Last week was all things Progesterone – the role it plays in fertility, symptoms of Progesterone Deficiency, and how you can naturally support Progesterone production. Today I’m going to take it one step further to tell you why and how you should use bioidentical progesterone to naturally increase progesterone levels.
Natural progesterone is the identical 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 used in oral contraceptives (progestins) or as the common prescription, Provera.
Synthetic progestins, like Provera or medroxyprogesterone, can produce severe side effects including increased risk of cancer, abnormal menstrual flow, fluid retention, nausea, depression and can even increase risk of heart disease and stroke.
Side effects are extremely rare with natural progesterone. The only one of concern is that it can potentially alter the timing of your menstrual cycle.
Natural progesterone is very useful to balance excess estrogen which can be a major risk for breast cancer. Natural progesterone can also be used by the body 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.
Natural progesterone is used for a variety of reasons including:
There is also research and medical theory indicating the appropriate balance of progesterone:
Progesterone, which plays a crucial role in brain function, is often called the “feel good hormone” because of its mood-enhancing and antidepressant effects.
Patients who complain about anxiety and irritability often notice that a corrected balance of progesterone vastly reduces or eliminates these feelings.
While a progesterone pill may be considered “easier” to take, studies have shown that upwards of 90% of the oral dose is lost through the liver. Therefore, you will need to take an oral dose that is 500% higher than you need. Another consequence to taking oral progesterone is that over 30 different metabolites are created in your liver when you swallow the progesterone and any of these can then have unwanted side effects.
If nature had intended to locate your ovaries in your stomach or somewhere else in your GI tract it might make sense for women to swallow progesterone. Of course your ovaries are not in your GI tract but in your pelvis outside your GI tract and connected to your uterus and vagina through your fallopian tubes. Your ovaries have direct access to your bloodstream through a pelvic plexus of veins, which delivers their hormone secretions to your heart which in turn pumps them, unchanged to hormone sensitive cells throughout your entire body.
To closely mimic the body’s progesterone cycle, it is recommended to use progesterone cream twice daily and should be rubbed into your mucous (epithelial) membranes that line your uterus and vagina.
Ideally, progesterone cream should NOT be applied to your skin. Instead use mucous epithelial membranes of your labia. Absorption through these membranes is more complete than through skin, and hormones absorbed through vaginal membranes enter the same pelvic plexus of veins that your ovaries normally empty into.
Progesterone cream must be used cautiously when applied to skin as progesterone is highly fat soluble and will accumulate in fat tissue.
What happens, not only for progesterone cream, but for ANY hormone preparation you use by applying as a cream to your skin, is that within a few weeks to a few months you will saturate the fat tissue with the hormones and they will actually stop working or can even make your symptoms worse.
The problem relates to the fact that progesterone is highly fat soluble and once applied to your skin will store itself in your fat tissue. When one initially uses the cream, there aren’t any problems as the fat stores are very low. But as time goes on, the cream accumulates and contributes to disruptions in your 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.
The other issue with the accumulation of progesterone in the fat stores is that it leads to very high levels of the hormone. 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.
If you apply the cream to your mucous epithelial membranes that line your uterus and vagina you obtain a virtually ideal administration system. Not only is absorption through these membranes more complete than through your skin, but hormones absorbed through your vaginal membranes enter the very same pelvic plexus of veins that your ovaries normally empty into.
From here the hormones are carried to your heart and lungs and distributed to your tissues just as if your ovary had actually produced them.
I recommend the Progest-Avail progesterone oil.
When it comes to dosage, more is not better. Too much progesterone may cause hormonal imbalances, just like too little progesterone can.
For most premenopausal women the usual dose is 20-40 mg/day for the two weeks before expected menses, stopping the day or so before menses. Progesterone cream use should begin directly after ovulation and end once menstruation begins (unless you’re trying to conceive). Progesterone should be divided into two daily doses – half your dose in the morning and half your dose in the evening before bed.
I recommend that women track ovulation using an Ovulation Predictor Kit (such as Advanced Blue Digital) so that you know the best day to begin progesterone use. Once you notice ovulation has occurred, progesterone cream should begin. If you don’t notice ovulation by day 16, then begin progesterone use. This means you’ve had an anovulatory cycle and you definitely need progesterone support.
I also recommend women be sure to track their menstrual cycle with a fertility app or other tracking tools so you can keep track of when you’re supposed to start your cycle and can stop progesterone appropriately.
If you are NOT trying to conceive, then you should stop progesterone when you begin to menstruate or the day you expect to get your period, whichever comes first.
If you ARE trying to conceive, make sure you continue using progesterone until you know if you are pregnant or not. If you are pregnant, CONTINUE using progesterone (see more information on this below). If you are absolutely sure that you are not pregnant, then you can discontinue progesterone to trigger your natural menstrual cycle.
The abrupt lowering of your progesterone level is the primary stimulus for your period to start.
When a women is in menopause she may only need 15 mg but taken for the first 25 days of the month, then take 5 or 6 days off and restart on the first of the month.
A loading dose of progesterone cream is beneficial in women who have had many months (or years!) of anovulatory – or no ovulation- cycles. Going this long without ovulating can lead to extreme progesterone deficiency. For each cycle that passes without ovulation, estrogen dominance becomes more likely as your progesterone stores are depleted. For more details on symptoms of progesterone deficiency vs estrogen dominance, see The Role that Progesterone Plays in Fertility.
In cases like this, a loading dose is recommended. Essentially, a higher dose of progesterone is used for one to two months, before going back down to a regular dose. A loading dose requires 40mg twice a day, one 40mg application in the morning and one 40mg application in the evening, for a total of 80mg of natural progesterone a day. Apply for two weeks before your period (about day 14 in the cycle), up until menstruation begins.
Low progesterone while trying to get pregnant can be a cause of recurrent miscarriages. Progesterone creates a healthy environment in the womb by maintaining the uterine lining. It also reduces the chances of blood clots and the immune system responding to the fetus as if it was a foreign substance. Using progesterone cream during and throughout pregnancy can help you maintain and sustain a full-term pregnancy.
Under the care of a doctor or midwife, natural progesterone cream use can prevent first trimester miscarriage (when the primary cause is low progesterone). By the second trimester, the placenta itself is responsible for producing progesterone, so you can stop using the progesterone cream (again, under the care of a doctor or midwife).
Estrogen dominance may become worse when you first start using progesterone cream. After an extended period of progesterone deficiency, your estrogen receptor sites will be stimulated by the use of progesterone cream. This is a good sign though! It means that your body is responding well to the progesterone. It may take a few cycles of experiencing estrogen dominance symptoms – breast tenderness and swelling, spotting, fluid retention, hot flashes, fatigue, etc – before your progesterone levels regulate.
Progesterone use should be not be quit cold turkey. It’s important that you gradually wean yourself off of it by slowly reducing the amount each time you use it. This should be done on the last cycle that you plan on using the cream. If you are pregnant, do not do this until at least the 16th week of gestation, when the placenta takes over progesterone production.
A severe progesterone deficiency will require significantly longer progesterone cream supplementation to regulate your levels. It can take anywhere between 4 – 12 months for women with extreme progesterone deficiency to see results. Following a loading dose protocol may help to bring the levels up quicker, but consistency of use over an extended period of time is best.
Splitting the dosage between AM and PM is important! Splitting the dosage ensures 8-12 hours of sustained delivery – which more closely mimics how your body produces progesterone. If you do one big dose in the morning, and nothing in the evening, you are risking a full 12 hours of no progesterone absorption.
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