Progesterone is a naturally occurring
steroid hormone. In nonpregnant
women, the main sites of progesterone synthesis are the ovaries and the adrenal cortices.
Because of the poor oral absorption of progesterone and its susceptibility to rapid
first-pass metabolism in the liver, a variety of oral, injectable and implantable
synthetic analogs, called "progestins," have been developed. Progestational
agents have many important clinical functions, including regulation of the menstrual
cycle, prevention of endometrial hyperplasia, treatment of abnormal uterine bleeding and
contraception.
Some thoughts about
natural progesterone
Because of the reported side effects of synthetic analogs called progestins, there has been interest in replicating
the natural hormone for clinical use. Natural progesterone is obtained primarily from
plant sources and is currently available in intradermal, injectable, intravaginal and oral
formulations. An oral micronized progesterone preparation has improved bioavailability and
fewer reported side effects compared with synthetic progestins.
Natural progesterone is obtained from compounds derived from soybeans and
Mexican yam roots, and occasionally from animal ovaries. The hormone is not available from
any natural source without extraction and synthesis.
Oral micronized progesterone is available. Micronizing is a process designed to increase the
half-life of progesterone and reduce its destruction in the gastrointestinal tract.
Micronization decreases particle size and enhances the dissolution of progesterone.
Maximal serum concentrations are achieved more rapidly with orally administered micronized
progesterone than with injected progesterone. Absorption of micronized
progesterone is enhanced twofold when the hormone is taken with food. However,
this may also increase progesterone side effects.
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How's is natural progesterone made?
The human body uses a natural hormone called pregnenolone
to convert into progesterone. While oral progesterone is only available by
prescription, pregnenolone is sold over the counter. The biological actions of
pregnenolone hormone somewhat overlap with that of progesterone hormone.
Alternatives to
progesterone hormone
There are several supplements without hormones that could address some of
the problems that are sometimes recommended to be solved with progesterone. It
is best to limit the use of hormones since they can have serious side effects.


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Benefit of
progesterone cream
Transdermal progesterone cream is promoted as an alternative to hormone
replacement therapy for symptoms of menopause. It has been difficult to
interpret and make sense of many studies with progesterone cream. Progesterone
metabolism is complex, and transdermal skin application in varying dosages and
concentrations make interpretations of studies quite difficult. Some women
benefit from progesterone cream application, others may not. Various dosages of
progesterone cream and concentrations are available over the counter and by
prescription. One option is to use a low dosage progesterone cream available
over the counter to see if this works for you before resorting to higher potency
skin creams available by prescription.
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Uses of progesterone hormone
Progesterone is used as a part of hormone
replacement therapy in women who have passed
menopause (the change of life) and
have not had a hysterectomy (surgery to remove the uterus). Hormone replacement
therapy usually includes estrogen, which is used to treat symptoms of menopause
and reduce the risk of developing certain diseases. However, estrogen can also
cause abnormal thickening of the lining of the uterus and increase the risk of
developing uterine cancer. Progesterone helps to prevent this thickening and
decreases the risk of developing uterine cancer. Progesterone is also used to
bring on menstruation (period) in women of childbearing age who have had normal
periods and then stopped menstruating. Progesterone is in a class of medications
called progestins (female hormones). It works as part of hormone replacement
therapy by decreasing the amount of estrogen in the uterus. It works to bring on
menstruation by replacing the natural progesterone that some women are missing.
Adolescents and perimenopausal women may require progestational agents for the treatment of dysfunctional
uterine bleeding resulting from anovulatory cycles. These agents may also be used in women
at risk for endometrial hyperplasia because of chronic unopposed estrogen stimulation.
Progestin-only contraceptives can be used in women with contraindications to estrogen;
however, efficacy requires rigorous compliance. New progestins for use in combination oral
contraceptive pills were specifically developed to reduce androgenic symptoms. It is
unclear whether these progestins increase the risk of venous thromboembolic disease
(blood clots).
Progesterone balance
Progesterone plays an important role in postovulatory regulation of the
menstrual cycle. Under the influence of luteinizing hormone, the corpus luteum secretes
progesterone, which stimulates the endometrium to develop secretory glands. The corpus
luteum produces progesterone for approximately 10 to 12 days of the cycle. If a fertilized
ovum is not implanted, progesterone and estrogen levels decline sharply, resulting in
menstrual bleeding. If fertilization occurs, progesterone supports implantation of the
ovum and maintains the pregnancy.
