Topical Progesterone - When, Why, and How - Part 2

Thank you so much for the ton of questions we received in regards to progesterone. I spoke to two renowned colleagues, both board-certified ObGyns—Dr. Anna Cabeca and Dr. Shawn Tassone to get their input on more nuanced cases of using progesterone.

Dr. Anna Cabeca has worked with women for over 20 years (she no longer works with private patients) and is the creator of the highly popular vaginal rejuvenation cream, Julva (our Hormones balance community loves it) and Mighty Macaa wonderful and gentle pick-me-up maca blend I often drink in the afternoon.

Dr. Tassone is one of the very few colleagues who still takes one-on-one patients. If you need a consult, especially pertaining to bioidentical hormone usage, I highly recommend consulting with him (he’s Austin, Texas-based but offers Skype calls). In my experience, talented, and popular practitioners stop taking patients at some point. I, therefore, recommend reaching out to him sooner than later. You can book a consult with him here.

In part 1 of the Progesterone Series, “Topical Progesterone – When, Why, and How – Part 1”, I covered the basics of using progesterone—how it can help, who would benefit the most, how to pick the cleanest product, the product I use (ProgestPure), when to use it, and how to dose.

In this article, we will go deeper to answer more complex questions.

1. “I used progesterone for a while and had adverse reactions. Why?”

(Your comments here varied from weight gain, insomnia, lumpy breasts, bigger fibroids, feeling dizzy, lightheaded, angry, depressed, experiencing rising heart rate, and water retention.)

First of all, most women using bioidentical progesterone experience the complete opposite reaction and this is why progesterone is so popular among millions of women.

The first thing to look at is the type of progesterone you tried— was it synthetic or bioidentical?

Was it synthetic progesterone, called progestin, or medroxyprogesterone (sold under brand names such as Provera, Prempro, Premphase and various others as birth control pills)? This form of progesterone has been linked to causing breast cancer and is why the Women’s Health Initiative was terminated earlier. This is not the form of progesterone any woman should ever use—this includes contraceptives. Dr. Cabeca shared that lower body extremities such as growing fibroids or leg edema are pretty common symptoms when using synthetic progesterone.

If you used bioidentical progesterone (compounded is also bioidentical), there could be a few reasons why you may have had a paradoxical reaction:

Adrenal issues. In all her years of private practice, Dr. Anna Cabeca shared that most adverse reactions were related to the adrenals. Since cortisol is made from progesterone, a person with high cortisol levels and a stressful life will drive the cortisol pathway—causing many of the symptoms described above.

In these circumstances, Dr. Cabeca recommends starting on smaller doses of topical progesterone (not the pill, so we bypass the liver) and starting with as little as 10mg (that’s ½ dropper of ProgestPure), then slowly building up from there. Some women may need as low of a dose as 1mg (that’s 2 drops of ProgestPure).

In tandem, adding in adrenal support—using adaptogens (I wrote about them here), getting enough sleep, getting out in nature, self-care (get #MeCare ideas here)—will be critical to improving your tolerance to progesterone.

Progesterone in a pill form can have a dose as high as 100mg; starting at 20mg might be a better option.

2. “My estrogen dominance symptoms got worse with progesterone. Why?”

According to International Women’s Pharmacy, this could be the reason:

“Ironically, estrogen side-effects may occur when progesterone therapy is initiated. Estrogen symptoms such as headaches, nausea, and depression sometimes get worse with progesterone replacement, particularly when the dose is small. Progesterone stimulates estrogen receptors for estrogen. The initial stimulation occurs and potentiates the estrogen effect. When activity is potentiated, the amount of non-converted progesterone may not be enough to counter or balance these symptoms. Higher doses of progesterone may be needed.”

3. “Can progesterone help Candida (yeast overgrowth)?”

According to a number of studies, yes.

This research showed that estrogen drives up and progesterone opposes the growth of Candida. This study demonstrated that progesterone can help with preventing candida biofilm formation (which is part of the reason why candida is so hard to get rid of).

