Frequently Asked Questions About Progesterone Cream
by Dr. 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 a suggested part of Bio-identical 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 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 support overall hormone balance after menopause.
Dr. Lee recommends the creams that contain 450-500 mg of progesterone per ounce, which is 1.6% by weight or 3% by volume. Daily, a good dosage would provide about 20 mg/day.
Q: Why not just use the progestin Provera as prescribed by most doctors?
A: Many women tend to prefer progesterone 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 can also contribute to many other side effects, including partial loss of vision, breast cancer, an increased risk of strokes, fluid retention, migraine headaches, asthma, cardiac irregularities and depression.
Q: What is estrogen dominance?
Estrogen Dominance is used 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 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 maybe 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 bio-identical 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?
For pms, progesterone would be used for 14 days before expected menses, stopping the day or so before menses. For perimenopause, use progesterone day 8 through the rest of the month. 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 1.6% by weight or 3% by volume. Daily, a good dosage 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 can be 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 can 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: The Breakthrough Book on Natural Progesterone, (Warner Books, 1996)
- What Your Doctor May Not Tell You About Premenopause: Balance Your Hormones and Life from Thirty to Fifty (Warner Books, 1999),
Q: Where can I get natural progesterone?
A: Here is a web page where you can get more information about Awakening Woman Natural Progesterone Cream.
Dr. John Lee has led the way in the field Of bio-identical hormone replacement.
John R. Lee, M.D. is internationally acknowledged as a pioneer and expert in the study and use of the hormone progesterone, and on the subject of Bio-identical Hormone Replacement Therapy for women. He used transdermal progesterone extensively in his clinical practice.
Dr. Lee had a distinguished medical career, including graduating from Harvard and the University of Minnesota Medical School. He retired from a 30-year family practice in Northern California to write and travel around the world speaking to doctors, scientists and lay people about progesterone. Dr. Lee taught a very popular course on "Optimal Health," at the College of Marin for 15 years.
Dr. Lee was the author of the best-selling books, What Your Doctor May Not Tell You About Breast Cancer, What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone (Warner Books, 1996), What Your Doctor May Not Tell You About Premenopause: Balance Your Hormones and Your Life from Thirty to Fifty (Warner Books, 1999), and editor of the John R. Lee, M.D. Medical Letter.
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