Progesterone side effects
Progesterone may cause side effects if the blood progesterone level is
too high. Some of these side effect symptoms Include:
headache, breast tenderness
or pain, irritability, gastrointestinal symptoms, tiredness, muscle, joint, or
bone pain, insomnia, and mood swings.
Q. I wanted to comment that natural progesterone
is not the best thing for everyone. I am 45, in perimenopause and have had a
hysterectomy. A doctor prescribed oral micronized progesterone (starting at
100mg then up to 400mg) every night, telling me that it would help me sleep. It
did give me a very drunk feeling after I would take it but it never really
helped me to sleep better. After a few weeks I started having trouble with
insomnia, anxiety every morning, acne, nervousness. The doctor suggested this
was because I needed even more progesterone and to up the dose, which I did. It
just made everything worse. I stopped the progesterone and after several weeks
the anxiety went away and I was finally able to sleep OK again. I then found out
that one of the major metabolites of oral progesterone is allopregnanolone which
is a potent natural benzodiazepine. Some studies I read suggest that chronic
exposure to too much allopregenanolone causes anxiety. This was my experience. I
had a rough several weeks after stopping the progesterone – just like one might
after taking a benzodiazepine. I was not aware that for some people progesterone
can have such a negative affect until it actually happened to me. There is so
much hype on the internet about progesterone with no mention that for some women
it apparently can have a negative and not positive affect. Previous to trying
the oral progesterone, I had tried the progesterone cream (30mg a day). It was
also not helpful. As I understand it, the reason oral progesterone is “supposed”
to help you sleep is not because of the progesterone but because of the
allopregnanolone produced when it is metabolized in the liver. I wish I had been
more aware of some of the potential downsides of oral progesterone before I took
it so that I would have realized sooner than it was not for me.
A. Thanks for sharing your progesterone side effect experience.
Hormones are very powerful, and low dosages can sometimes be helpful while high
dosages cause side effects. In my opinion, 100 mg is a very high dose, and
sometimes a lower dosage of 10 mg or so can help women while higher amounts
cause side effects. This may be true of sleep. Low progesterone dosage may help
with sleep while higher amounts can cause insomnia.
Q. Thank you so much for the response and the
comment about a lower dose. I have recently increased my estradiol (Vivelle
patch) and am sleeping much better for now. Since I have a history of
endometriosis I do have a concern that the increased estradiol will reactivate
the problem/pain that I had for so long… time will tell. I hope it doesn’t end
up being a trade of one (disturbed sleep) for the other (endo pain). I will very
much keep in mind the idea of a much smaller dose of progesterone and really
appreciate your comment. The doctor who prescribed it to me has patients on
800-1000mg of progesterone to help them sleep! Anyway, I never expected to
receive a response so it was a nice surprise. I definitely have found over the
last two years that for me, more of a good thing is not always better… in fact,
more of a good thing has often been worse… so I agree with Dr. Sahelian’s
methods of supplementing in small doses and appreciate him being realistic amid
all the “hype” about supplements.
Q. I feel it important to mention that there are
many more side effects of topical progesterone cream than those listed on
your web site. Namely, progesterone withdrawal can lead to severe side
effects similar to those experienced when withdrawing from a
benzodiazepine. Also, hair loss is a major problem as well, although full
recovery is expected when progesterone is stopped.
A. Thanks for letting us know your personal
progesterone use experience.
How is progesterone
available?
Progesterone is sold as an injection, cream, progesterone pill ( capsule,
tablet ), and as progesterone suppository.
Absorption of progesterone cream
Women who use over-the-counter progesterone creams could be exposed to
hormone levels comparable to those used in a form of hormone replacement
therapy. A study compared one brand of progesterone cream with a prescription
oral progesterone that, like the cream, is derived from plant sources and
provides a hormone that is structurally identical to the natural progesterone in
a woman's body. The prescription product, Prometrium, is used as part of hormone
replacement therapy after menopause, and for restoring menstruation in younger
women whose periods have stopped because of another illness. The study found
that the over-the-counter progesterone cream, when taken as the label directs,
exposed study volunteers to as much hormone as the prescription did. The
potential problem stems from the fact that these creams are categorized as
herbal beauty products and women use them without medical supervision -- for a
range of conditions the products purportedly aid, from PMS to hot flashes to
osteoporosis. Due to the imprecise nature of using a progesterone cream means
there is a high probability of taking more than the intended or ideal dose.
Progesterone danger with
Depo Provera
Contraception with depot medroxyprogesterone acetate is associated with
an increase in the risk of diabetes in some Latino women with prior
pregnancy-related or "gestational" diabetes. Depot medroxyprogesterone (DMPA)
contraceptives are given by monthly injections, and are often referred to by one
brand name, Depo Provera.