4. “Can progesterone help with weight loss?”

Yes, if the weight gain is caused by estrogen dominance or adrenal issues. It might help, to some degree, women with low thyroid function. It should however not be seen as the only go-to weight management tool.

5. “Who should not be using progesterone?”

Women with vaginal bleeding should not use progesterone or any other hormone therapy until a diagnosis is made.

5. “Why are my symptoms of Candida worse when I supplement with progesterone?”

Some women experience the contrary—worsening of Candida. This is what happens: A week before menstruation, progesterone levels rise. Progesterone increases glucose (or sugar) levels in the blood, which is exactly what Candida yeast cells thrive on. (This also explains why women with Candida crave sugar and carbs before their period.). Then, the increased sugar intake often leads to irritability, mood swings, and depression.

Other women have no such result. I’ve struggled with Candida for years and have never noticed progesterone making it worse.

7. “Can women with PR+ (progesterone receptor positive cancer) use progesterone?”

This is a controversial topic and you would need to do your own research to decide what resonates with you. Progestin (the synthetic progesterone) has been linked to various forms of cancers; it is, however, a totally different animal from bioidentical progesterone. Please read Part 1 of the Progesterone Series article that cites all the studies that prove this point. What fuels the cells is either synthetic progesterone or the “dirty” progesterones (which are the unfavorable metabolites of progesterone) which are broken down in your gut and liver.

For simplicity, it is contraindicated for women with a history of PR+ breast cancer to take progesterone as a DIY solution. However, if you agree with the above paragraph, I recommend working with a functional practitioner to lay the foundation for a safe application. This may mean doing some gut healing and liver detoxification to prepare your body for a safe progesterone metabolism. I also recommend testing to see how you progress.

8. “What is better—progesterone in pill or topical form?”

The answers vary depending on who you ask.

Dr. Anna prefers to use topical progesterone and Dr. Shawn prefers a pill, even though he often compounds progesterone with other hormones (like estrogen, DHEA or testosterone), and he ends up using progesterone in the topical form most of the time.

Oral progesterone tends to have better results in women with GABA deficiency and who struggle with anxiety. However, it is contraindicated in women with digestive issues (such as SIBO or candida yeast overgrowth) and liver issues such as the non-alcoholic fatty liver (NAFL).

Topical progesterone is easy to obtain as it’s an over-the-counter product (even health stores sell them) so it’s easier for you to pick one. A pill is prescription-only and you would need to work with a functional practitioner to get it.

At the end of the day, it’s a personal choice and you can try both to see which helps you more. I personally opted out from a pill just because I don’t want to take yet another pill and tax my digestion and liver.

It is possible to use both oral and topical progesterone at the same time and get the benefits of both.

9. “Should I stop taking progesterone at some point?”

It depends on the person. Here are some guidelines.

Some women only need to take progesterone for a while and then their body recalibrates—when they stop, the symptoms do not return.

Other women feel their symptoms return, in which case, continuing is advised.

In conclusion: Try progesterone for a few months and then take a couple of weeks off to see how you feel. If symptoms return, get back on it. Some women reduce the dose which is perfectly fine.

10. “Will my body stop producing its own progesterone when I start supplementing?”

That’s a really good question. Both Dr. Cabeca and Dr. Tassone agree that it does not as long as we don’t use very high doses. The added progesterone needs to act as a complementary source that reduces your symptoms. You will still be producing your own hormones and only using the supplemental progesterone to replenish the lack and mitigate symptoms.

11. “Can I use progesterone-enhancing herbs such as vitex, maca or supplements like zinc and vitamin E?”

Yes, absolutely. Dr. Cabeca recommends many of them to be used in conjunction with progesterone.

12. “Can I start feeling worse before feeling better?”

Yes, it can happen. 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: 10mg per day) and trying that for a month before slowly titrating up. If you find no relief, I recommend working 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 to help you.

13. “Can lactating women take progesterone?”

