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, 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.
Most of the readers of Hormones Balance are women after age 45 – it is therefore no surprise that many show signs of progesterone deficiency. In fact, ovarian production of estrogen can decline by as much as 60% and levels of progesterone can drop as much as 100% once ovulation ends. For some women that can happen as early as their 40-ties.
What are the symptoms of low progesterone?
- Hot flashes and night sweats
- Insomnia and mid night waking
- Fertility or menstrual problems
- PMS or PMDD
- Anxiety and restlessness
- Irritability and nervousness
- Low mood and depression, especially around ovulation and pre-period
- Mood swings
- Weight gain and cellulite, especially around the thighs and buttocks
- Fluid retention – your fingers and toes swell up
- Brain fog
- Sagging skin
- Low thyroid
- Pain and inflammation
- Excessive menstruation
- Migraine headaches before cycles
- Decreased libido
- Decreased HDL (“good” cholesterol)
What is progesterone’s role in a woman’s body?
Progesterone is often mentioned as the hormone necessary in fertility and pregnancy but its role is far wider than that.
Here are some of the reported health benefits of having leveled progesterone levels – including women in peri- and menopause.
- Reduction of hot flashes and night sweats (this study shows a reduction as high as 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)
- Restoration of ovulation and a healthy luteal phase (women in peri-menopause often experience shortened luteal phase)
- Improve quality of sleep
- Reduction of uterine fibroids and endometriosis
- Reduction of pelvic pain
- Improved libido
- Increased thyroid function (shown to increase free thyroxine)
- Breast cancer prevention (studies here and here)
- Improved fertility, ovulation and health of the first-trimester pregnancy
- Reduction or disappearance of breast lumps
- Progesterone inhibits mast cells releasing histamine
- 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
- Potential support with autoimmune and inflammatory diseases
- Improved brain health
- Supports recovery from TBI (Traumatic Brain Injury)
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.
Other causes can be:
- Excessive arginine consumption (often used in heart and blood vessel conditions including congestive heart failure (CHF), chest pain, high blood pressure, and coronary artery disease)
- High sugar consumption, high blood sugar levels
- Consumption of trans fats
- Deficiency of vitamins A, B6, C and zinc
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 oral form of progesterone?
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 running the risk of your body breaking down progesterone into “dirty” progesterone metabolites, which can be harmful.
Furthermore, oral progesterone is largely converted to allopregnanolone on its first pass through the liver. This isn’t the best choice as a progesterone replacement therapy because allopregnanolone attaches to GABA receptors, creating anxiolytic (anti-anxiety) and somniferous (induces sleep) effects. Oral progesterone does not offer all the other benefits of progesterone (described above).
For these reasons, I recommend progesterone in a topical form, not an oral form.
The difference between bioidentical and synthetic progesterone (progestin)
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) come from pregnant mares and are synthetically altered 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 and often presented by doctors as “safer” than estrogen-based contraceptives – which is misleading and incorrect.
The side effects from using progestins can include:
- Increases appetite
- Weight gain
- Fluid retention
- Decreases energy
- Breast tenderness
- Decreases sexual interest
- Hair loss
- Interferes with the body’s own production of progesterone
- Does not help balance estrogen
- Remains in the body longer
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 cute and funny 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. That’s what California Prop 65 warning contains – it covers “Progestogen” and the warning is based on the use of progestins and NOT progesterone.
Effects from Bioidentical Progesterone not seen with Progestins
I want to address one vital issue: Not all hormones are the same. So many women are terrified by them, are told by their uninformed physicians in a blanket statement that “Hormones cause cancer.” As a result, women go through life like “living dead;” suffering from an awful load of symptoms that would be resolved by using bioidentical hormones.
I recently attended an endocrine symposium and learned even more about progestin and what they DO NOT help with (while natural can help with all these):
- Helps balance estrogen
- Leaves the body quickly
- Improves sleep
- Natural calming effect
- Lowers high blood pressure
- Helps the body use and eliminate fats
- Lowers cholesterol
- Increases scalp hair
- Helps balance fluids in the cells
- Increases the beneficial effects of estrogen on BV
- Increases metabolic rate
- Natural diuretic
- Natural antidepressant
- Is anti-inflammatory
- Stimulates the production of new bone
- Enhances the action of thyroid hormones
- Improves libido
- Helps restore proper cell oxygen levels
- Induces conversion of E1 to the inactive E1S form
- Promotes Th2 immunity
- Is neuroprotective, promoting myelination
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. Many doctors have never been educated and updated on the nuance of this study and issue a blanket statement to their patients – which doesn’t serve women, especially who need it badly.
