QUESTION: I am 50 years old and in peri-menopause and I have discussed hormone replacement with my doctor. I am currently taking Realize, recommended by my doctor, to help with hormone related issues. It has helped with the hot flashes, sleeping and night sweats. My concern – along with my doctor – is that hormones put a person at an increased risk for cancer. Even just progesterone on is own. I want to get your take on this. And what benefits will I receive by using a good progesterone cream.

LARRY’S RESPONSE: I am not familiar with Relizen and when I searched for it on Google I discovered that it is “… a unique, non-hormonal, oral option made from a Swedish flower pollen extract that provides relief of hot flashes and other symptoms of menopause.” That tells me almost nothing. It is probably safe – the advertising says so – but I am unable to comment on it’s usefulness.

I don’t agree that hormones generally put a person at increased risk for cancer, especially when considering bioidentical hormones, which are identical to the hormones made in our bodies since day one. If they actually increase the risk of cancer, why are cancers more prevalent later in life, when hormone levels are lower, than they are in youth, when our hormones are “raging”. This is a particularly cogent question when discussing the cancer risks of testosterone supplements in men.

Yes, studies have demonstrated that synthetic hormones (medroxyprogesterone acetate) and those derived from other species (Premarin contains conjugated estrogens, which are derived from pregnant mare urine) are associated with more cancer risk. I don’t know of any work that demonstrates danger from natural human (bioidentical) hormones – particularly when used in physiologic doses.

I have been directly involved in hormone replacement work for at least a couple of decades and come to recognize far more confusion today than ever before. Except in rare situations, I no longer think anyone needs estrogen replacement, whether with commercial drugs or bioidentical hormones. I also see minimal use for testosterone supplements – for men or women. Progesterone, however, is another story altogether.

At menopause (not a disease, by the way), estrogen levels fall, but not near as much as progesterone levels. In the healthier world of yesterday, the falling hormones didn’t cause much of a problem – slight discomfort that lasted a short time. In our present world, everything is contaminated with substances that act like estrogens in our bodies. This toxicity pushes all of us into an area where we experience symptoms associated with high estrogen levels, but our measured blood levels are normal – primarily because we don’t measure the toxic chemicals in our bodies. This is referred to as Estrogen Dominance (ED). As a person ages, the estrogen toxicity climbs. The symptoms sometimes become unbearable. I suggest the rise in male Erectile Dysfunction (another ED) may also be associated with estrogen-like substances from from our food supply and the environment. The solution, though, is not adding more estrogens. Instead, I suggest using a progesterone supplement according to a schedule that mimics the natural rise and fall of progesterone in the human body.

I have often said, “Everyone needs progesterone”, and I mean it.

Do not use topical progesterone supplement creams/lotions that contain parabens because they can act like estrogen in the body. If having cycles, day one is the first day of the period. Otherwise, a calendar is a great method for keep track. Here’s the dose cycle I suggest;

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

Men can apply 10 mg daily, 6 days a week.

It is always valuable to take time off from any hormone therapy, even safe progesterone.