Using the contraceptive Depo-Provera ( brand name for medroxyprogesterone acetate) is associated with bone loss. Depo-Provera, also known as DMPA, is a long-lasting contraceptive hormone that is injected every three months. Dr. M. Kathleen Clark and colleagues at the University of Iowa in Iowa City compared changes in bone mineral density in 178 women starting on Depo-Provera for the first time and 145 women not using hormonal contraception. Average bone density at the hip fell 2.8 percent one year after starting Depo-Provera and 5.8 percent after two years. Loss of bone density in the spine was similar. In contrast, average bone loss at the hip and spine was less than 0.9 percent among the comparison group of women, the team reports in the medical journal Fertility and Sterility. The U.S. Food and Drug Administration has issued a black box warning on Depo-Provera stating, in essence, that bone density is lost and may not be regained, particularly when it is used for more than two years.
Progesterone Research Update
Progesterone: the forgotten hormone in men?
Aging Male. 2004 Sep;7(3):236-57. Oettel M, Mukhopadhyay AK.
'Classical' genomic progesterone receptors appear relatively late in
phylogenesis, i.e. it is only in birds and mammals that they are
detectable. In the different species, they mediate manifold effects
regarding the differentiation of target organ functions, mainly in the
reproductive system. Surprisingly, we know little about the physiology,
endocrinology, and pharmacology of progesterone and progestins in male
gender or men respectively, despite the fact that, as to progesterone
secretion and serum progesterone levels, there are no great quantitative
differences between men and women (at least outside the luteal phase). In
a prospective cohort study of 1026 men with and without cardiovascular
disease, we were not able to demonstrate any age-dependent change in serum
progesterone concentrations. Progesterone influences spermiogenesis and testosterone biosynthesis in the Leydig
cells. Other progesterone effects in men include those on the central
nervous system (CNS) (mainly mediated by 5alpha-reduced progesterone
metabolites as so-called neurosteroids), including blocking of
gonadotropin secretion, sleep improvement, and effects on tumors in the
CNS (meningioma, fibroma), as well as effects on the immune system,
cardiovascular system, kidney function, adipose tissue, behavior, and
respiratory system. A progestin may stimulate weight gain and appetite in
men as well as in women. The detection of progesterone receptor isoforms
would have a highly diagnostic value in prostate pathology (benign
prostatic hypertrophy and
prostate cancer). The modulation of progesterone
effects on typical male targets is connected with a great pharmacodynamic
variability. The reason for this is that, in men, some important effects
of progesterone are mediated non-genomically through different molecular
biological modes of action. Therefore, the precise therapeutic
manipulation of progesterone actions in the male requires completely new
endocrine-pharmacological approaches.
Soymilk or progesterone for prevention of bone
loss--a 2 year randomized, placebo-controlled trial.
Eur J Nutr. 2004 Aug;43(4):246-57. Epub 2004 Apr 14.
Given concerns over the use of hormone replacement therapy (HRT),
women are seeking natural alternatives to cope with the symptoms and
effects of menopause. The bone sparing effects of soy protein and its
isoflavones is well established in animal studies, while 5 previous human
studies on soy and bone have yielded variable outcomes due in part to
their short duration of study. Progesterone has been suggested as a bone-trophic
hormone, but the effect of long-term, low dose transdermal progesterone is
unknown. AIM: The aim of the study was to compare for the first time the
long-term effects of soymilk, with or without isoflavones with natural
transdermal progesterone, or the combination, on bone mineral density in
the lumbar spine and hip. METHODS: Postmenopausal, Caucasian women with
established osteoporosis or at least 3 risk-factors for osteoporosis, were
randomly assigned, double-blind to one of four treatment-groups: soymilk
containing isoflavones (soy+, n = 23), transdermal progesterone (TPD+, n =
22), or the combination of soy+ and TDP+,(n = 22) or placebo (isoflavone-poor
soymilk, soy/ and progesterone-free-cream TDP/, n = 22). All subjects
received comparable intakes of calcium, minerals and vitamins. Bone
mineral content (BMC) and density (BMD) were measured in lumbar spine and
hip by using dual-energy X-ray absorptiometry (DEXA) at baseline and after
2 years. The percentage change in lumbar spine BMD and BMC
respectively, did not differ from zero in the soy+ group
and TDP+ group but significant bone loss occurred in the
control group and the combined treatment group. No significant changes occurred for femoral neck BMD or BMC.
