Bioidentical Progesterone
The progesterone the body produces has three critically important rolls: it ensures the development and survival of the foetus, it acts as a precursor for the production of other steroid hormones (aldosterone, cortisol, testosterone, and the estrogens) and it has its own range of biological functions such as normalizing blood clotting, blood sugar and zinc and copper levels, maintains cellular oxygen levels: using fat for energy and restoring sex drive. It also works as a mild diuretic, is a natural antidepressant, helps build bones, maintains healthy blood vessels, counteracts the effects of estrogen, helps protect against breast and endometrial cancer and aids thyroid function.The female body makes about 1 to 2mg a day during the first half of the cycle which increases to about 20 to 40mg per day in the second half.
During the first half of a normal menstrual cycle estrogen is the dominant female hormone. It is responsible for maturation of the ovarian follicle and ultimately causes ovulation. In mid cycle when the egg is released progesterone is released and becomes the dominant hormone inhibiting the action of estrogen. Progesterone prepares the endometrial lining to receive a fertilized egg. If the egg is fertilized more progesterone is produced, but if not, progesterone production ceases and once levels fall below a critical level the endometrial lining breaks down and menstruation occurs.
During perimenopause the progesterone phase of the cycle gets shorter and fluctuating levels of estrogens further effects progesterone levels causing a loss of synchronicity of the cycles. After menopause women lose two-thirds of their remaining progesterone and within six months blood levels fall to a barely functional level.
A lack of circulating progesterone may cause any of the following symptoms: swollen breasts, headache, low libido, anxiety, depression, insomnia, cramps, emotional swings, weight gain, bloating, fuzzy thinking, facial hair, acne, etc.
Progesterone is an essential component of HRT which opposes estrogen induced endometrial hyperplasia and possible endometrial carcinoma. Recent studies also indicate its protective effect against breast carcinoma. Because progesterone is a precursor for so many hormones, the whole body suffers if we are short of it because other hormones cannot be produced in sufficient quantities. This widespread precursor role helps us understand why it has such beneficial effects such as improved sleep and mood, more energy, clearer head, improved thyroid levels, improves migraines, prevents cardiovascular disease, helps with fluid retention, helps dry skin, treats infertility, tremendous sense of well being, end of hot flushes as well as increasing bone density. In addition progesterone enhances estrogen receptoer sensitivity to estrogens and is thus required for estrogens to have their full effect.
The most important factor in osteoporosis is the lack of progesterone, which is able to stimulate osteoblast mediated new bone formation. The use of bioidentical progesterone, alone and in combination with estrogen, has shown to significantly improve bone densities. Dr John Lee has been the pioneer in research on bioidentical progesterone’s effects on osteoporosis. He followed 100 postmenopausal women, average age of 65.2, with evidence of osteoporosis for three years. His treatment program included 300mg calcium, 150mg magnesium and transdermal progesterone (dosage protocol below). The results were astounding with a 15.4% increase in bone mineral densities and no loss of height. The synthetic progestins have been found to produce only modest bone benefits when compared to bioidentical progesterone. Progesterone therapy has also been used in men to prevent osteoporosis whom cannot take testosterone supplements due to prostate cancer.
Progesterone ‘v’ Progestins
In HRT it is very important to understand the difference between bioidentical progesterone and progestogens (progestins). Progestogens are synthetic derivatives of progesterone commonly used in HRT. These may include medroxyprogesterone (Provera), and dydrogesterone (duphaston) which are made from testosterone or norethisterone (primult N) a derivative of progestogen. Studies show that these synthetic derivatives do not protect against cancer, heart disease and osteoporosis in the way that bioidentical progesterone does. Other problems with synthetic progestogens are risk of blood clots, cardiovascular risks increase, allergic reactions, headache, weight gain, irregular bleeding, skin rashes, decreased glucose tolerance, water retention, may stimulate breast cancer, depression, increase low density lipoprotein cholesterol, increased androgenicity and bloating. Bioidentical Progesterone appears to produce far less side effects than its synthetic counterparts with potentially many more benefits. It has also been used to treat PMT, anxiety, depression, prevent miscarriage and osteoporosis.
Many natural wild yam creams are available on the market which claim to provide progesterone replacement. Although these creams may possess weak progesterogenic activity they do not contain any progesterone but a precursor called diosgenin. Diosgenin is unable to be converted to progesterone in the human body due to a lack of appropriate enzymes. These creams are unpredictable and vary from person to person.
Bioidentical progesterone used in our products is produced by extracting diosgenin (a hormone precursor) from soybeans. Diosgenin is then converted into progesterone which is exactly the same as the progesterone produced by the human body. The progesterone is highly purified (99.8% pure) and then micronized (to reduce particle size) to enhance absorption. Bioidentical progesterone is much weaker than its synthetic counterparts.
