Questions and Answers
1 What is progesterone?
- 2 What is the difference between natural progesterone and progestins like Provera®?
- 3 What is estrogen?
- 4 What are progesterone and estriol made from?
- 5 What is “estrogen dominance”?
- 6 What causes “estrogen dominance”?
- 7 What are the symptoms of “estrogen dominance”?
- 8 What are the benefits of progesterone?
- 9 When is progesterone recommended?
- 10 How do I know if I need progesterone alone or progesterone with estriol?
- 11 Can estrogens be used without natural progesterone?
- 12 How much progesterone should I use?
- 13 Where should I apply progesterone lotion?
- 14 Where should I apply estriol & progesterone lotion?
- 15 Wouldn't it be easier to just take a progesterone pill?
- 16 How safe is progesterone supplementation?
- 17 What are the symptoms of excess progesterone?
- 18 Who should not use progesterone?
- 19 Who should not use estriol with progesterone?
- 20 I am already taking a hormone prescription from my doctor, why should I change to natural hormones?
- 21 Can I discontinue HRT?
- 22 I'm post menopausal, will I start menstruating again if I use natural hormones?
- 23 Is natural progesterone and estriol useful after hysterectomy, oophorectomy (removal of ovaries) and menopausal women?
- 24 Can I use natural progesterone if there is a family history of breast or uterine cancer?
- 25 Can I use progesterone if I am on birth control pills?
- 26 If natural progesterone has so many benefits, why don't physicians routinely recommend it to their patients?
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 produced in the body from cholesterol, and is a precursor to most of the other steroid hormones, including cortisol, estrogens and testosterone.
In a normally cycling female, the corpus luteum produces 12 to 24 mg of progesterone daily during the luteal phase (second half) of the menstrual cycle.
Simplified pathway for biosynthesis of hormones (graph opens in new window)
2 What is the difference between natural progesterone and progestins like Provera®?
Natural progesterone is identical with the hormone produced by human body and has no undesirable side effects when used as directed.
Progestins are substances similar to, but not identical with progesterone:
Black circles indicate groups added to natural progesterone. Because of this “uniqueness” Provera® could be patented.
Pharmaceutical companies devoted much effort to developing progesterone-like substances that are patentable. While those substances are capable of inducing more potent body responses than natural progesterone, they carry serious side effects: breast cancer, strokes, fluid retention, migraine headaches, asthma, cardiac irregularities and depression.
3 What is estrogen?
More accurately estrogens; it’s the name of a group of hormones: estradiol, estrone and estriol. Estriol is the weakest and safest estrogen that might even protect against breast cancer. Estrogens are to a woman what testosterone is to a man. However, both women and men have some of each, but in different proportions. Estrogens are the basic female sex hormones and are responsible for the development of female characteristics. In order to maintain good health estrogens should be balanced by progesterone *.
4 What are progesterone and estriol made from?
Progesterone USP and Estriol USP used in natural hormone replacement (NHRT) are made from a substance called diosgenin, which is extracted from wild yam (Dioscorea villosa), or from soybeans. In a laboratory process, diosgenin is transformed into progesterone or estriol, identical with the human hormones.
Some companies are selling diosgenin, which they label as "wild yam extract" claiming that the body will convert it into hormones as needed. While this can be done in a laboratory, there is no evidence that this conversion takes place in the human body.
5 What is “estrogen dominance”?
This term coined by Dr. John R. Lee* relates to a condition when there is insufficient progesterone in proportion to estrogen (estrogen is unbalanced or unopposed).
6 What causes “estrogen dominance”?
Major causes of estrogen dominance:
- non-ovulatory cycles: many women experience them as many as ten years before menopause. In those cycles enough estrogen is made to create menstruation, but not enough of progesterone is made to balance it. Even after menopause estrogen continues to be produced in the fat cells while progesterone production is greatly diminished
- environmental estrogens; our food is a significant source of those: livestock is fed estrogens to grow faster and gain weight by retaining water; crops are sprayed with pesticides that mimic estrogens.
- birth control pills, ERT and HRT
- impaired liver function
- prolonged intense stress increases demand for cortisol, which is made from progesterone. The process leaves less progesterone available for balancing estrogen.
7 What are the symptoms of “estrogen dominance”?
Symptoms of estrogen dominance include weight gain, bloating, mood swings, irritability, tender breasts, headaches, fatigue, depression, hypoglycemia, uterine fibroids, endometriosis, fibrocystic breasts and PMS. Estrogen dominance is known to increase the chance of developing cancer of the breast, ovary, endometrium (uterus), and in men - prostate.
