Complications Regarding Progesterone Cream
by Dr. Joseph Mercola

If one has not read Dr. Lee’s books on What Your Doctor May Not Tell You About Premenopause and What Your Doctor May Not Tell You About Menopause, I would highly recommend them. These books are classics and should be in everyone’s natural medicine library. Progesterone cream has been one of the most important supplements I have ever used in my practice.

I have come to a recent realization regarding the use of these creams. Most women in our culture are estrogen dominant, so using the progesterone goes a long way towards balancing hormones which usually decreases a woman’s risk for breast cancer, improves her PMS and breast tenderness and normalizes her cycle. Like most good things in life if one uses too much of the hormone cream, complications can develop in disruption in one’s hormone balance.

Dr. Lee is fond of using the lower dose creams to avoid this. But this complication can still occur with the low-dose creams. I always attempt to provide the most cost effective solution in my practice so I use prescription strength 10% cream. Theoretically, there is no problem with this if one uses it as directed. There is a huge cost savings as this concentration is able to get the cost down to $3 per month. However, if one uses more than 1/16 of a teaspoon, complications appear to be inevitable.

The problem relates to the fact that progesterone is highly fat soluble and once applied to the skin will store itself in a woman’s fat tissue. When one first uses the cream, there is no problem here as the fat stores are very low. But as time goes on, the cream accumulates and contributes to disruptions in the adrenal hormones such as DHEA, cortisol, and testosterone. I have learned that although progesterone cream is an enormously useful tool, it needs to be used very cautiously.

I have also learned that it is FAR MORE IMPORTANT to work to normalize the adrenal hormones first. Once the adrenal hormones are balanced, the progesterone levels will frequently normalize and one will not require any cream. The wonderful thing about adrenal normalization is that it usually only takes 3-6 months to balance these hormones. Once they are balanced, one usually does not require any hormone supplements to keep them balanced.

The balancing process involves lifestyle changes first. If you haven’t already guessed it by now, the diet at Read This First on my home page www.mercola.com is the first step. Secondly, one needs to get to bed by 10 PM. This is an essential part of the process. If one is routinely going to bed after 10, then one’s biorhythms will be disrupted. Addressing emotional stress in one’s life is the other huge component. I believe that the therapy we are now offering in with Applied Psychoneurobiology, APN, (see the article section on my web site) is one of the most effective tools for this. APN clearly is not the only way to address this and there are many other wonderful approaches out there. Journaling is one of the better and least expensive ones, but there are many other approaches also.

Once the lifestyle issues are addressed, then one would ideally evaluate the adrenal and female hormones. One of the better ways to do this is though measuring salivary hormone concentrations. I had been using Aeron Labs, and they do good work. Dr. Zava used to run it and now he runs his own company, which is also a fine lab. However, I have recently been introduced to BioHealth Diagnostics (800-570-2000) and I am hugely impressed with their services. They hold regular seminars and are even having one this weekend in San Diego. I would have loved to attend, but I am still catching up from my earlier learning tour. They also hold weekly phone seminars for health care professionals, which are excellent.

I really believe they have a huge jump on the other labs as they run multiple samples to make these measurements. One can certainly perform the same test at other labs, but the bill for all the samples would literally by two to three times as expensive. The other labs also do not have an educational component. They have a wonderful clinician, Dr. Dan Bivens, who walks the health care professional through proper evaluation of the test results.

Once the results are in, the hormonal manipulation generally involves using sublingual hormones such as DHEA and pregnenolone or cortisol improving agents such as licorice root extract. The exact dosage, timing and use are determined by the results of the test. The absolutely incredible aspect of this testing and treatment strategy is that it recalibrates the brain and helps the body to start making the hormones by themselves so one is not stuck on hormone treatment for the rest of their life.

Getting back to progesterone cream, I have been finding that many of the women who were on the cream have terribly elevated levels of this hormone. This is not good. Progesterone is normally a cyclical hormone and the body really needs to see a change in the concentration to affect a proper physiological response. If the level is constantly above the concentration that it recognizes as "off" or low, this is not possible. Fortunately, this is repairable. But it may involve going off the cream for as long as two years to wash the progesterone out of the system.

I am still in an evaluation stage and learning about how common this is in my own practice as I have just started using this system for the past month. At this point, I am relatively convinced that this is a big part of the picture for hormone replacement.

Recommendations
If you are a health care professional and dispensing or recommending progesterone cream, I would recommend you contact BioHealth Diagnostics for an information kit. If you are not one of my patients, you can contact them for a health care professional in your area. If you are one of my patients, there will be a huge shift in the way that we are administering the dispensing of progesterone cream in our office. We will not dispense any cream at this point without a proper evaluation of one’s adrenal and female hormones. This will be done through salivary hormone testing. This test is usually covered by one’s health insurance. This will allow me to normalize and restore the finely tuned hormone balance that one’s body is designed to have, rather than blindly slapping on progesterone cream without any appreciation of the potential complication or hormone disruptions.

Natural progesterone is the exact same hormone that is produced by a woman's ovary. It is made from naturally occurring plant steroids found in the wild yam. It is NOT the synthetic version that is commonly purchased as tablets with a prescription such as Provera. The synthetic progesterone can produce severe side effects including increased risk of cancer, abnormal menstrual flow, fluid retention, nausea, and depression. Side effects are extremely rare with natural progesterone. The only one of concern is that it might slightly alter the timing of the menstrual cycle.

Reasons Why Natural Progesterone Made by Your Body Is Good
Natural progesterone is very useful to balance excess estrogen. Natural progesterone is also different from estrogen in that your body can use it as a precursor or starting material to make other hormones such as adrenal hormones. It can even convert it into estrogen or testosterone if your body needs it. The table on the next page lists the properties of estrogen relative to progesterone. Some of the reasons that estrogen is frequently in excess in many women are:

1. Over production of estrogen. Ovarian cysts or tumors can lead to excess estrogen production. Stress also increases production, but probably the most common cause is obesity. All body fat has an enzyme which converts adrenal steroids to estrogen, so the more fat you have, the more estrogen is present.

2. Inability to breakdown estrogen. Excess estrogen is generally removed by the liver. Diseases of the liver like cirrhosis or decreased enzyme activity can lead to increased estrogen levels. Vitamin B6 and magnesium are necessary for the liver to neutralize estrogen. Increased sugar intake will also excrete magnesium and interfere with its ability to breakdown estrogen.

3. Exposure to pesticides in foods. Most of us eat foods that have pesticides on them. These and many other unnatural chemicals share a common structure with estrogen and serve as "false" estrogens which further stimulates the body's estrogen receptors.

4. Estrogen supplementation. Clearly any additional estrogen given by prescription will increase the level unless it is properly balanced with natural progesterone.

5. Decreased production of progesterone. Progesterone is necessary to counterbalance estrogen. If women do not ovulate during their cycle they will not produce any progesterone that cycle. This happens commonly and worsens the already disturbed progesterone/estrogen balance.

For More Detailed Information on Natural Progesterone: You can purchase What Your Doctor May Not Tell You About Menopause by Dr. John Lee. It is paperback book for $13 and was published in May of 1996 and the newer version What Your Doctor May Not Tell You About Pre Menopause published in 1999 with a blue cover.