What you will learn in this article:
- The role of progesterone in a woman’s body
- Symptoms of progesterone deficiency
- Why can women get so depleted in progesterone?
- Benefits of topical progesterone
- Difference between synthetic and bioidentical progesterone
- What form is best – oil or cream?
- What your progesterone should be free of?
- What dosage and how to apply?
- The product I use and recommend
This is Part 1 of the progesterone article series. In Part 2 (coming end of February), you will learn more about paradoxical cases and reactions to progesterone (rare but they happen) and what could be causing them.
You know I’m a big proponent of using food as the key tool to balance hormones. I would like to remind you that food is the foundation of your hormonal health.
Herbs and supplements can play a big role, too. My mantra on how to prioritize these modalities is simple:
If you are getting no results with diet and herbs alone, it might be time to explore bioidentical hormones, such as progesterone.
So who should resort to using topical hormones such as estradiol, estriol, DHEA or progesterone? It depends on the person. Don’t you just cringe hearing that? But don’t worry, I will break it down for you.
Some women can function beautifully without taking any supplemental hormones. Others might need progesterone only, and some might need all four of them. Furthermore, your body changes and over time you might see a need to increase some and decrease or drop others.
How to know which hormones you are deficient in?
Two ways: By tuning into your symptoms or urine testing.
#1 If you go by symptoms, take this hormone quiz to find out what your imbalances might be.
#2 If you prefer to test, you can order the DUTCH urine test (this is the most sophisticated hormone panel in the market today). You can email our team to help you find a practitioner who can interpret the DUTCH results for you. It’s the most reliable sex hormones test to date.
If you are low on estrogens and testosterone and want to start supplementing with estrogens (typically estrone (E1), estradiol (E2) and estriol (E3)), or DHEA/testosterone, I recommend working under the supervision of a functional practitioner who has years of experience with bioidentical hormones (not synthetic – more on that later).
Estrogens and DHEA/testosterone can be tricky and if you do not break them down properly, this can lead to worsening symptoms and even development of hormonal cancers, fibroids, endometriosis, and facial hair.
If you need practitioner recommendations, please briefly describe your condition and email us at [email protected] – we will connect you with a trusted practitioner. I personally no longer offer 1:1 consultation.
Progesterone is my favorite bioidentical hormone. It’s benign (caveat on this below) and generally safe causing very few side effects, if any. If you suffer from symptoms of low progesterone (more on this below) and are either in perimenopause or menopause, topical progesterone can help you feel like yourself again.
What is the role of progesterone in a woman’s health?
#1 It is perhaps best known for its role in pregnancy and fertility, as it is essential for regular menstrual cycles. It is critical for healthy pregnancies
#2 It has beneficial effects on the central nervous system. For instance, progesterone appears to protect the brain from damage when a stroke occurs, and when combined with vitamin D, progesterone has been shown to improve symptoms in traumatic brain injury patients.
#3 It can also improve the quality of sleep
#4 Has important anti-inflammatory effects
#5 Opposes estradiol
#6 It helps women feel calm and grounded. Many women with depression and anxiety could benefit from topical progesterone.
What are the symptoms of low progesterone?
- Fertility or menstrual problems
- PMS or PMDD
- High anxiety and low mood and depression, especially around ovulation and pre-period
- Insomnia and mid night waking
- Weight gain and cellulite, especially around the thighs and buttocks
- Fluid retention – your fingers and toes swell up
- Hot flashes and night sweats
- Brain fog
- Sagging skin
- Thyroid issues
Progesterone and estrogen dominance
Low progesterone symptoms result not just because the body needs progesterone to stave off these symptoms but also because of the impact of the progesterone to estrogen ratio.
When progesterone levels drop below a certain level, estrogen becomes the dominant hormone, and this change in the balance between the levels of these two hormones is what ultimately leads to many of the symptoms that people experience when their progesterone levels go down.
When this imbalance occurs, certain herbs can help to restore balance, but sometimes progesterone is needed to relieve problematic symptoms.
Why can women get so depleted in progesterone?
Several factors make it more likely for your progesterone levels to drop.
Three primary factors are:
Age: as you get older, your estrogen and progesterone levels both drop. However, because progesterone drops more significantly, the estrogen to progesterone ratio becomes higher than it was when you were younger, which is associated with estrogen dominance symptoms.
Take a look at the chart below – it shows the drop of estrogen and progesterone over time. Can you see how, for example, a woman age 35 has her estrogen and progesterone at about 1:1 ratio? Now take a look at how that changes when she is 55 – her estrogen, even though it’s lower, it’s more dominant as compared to her progesterone levels.
