Frequently Asked Questions
About Progesterone Cream
by 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 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.
Q: 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.
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 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 is 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 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.
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?
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.
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. 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 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 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.
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 Pre menopause: Balance
Your Hormones and Life from Thirty to Fifty (Warner Books, 1999)
Osteoporosis
A crippling disease that is preventable and reversible.
By John R. Lee, M.D. and Virginia Hopkins
Although cardiovascular disease is the leading cause of death among
American women, osteoporosis is the disease they are most likely to
develop as they age. Four out of ten white women in the U.S. will fracture
a hip, spine, or forearm due to osteoporosis. As many as five out of ten
will develop small fractures in their spine, causing great pain and a
shrinking in height. This amounts to 15 to 20 million people affected by a
crippling and painful disease that is almost entirely preventable and
reversible.
Osteoporosis is a gradual decrease in bone mass and density that can
begin as early as the teen years. Bone mass should be at its peak in our
late 20s or early 30s, but thanks to a poor diet and lack of exercise, many
women are already losing bone in their 20s. Bone loss occurs more rapidly
in women than in men, especially right around the time of menopause,
when an abrupt drop in estrogen and progesterone accelerates bone loss.
When you think of your bones you may imagine a dead skeleton, but your
bones are living tissue, just like the rest of your body, and they need a
good supply of nutrients and regular exercise. New bone is constantly
being made, while old bone is being reabsorbed and excreted by the
body. Our larger long bones, such as our arm bones and leg bones, are
very dense, and they are completely replaced about every 10-12 years.
Our less dense bones, such as our spine and the ends of our long bones,
are less dense and turn over every 2-3 years. Thus, as you can see, we
always have the opportunity to be creating better bone for ourselves.
We all hear about how having enough calcium in the diet and taking
estrogen can help prevent osteoporosis, but there is a much bigger
nutritional and lifestyle picture to look at when we are talking about
preventing this bone-robbing disease. You'll be happy to know that for the
vast majority of women, there is no need to take estrogen to prevent
osteoporosis.
The most important element of bones is minerals. Without minerals we
don't have bones. The most important bone minerals are calcium,
magnesium, potassium, phosphorous and fluoride. Equally important is the
balance between the minerals. Too much phosphorous or fluoride will
create poor bone structure. (Nearly all of us already ingest too much
fluoride.) Without enough magnesium, the calcium can't be absorbed onto
the bone. Vitamins are also involved. For example, vitamin B6 works with
magnesium to get calcium onto your bones.
The hormones testosterone, estrogen and progesterone are also actively
involved in the making and unmaking of bone. Testosterone and
progesterone build bone, while estrogen appears to indirectly slow bone
loss.
In osteoporosis, the old bone is being reabsorbed faster than new bone is
being made, causing the bones to lose density and become thinner and
more porous. The integrity and strength of our bones is related to bone
mass and density. The bones of a woman with osteoporosis gradually
become thinner and more fragile. A progressive loss of bone mass may
continue until the skeleton is no longer strong enough to support itself.
When that happens, bones can spontaneously fracture. As bones become
more fragile, falls or bumps that would not have hurt us before, can cause
a fracture. Bone loss seems to be most severe in the spine, wrists and hips.
Unfortunately there are usually no signs or symptoms of osteoporosis until
a fracture occurs.
Early Signs of Osteoporosis
Sudden insomnia and restlessness
Nightly leg and foot cramps
Persistent low back pain
Gum disease, loose teeth
Gradual loss of height
Your Risk of having osteoporosis is higher if you:
Are a woman
Have a family history of osteoporosis
Are white
Are thin
Are short
Went into menopause early
Have a low calcium intake
Don't exercise
Smoke cigarettes
Drink more than two alcohol drinks daily
Are on chronic steroid therapy (e.g. Prednisone)
Are on chronic anticonvulsant therapy
Are taking drugs which can cause dizziness
Are hyperthyroid
Eat too much animal protein intake
Use antacids regularly
Drink more than two cups of coffee daily
How Aware of Osteoporosis Are You?
A Gallup poll sponsored by the National Osteoporosis Foundation found
that:
75% of women believed they were familiar with osteoporosis, but
80% were not aware that it was responsible for disabling fractures,
90% percent were surprised to learn that osteoporosis frequently
causes death, and
60% could not identify the risk factors of osteoporosis.
Should You Take Hormone Replacement Therapy to Prevent
Osteoporosis?
