When it comes to hormone balancing, it’s time for women to know the truth about the benefits of progesterone USP. Many women get confused because their doctor or practitioner treats progesterone (natural) and progestin (synthetic) as if they’re the same and produce the same results. They are not. But first, some background…
When the total truth came out about synthetic HRT (hormone replacement therapy) via the Women’s Health Initiative in 2002 and then in 2004 with the synthetic estrogen-only arm of the study, which was also ended because hormone replacement therapy (HRT) with conjugated equine (horse-derived) estrogen was found to increase the risk of stroke, the medical community went into turmoil and even divisiveness as to what they should recommend to women who present with symptoms of hormone difficulties. The findings of the first report had an immediate impact on the millions of women using synthetic HRT, and research reported that 50% of these users discontinued their personal use of synthetic HRT. Seemingly, both then and even now, millions of women remain unsure about what is safe and effective for relieving symptoms of fluctuating hormones while not causing more health concerns down the road.
Progesterone USP and Your Endocrine System
First, we need to distinguish between what progesterone does in the body and the definitions of natural progesterone and synthetic progestin.
What is progesterone? Progesterone is often thought of as the hormone balancer, especially when it comes to estrogen. Progesterone is a steroid hormone produced by the corpus luteum after ovulation and, in smaller amounts, by the adrenal glands. It is the precursor, or the substance from which most other steroid hormones are derived, including cortisol, androstenedione, the estrogens, and testosterone. Progesterone’s roles range from normalizing blood sugar levels and facilitating thyroid hormone action to regulating menstrual cycles and maintaining a healthy pregnancy. While estrogen levels rise during the first half of the menstrual cycle, progesterone rises in the middle. Progesterone’s most important jobs in menstruating women are two-fold: 1) it prepares the uterus for implantation with a healthy fertilized egg, and 2) it supports the early stage of pregnancy. If implantation does not occur, progesterone levels will drop until another menstrual cycle begins.
Studies show that progesterone has anti-proliferative effects on breast cancer and leukemia cells (Formby 1998; Hayden 2009; Hilton 2010). Breast cancer is 5.4 times more common in pre-menopausal women with low progesterone levels than with favorable levels (Cowan 1981). Other data suggest that while bioidentical (natural) progesterone does not increase the risk of breast cancer, synthetic progestins used in conventional HRT (Hormone Replacement Therapy) do (Campagnoli 2005). Natural (bioidentical) progesterone has also been found to have neuroprotective properties. One study called for more attention to progesterone as a “potent neurotrophic agent that may play an important role in reducing or preventing motor, cognitive, and sensory impairments [in both men and women]” (Stein 2005).
What Is Bioidentical (Natural) Progesterone? Bioidentical progesterone is made in the body or produced (not extracted) in the laboratory from soybeans or Mexican wild yam root (Dioscorea villosa). Pennsylvania State University professor Russell Marker discovered the process in the 1930s, transforming diosgenin from wild yams into natural progesterone. Natural progesterone refers to bioidentical hormone products with a molecular structure identical to the hormones our bodies naturally produce. One of the most effective forms of bioidentical progesterone is called micronized progesterone. Micronization allows steady, even absorption. Accordingly, both the micronized progesterone and other commercially available progesterone creams contain bioidentical progesterone. (1)
What Are Synthetic Progestins? Unlike natural progesterone, non-bioidentical synthetic progestins are not molecularly identical to the hormones the body produces naturally. Synthetic progestins were first developed for use as contraceptive agents. Because natural progesterone has a very short half-life, researchers sought an agent that would produce longer-lasting, more potent effects. Birth control pills usually contain a synthetic progestin and a synthetic estrogen. Synthetic progestins are very potent, with just a small dose preventing ovulation and thus functioning as birth control. A slight change in the chemical structure of progesterone has allowed pharmaceutical companies to create patentable and highly profitable birth control products. (1)
One of the most common progestins, medroxyprogesterone acetate (Provera®), is linked to blood clots, fluid retention, acne, rashes, weight gain, depression, certain cancers, and other disorders. Non-bioidentical progestins can also bind to glucocorticoid, androgen, and mineralocorticoid receptors, which may explain the wide range of adverse side effects many women experience when taking synthetic progestins. The vast majority of research studies were conducted using progestins rather than natural progesterone, which helps explain the disparity and negativity of the results. (1)
The FDA has also approved Prometrium®, an oral pill containing 200 mg of natural micronized progesterone taken daily. Because orally administered progesterone is metabolized by the liver, it is usually contraindicated in patients with certain liver conditions. Initial liver metabolism of progesterone (called “first-pass” metabolism) also creates higher levels of certain metabolites of progesterone than transdermal or transmucosally administered progesterone. (1)
Experience tells us that when the endocrine system is being supported, a woman’s overall health, mood, and sense of well-being are maximized. Natural progesterone USP cream, when used correctly, can help many women through the often unbearable symptoms of peri-menopause, menopause, and post-menopause while providing many extra health benefits. Because it has the same molecular structure as the natural progesterone the body produces and recognizes, progesterone USP cream is absorbed through the skin directly into the bloodstream and, unlike oral progesterone or progestin, bypasses liver filtering. (1)
As beneficial as natural progesterone USP cream is for many women, remember that we are dealing with a very delicate system: the endocrine system, which affects nearly the entire body.