8 What are the benefits of progesterone?
There are many functions of progesterone in human body, but one of its most important roles is to oppose the negative effects of excess estrogen.
John R. Lee, M.D.* lists the following benefits of progesterone:
- Protects against fibrocystic breast
- Protects against endometrial, breast and ovarian cancer and in men – prostate cancer
- Helps normalize blood sugar levels
- Helps use fat for energy
- Prevents water accumulation (acts as mild diuretic)
- Helps (normalizes) thyroid hormone function
- Stimulates new bone formation (osteoporosis protection and even reversal)
- Improves brain function, has antidepressant properties
- Improves skin problems including acne, seborrhea, rosacea, psoriasis
- Diminishes muscular aches and pains, has anti-inflammatory properties
- Improves sleep pattern
- Improves libido.
9 When is progesterone recommended?
Dr. Lee and other authors* recommend using progesterone for:
PMS: symptoms that occur consistently 7 to 14 days before the period and stop with or shortly thereafter.
Premenopausal/menopausal symptoms: water retention, breast swelling, fibrocystic breast, uterine fibroids, loss of libido, mood swings, depression, cravings for sweets, weight gain, fat deposits at hips and thighs. Light symptoms resulting from estrogen fluctuations, like hot flashes, night sweats and vaginal dryness can also be relieved by progesterone.
Osteoporosis: Healthy bone is being continuously reconstructed: new bone is created while the old tissue is reabsorbed. After the age of 30 the process of creating new bone tends to slow down. This imbalance leads to osteoporosis. After menopause the process of bone loss accelerates. Progesterone stimulates new bone formation, preventing osteoporosis; it can even reverse its progress. You should also supplement calcium and magnesium, vitamin D and other micronutrients. Include weight-bearing exercise in your self-care.
10 How do I know if I need progesterone alone or progesterone with estriol?
Dr. Lee and other authors* explain that if you have moderate to heavy symptoms resulting from estrogen fluctuations like hot flashes and night sweats, or overall low level of estrogens is causing vaginal dryness or “mental fog” that does not clear with progesterone itself, then use progesterone with estriol. If in doubt, first try progesterone alone.
11 Can estrogens be used without natural progesterone?
Dr. Lee and other authors* clearly state that estrogens should always be used with progesterone.
12 How much progesterone should I use?
An appropriate dose is the minimal amount that alleviates hormonal imbalance symptoms. Do not exceed the dose recommended on bottle label or information insert.
If you do not have clearly visible symptoms and are taking progesterone preventively because of its benefits, do not exceed 10 - 15 mg per day depending on your weight and progesterone deficiency. After about a year you can reduce the dose to 7 to 10 mg per day. As a guide, monitor your bone density and have the progesterone level checked by your physician or use a saliva test.
13 Where should I apply progesterone lotion?
Absorption is best from face, neck, chest, breasts, inner arms, palms of the hands and the backside of the knees.
14 Where should I apply estriol & progesterone lotion?
As described above, except breasts.
15 Wouldn't it be easier to just take a progesterone pill?
Transdermal application requires much smaller doses than oral because up to 90% of the oral dose is lost through liver metabolism. Thus, 200 mg orally is needed to achieve an effect similar to 20 mg transdermally. Such a high oral dose creates short-lived high levels of progesterone and unnecessarily overloads the liver.
16 How safe is progesterone supplementation?
It is very safe because human body can accommodate very high levels of the hormone. During the third trimester of pregnancy, the placenta produces about 300 mg of progesterone daily, so one-time overdose is virtually impossible. You would need to apply more than 200 drops of ClearPatch 5% lotion to reach 300 mg dose.
17 What are the symptoms of excess progesterone?
Too much progesterone can cause a few very typical and
temporary side effects, usually a feeling of drowsiness or sleepiness. By observing these reactions you can adjust optimum individual dose: reduce the amount or discontinue for a period of time if they occur.
Long-term excessive use of progesterone may result in signs of estrogen deficiency, such as hot flashes. If this occurs, reduce progesterone dose; avoid using higher than the recommended dosage to avoid hormonal imbalance. More is not better when it comes to hormone balance *.