Daily intake of two glasses of soymilk containing 76 mg isoflavones prevents lumbar spine bone loss in postmenopausal women.
Transdermal progesterone had bone-sparing effects but when combined with
soy milk a negative interaction between the two treatments occurs
resulting in bone-loss to a greater extent than either treatment alone.
Progesterone emails
Q. Can
DHEA convert to progesterone in some
women, rather than estrogen and testosterone?
A. Pregnenolone converts into DHEA and progesterone.
DHEA does not convert into progesterone, rather it converts into estrogen
and testosterone.
Q. After reading about progesterone,
pregnenolone and DHEA is there any way to stimulate the body to make it's
own progesterone? Or what is the best way? It's all rather confusing.
A. We're not aware of a way to stimulate progesterone
by itself.
Q. Natural Progesterone: The Multiple Roles of a Remarkable Hormone"
(written for doctors by Dr. John R. Lee (a brilliant man who wrote this to
enlighten all doctors for themselves and their patients). He saved me as
I had a horrific time with PMS and then Pre-Menopause and learned through
his groundbreaking book (for we lay-people), "What Your Doctor May NOT
Tell You About Menopause" the VALUE of natural progesterone cream (the
best delivery system to replenish what naturally dissipates with age (NO
not the estrogens, the progesterone hormone--not the SAM-e in one of the
latter comments here in these recommendations--the progesterone is what
needs to be replaced to feel completely normal again. The lie of using
estrogen goes back about 80 years when the discovery of the tropical oils
to make bio-identical progesterone (by Russell E. Marker Ph.D.--a
biochemist at Pennsylvania State U. in the 1920s) was a discovery that Dr.
Marker gave to society (No Prescription Needed). To make the
billions that the pharmaceutical industry has been raking in for years,
they had to push and promote the use of estrogen (which does require a
prescription). You know the problems that have ensued as women DO
NOT need more estrogen. And certainly not the synthetic kind either
(that will kill us). So many problems exist for women now as the
estrogen has been accepted as the hormone to replace.
Q. What is your opinion regarding taking oral
progesterone for individual with
candida over growth, candida infection,
or food allergy?
A. Firstly, I am skeptical of a candida diagnosis.
Second, I have not seen studies regarding the use of progesterone in relation to
real candida overgrowth.
Q. I love your newsletters. Do want to comment as a 55 year old who is finally through menopause, that besides the black cohosh (I didn't use the St. John's Wort), I found progesterone cream, pharmaceutical grade, very helpful for moods, and hot flashes.
Q. When I'm not on any birth control, my sex drive
was normal, and my husband and I had sex 5-7 times a week. Now that I'm
back on my progesterone depo shots again, my sex drive has decreased and
we haven't had sex in two weeks. I feel horrible, because I'm just not
interested in sex. I love him and our life together is great overall, but
when I'm on the shot, my drive just isn't there. But, I don't know if
Passion Rx would be right for me. I don't have any heart conditions, and
the only medication I'm on is the depo. I have a medical condition, but
it's orthopedic, so I don't think this supplement would affect it at all.
I guess I just want to know if Passion Rx would help a decreased sex drive
due to birth control.
A. It's very difficult to predict whether an
aphrodisiac herb or a sex formula will help any particular individual.
It's like asking if Viagra will help a man. It can in 60 to 70 percent of
cases, but one cannot say any medicine or herbal supplement will help a
person for certain. The only way to tell is by trial and error.
Q. I was on natural progesterone cream for thr
previous 2 months and I was seeing a great difference in my PMS (which I
wasn't having until about 6 months ago) and my libido was getting better.
I went to see my gynecologist who by the way pooh pooh's natural
progesterone cream, regardless I've read Dr. Lee's book (which she rolls
her eyes at as well). I can't seem to find a Dr. that doesn't. My problem
is that I am going to go in and have the "Essure" procedure done for my
sterilization method and my gyno said I had to be on Depo-Provera for at
least 2 months prior to the procedure as it cleans and slicks out my
uterus so she has a clear path for the Essure implants. My question is:
can I continue the natural progesterone cream safely while I am on the
Depo-Provera shots? Please any help with this would be greatly appreciated
as no one here in Canada is really familiar with using both at the same
time. By the way Depo is driving me bonkers, can't wait to get off of it.
A. This is a type of personal question are not in a
position to respond to.
Q. Could you please tell me if this cream put out by
Dr. Helen Pensanti natural progesterone cream / red clover/ wild yams
would be causing tingly sensations around my eyes and nose been using this
for a wk. and 4 days didn't have this till then.
