By Dr. Mercola
Bioidentical hormone therapy has become widely adopted as a useful method of normalizing hormone levels. While it is far safer than synthetic or animal based hormones like Premarin, there are clearly some dangers associated with its use and the purpose of this article is to highlight some of the major ones.
This article is in no way meant to be a comprehensive review of the topic, but merely to point out some of the major concerns and approaches as I see them from having practiced medicine for nearly three decades.
If you have any interest. I would strongly recommend purchasing Dr. Wright's new book Stay Young and Sexy. It is under $10 and simply the best book I have reviewed on the topic. If the book were $100 it would be worth the price. This book is a classic and should be in everyone's natural medicine library. The publisher has also created a web site with a free hormone self assessment and sample chapters at www.stayyoungandsexy.com.
I will focus much of this article on natural progesterone cream as it is one of the most popular and useful ones for women.Typically, women find rapid improvement in two of the most common premenopausal challenges which are PMS and painful cramps. It can be also extraordinarily useful to prevent miscarriages but dosing would be continuous after conception.
Dr. John Lee was my original mentor in this area but he passed away a number of years ago and did not fully appreciate the challenges that are associated with using the creams on your skin.
Dr. Jonathon Wright, along with Dr. Lee, are considered the pioneers in introducing bioidentical hormone therapy in the United States. Dr. Wright is still alive and I believe has successfully resolved the challenge associated with using the creams. Before I discuss that though, let's first do a brief review of why progesterone is important.
Natural progesterone is the identical hormone that is produced by a woman's ovary. It is made from naturally occurring plant steroids found in the wild yam. It is NOT the synthetic version that is commonly purchased as tablets with a prescription such as Provera.
Synthetic progesterones, like Provera or medroxyprogesterone, can produce severe side effects including increased risk of cancer, abnormal menstrual flow, fluid retention, nausea, depression and can even increase risk of heart disease and stroke.
Side effects are extremely rare with natural progesterone. The only one of concern is that it can potentially alter the timing of your menstrual cycle.
Reasons Why Natural Progesterone Made by Your Body Is Good
Progesterone is a steroid hormone made by a woman's ovaries when she ovulates and in smaller amounts by the adrenal gland. A menstruating woman will typically produce about 20 to 30 mg of progesterone a day during the luteal or last phase of her menstrual cycle.
While menopause doesn't typically occur until age 50 or later, many women can start going out of balance in their 30s or even earlier. This decline in progesterone is not trivial for as women age into their fourth, fifth, and sixth decade, their progesterone levels continue to fall. By the time they reach perimenopause as much as 75% or more of their youthful progesterone secretion may already be missing.
Natural progesterone is very useful to balance excess estrogen which can be a major risk for breast cancer. Natural progesterone is also different from estrogen in that your body can use it as a precursor or starting material to make other hormones such as adrenal hormones. It can even convert it into estrogen or testosterone if your body needs it.
Natural progesterone is made from a substance called diosgenin which is commonly extracted from wild yams or soybeans. Even though it may be extracted from soy it is a highly purified hormone and there are absolutely no remnants of soy substances that would lead to any problem.
Many if not most women in our culture are estrogen dominant, so using the progesterone goes a long way towards balancing hormones which usually:
- Decreases a woman's risk for breast cancer,
- Improves her PMS and breast tenderness and
The table below lists the properties of estrogen relative to progesterone. Some of the reasons that estrogen is frequently in excess in many women are:
- Overproduction of estrogen. Ovarian cysts or tumors can lead to excess estrogen production. Stress also increases production, but probably the most common cause is obesity. All body fat has an enzyme which converts adrenal steroids to estrogen, so the more fat you have, the more estrogen is present.
- Inability to breakdown estrogen. Excess estrogen is generally removed by the liver. Diseases of the liver like cirrhosis or decreased enzyme activity can lead to increased estrogen levels. Vitamin B6 and magnesium are necessary for the liver to neutralize estrogen. Increased sugar intake will also excrete magnesium and interfere with its ability to breakdown estrogen.
- Exposure to pesticides in foods. Most of us eat foods that have pesticides on them. These and many other unnatural chemicals share a common structure with estrogen and serve as “false” estrogens which further stimulates the body's estrogen receptors.
- Estrogen supplementation. Clearly any additional estrogen given by prescription will increase the level unless it is properly balanced with natural progesterone.
- Decreased production of progesterone. Progesterone is necessary to counterbalance estrogen. If women do not ovulate during their cycle they will not produce any progesterone that cycle. This happens commonly and worsens the already disturbed progesterone/estrogen balance. Decreased progesterone levels are one of the most common reasons for miscarriages.
To minimize your risk of cancer it is very important to understand that you should never take any supplemental estrogen without taking natural progesterone. Note that I use the term “natural' progesterone, or the real hormone. Taking synthetic versions like Provera will actually increase your risk of cancers and heart disease.
|Estrogen Effects||Progesterone Effects|
|Stimulates breasts cysts||Protects against breast cysts|
|Increases body fat storage||Helps use fat for energy and keep it off hips|
|Salt and fluid retention||Natural diuretic (water pill)|
|Depression and headaches||Natural anti-depressant|
|Interferes with thyroid hormone||Facilitates thyroid hormone action|
|Increases blood clotting and risk of stroke||Normalizes blood clotting|
|Decreases libido (sex drive)||Increases libido|
|Impairs blood sugar control||Normalizes blood sugar levels|
|Loss of zinc and retention of copper||Normalizes zinc and copper levels|
|Reduced oxygen level in all cells||Restores proper cell oxygen levels|
|Increased risk of endometrial cancer||Helps prevent endometrial cancer|
|Increased risk of breast cancer||Helps prevent breast cancer|
|Helps decrease bone loss slightly||Increases bone building|
Why You Should AVOID All Oral Hormone Preparations
There are many ways to “naturally” address bioidentical hormone replacement but one of the most common mistakes is to use oral hormones.
