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FAQs About Natural Progesterone Cream by John R. Lee, M.D. and Virginia Hopkins

Posted Feb 10 2010 10:00pm

I posted these links last week on two new websites I foundVirginia Hopkins Health Watch and Health Watchers’ News & Views.

Both sites have some excellent resources and articles on menopauseperimenopause and bio-identical hormones.  I contacted Virginia Hopkins to receive permission to reprint some of their articles and she kindly gave me the permission to reprint this one.

It is a Frequently Asked Questions article on natural progesterone and estrogen dominance with Dr. John R. LeeMDthe author of What Your Doctor May Not Tell You About Menopause and What Your Doctor May Not Tell You About Premenopause.

Q: What is progesterone ?

A: Progesterone is a steroid hormone made by the corpus luteum of the ovary at ovulationand in smaller amounts by the adrenal glands. Progesterone is manufactured in the body from the steroid hormone pregnenoloneand is a precursor to most of the other steroid hormonesincluding cortisolandrostenedionethe estrogens and testosterone.

In a normally cycling femalethe 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 reasonsbut 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 menopausewhich 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 hormonesits 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 Proverabecause 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 progestinsremember that the placenta produces 300-400 mg of  Progesterone daily during the last few months of pregnancyso we know that such levels are safe for the developing baby. But progestinseven at fractions of this dosecan cause birth defects. The progestins also cause many other side effectsincluding partial loss of visionbreast cancer in test dogsan increased risk of strokesfluid retentionmigraine headachesasthmacardiac 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 symptomswill recognize the hallmark symptoms of estrogen dominance: weight gainbloatingmood swingsirritabilitytender breastsheadachesfatiguedepressionhypoglycemiauterine fibroidsendometriosisand fibrocystic breasts. Estrogen dominance is known to cause and/or contribute to cancer of the breastovaryendometrium (uterus)and prostate.

Q: Why would a premenopausal woman need progesterone cream?

A: In the ten to fifteen years before menopausemany women regularly have anovulatory cycles in which they make enough estrogen to create menstruationbut they don’t make any progesteronethus 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 blockadeand stress management is important.

Q: What is progesterone made from?

A: The USP progesterone used for hormone replacement comes from plant fats and oilsusually a substance called diosgenin which is extracted from a very specific type of wild yam that grows in Mexicoor from soybeans. In the laboratory diosgenin is chemically synthesized into real human progesterone. The other human steroid hormonesincluding estrogentestosteroneprogesterone and the cortisones are also nearly always synthesized from diosgenin.

Some companies are trying to sell diosgeninwhich they label “wild yam extract” as a medicine or supplementclaiming that the body will then convert it into hormones as needed. While we know this can be done in the laboratorythere 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-solubleit is easily absorbed through the skin. From subcutaneous fatprogesterone is absorbed into capillary blood. Thus absorption is best at all the skin sites where people blush: faceneckchestbreastsinner 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 mensesstopping the day or so before menses.

For postmenopausal womenthe 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 ouncewhich is 1.6% by weight or 3% by 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 pregnancythe placenta produces about 300 mg of progesterone dailyso 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. HoweverDr. 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 progesteronebecause some 80% to 90% of the oral dose is lost through the liver. Thusat 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 issuesa hormone balance programas well as detailed descriptions of how to use natural progesteronethe following books by John R. LeeM.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

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