There is a misperception that osteoporosis begins at menopause. In reality,
bone mass begins declining in most women in their mid-thirties, accelerates
for 3-5 years around the time of menopause, and then continues to decline
at the rate of about 1-1.5% per year. Because bone loss accelerates at
menopause, and because estrogen levels decline at menopause,
conventional medicine has adopted the belief that osteoporosis is an
estrogen deficiency disease that can be cured with estrogen replacement
therapy. This is only partly true. The missing piece of this puzzle is diet and
lifestyle, plus the bone-building hormone progesterone, which drops much
more precipitously at menopause than estrogen does. (When I refer to
progesterone, I mean the natural hormone, not the synthetic progestins.
Read my books for details on the differences.)
There is no question that estrogen can slow bone loss around the time of
menopause, but the scientific evidence is very clear that after 5-6 years,
bone loss continues at the same rate, with or without estrogen. A very
large study published in the New England Journal of Medicine in 1995,
studying risk factors for hip fractures in white women, which followed over
9500 women for eight years, found no benefit in estrogen supplementation
in women over the age of 65. If estrogen was the only known treatment
for osteoporosis, it might be worth taking it to get the small saving in bone
density, despite all the risks and side effects. But since it's clear that
progesterone, combined with proper diet and exercise, steadily increases
bone density regardless of age, there are very few women who should
ever need to take estrogen for osteoporosis.
Women who need estrogen tend to be those who are petite, slim and
small-boned. After menopause, a woman’s fat cells make estrogen, but a
slim woman may not be making enough to keep up with bone loss. Those
women may need a very low dose of estradiol. You can read the
November 98 issue of my newsletter, theJohn Lee R. Lee M.D. Medical
Letter, for a detaled article on how to decide whether you need estrogen.
There are a number of pharmaceutical drugs being used to treat
osteoporosis, none of which work very well, and all of which have
unpleasant side effects. One of the best known is fosamax, a
biphosphonate drug that can slow bone loss. Unfortunately, the old bone
which is saved by using fosamax is eventually structurally unsound, and
after three or four years it has no benefit, and I suspect it tends to increase
the rate of hip fracture after about five years. For awhile fluoride was being
touted as an osteoporosis drug, but like fosamax, it only slows bone loss
temporarily, and the long term consequence is an increased rate of hip
fracture due to structurally unsound bone. Another conventional medicine
osteoporosis drug is called Calcitonin-salmon (Calcimar). This is a
hormone made by the thyroid gland that can temporarily slow bone loss.
Again, the long term side effects are not well known, and its effectiveness
diminishes rapidly after a few years.
Progesterone and Osteoporosis
One of the most important factors in osteoporosis is a lack of
progesterone, which causes a decrease in new bone formation. Years of
clinical experience giving women progesterone showed me that using a
natural progesterone cream will actively increase bone mass and density
and can reverse osteoporosis. These patients consistently show as much
as a 29 percent increase in bone mineral density in three years or less of
progesterone therapy. After treating hundreds of patients with
osteoporosis over a period of 15 years, I found that those women with the
lowest bone densities experienced the greatest relative improvement, and
those who had good bone density to begin with, maintained their strong
bones.
Postmenopausal women using a transdermal (on the skin) progesterone
cream or oil should use the equivalent of 15-20 mg daily for three weeks
out of the month, with a week off each month to maintain the sensitivity of
the progesterone receptors. You can read my book What Your Doctor
May Not Tell You About Menopause for details on how to use
progesterone cream.
Exercise for Strong Bones: Use 'Em Or Lose 'Em
Lack of exercise is one of the primary causes of osteoporosis. Using your
bones keeps them strong and healthy. Weight-bearing exercise is the only
thing besides progesterone found to actually increase bone density in
older women. By weight-bearing I mean exercise that uses your bones.
Brisk walking counts as weight-bearing exercise, but add some hand-held
weights and it's even better. Pushing a vacuum cleaner or lawn mower,
gardening, dancing, and aerobic exercise also qualify.
Your exercise plan should include a minimum of 20 minutes of weight
bearing exercise three to four times a week. An hour is even better. In
contrast to women who exercise, those who don't continue to lose bone,
regardless of what else they are doing. Studies of elderly people who fall
and break a bone show that these people had poor flexibility, poor leg
strength, instability when first standing, and difficulty getting up and down
in a chair. Exercise can help increase flexibility, strength, and coordination.
A weight lifting program of just half an hour three to four times a week can
significantly improve bone density. You don't need to go to the gym to do
a weight lifting program. You can lift a can of peas or a small carton of
milk. Women with advanced osteoporosis should work with a physical
therapist to create a safe, effective program to reduce the risk of fracture.
The Asian movement exercises such as yoga, tai chi and chi kung can also
be excellent for improving strength, flexibility and coordination.