If nature had intended to locate your ovaries in your stomach or somewhere else in your GI tract it might make sense for women to swallow progesterone. If your ovaries were in your GI tract, your body would certainly have been equipped with a way to process them safely and efficiently so that everything worked in perfect synchrony.
Of course your ovaries are not in your GI tract but in your pelvis outside your GI tract and connected to your uterus and vagina through your fallopian tubes. Your ovaries have direct access to your blood stream through a pelvic plexus of veins, which delivers their hormone secretions to your heart which in turn pumps them, unchanged to hormone sensitive cells throughout your entire body.
If you swallow steroid hormones you will seriously distort their natural metabolism When you swallow them they will encounter potent stomach acids. The hormones that survive this assault then go to your liver where they will be further broken down. Your liver screens all molecules that enter your blood stream, passing some onward, modifying or detoxifying others, and rejecting a few.
This routing of orally swallowed hormones is in sharp contrast to the way nature intended them to be distributed to your tissues. If you swallow hormones only 10-15% will eventually reach the target tissues and you will need to take an oral dose that is 500% higher than you need. Over 30 different metabolites are created in your liver when you swallow the progesterone and any of these can then have unwanted side effects.
So if you or anyone you know currently use oral hormones like progesterone or DHEA or any hormone, I encourage you to strongly consider phasing them out.
Like most good things in life if you use too much of the hormone cream, complications can develop and disrupt your hormone balance.
The Key to Safely and Effectively Using Progesterone Cream
If you want to copy nature and reproduce a hormonal environment that most closely resembles a normal premenopausal woman the first logical step would be to get the hormones directly into your blood stream, just the way your ovary does.
Hormones carefully measured and formulated in an appropriate cream or gel need only be rubbed once or twice a day into your mucous (epithelial) membranes. Since there are no destructive detours through your GI tract when administered this way, your tissues are exposed to the appropriate concentrations of the hormone without the side effects of 30 different liver metabolites.
I first started using these creams in the early 1990s be became gradually disenchanted with them after I noticed that they typically worked wonderfully initially but then invariably stopped working. This is now known as “dermal fatigue”.
What happens, not only for progesterone cream, but for ANY hormone preparation you use by applying as a cream to your skin is that within a few weeks to a few months you will saturate the fat tissue with the hormones and they will actually stop working or can even make your symptoms worse.
The problem relates to the fact that progesterone is highly fat soluble and once applied to your skin will store itself in your fat tissue. When one initially uses the cream, there aren't any problems as the fat stores are very low. But as time goes on, the cream accumulates and contributes to disruptions in your adrenal hormones such as DHEA, cortisol, and testosterone. I have learned that although progesterone cream is an enormously useful tool, it needs to be used very cautiously.
I found that many of the women who were on the cream have terribly elevated levels of this hormone. Progesterone is normally a cyclical hormone and the body really needs to see a change in the concentration to affect a proper physiological response. If the level is constantly above the concentration that it recognizes as “off” or low, this is not possible.
Fortunately, this is repairable. But it may involve going off the cream for as long as two years to wash the progesterone out of your system.
Best Way to Use Progesterone Cream
The key mistake that many well intentioned knowledgeable doctors, including myself made is to advise to use the cream on your skin. While this certainly provides better results than swallowing the hormones, it can still be improved.
There is a relatively minor tweak you can make with the creams which avoids nearly all of the side effects of applying the cream on your skin.
If you apply the cream to your mucous epithelial membranes that line your uterus and vagina you obtain a virtually ideal administration system. Not only is absorption through these membranes more complete than through your skin, but hormones absorbed through your vaginal membranes enter the very same pelvic plexus of veins that your ovaries normally empty into.
From here the hormones are carried to your heart and lungs and distributed to your tissues just as if your ovary had actually produced them.
Men also require hormones. Obviously men don't have a vagina to use but we do have a rectum that has a similar mucosal epithelial surface and can be used to administer the hormones in a near ideal fashion without any of the complications previously described.
Timing and Dose of Progesterone Cream
For most premenopausal women the usual dose is 15-24 mg/day for 14 days before expected menses, stopping the day or so before menses. So you would use the cream for twelve days and then stop. Typically this would mean you would start on day 12 of your cycle and stop on day 26.
The abrupt lowering of your progesterone level is the primary stimulus for your period to start. Hopefully when it starts any PMS and painful periods will be dramatically reduced.
When a women is in menopause she may only need 15 mg but taken for the first 25 days of the month, then take 5 or 6 days off and restart on the first of the month.
For most women a single daily application will work. However, because the half-life is relatively short, some women find that they get a more satisfactory response by splitting the daily dose in two, half in the morning and half in the evening. If you are only taking the hormones in the morning and begin to feel symptoms later in the day, splitting the dose in two should solve this problem.
Testing of Your Natural Hormones
This is somewhat of a controversial area but basically involves three different types.
I have never been a fan of blood testing as many of the hormones are secreted in a pulsatile fashion and it is difficult to get an accurate idea of the levels in this way.
Saliva testing is easier than urine but is not as accurate.
My current belief is that a 24 hour urine test is the preferred method and the one I use for myself and family. This is the one that Dr. Wright advocates in his own clinic. Dr. Wright has trained many hundreds of physicians in this system and if you are seeking further guidance in this area it would be wise to seek one of them to help you in this area.
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