Hormone Replacement Therapy: Progesterone

That "progesterone" you’re taking for hormone replacement therapy might be an imposter. Although most doctors won't tell you the difference between synthetic and bioidentical hormones unless you ask, conventional hormones are molecularly altered and don't behave the same way in your body as bioidenticals.

What is natural progesterone?

True progesterone is a steroid hormone made by your ovaries when you ovulate (release an egg) in the middle of your menstrual cycle. A small amount is made by the adrenal glands and nerve cells. Progesterone is manufactured in the body from a steroid hormone called pregnenolone and it is a pre-cursor to most other steroid hormones.

While the estrogen hormone gets all the glory and most of the controversy, progesterone deserves some of the positive attention. Progesterone’s most important role is to balance or oppose the effects of estrogen. Doctors today won’t prescribe an estrogen-only oral contraception or hormone replacement therapy (HRT) due to the dangers of estrogen dominance in the body. Progesterone also stimulates bone building and thus helps protect against osteoporosis (while estrogen helps maintain bone density).

Is there a difference between natural progesterone replacement therapy and synthetic?

Absolutely. To accurately use the term “progesterone” the hormone must either:

1. Naturally occur in the body
2. Be bioidentical

Bioidentical simply means the hormone is created in a laboratory to be an exact duplicate of what your body makes. The progesterone used for natural hormone replacement therapy often comes from plant fats and oils, usually a substance called diosgenin that is extracted from a wild yam that grows in Mexico, or from soybeans. The other human steroid hormones including estrogen, testosterone, and the cortisones, nearly always come from synthesized diosgenin.

What's important to note is that the combination birth control pill or conventional hormone replacement therapy (HRT) have progestin, which is not progesterone. Provera is one of the most commonly used progestins for HRT.

2 Reasons to consider using natural progesterone for HRT:

• Safety. Consider this: In the 3rd trimester of pregnancy the placenta produces huge amounts, 300-400 mg, of progesterone daily without any risk to the developing baby. Yet even a fraction of that amount of progestin could cause birth defects. The list of side effects and warnings from progestin or "medroxyprogesterone acetate" is eye-opening.

• Cost. Synthetic hormones like progestin, or Provera, are not naturally occurring in your body. Drug companies purposely make these medications different so they can patent them. This allows the drug company to sell the medications exclusively for years (until the patent runs out) and therefore charge more money because they have no competition. While natural substances like bioidentical progesterone, cannot be patented so they are less expensive to you.

If you're considering starting HRT and are concerned about the effectiveness and safety of conventional vs. natural hormones, Dr. John Lee, a pioneer in natural women's health and author of Hormone Balance Made Simple, points out, “Synthetic hormones are not necessarily made, sold, and prescribed because they work better than natural hormones, but because natural hormones can’t be patented.”

Are there risks with natural progesterone?

Natural progesterone has few if any risks or side effects. Initially as your body adjusts or if you use progesterone in excess, the following side effects may occur:

• Sleepiness/lethargy
• Edema (water retention)
• Candida (yeast)
• Bloating
• Lowered libido
• Mild depression
• Exacerbates symptoms of estrogen deficiency

Most health care professionals prescribe between 10-40mg daily, once or twice a day for 15-25 days of the month. The number of days and dose depends on if you are ovulating, had your ovaries removed or are in peri or full menopause. In some cases, patients have been prescribed as much as 100 mg per day which is in gross excess. In addition, some doctors prescribe a transdermal patch (on the skin) that includes other bioidentical hormones (estrogen or testosterone). Transdermal patches should include only individual hormones to allow you to regulate the dose and accurately monitor symptoms.

Be Sure to Get the Real Deal

Ideally you'll want to buy your progesterone from a compounding pharmacist who will ensure you receive the proper quality and concentration of the hormone through a measured pump container or transdermal patch. If you do buy progesterone cream at a health or drug store, check to see the amount listed on the label. Be wary of brands that claim to have wild yam but don't, or have very small amounts of progesterone. If the label doesn't list the exact amount of progesterone you have no way of knowing what you're getting unless you call the company. Verify the amount (and the company's credibility) before you use any progesterone cream.

Be sure to get your hormone levels checked via a saliva test (more accurate than blood to measure progesterone) before you begin any HRT program. If you're considering bioidentical HRT be sure to consult with a reputable doctor who has vast experience in both conventional and natural hormone replacement therapy.

Progesterone cream

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