According to Dr. Uzzi Reiss*, there is a very small percentage of women who respond paradoxically to progesterone. They are usually the same women who have difficulties tolerating birth control pills or HRT. For those women, an otherwise normal dosage of progesterone produces a reaction opposite to the one described above. For example, they might experience feeling anxious and have difficulty sleeping. The reaction does not pose any danger. They can discontinue using progesterone or use the very small amount they can tolerate, because even a small dose is usually enough to achieve the benefits that would require a much higher dose in other women.
Persons responding paradoxically often have an underlying condition e.g. systemic candidiasis. Treatment of this condition usually resolves progesterone paradox.
18 Who should not use progesterone?
Do not use progesterone while using hormone-based birth control. Consult a doctor in case of a serious health condition, taking prescription medication, when using hormonal therapy, pregnant, planning to become pregnant or nursing.
19 Who should not use estriol with progesterone?
Contraindications to estrogens use include the following:
- Suspected or previously diagnosed estrogen-dependent neoplasia (breast or advanced stage uterine cancer)
- Active thrombosis or embolic disease
- Undiagnosed uterine bleeding
- Active liver disease or severely impaired liver function
Do not use estriol with progesterone while using hormone-based birth control, if pregnant, planning to become pregnant or nursing. Consult a doctor in case of a serious health condition, while taking prescription medication or using hormonal therapy.
20 I am already taking a hormone prescription from my doctor, why should I change to natural hormones?
There are many side effects to synthetic hormone replacement therapy, which are dangerous to your health, especially if taken without progesterone. Estrogens (estrone and estradiol) without progesterone increase the chance of developing endometrial (uterine) or breast cancer *. Unbalanced estrogens interfere with thyroid function and cause water retention, fibrocystic breasts and even fibroid tumors of ovaries. These effects and potential problems caused by unopposed (unbalanced) estrogens are greatly reduced or even eliminated by the presence of progesterone *.
21 Can I discontinue HRT?
Many women taking estrogen or estrogen combined with progestins were able to discontinue their HRT. It is best to consult a medical professional before doing so, preferably one with NHRT (natural HRT) experience.
In his books*, Dr. Lee gives guidelines for replacing HRT with natural hormones.
22 I'm post menopausal, will I start menstruating again if I use natural hormones?
In his books*, Dr. Lee explains that occasionally, upon initial use of progesterone or estriol you may experience menstrual flow. This is a normal response and is not a cause for alarm. Even progesterone alone is capable of re-sensitizing estrogen receptors and that in turn occasionally stimulates uterine shedding - thus the bleeding. If this occurs for more than a few months, consult your health care practitioner.
23 Is natural progesterone and estriol useful after hysterectomy, oophorectomy (removal of ovaries) and menopausal women?
Many women experience hot flashes following hysterectomy and complete removal of ovaries, as in the beginning of the natural onset of menopause.
Dr. Lee and other authors* recommend natural progesterone for relief of mild hot flashes and other symptoms in most women within 3 to 8 weeks. If hot flashes are not completely relieved, estriol with progesterone can be used. Consultation with a health care practitioner is recommended.
24 Can I use natural progesterone if there is a family history of breast or uterine cancer?
Dr. Lee and other authors* point to estrogen dominance as factor contributing to breast and uterine cancer. According to the authors, restoring hormonal balance with natural progesterone reduces cancer risk.
25 Can I use progesterone if I am on birth control pills?
Birth control pills usually contain synthetic progestins. It is not recommended to take them together with natural hormones. Birth control pills have been known to cause many health problems when taken over a long period of time.
26 If natural progesterone has so many benefits, why don't physicians routinely recommend it to their patients?
Progesterone is a natural substance and as such cannot be patented for sale at high profit margins. That makes pharmaceutical companies uninterested in marketing and promoting natural products such as progesterone. If pharmaceutical representatives don't market a product to physicians, many physicians are simply unaware of its existence.
John R. Lee, M.D. What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone
John R. Lee, M.D. What Your Doctor May Not Tell You About Premenopause: Balance Your Hormones and Life from Thirty to Fifty
Uzzi Reiss, M.D., O.B.-GYN. Natural Hormone Balance for Women: Look Younger, Feel Stronger and Live Life with Exuberance
Joseph McWherter, M.D. Avoiding Breast Cancer While Balancing Your Hormones. The FEM Centre Breast Cancer Program.
prescribed by your physician. For those with chronic medical problems
or taking a regularly prescribed medication, please consult your health care practitioner.
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