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Progesterone Supplementation

How and when to use natural progesterone supplementation

Additional progesterone can be a shot in the arm for many women with moderate to severe symptoms of hormone imbalance — especially at the beginning of perimenopause — and particularly when used as part of a comprehensive plan. We’ve seen women respond extremely well to small amounts of progesterone in over-the-counter formulations for just weeks or months; others need therapeutic doses over longer time periods.

If you are experiencing moderate to severe, persistent symptoms of hormonal imbalance, or weaning yourself of HRT, you probably would benefit from additional progesterone. As long as you’re receiving regular medical check-ups to rule out any serious problem, it’s relatively safe to experiment with non-prescription strength bioidentical progesterone. However, if you don’t respond well to that, I always recommend having your health practitioner do a hormone panel. A simple saliva test, and possibly a blood test, will show whether or not you have a serious progesterone deficiency that warrants a prescription-strength version.

Conventional doctors will often prescribe synthetic progesterone, or progestins, to women who experience major discomfort. In my experience, progestins help with heavy bleeding but only in the short term, and they may make PMS and depression worse. Longer exposure can cause even more problems.

Progestins are large synthetic molecules that do not bind with the progesterone receptors in a cell. In other words, they are not bioidentical — their shape does not fit the cell receptor — so the cell has a diminished capacity to accept it. However, your body does recognize increased levels of progesterone in your blood and consequently downgrades its own progesterone-release mechanism. So in reality, taking a synthetic progesterone can actually decrease your body’s ability to create its own natural form!

The most efficient way for our bodies to accept progesterone support is in a bioidentical form. We’ve had best results with the cream form of micronized progesterone USP. (“USP” means the progesterone meets the standards set by the U.S. Pharmacopeia, which works closely with the FDA.)

Progesterone USP is real progesterone, not a phytoestrogen. Yam creams alone are not effective; the ingredients therein must be synthesized into progesterone USP to be truly therapeutic. If you’ve tried some over-the-counter progesterone products and been disappointed, you may still benefit from the right kind of progesterone support in the right dosage for you. If your symptoms are moderate to severe, like most women’s, you also need to combine progesterone with other forms of support.

It is recommend to apply 30-40 mg of high-quality, micronized progesterone USP cream to the inner part of the wrists for two weeks, starting at the mid-point of their monthly cycle. Since everyone is different, some women need more, some need less to restore their equilibrium. We find our progesterone cream is so safe that we can experiment with dosages to see what works best.

In all but the most severe cases using progesterone in a cream because it is more natural than the pill form. The hormone is absorbed through the skin directly into the bloodstream, which allows us to get the desired results with lower dosages than are required to survive the digestive tract. We’ve found the progesterone cream in our Personal Program to be the most efficient, most recognizable, most natural way to get your body what it needs. You don’t have to use ours, but you should look for a progesterone cream with the following attributes:

Includes pharmaceutical-grade progesterone USP
  • Micronized
  • Bioidentical
  • All natural
  • Hypoallergenic
For patients with severe PMS, heavy bleeding or other severe symptoms that don’t respond to progesterone cream, I often switch to pill form because it’s easier to deliver the higher dosage and the dosage is standardized.

We disagree with Dr. Lee that women should use progesterone supplements the rest of their lives. Our belief is that the smallest intervention that restores hormonal balance is best. In most cases we recommend you use progesterone as a bridge, and curtail its use or drop it entirely when doing so doesn't result in a return of your symptoms.

A special note about progesterone use after menopause: although there is no evidence that it’s unsafe, it clearly is not natural to add progesterone to your body indefinitely after menopause, and we don’t feel it’s gotten adequate long-term study. We tell our post-menopausal patients they may safely use additional progesterone for up to a year. These women often benefit immediately from the extra progesterone, but it’s safest to use it as a bridge to a new, more natural balance in their bodies.
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