HORMONES -
PROGESTERONE FAQ

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Frequently Asked Questions About Progesterone Cream
by John R. Lee, M.D. and Virginia Hopkins

Q: What is progesterone?

A: Progesterone is a steroid hormone made by the corpus luteum of the ovary at ovulation, and in smaller amounts by the adrenal glands. Progesterone is manufactured in the body from the steroid hormone pregnenolone, and is a precursor to most of the other steroid hormones, including cortisol, androstenedione, the estrogens and testosterone.

In a normally cycling female, the corpus luteum produces 20 to 30 mg of progesterone daily during the luteal phase of the menstrual cycle.

Q: Why do women need progesterone?

A: Progesterone is needed in hormone replacement therapy for menopausal women for many reasons, but one of its most important roles is to balance or oppose the effects of estrogen. Unopposed estrogen creates a strong risk for breast cancer and reproductive cancers.

Estrogen levels drop only 40-60% at menopause, which is just enough to stop the menstrual cycle. But progesterone levels may drop to near zero in some women. Because progesterone is the precursor to so many other steroid hormones, its use can greatly enhance overall hormone balance after menopause. Progesterone also stimulates bone-building and thus helps protect against osteoporosis.

Q: Why not just use the progestin Provera as prescribed by most doctors?

A: Progesterone is preferable to the synthetic progestins such as Provera, because it is natural to the body and has no undesirable side effects when used as directed.

If you have any doubts about how different progesterone is from the progestins, remember that the placenta produces 300-400 mg of progesterone daily during the last few months of pregnancy, so we know that such levels are safe for the developing baby. But progestins, even at fractions of this dose, can cause birth defects. The progestins also cause many other side effects, including partial loss of vision, breast cancer in test dogs, an increased risk of strokes, fluid retention, migraine headaches, asthma, cardiac irregularities and depression.

Q: What is estrogen dominance?

A: Dr. Lee has coined the term "estrogen dominance," to describe what happens when the normal ratio or balance of estrogen to progesterone is changed by excess estrogen or inadequate progesterone. Estrogen is a potent and potentially dangerous hormone when not balanced by adequate progesterone.

Both women who have suffered from PMS and women who have suffered from menopausal symptoms, will recognize the hallmark symptoms of estrogen dominance: weight gain, bloating, mood swings, irritability, tender breasts, headaches, fatigue, depression, hypoglycemia, uterine fibroids, endometriosis, and fibrocystic breasts. Estrogen dominance is known to cause and/or contribute to cancer of the breast, ovary, endometrium (uterus), and prostate.

Q: Why would a premenopausal woman need progesterone cream?

A: In the ten to fifteen years before menopause, many women regularly have anovulatory cycles in which they make enough estrogen to create menstruation, but they don't make any progesterone, thus setting the stage for estrogen dominance. Using progesterone cream during anovulatory months can help prevent the symptoms of PMS.

We now know that PMS can occur despite normal progesterone levels when stress is present. Stress increases cortisol production; cortisol blockades (or competes for) progesterone receptors. Additional progesterone is required to overcome this blockade, and stress management is important.

Q: What is progesterone made from?

A: The USP progesterone used for hormone replacement comes from plant fats and oils, usually a substance called diosgenin which is extracted from a very specific type of wild yam that grows in Mexico, or from soybeans. In the laboratory diosgenin is chemically synthesized into real human progesterone. The other human steroid hormones, including estrogen, testosterone, progesterone and the cortisones are also nearly always synthesized from diosgenin.

Some companies are trying to sell diosgenin, which they label "wild yam extract" as a medicine or supplement, claiming that the body will then convert it into hormones as needed. While we know this can be done in the laboratory, there is no evidence that this conversion takes place in the human body.

Q: Where should I put the progesterone cream?

A: Because progesterone is very fat-soluble, it is easily absorbed through the skin. From subcutaneous fat, progesterone is absorbed into capillary blood. Thus absorption is best at all the skin sites where people blush: face, neck, chest, breasts, inner arms and palms of the hands.

Q: What is the recommended dosage of progesterone?

A: For premenopausal women the usual dose is 15-24 mg/day for 14 days before expected menses, stopping the day or so before menses.

For postmenopausal women, the dose that often works well is 15 mg/day for 25 days of the calendar month.

Q: What amount of progesterone do you recommend in a cream?

A: Dr. Lee recommends the creams that contain 450-500 mg of progesterone per ounce, which is 1.6% by weight or 3% by volume. This means that about ¼ teaspoon daily would provide about 20 mg/day.

Q: How safe is progesterone cream?

A: During the third trimester of pregnancy, the placenta produces about 300 mg of progesterone daily, so we know that a one-time overdose of the cream is virtually impossible. If you used a whole jar at once it might make you sleepy. However, Dr. Lee recommends that women avoid using higher than the recommended dosage to avoid hormone imbalances. More is not better when it comes to hormone balance.

