Ask Larry:

Question: I am 65 and have recently been prescribed low dose Climara patches for hot flashes. Should I be using a progesterone 20mg cream with them?

Larry’s Response:

I begin by stating my conviction that everyone is estrogen dominant and that few of us need any extra estrogen. Instead, most hormone balance concerns should first be addressed with progesterone replacement. Estrogen Dominance does not mean a person has TOO MUCH human estrogen. In fact, s/he may have a normal level or even be in the low range. There are many substances in our environment (see below) that have estrogen-like activity in the body, causing people to have symptoms that are commonly associated with excess estrogen. Yet, when tested, their levels may be low. That’s when doctors step in and prescribe estrogen replacement – using natural (bioidentical) or synthetic hormones. In either case, the person is prescribed more of what is already responsible for the symptoms.

I’ve observed for over at least a decade that the incidence of estrogen dominance is increasing. Hence, my suggestion that everyone is estrogen dominant to one degree or another. The hormone that helps balance all estrogen dominance symptoms is progesterone – when used properly according to a schedule of cycling. This is what we recommend;

  • Apply 20mg once daily for days 1 through 12.
  • Apply 20mg twice daily for days 13 through 26.
  • Stop.
  • Start again on day one.

**If having cycles, day one is the first day of the period.
**If NOT having cycles, day one is the first of the month – according to a calendar.

We suggest that men use approximately 10mg of progesterone daily, six days each week. Skipping Sunday seems the easiest schedule to remember and follow.

Climara is a patch that delivers Estradiol, a natural, bioidentical estrogen. It is prescribed by your doctor and I’m not in the position to question the order or suggest you do anything except follow your doctor’s orders. Please don’t alter the orders without talking to the doctor. Also, if your doctor has decided that you need estrogen and not progesterone, follow his/her orders until you have a chance to discuss it.

To specifically address your question, let’s consider the details of what I wrote above;

  • Everyone is estrogen dominant – we have excess estrogen activity
  • Estrogen dominance can be balanced with supplemental bioidentical progesterone.
  • Therefore, it seems wise that people who use estrogen supplementally should also be using progesterone for balance.

Still, I return to my admonition, do what your doctor has ordered until the two of you talk and have an understanding of your needs.