This imbalance may also account for why older women are more likely to develop estrogen receptor-positive breast cancer at the later age – the culprit is estrogen dominance with low progesterone levels.
Stress: Stress can cause progesterone levels to drop. When we are stressed, we produce and release higher levels of the hormone cortisol. Both cortisol and progesterone are produced from pregnenolone. When you are in chronic stress, the body will prioritize and divert the available pregnenolone to produce higher amounts of cortisol to help you get through stress.
This means there might not be enough to produce sufficient levels of progesterone. This is called “pregnenolone steal” and it’s the leading cause of low progesterone problems.
Toxic skincare and house cleaning products: The use of toxic cosmetic products or house cleaning products introduce molecules known as xenoestrogens, which interfere with normal female sexual hormone activity. Using these types of products can cause imbalances in the estrogen to progesterone ratio and thereby lead to symptoms associated with low progesterone.
When to use topical progesterone
At the beginning of the article, I mentioned how food, nutrients, and herbal solutions can naturally boost progesterone levels.
However, there might be circumstances where you can’t or won’t change your diet or have no access to these herbs. Or perhaps, which I hope is not the case, you have tried nutritional strategies but are still highly symptomatic. In these circumstances, topical progesterone might be a good solution.
Right after publishing my cookbook, Cooking for Hormone Balance, I went on the road actively promoting the book. I was already tired, having worked for months on the book launch plans (concurrently preparing the launch of our online cooking program) – it, therefore, was a stressful and intense time and I started feeling my health decline. I didn’t feel as rested after a night’s sleep and my periods got slightly irregular.
This is when I brought on topical progesterone and felt instant relief. I also felt much calmer during the day, in spite of the barrage of challenges.
Therefore, in times of acute stress, such as divorce, work deadlines, or illness, bringing in topical progesterone might be a great idea.
Topical or pill form?
Putting topical progesterone on your body allows it to bypass digestion and the liver which is good for two reasons.
One, you don’t tax your digestion and liver with yet another compound to be absorbed and metabolized.
Two, if your gut and liver aren’t functioning optimally, you are not running into the risk of your body breaking down progesterone to “dirty” progesterone metabolites, which can be harmful.
For these reasons, I recommend progesterone in a topical form, not an oral form.
Benefits of using progesterone
It is no surprise why so many women rave about progesterone.
Here are some of the reported health benefits.
- Reduction of hot flashes and night sweats (this study shows a reduction of 80%)
- Improvement of bone health and osteoporosis – even osteoporosis (by having an osteoblastic effect)
- Reduction in PMS symptoms; bloating, water retention, and mood swings
- Restoration of a healthy menstrual cycle (less bleeding, shorter days)
- Reduction of uterine fibroids and endometriosis
- Reduction of pelvic pain
- Improved libido
- Improved fertility, ovulation and health of the first-trimester pregnancy
- Reduction or disappearance of breast lumps
- Relief of pain in fibrocystic breasts
- Deeper and more restful sleep
- Mood enhancement
- Anxiety relief
- Anti-inflammatory effect – I used it post-surgery as well to lower the inflammation
- Improved brain health
- Supports recovery from TBI – Traumatic Brain Injury
The difference between bioidentical and synthetic progesterone
Until today, there is fear among women and unaware doctors of using any form of hormone replacement therapy (more on that below). This fear can be debunked once we understand that there is a big difference between bioidentical progesterone and progestin.
True progesterone is naturally produced by the body.
Progestins (brand names include Prempro) are synthetically developed in laboratories. The problem with progestins is that they don’t “fit” into the progesterone receptor the way natural progesterone does – their molecular structure is different which can cause a host of health issues – see more on that below.
They are referred to HRT which stands for Hormone Replacement Therapy. Progestins are also used in birth control pills.
Bioidentical progesterone, also called “natural”, is derived from plants – typically from yams or soy. To be clear – they are also created in a lab but the molecular structure resembles true progesterone produced by your own body.
Yam or soy in their natural form whether eaten or applied topically, will not have the same effect as bioidentical hormones. If you watched the TV series “Frankie and Grace,” Frankie starts a new business venture making yam cream from her boyfriend’s harvest to boost progesterone in women. It’s a nice story but it’s also misleading. Women who report improvement on yam creams are probably experiencing the placebo effect.
“Progestogen” (sometimes spelled “progestagen”) is a general term for hormones that act like progesterone, and therefore includes both progesterone and progestins.
Does hormone replacement therapy cause cancer?
The scare of hormones causing cancer and other health issues started with the World Health Initiative. It studied more than 15,000 women between the ages of 50 and 79 who were given HRT in the form of estrogen and progestin (not bioidentical progesterone) for a period of over 10 years.