During the peri-menopausal years, it is progesterone, not estrogen as many believe, that is the first hormone to decline. The total amount of progesterone produced in the body declines to less than one percent of the normal, healthy level. This drop could be from low levels of dietary zinc, magnesium deficiency, Vitamin B-6 deficiency, or too many prescription meds such as antidepressants. All of these can disrupt healthy progesterone levels. However, lifestyle choices seem to be the most important factors in causing estrogen and progesterone imbalance. Some of the symptoms from declining progesterone levels are mood swings, insomnia, depression, weight gain, hot flashes, fuzzy thinking, PMS, and irritability.
When using any type of HRT, do your own research and separate fact from fiction.
Four head-to-head studies comparing progesterone to non-bioidentical synthetic progestogen (progestin) reported that women experienced greater satisfaction, improved quality of life, and fewer side effects when switched from progestin to progesterone (Hargrove 1989; Montplaisir 2001; Ryan 2001; Lindenfeld 2002). The beneficial effects of progesterone compared to non-bioidentical progestin included a 30% reduction in sleep problems, 50% reduction in anxiety, 60% reduction in depression, 25% reduction in menstrual bleeding, 40% reduction in cognitive difficulties, and 30% improvement in sexual function. Eighty percent of women in the study reported overall satisfaction with the bioidentical progesterone formulation (Fitzpatrick 2000).
Does the Body Store Progesterone USP?
Years ago, a “theory” about progesterone USP cream and how the body uses it was posted in an online article that basically stated: “… progesterone is highly fat soluble and once applied to the skin will store itself in a woman’s fat tissue. When someone first uses the cream, there is no issue because 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.” Of course, many grabbed this info, and it spread like wildfire among women and practitioners, causing many to question the use of progesterone USP.
What are the facts? Progesterone USP is extremely lipophilic, more so than any other steroid hormone. As such, most of a good progesterone cream is quickly and thoroughly absorbed into the skin, regardless of the carrier (note: some carriers are better than others). Progesterone USP should always be used cautiously and, in fact, I always recommend saliva testing one’s hormones BEFORE using any type of HRT.
The belief that, in females, natural progesterone is absorbed by fat and released as needed is not entirely true. However, ample evidence shows that virtually all of a dose of transdermal progesterone cream is absorbed rapidly into the bloodstream and therefore not stored. It is important to understand that using correct application sites (as well as rotating application sites) is extremely important and can determine whether or not a bioidentical progesterone cream will be effectively utilized by the body. Of course, if one rubbed progesterone cream on the buttocks (which is not a recommended application site) every day, there is obviously a chance some of it could be held in fat. Progesterone USP should always be applied to thin-skin areas where blood vessels can be seen, such as the inner arms, backs of hands, wrists, neck, chest (not breasts), backs of knees, and tops and bottoms of feet. For many years, practitioners were either unaware of, or did not communicate to their clients, the importance of applying progesterone cream to the appropriate sites. If the progesterone cream is pH-balanced, it can be applied around the vaginal area (called trans-mucosal application). Many women report effective results with less cream when used this way.
It’s important to note that one can have access to the best formulated progesterone USP cream available, but if one does not know or understand how to use natural progesterone USP correctly, maximum benefits will not be achieved.
Using Progesterone USP
Before recommending progesterone USP, knowledgeable practitioners will recommend saliva testing of the sex hormones as well as cortisol in order to establish the actual need for hormone therapy and to provide a baseline for future testing. Many practitioners do not understand the importance of saliva testing hormone levels before using any type of hormone therapy. And unfortunately, some practitioners are not educating women about the difference between saliva testing and serum testing, as well as why saliva testing is usually more reliable in establishing the need for HRT.
Although overuse of progesterone USP usually won’t cause harm, the goal is to achieve the needed support. High levels of progesterone showing up on saliva tests almost always indicate contamination of the test (example — one has applied progesterone and then touched their lips or even the top of the testing vial with the hand used to apply the progesterone, etc.), the amount of progesterone one is using is much too high for the physiological need of their body, or one is using progesterone and didn’t indicate this on the saliva test questions.