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.
For example, this study demonstrated that progestin and norethisterone (a synthetic and potent progestogen hormone used to stop uterine bleeding) caused the proliferation of progesterone receptor breast cancer cells.
This study compared bioidentical estrogen and progesterone to horse-derived estrogen and progestin, and concluded: “By contrast, two 28-day cycles of daily oral conjugated equine estrogens (CEE) 0.625 mg and oral medroxyprogesterone acetate (MPA) 5 mg for the last 14 days of each cycle significantly increased proliferation at both the cell level and at the mRNA level, and significantly enhanced mammographic breast density, an important risk factor for breast cancer.”
This study has demonstrated that the “Exposure to progesterone for 14 days reduced the estradiol-induced proliferation of normal breast epithelial cells in vivo.” This is important because carcinoma is a malignancy of the epithelial tissue and it accounts for 80 to 90 percent of all cancer cases.
One more study I wish to share with you found that natural progesterone has been shown to decrease the risk of developing breast cancer. This study looked at 80,000 postmenopausal women for 8 years using different forms of HRT. It found that women who used estrogen in combination with synthetic progestin had a 69% increased risk of developing breast cancer when compared to women who never took HRT. Women who used progesterone in combination with estrogen had no increased risk in developing breast cancer compared to women that did not use HRT and also had a decreased risk in developing breast cancer compared to the women that used progestin.
Progesterone for cancer prevention?
Yes. Most of my colleagues who practice functional medicine and specialize in women’s health, prescribe progesterone as a way to prevent estrogenic cancers such as breast, ovarian and uterine cancers. Progesterone protects against endometrial and breast cancer. The 1981 Johns Hopkins study found that infertile women with progesterone deficiency had a premenopausal breast cancer risk that was 540% greater than that of women whose infertility was not related to their hormone status. Furthermore, these women had a 1,000% greater risk of death from all types of cancer. Studies showed that progesterone suppressed the cells from spreading and induced cell death in malignant mesothelioma cancer cells and that it also can inhibit growth and cause cell death in breast cancer cells.
How to choose your topical progesterone?
If you are ready to give it a try, here are a few guidelines what bioidentical progesterone should NEVER contain:
- Parabens (a form of xeno-estrogens that mimic estrogens)
- Mineral oil
- Fragrance (they contain phthalates which are toxic estrogens)
- Yams in their direct form (they are not harmful, just ineffective and your are wasting money)
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?
Women going through peri-menopause, menopause and post-menopause, who suffer from hot flashes, night sweats, can use topical progesterone for 25 days out of a 30-day calendar, with 5 days off. If you are in peri-menopause and still menstruating, start progesterone 5 to 7 days after the first day of your period and continue until the next period.
Menstruating women are advised to use topical progesterone during their luteal phase, which is day 14 to 28 of the cycle. Day 1 is the first day of your period. If your period is irregular or absent, start progesterone on day 14 and teach your body to learn a new cycle. Stop when your period comes back.
Women with no ovulation like in the case of PCOS can pick a day and start 7 days after the first day of the period and continue until the period starts again.
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.
Another way to dose is to use your body weight.
Women under 150 lbs – start with 20–30mg of bioidentical progesterone.
Women over 150 lbs – start with 40-50mg of bioidentical progesterone.
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.
Can I start feeling worse before feeling better?
Yes, it can happen. I suggest to read more on paradoxical reactions to progesterone in Part 2 of the Progesterone series. Some women experience exacerbated symptoms of estrogen dominance (such as tender breast, poor sleep) before they feel better. Functional practitioners recommend reducing the dose by half (meaning: 10 mg per day) and trying that for a month before slowly titrating up. If you find no relief, I recommend to work with a skilled practitioner who can guide you. If you need help finding one, please email my team here and we will do our best.
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. Furthermore, as also mentioned above, the use of synthetic estrogen and progestin is a likely culprit behind ER+ and PR+ breast cancers.
Furthermore, 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 they can happen).