Q1: What is progesterone?
Q1:
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.
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Q2: 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.
Q3: 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.
Q4: 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.
Q5: 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.
Q6: 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.
Q7: 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.
Q8: 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.
Q9: 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. This means that about 1ž4 teaspoon
daily would provide about 20 mg/day.
Q10: 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.
Q11: 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.
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Q12: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
Pre menopause: Balance Your Hormones and
Life from Thirty to Fifty (Warner Books,
1999)
Dr. Lee's monthly
newsletter, the John
R. Lee, M.D. Medical Letter, is also
highly recommended for the latest news and
breakthroughs in hormone replacement therapy,
as well as practical, how-to information
on hormone balance and optimal health. For
more information visit www.johnleemd.com
online, call (800) 528-0559, or write to
P.O. Box 84900, Phoenix, AZ 85071.