08 Mar 2017
Dr. Anna’s Quickstart Guide to Progesterone and Progestins
A recent post about progesterone in the Hormone Harmony Club on Facebook sparked a lot of conversation among our members.
Here’s the post:
My doctor told me to stop my progesterone cream and prescribed Prometrium pills (1 at bed) and an estrogen gel pump (2 pumps at bed). I am SO worried about taking these and don’t know what to do. I’ve always been afraid of estrogen supplementation and read so many different things. He said as long as you’re taking Prometrium with it it’s safer, but the pamphlet I got from the pharmacy says taking progestin with Estrogel actually increases your risks.! I just don’t know what to do anymore!
There are several layers to this question, so let’s start with the most confusing part first.
PROGESTERONE is not the same as PROGESTIN.
Say it with me ladies, “PROGESTERONE is not the same as PROGESTIN.”
Unfortunately, the medical community and some regulatory agencies (California, in particular) have lumped our sweet bioidentical progesterone in with progestins. But progestins are synthetic, not bioidentical.
Synthetic progestins (i.e. medroxyprogesterone, Provera, Prempro, birth control pills) are not your friends. They can produce severe side effects including increased risk of cancer, abnormal menstrual flow, fluid retention, nausea, depression.
On the other hand, progesterone is bioidentical. It is the same chemical compound your body makes. In addition to counteracting the effects of estrogen, it is helpful for bone health, nerve health and keeps you pleasant and calm on most days.
Side effects are extremely rare with natural progesterone. The most common ones are alteration of your cycle and drowsiness.
PROGESTERONE is a perimenopausal woman’s BFF.
Capsules or cream?
There’s a lot of confusion around why a woman would choose progesterone cream or capsules. And understandably so since they are the same compound.
Oral progesterone (compounded or Prometrium) is bioidentical. It is most commonly used to help women with insomnia.
What makes oral progesterone better for sleep?
When progesterone passes through your liver to be metabolized, a compound called allopregnenolone is made. This makes you sleepy. HOORAY!!!
For all purposes other than insomnia, cream is fine (and available over-the-counter). It is made from diosgenin which is extracted from wild yams and converted in the lab into bioidentical progesterone. Your body cannot do this conversion on its own which is why plain old wild yam cream doesn’t work.
What’s the Right Dose?
There is a LOT of controversy about dosing of cream. I have seen stories of women using as much as 1000 mg/day…and as little as 20 mg. Your body normally makes 20-30 mg/day when you are cycling. But if you don’t ovulate (and this is what happens in perimenopause), your progesterone level plummets which creates symptoms like insomnia, weight gain, anxiety, palpitations, etc. I generally have my clients start with 20-40 mg/day at bedtime. I do have one client on 250 mg/day…but we didn’t start there! For oral dosing, 100-200 mg is usually the starting dose.
Does Progesterone Cause Cancer???
Now for the third layer of the question.
Progesterone has NEVER been implicated in causing breast cancer and in fact, has a protective effect. You can read more about that here. It is safe to use by itself. Progesterone is helpful for many women, but it’s not a magic bullet. You need to look at the whole picture of hormones and health to determine if it’s a good idea to use it or not.
Synthetic progestins HAVE been shown to increase the risk of breast cancer (Women’s Health Initiative Study 2002) and I generally recommend avoiding them if possible.
As for MDs and other practitioners who say cream is not safe because it’s not regulated…I say BS. Compounding pharmacies and reputable companies have quality standards. Pharmacists aren’t standing around in the back room whipping up witches’ brew! Just because Pharma doesn’t make it doesn’t mean it doesn’t work.
If you’re on the fence or afraid to try progesterone, I can help you with that. Don’t suffer, get the real 411 from a health care professional and menopause expert. Find out more about that here: http://www.drannagarrett.com/lets-talk/.
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Her clients would tell you that her real gift is helping them reclaim parts of themselves they thought were gone forever.
Find out more about working with her at http://www.drannagarrett.com/work-with-me/.