The study had to be stopped early due to the high occurrence of breast cancers, blood clots, strokes, and cardiovascular diseases. This sent waves of fear amongst women and doctors and all hormones were declared unsafe.
If you want to know more on this topic, please read my friend, Dr. Mache Siebel’s post. Today we know that progestin was the likely culprit. Not surprisingly, a pharmaceutical company was behind supplying the progestin to the WHI study.
Enough studies have been done to date to establish, over extended periods of time, that bioidentical progesterone is a completely different compound and its benefits outweigh the risks.
How to choose your topical progesterone?
Bioidentical progesterone should not contain:
- Parabens (a form of xeno-estrogens that mimic estrogens)
- Mineral oil
- Fragrance (they contain phthalates – toxic estrogens)
- Yams in their direct form (they are not harmful, just ineffective)
What I use and recommend
Because of my personal experience of using topical progesterone (in the past and present – as I’m going into perimenopause at age 46), I have turned to one of the top experts in the country to help formulate our own Hormone Balance Nutritionals topical progesterone – ProgestPure.
ProgestPure is a natural topical progesterone serum providing 20 mg of bioidentical progesterone in every 1 ml serving. This highly bioavailable progesterone serum contains just four ingredients: micronized USP progesterone, dimethyl isosorbide, Caprylic/capric triglyceride (from coconut), and vitamin E. It is free of parabens, mineral oil, and petroleum.
ProgestPure consists of a super-micronized form of natural progesterone in a proprietary triglyceride carrier that facilitates better progesterone absorption than conventional creams. This serum also contains a natural sugar-based complex, dimethyl isosorbide, which increases progesterone solubility and facilitates deeper penetration through the skin at a faster rate.
Additionally, this compound helps preserve the potency of the progesterone, in contrast to water-based products, which are susceptible to reductions in the potency of as much as 30% or more within the first 60-90 days of manufacturing due to hydrolysis of the active components.
Cream or oil?
Many bioidentical progesterones are sold in the form of creams. Anecdotally speaking, my functional medical practitioner friends generally recommend oil-based bioidentical progesterone over creams. They cite better absorption, efficacy and longer shelf life. Some say that cream-based progesterone loses its potency quicker than oil-based. ProgestPure is oil based.
Where to apply topical progesterone and why?
Rotate where you apply the topical progesterone, and in doing so, switch between fatty and non-fatty areas. Whereas fat will store the progesterone and absorb the progesterone into capillary blood, progesterone applied to thinner areas will more readily be taken up into the body and metabolized.
Uptake is best in the places where you blush – such as the face, neck, and chest. Rotating whether progesterone is put on fat or thin areas of the body can help to produce both immediate and sustained benefits of the topical progesterone.
When to use topical progesterone?
Menstruating women are advised to use topical progesterone during their luteal phase, which is day 14 to 28 of your cycle. Day 1 is the first day of your period. If your period is irregular, start progesterone on day 14 nevertheless and teach your body to learn a new cycle.
Menopausal and post-menopausal women should use topical progesterone for 25 days out of a 30-day calendar, with 5 days off.
How much progesterone should you use?
It will depend on how low and symptomatic you are, your diet, and stress levels (remember the pregnenolone steal I talked about above?). I recommend to start slow and then dose up.
If you chose to use ProgestPure, start with one full dropper which will give you 20 mg of bioidentical progesterone. You can double that (by doing it twice a day) to 40mg per day if symptoms don’t improve.
If you want to try a higher dosage, I recommend working with a skilled functional practitioner who knows the ins and outs of bioidentical hormones and tests your levels to be sure that you don’t overproduce the “dirty”: progesterone.
Who should not use progesterone?
Women with progesterone receptor-positive breast cancer should not use topical progesterone, even though progesterone is likely not the main culprit in this form of breast cancer.
According to functional oncologists and functional endocrinologists, the problem is in how the body breaks down progesterone into specific metabolites (I call them “dirty” progesterones) that can cause problems, as well as the use of progestins like those in birth control pills.
Indeed, research has shown that the use of birth control pills could increase the risk of breast cancer and may contribute to a substantial number of breast cancer diagnoses. Nevertheless, until there is more research to more clearly elucidate the causes and contributing factors associated with progesterone receptor-positive breast cancer, I do not advise the use of topical progesterone for these individuals.
In addition to the breast cancer patients described above, those with hormonal issues, and those receiving doctor’s advice not to use it should not use topical progesterone.
In Part 2 of the progesterone series, I will talk about the paradoxical responses to progesterone (rare but them can happen).
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