Progesterone USP should always be used in a physiologically appropriate amount that is carefully measured for each application. Apply it to the correct sites, and make sure they’re clean and rotated with each use. Trying to “eye” the application amount usually results in applying more or less than needed. This can cause a roller coaster effect on one’s hormones.
To maintain stable hormone levels, use progesterone cream in doses that match your natural cycle, as nature intended. This ensures you always have sufficient progesterone in the body. Of course, some things cannot be fully controlled, such as the impact of our environment. However, we can control the dose and application of USP progesterone by staying consistent. Stopping and starting, or using it randomly, isn’t conducive to hormonal balance; it can confuse the body and make you feel less than your best. Thus, consistency and compliance are mandatory when using progesterone USP. For most women, it can take from three to six months or more for full symptom relief to occur.
Progesterone USP – Hormone Symptom Rescuer?
Natural progesterone USP is often advertised as being able to resolve all of women’s hormone symptoms. However, natural hormone support isn’t just about adding more progesterone USP and/or more estrogen. Instead, it’s about achieving and maintaining an effective estrogen-to-progesterone homeostasis, as nature intended. If your body is already experiencing high estrogen levels, you will need to address estrogen dominance separately from progesterone deficiency. In many cases, women are ovulating and producing very normal physiological progesterone levels that would definitely be enough to keep them well and balanced, if they weren’t estrogen dominant. So simply adding more progesterone cream may sometimes be a cop-out instead of taking personal responsibility for lifestyle changes that will further support hormone wellness.
Related: Endocrine Disrupting Chemicals – What You Need to Know
Don’t Forget Your Liver!
The liver deserves very special attention whenever we discuss women’s hormone homeostasis.
One of its many responsibilities is processing steroid hormones and preparing their metabolites for elimination. Estrogens and progesterone undergo metabolic transformation through several pathways, after which their metabolites may be eliminated through urine or bile. The digestive system also participates in this process, making healthy bowel function another important consideration.
Supporting liver health through adequate nutrition, fiber-rich organic plant foods, regular physical activity, proper hydration, and reduced exposure to unnecessary environmental chemicals can support overall metabolic wellness.
Organic cruciferous vegetables, including broccoli, cauliflower, Brussels sprouts, and cabbage, provide beneficial plant compounds that support normal cellular and metabolic processes. Foods such as organic garlic, onions, leafy greens, and other nutrient-dense vegetables also contribute to a healthy dietary foundation.
Rather than focusing exclusively on adding hormones, natural wellness encourages us to consider how well the body’s entire terrain functions, including how hormones are produced, used, metabolized, and eliminated.
Like most things in life, we must always use caution. There is no magic bullet for supporting a healthy endocrine system. Bioidentical progesterone USP is one of the safest ways to support hormone homeostasis, especially when combined with a whole-body balancing program as mentioned above.
In closing, the following table shows the benefits of natural progesterone compared to estrogen. As you can see, progesterone USP has many effects and should be used wisely. One thing to remember is that if your healthcare practitioner recommends the use of any type of estrogen*, it should always be balanced with progesterone USP.
Estrogen Effects |
Progesterone USP Effects |
|
Stimulates breasts cysts |
Protects against breast cysts |
|
Increases body fat storage |
Helps use fat for energy and keep it off hips |
|
Salt and fluid retention |
Natural diuretic (water pill) |
|
Depression and headaches |
Natural anti-depressant |
|
Interferes with thyroid hormone |
Facilitates thyroid hormone action |
|
Increases blood clotting and risk of stroke |
Normalizes blood clotting |
|
Decreases libido (sex drive) |
Increases libido |
|
Impairs blood sugar control |
Normalizes blood sugar levels |
|
Loss of zinc and retention of copper |
Normalizes zinc and copper levels |
|
Reduced oxygen level in all cells |
Restores proper cell oxygen levels |
|
Increased risk of endometrial cancer |
Prevents endometrial cancer |
|
Increased risk of breast cancer |
Helps prevent breast cancer |
|
Helps decrease bone loss slightly |
Increases bone building |
*A new study published in JAMA Internal Medicine 2013 links conjugated equine estrogen hormone therapy — estrogen derived from the urine of pregnant horses — to a woman’s risk of developing heart disease. The study involved 384 women who were postmenopausal and taking hormone replacement therapy (HRT). The women were ages 30 to 79. This risk of taking conjugated equine estrogens was compared to the risks of a second type of hormone therapy, estradiol, which is a natural estrogen. Women who used the estrogens that came from horse urine — also known as Premarin — were twice as likely to have venous thrombosis. The women taking conjugated equine estrogen were also slightly more likely to have heart attacks, but risk of stroke did not vary based on which medication was taken.
Resources
1) Report. Bioidentical Hormones: Why Are They Still Controversial? Life Extension Magazine October 2009