A. You may wish to ask Dr. Helen Pensanti since we are
not familiar with this progesterone cream product.
Q. Is there any need for progesterone cream if a
pregnenolone supplement is taken?
A. It depends on the amounts used since progesterone cream and
pregnenolone have overlapping functions.
Q. Can progesterone cream be applied the same day as
taking a resveratrol
pill?
A. Probably but there is no research combining the two.
Q. Q. I have comment on the
hormone replacement therapy section of Dr. Sahelian's
newsletter 2007
January. I am assuming one of the
bioidentical hormone supplements mentioned would be progesterone
cream, derived from yam. For sometime, as a premenopausal woman, and now a
postmenopausal woman, I have used this progesterone cream supplement with
excellent results. First, I used Dr. Lee's (His well known book about what
women should know about menopause is excellent) recommendations, but of
late, have been using it under the direction of both an MD, and a
nutritionist / chiropractor with years of experience in holistic health.
This last physician has carefully measured the levels of progesterone in
my body, and prescribed the dose accordingly. The point I want to make is
that given the role of progesterone in the body, and it's amazing ability
to counteract the deleterious effect of estrogen like compounds that we
are subject to (i.e. plastics , pesticides, herbicides and numerous other
things ) my doctors, and a number of others I know are giving women like
me great relief from the symptoms of excess estrogen in the body. These
symptoms include hot flashes, sleeplessness, heart palpitations, fatigue,
depression, propensity to low blood sugar just to name a few. Because the
progesterone cream bypasses the liver, small doses can be used, and
adjusted to comfort levels. Then, saliva testing done regularly to
ascertain levels helps to ensure adequate, but not excess
therapeutic levels. I am sure not many studies have been done using
progesterone cream, because it is cheap, and no one stands to make a
fortune (i.e. a drug company) selling it. But results are all that counts
with me, especially when
I can measure by the saliva test just how much I need. Just wanted to give
this input, as have not seen much about it in your letters. I know lots of
women personally who have achieved results with this progesterone cream
method. Thanks for all your excellent letters.
A. Thank you for your email. The field of hormone replacement
therapy is very complicated and each woman has to find out for herself the
best way to achieve this and you seem to have done so for yourself.
Congratulations. As to progesterone cream, I think there is good potential
here that is not being taken advantage of by many doctors, and with time I
will evaluate more studies on this topic.
Q. Re: Progesterone cream side effects. I have been
using natural progesterone cream. It is somewhat helpful with hot flashes.
However, the downside for me is that it causes depressive moods. Since my
use of other HRT was discontinued abruptly, I need to be able to continue
using this progesterone cream to treat menopausal symptoms, while finding
a supplement to remedy the depressive mood effects. Which of Dr. Sahelian
mood remedies would be best to help counteract the depressive effects of
the natural progesterone?
A. We can't give any specific advice on specific supplements, but
we can refer you to the page on
depression that
you could look over with your doctor.
Q. I have found a cream (800mg of bioidentical
progesterone USP) that has both progesterone and pregnenolone in the
formulation. What are the benefits to using a pregnenolone and
progesterone cream and what are the possible disadvantages if any? My
personal experience with the combination cream has been good to relieve
foggy thinking that happens around day 14-16. Now I'm feeling better then
all of a sudden now around day 22 I'm dealing with swollen hurting breasts
and sleeplessness. I thought progesterone cream was suppose to take away
swollen breasts and help you to be calm and sleep better.
A. The dosage of any medicine has an enormous influence on the
effects. A medicine can be beneficial or harmful depending on how much of
it is used and how often. High doses of many hormones, particularly
pregnenolone, lead to to insomnia. I am not familiar with the use of a
combination pregnenolone and progesterone cream.
Q. I have read the article on progesterone. I am a 27 year old man who suffers benign prostatic hyperplasia (BPH) and Male pattern hair loss. I have read Dr. John Lee article, He said that progesterone was found to be a natural and significant 5aR inhibitor. I started to use about 10mg progesterone cream per night. It reduce oily on my scalp obviously, my prostate also improve. I believe that the level of my DHT decrease. I feel comfortable during intercourse. (I don't want to use Proscar because of the side effect of impotence). I feel very well after using the cream. However, After 10 days, I noted that my breast is being enlarge.
See a list of hormones
Additional links
Cordyceps mushroom,
libido
herbs gaba
has been marketed for stress,
kava is useful for anxiety
ahcc for immune
carnosine as an
antioxidant
This progesterone page was last updated February 2008.