In order to maximize the benefits of progesterone supplementation it is important to avoid low blood sugar levels as they prevent receptor binding and utilization for up to seven days. It is for this reason the three hourly starch diet is recommended.
Progesterone in Men
Some men produce insufficient adrenal progesterone which may cause atherosclerosis, cardiovascular disease and osteoporosis. Therefore progesterone is increasingly used in males to treat these conditions. The best form of treatment in males is 5 to 10mg daily applied transdermally.
Progesterone for Endometriosis, Fibroids and Ovarian Cysts
Considerable success has been achieved treating endometriosis, fibroids and ovarian cysts with bioidentical progesterone. By counter balancing the excess estrogen with progesterone symptomatic relief is possible and preferable to the alternatives such as hysterectomy and surgery. The balance of the three endogenous estrogens and estrogen metabolites is also important in treating these conditions. Click here for more information – even though this information is specifically on breast cancer the hormone imbalance is similar for these conditions and therefore treatment is also.
Progesterone and Breast Cancer
Progesterone may also be used to prevent and help treat estrogen induced breast cancer as it opposes undesirable effects of estrogen. Studies show that the incidence of breast cancer is 5.4 times greater in women with low progesterone levels. Studies also show that women diagnosed with breast cancer almost all have low progesterone levels.
Progesterone Aiding Fertility and Pregnancy
Progesterone can be used to aid conception, maintain pregnancy and for post natal depression (contact us for more details).
Dosing Protocols
Doses are specific for each patient and are based on saliva/blood test results in conjunction with any symptoms currently being experienced. Doses are either increased or decreased according to these two parameters until levels are optimal and the patient feels in peak health. As a generalization most women only require about 10mg to 40mg a day. Higher doses are not recommended, and usually not necessary, as in the long term high progesterone levels can cause insulin resistance, supres the immune system and cause depression. In addition high progesterone levels can also cause a down regulation of estrogen receptors and hus cause estrogen deficient symptoms despite levels being adequate. A healthy female body only makes between 20 and 40mg a day so you should not require any more than this.
Symptoms of progesterone deficiencies include: swollen breasts, headache, low libido, anxiety, depression, insomnia, cramps, emotional swings, weight gain, bloating, fuzzy thinking etc.
Symptoms of excess of progesterone are rare as women are able to tolerate very high levels of bioidentical progesterone, however symptoms of sleepiness, drowsiness or depression may occur. Hot flushes may also occur if excessive levels cause a down regulation of estrogen receptors.
Some women may experience a temporary increase in symptoms such as breast tenderness, fluid retention or spotting when they commence progesterone treatment. This is known as estrogenic sensitivity and is a result of estrogen dominance, rather than intolerance to progesterone and eases within two to three weeks
Progesterone is best taken in creams which are effectively absorbed through the skin into the subcutaneous fat layer bypassing the stomach and liver allowing lower doses to be administered. The subcutaneous fat layer then acts as a slow release mechansim releasing progesterone into the blood stream at a steady rate over time. Progesterone may also be administered in capsules however it possesses poor, but predictable, oral bioavailbility (15%) so larger doses are required. Finally it may also be administered as a sublingual drop, subbuccal lozenge or Vitamin E subbuccal paste however these provide the most unfavourable pharmacokinetics as rapid absorption and rapid elimination (due to a very short half life) results in wildly fluctuating levels.
Unlike other progesterone creams available our laboratory only uses the micronized form of progesterone. This means the particle size of the progesterone has been greatly reduced in order to maximize its absorption. The use of micronized progesterone produces a much more effective cream. In addition our cream base used to administer the progesterone is free of all nasty chemicals such as petrochemicals (parafins) and hormone disrupters such as propylene glycol and parabens. For more information on avoiding these nasty hidden ingredients in your creams click here.
Testing Progesterone Levels Warning
Doctors must be made aware that progestrone taken in creams will not show up on subsequent blood tests due to the fact that once it penetrates the skin and enters the blood stream it attaches itself to red blood cell membranes in order to travel throughout the body. When blood samples are taken they are centrifuged before analysis to remove all red blood cells along with most of the progesterone. Doctors ignorant to this fact promote that you can bathe in the cream without absorbing any as shown by blood tests.
We have encountered many women where their doctor relied totally on blood tests while treating with progesterone cream. Their doses were usually very high in order to get a sufficient blood test reading however when subsequent saliva tests were performed their real levels were found to be far in excess of normal levels.
On the otherhand if saliva analysis is performed progesterone will be detected several hours after administration. As it gives a true reading of your current levels there is no risk of excessive dosing.
If your doctor is unaware of these bioidentical hormones and are willing to learn about them they can contact us for a copy of our Comprehensive Prescribers Guide for Bioidentical Hormones. Audio CD’s are also available which are very informative covering many aspects of bioidentical hormones presented by medical experts.
