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FAQ about Progesterone

What is Progesterone?

Progesterone is a steroid hormone made by the corpus luteum 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, and 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.

Why do women need progesterone?

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 (prevent estrogen dominance).  Unopposed estrogen creates a strong risk for breast cancer and reproductive cancers.  Estrogen levels drop only 40 to 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.

Do I need progesterone if I’ve had a hysterectomy?

There is a common belief among some in the medical community that if a woman has had a hysterectomy, specifically having her uterus removed, there is no need for progesterone. However, progesterone has other uses in the body besides balancing the effects of estrogens in the uterus. Progesterone receptors are found in many other areas of the body including the kidneys, thyroid, bones, and nerves. Read our article, “Do Women Need Progesterone after a Hysterectomy” for more detailed information.

Why not just use a progestin (medroxyprogesterone) as prescribed by some doctors?

Progesterone is preferable for us to the synthetic progestins such as Provera, because it is natural to the body.  If you have any doubts about how different progesterone is from the progestins, remember that the placenta produces 300 to 400mg 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 breast cancer, increased risk of strokes, fluid retention, migraine headaches, asthma, cardiac irregularities and depression. For more information about the difference between bioidentical progesterone and medroxyprogesterone click here.

What is estrogen dominance?

Estrogen dominance is a term 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 potent and potentially dangerous hormone when not balanced by adequate progesterone.  Both women who have suffered from PMS and women that 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.

Why would a premenopausal woman need progesterone cream?

In the ten to fifteen years before menopause, many women regularly have anovulatory cycles (menstrual cycles that do not release an egg) 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 and the precursor for cortisol is progesterone.  When progesterone is shunted to cortisol we call this a “progesterone steal”.  Additional progesterone is required to overcome this shunt and stress management is important.

shutterstock_173835521Where should I apply the progesterone cream?

Because progesterone is very fat-soluble, it is easily absorbed through the skin.  Once administered the progesterone is absorbed into capillary blood.  Apply the cream to thin skin with high capillary density…..chest, breast, inner arms, and neck.  Some women love the way progesterone works as a face cream.  Rotate among three or four different skin sites on different days.  Always apply after, not before a bath or shower.  If used at bedtime it may be calming and help you sleep. Be careful to prevent avoid transferring hormones to an unintended person. Wash hands after applying and allow a couple of hours after application before allowing someone to come in contact with that area of skin.

Is progesterone cream safe to use?

During the third trimester of pregnancy, the placenta produces about 300mg of progesterone daily, so we know that a onetime overdose of cream is virtually impossible.  If you used a whole jar of cream at once, it might make you sleepy.  However, more is NOT better when it comes to hormone balance.  Using more progesterone than you need can cause the hormone to be stored in fat which will result in weight gain and will be slow to leach out.

What are the possible side effects of progesterone cream?

  1. Lethargy or sleepiness:  Caused by a by-product called allopregnanolone
  2. Edema:  Caused by excess conversion to deoxycortisone, a mineralocorticoid that causes water retention
  3. Bloating:   Excess progesterone slows gastrointestinal transport which can lead to bloating and gas.  During pregnancy the high levels of progesterone slow food transport through the GI tract to enhance absorption of nutrients.
  4. Exacerbated symptoms of estrogen deficiency:  Excess progesterone in the absence of estrogen.  A woman must have estrogen on board for progesterone to work.

What is the recommended dosage for progesterone?

For premenopausal women the usual dose is 20 mg/day on day 14 thru 25 of cycle. (Day 1 is the first day of your cycle).  For postmenopausal women, the dose that often works well is 20 mg/day for 25 days of the calendar month. See our article “Progesterone Dosing Recommendation” for more information.