Progesterone–who needs it? (who doesn’t need it?)

Progesterone is a critical ovarian produced steroid hormone that plays specific roles throughout a woman’s life. For women who are premenopausal, progesterone production begins around mid-cycle, rises to a peak @ day 21 of the typical cycle, and then plummets in the absence of pregnancy, triggering a period @ 2-5 days later. Low progesterone during this “luteal” or “moon phase” of one’s cycle is referred to commonly as PMS. During this PMS time of the month low progesterone and normal or high estrogen levels create the typical pattern of “estrogen dominance,” with weight gain, water retention, breast tenderness, mood swings and general crabbiness. For these women, when testing confirms low luteal progesterone, anti-aging physicians prescribe bioidentical progesterone. This includes either (or both) topical progesterone or oral progesterone. With proper dosing and timing adjustments PMS symptoms will usually decrease or disappear altogether.

Most gynecologists and family doctors only think about the uterine protective effects of progesterone, so that when women have hysterectomies they don’t recommend it. That is a very bad decision, as post hysterectomy patients generally gain a lot of weight and experience major mood problems when they are given nothing or unopposed estrogen. What they need, as virtually all postmenopausal women need, is progesterone (and usually estrogen as well in the form of Biest). .

What are the roles of Progesterone in one’s body?

Progesterone::

Balances the effects of estrogen
Has a calming effect and enhances mood
Has beneficial cardiovascular effects
Balances blood sugar and thyroid function
Helps rebuild bone 9up to 10% increase in bone density on clinical studies).

Among the many symptoms of low progesterone are::

Anxiety
Depression
Irritability
Mood swings insomnia
Pain and inflammation
Osteoporosis
Decreased HDL
Painful menstruation

I have seen many women gradually reduce and later discontinue (under medical supervision) their anti-anxiety and anti-depressive drugs as well as sleeping pills after they achieved the optimal progesterone levels and proper progesterone to estradiol ratio (the goal is @ 300 to 1 on salivary or blood spot testing). Men with mood problems and those with high estradiol levels can be greatly helped by progesterone if levels are low.

Hormone receptor positive breast cancer is the major contraindication to progesterone. All patients seeking bioidentical hormone replacement therapy need regular cancer screening before and for the duration of treatment. There have been no studies showing an increased risk of cancer with bioidentical progesterone. Ther have been studies (Women’s Health Initiative) showing that the bio-similar (not bio-identical) progestins in Prempro increase risks for many conditions including cancer. That is why progestins should be avoided. True progesterone is healthy and natural for our bodies.

Women who are having periods usually use progesterone from days 14 to 25 of their cycle. Sometimes it is started earlier, like day 10, if mood problems warrant it. Too much progesterone thins out the lining of the uterus and can throw off the normal menstrual cycle and cause spotting at random times. Too much progesterone can also increase appetite and sugar cravings. That is why your doctor needs to be experienced In managing your use of hormones via followup labs and consultations.

Women who have stopped menstruating can use progesterone 5-7 days a week.

Compounded topical and oral progesterone is best obtained from experienced nationally recognized compounding pharmacies. Topical progesterone in a cream or gel is calming and often mood elevating when taken once daily, usually in the morning, applied to the forearms which are rubbed together. Oral sustained release progesterone capsules are taken an hour before bedtime if insomnia is an issue. Some women use both forms in the beginning and often later switch to just oral or cream.

So if you are interested in hormone and potentially slowing the aging process, be sure your doctor evaluates your progesterone levels using salivary of blood spot (capillary blood) samples. These are collected on @ day 21 of your cycle if you are menstruating or any day if you are not. If they are low please see your fellowship trained anti-aging, bioidentical hormone specialist who can prescribe the best progesterone dose, vehicle of delivery and schedule of use to meet your needs. Your clinical response and progesterone levels will then be monitored and the plan adjusted accordingly.

It is well worth the effort to balance estrogen EVEN IF YOU ARE NOT TAKING ESTROGEN. Creating a healthier progesterone to estrogen balance will promote a better shape, a better mood, a better sleep and a better you!

Stephen A. Center, MD
ABAARM Board Certified
Fellowship Trained Anti-Aging Medical Specialist