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Progesterone Therapy

Progesterone therapy is controversial in many ways. There is a debate about the similarity between natural progesterone (the molecule your body makes) and artificial progesterone (progestins). There is concern that combining estrogen with progesterone will actually increase breast cancer risk. There is concern that progesterone may blunt the cardiac protective effect of estrogen. There is controversy as to the best method of testing for hormone levels in order to diagnose and guide therapy. These controversies make it difficult for patients to make a choice. Everyone is looking for a simple answer. There is no simple answer. Therapy must be individualized and monitored for benefit.

The conventional medical community sees no difference between the progesterone your body makes and molecules designed to look like progesterone (progestins). In general, the conventional community tends to prescribe the progestins, and not natural progesterone. There is a group in the Integrative Medicine community that does not discriminate between real progesterone and the progesterone like molecules found in a variety of plant material (yams). I am interested in using the natural progesterone molecule that is the same molecule as our bodies make (men and women). I believe it has more health benefits and is safer. I believe the dose must be individualized for each woman. The dose may vary based on age, underlying health problems and an individuals ability to absorb and metabolize the hormone.

Recent medical literature has reported that the combination of estrogen (premarin) plus progestin (artificial progesterone) is associated with an increased risk to breast cancer after 5-10 years of use. There are multiple citations in the medical literature suggesting that natural progesterone is protective for breast cancer. These studies suggest that progesterone diminishes the cancer promoting effect of estrogen. A study by Chang, de Lignieres, et al entitled, “Influences of percutaneous administration of estradiol and progesterone on human breast epithelial cell cycle in vivo,” demonstrates the protective effect of natural progesterone.

The controversy as to the best test continues. Laboratory directors, who I trust, feel that the time will come when salivary sex hormone assays will be reliable. At this time the testing is not FDA approved. The reagent used to do this testing must be modified from reagent that was designed to test the hormone levels in serum. I find that salivary hormone assays may be a useful screen. They are not reliable for following patients who are using hormone supplements.  I will continue to use the serum levels for now.

Progesterone is a hormone that is necessary for fertility and the maintenance of a health pregnancy. Progesterone is important for good health in general. The brain and peripheral nervous system manufacture progesterone. This hormone is important for normal neurological functioning. Progesterone stimulates thymus gland activity and is important in healthy immune function. Progesterone is a ‘Pro-Hormone.’ Many other hormones are derived from it. It is an important hormone for stress adaptation since cortisol is made from progesterone. An increase in stress produces a relative progesterone deficiency since the progesterone is used to make additional cortisone. Excess cortisone competes with progesterone and can create signs of progesterone deficiency.

Signs and Symptoms of Progesterone Deficiency:

  • Psychological symptoms include anxiety, hyperirritability, mood instability and sleep disturbance
  • Difficulty with conception and maintenance of pregnancy
  • Fluid accumulation symptoms such as painful swollen breasts, hand and feet swelling and abdominal bloating
  • Fibrocystic breast disease
  • Premenstrual syndrome
  • Perimenstrual headache

Using Progesterone before Menopause:

Many women experience symptoms of estrogen dominance/excess. These symptoms include:

  • Psychological symptoms such as anxiety, depression, hyperirritability and nervousness
  • Cervical dysplasia
  • Dysfunctional uterine bleeding
  • Fibrocystic breast disease and or breast tenderness
  • Gall bladder disease
  • Fluid retention symptoms such as facial puffiness, hand and feet swelling and abdominal bloating
  • Facial flushing
  • Uterine fibroids

These symptoms or signs in a menstruating/premenopausal woman will prompt me to test for estrogen/progesterone ratios in the mid-luteal phase of the menstrual cycle. Treatment is based on lab findings plus the clinical presentation.

Using Progesterone during Menopause:

Estrogen levels decline during menopause. The ovary stops making hormones but estrogen is still produced by metabolism from the adrenal hormones. Estrogen levels decline by 40-60%. Progesterone levels decline more dramatically. In many women, estrogen replacement is not necessary. There may still be a role for progesterone replacement. Progesterone replacement may be considered:

  • To help in symptom control
  • To offset the adverse effects of estrogens on the breast and uterus
  • To improve bone metabolism and help prevent osteoporosis
  • To support the beneficial effects of estrogen on the cardiovascular system

Progesterone Dosing

The oral or trandsermal route can be effective treatment. Treatment is individualized as to dose and method of delivery.

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