
progesterone. Estrogen is a potent and potentially dangerous hormone
when not balanced by adequate progesterone.
Both women who have suffered from PMS and women who have suffered from
menopausal symptoms, will recognize the hallmark symptoms of estrogen
dominance: weight gain, bloating, mood swings, irritability, tender
breasts, headaches, fatigue, depression, hypoglycemia, uterine fibroids,
endometriosis, and fibrocystic breasts. Estrogen dominance is known to
cause and/or contribute to cancer of the breast, ovary, endometrium
(uterus), and prostate.
Q: Why would a premenopausal woman need progesterone cream?
A: In the ten to fifteen years before menopause,
many women regularly have anovulatory cycles in which they make enough
estrogen to create menstruation, but they don't make any progesterone,
thus setting the stage for estrogen dominance. Using progesterone cream
during anovulatory months can help prevent the symptoms of PMS.
We now know that PMS can occur despite normal progesterone levels when
stress is present. Stress increases cortisol production; cortisol
blockades (or competes for) progesterone receptors. Additional
progesterone is required to overcome this blockade, and stress
management is important.
Q: What is progesterone made from?
A: The USP progesterone used for hormone
replacement comes from plant fats and oils, usually a substance called
diosgenin which is extracted from a very specific type of wild yam that
grows in Mexico, or from soybeans. In the laboratory diosgenin is
chemically synthesized into real human progesterone. The other human
steroid hormones, including estrogen, testosterone, progesterone and the
cortisones are also nearly always synthesized from diosgenin.
Some companies are trying to sell diosgenin, which they label 'wild yam
extract' as a medicine or supplement, claiming that the body will then
convert it into hormones as needed. While we know this can be done in
the laboratory, there is no evidence that this conversion takes place in
the human body.
Q: Where should I put the progesterone cream?
A: Because progesterone is very fat-soluble, it is
easily absorbed through the skin. From subcutaneous fat, progesterone is
absorbed into capillary blood. Thus absorption is best at all the skin
sites where people blush: face, neck, chest, breasts, inner arms and
palms of the hands.
Q: What is the recommended dosage of progesterone?
A: For premenopausal women the usual dose is 15-24
mg/day for 14 days before expected menses, stopping the day or so before
menses.
For postmenopausal women, the dose that often works well is 15 mg/day
for 25 days of the calendar month.
Q: What amount of progesterone do you recommend in a cream?
A: Dr. Lee recommends the creams that contain
450-500 mg of progesterone per ounce, which is 1.6by weight or 3by
volume. This means that about ¼ teaspoon daily would provide about 20
mg/day.
Q: How safe is progesterone cream?
A: During the third trimester of pregnancy, the
placenta produces about 300 mg of progesterone daily, so we know that a
one-time overdose of the cream is virtually impossible. If you used a
whole jar at once it might make you sleepy. However, Dr. Lee recommends
that women avoid using higher than the recommended dosage to avoid
hormone imbalances. More is not better when it comes to hormone balance.
Q: Wouldn't it be easier to just take a progesterone pill?
A: Dr. Lee recommends the transdermal cream rather
than oral progesterone, because some 80 to 90% of the oral dose is lost
through the liver. Thus, at least 200 to 400 mg daily is needed orally
to achieve a physiologic dose of 15 to 24 mg daily. Such high doses
create undesirable metabolites and unnecessarily overload the liver.
Q: Where can I get more information on progesterone and natural hormone
balance?
A: For a detailed explanation of women's hormone
balance issues, a hormone balance program, as well as detailed
descriptions of how to use natural progesterone, the following books by
John R. Lee, M.D. are recommended:
What Your Doctor May Not Tell You About Menopause
What Your Doctor May Not Tell You About PREmenopause
What Your Doctor May Not Tell You About Breast Cancer
'Reprinted with permission of www.johnleemd.com .'