Q: Wouldn't it be easier to just take a progesterone pill?

A: Dr. Lee recommends the transdermal cream rather than oral progesterone, because some 80% to 90% of the oral dose is lost through the liver. Thus, at least 200 to 400 mg daily is needed orally to achieve a physiologic dose of 15 to 24 mg daily. Such high doses create undesirable metabolites and unnecessarily overload the liver.

Q: Where can I get more information on progesterone and natural hormone balance?

A: For a detailed explanation of women's hormone balance issues, a hormone balance program, as well as detailed descriptions of how to use natural progesterone, the following books by John R. Lee, M.D. are recommended:

What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone, (Warner Books, 1996)

What Your Doctor May Not Tell You About Pre menopause: Balance Your Hormones and Life from Thirty to Fifty (Warner Books, 1999)

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Usage Information

Transdermal Progesterone Cream (TPC)

Where should I apply TPC?   While TPC can be applied to any part of the body, we suggest that for best results it should be applied anywhere on your body where you blush. Dr. David Zava (ZRT Laboratories in Beaverton Oregon) reports rapid absorption when applied to the hands. It is often recommended that it be applied to a different part of the body with each application and to parts where there is a minimum of fat such as behind the knees and on the chest.

How much TPC should I use?  TPC usage depends on your current hormonal and menstrual status. The following are general recommendations that should be confirmed or modified after consultation with your medical health care provider. Salivary hormone testing will provide information about your current levels of progesterone and help you assess the amount of natural progesterone that you need and the amount of TPC to use.  Ask us about saliva test kits.

The following are general recommendations that may need to be modified for your specific situation:

·          Women in their reproductive years – still ovulating.  In this case, women would normally take TPC for PMS, painful cramping with periods, menstrual irregularities, and to protect against osteoporosis later in life.  Begin using TPC after you have ovulated. Ovulation usually occurs about 10 to 12 days after your period begins.  Count the day the period begins as the first day.   Apply one pump amount of TPC (20 mg. of Progesterone USP) every day from day 12 to day 26. 

·          Women who are perimenopausal (still menstruating with menopausal symptoms and/or PMS but not ovulating).  Count the day the period begins as the first day.   Day 1 to 6, do not use TPC.   Day 7 to 27, Apply one pump amount of TPC (20 mg. Of Progesterone USP)  every day.   If your period begins early, stop using TPC while you are bleeding. Count the first day of bleeding as one day of the cycle and begin the cycle again.  

·          Women who are post menopausal  .   Use a calendar day (e.g. the first day of the month) as day one. Day 1 – 12 apply one full pump of TPC once or twice daily.   Day 12 – 25 use one pump twice a day.  Day 26-30 or 31 – NONE.  Dr. John Lee suggests that the body be given a rest and progesterone not be applied during this period. We concur with this suggestion for most people.  Start again on the first of the monthly

·          Women with severe osteoporosis.   Day 1 – 25 use one to two pumps of TPC per day.   Day 25 – 30 (or 31) us none . Dr. Lee suggests that the body be given a rest and progesterone not be applied during this period.   Important Note: It is strongly suggested that you consult with a Health Care Practitioner to monitor your bone density while using TPC. Dr. Lee recommends that a bone mineral density analysis be conducted annually to monitor progress. Dr. Lee also notes that age has no effect at all on the effectiveness of progesterone when used for osteoporosis. For more information see osteoporosis.

How long will a 100ml container of TPC last?   Our non-prescription container of TPC will deliver a guaranteed minimum of 60 pumps. Depending on the usage, one container of TPC will last up to 2 months.   

Do I need a break from using the cream each month?  Yes. For menstruating women it is important that the progesterone cream only be used from the 12^th to the 26^th day, counting the day the period starts as the first day. The reason is that the body uses progesterone to hold the blood lining in place during the last two weeks of the menstrual cycle. If the progesterone cream is used out of sequence, it will interfere with the menstrual cycle.  For non-menstruating women, Dr. John Lee recommends that the cream be used for three weeks and a break of one week.

What is the shelf life of TPC?   TPC is compounded in our pharmacy and does not contain preservatives or unnecessary chemicals.  We do not have specific stability information.  We recommend that you use your TPC within three months.  The actual shelf life is probably longer because the cream is encapsulated in an airtight container.  With each use of the pump, a piston moves up underneath the cream to ensure that the remaining cream remains airtight.

Transdermal hormones are absorbed into the body shortly after being applied.  People commonly apply the products after showering or bathing.  There should be no concern about availability of the hormone if the area where the cream is applied is washed or shaved an hour or so after applying.

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