If you are suffering from postpartum depression, progesterone may help. It’s best to work with a functional practitioner to manage your condition.

14. “If I’m on estrogen HRT, should I also use progesterone?”

Yes, absolutely. Allopathic doctors have not evolved in their belief that women only need estrogen, many of them still cite the Women’s Health Initiative that concluded that progestin was the cause of women’s cancers, cardiovascular problems, etc.

As mentioned earlier, progestin is a synthetic hormone and should not be compared to bioidentical progesterone. It is best and safest for women to supplement with progesterone to oppose and balance out the added estrogen.

15. “Can I take progesterone after having a hysterectomy?”

Yes, definitely. It’s not only safe but recommended, especially if you were put on estrogen therapy.

16. “Could I use progesterone in menopause and postmenopause?”

Yes! It’s an erroneous assumption by allopathic doctors that women in menopause and postmenopause need no progesterone. The adrenal glands still produce progesterone. Women in menopause and postmenopause can benefit greatly from progesterone and mitigate symptoms such as memory loss, poor mood, cognitive decline, osteoporosis, leaky bladder, and hot flashes.

17. “How best to use progesterone in menopause and postmenopause?”

The best practice is 25 days on and 5 days off. You can also try it weekly: 6 days on and 1 day off.

18. “Where should I apply progesterone?”

We recommend rotating between fatty and non-fatty areas. Since fat will store the progesterone and absorb it into capillary blood, progesterone applied to thinner areas will more readily be taken up into the body and metabolized.

19. “What is your progesterone made of?”

Our ProgestPure is made from yams. Even though Frankie (from Grace and Frankie, a sitcom on Netflix) makes yam cream to help menopausal women, in reality, it won’t work. Yams need to get processed in a lab for the molecule to resemble women’s progesterone—that’s what ProgestPure is made from.

20. “Do you have soy in your ProgestPure?”

No, we do not, Our progesterone oil is made from yams.

21. “What is the benefit of using oil versus cream?”

For our ProgestPure we decided to go with oil for a couple of reasons.

One is the absorption issue—our ProgestPure consists of a super-micronized form of natural progesterone in a proprietary triglyceride carrier (i.e. oil) that facilitates better progesterone absorption than conventional creams.

The second is expiration time—creams that contain progesterone tend to lose their potency quicker than oil-based.

22. “Why does your ProgestPure carry the California Pro 65 warning?”

“Proposition 65, the Safe Drinking Water and Toxic Enforcement Act of 1986” was originally intended to protect drinking water sources from chemicals known to cause cancer, birth defects or other reproductive harm, and to inform citizens about exposures to such chemicals. Each year the Governor posts a list of chemicals “known to the state to cause cancer or reproductive toxicity.”

Progesterone is on the list.

Progesterone is a hormone that actually prevents cancer, it also helps with your thyroid, sleep, cycle, moods, pregnancy, bone health and more.

There are four major flaws in the study that caused progesterone to be added to the Prop 65 warning list:

1. The vast majority of the studies implicating progesterone were done on SYNTHETIC progesterone (progestins and other progesterone-like compounds called progestagens). These studies were NOT based on BIOIDENTICAL progesterone (as used in our ProgestPure).

Progestins and progestagens are similar in molecular structure to progesterone, but when they bind to progesterone receptors, their effects are amplified and more likely to cause abnormal responses—just like the ones in birth control pills.

2. The majority of the studies were done in combination with synthetic estrogens. Again, our ProgestPure does not use ANY synthetic hormones.

3. The few studies done on bio-identical progesterone were done with excessive and unreal doses (from 10 times to 10000 times the standard recommended dose).

4. No studies were done using transdermal creams. Only oral injected and suppository forms were used. This is important to note because hormones absorbed through the skin are metabolized differently than hormones that are administered via other means.

Like you, I was very surprised to hear that our product would bear such a warning, despite it being one of the purest bio-identical progesterone oils available.

To learn more about how to balance your hormones with supplements (and which to take), you can download our FREE Supplement Guide here.