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by Elora Gabriel


In recent years, due to the research of Dr. John Lee and others, the importance of natural progesterone has been well established.  Please see my article The Benefits of Natural Progesterone for more complete information on this essential hormone, and the difference between natural and synthetic progesterones. 

Natural progesterone is technically called "Progesterone USP" or sometimes "USP progesterone".  Because it is not cancer causing and because it is such a beneficial hormones, progesterone USP has been considered so safe that a "more is better" attitude has been adopted.  Whereas the ovaries only produce 20-50 mg./day of progesterone, doctors routinely prescribe 200 mg./day.  One of the rationales for using large amounts of progesterone is the belief that progesterone will convert into other hormones in the body, as needed.  For example, progesterone is supposed to convert to estrogen and testosterone.  And in fact, this is how the progesterone produced by our ovaries does work.

However, with the advent of the more accurate saliva hormone assays, we have learned that there is at least one important distinction between the way that ovarian progesterone and Progesterone USP work in the body.  While ovarian progesterone does have the ability to "cascade", or convert into other hormones in the body, there is no evidence that Progesterone USP cascades in the body, beyond a possible slight conversion to testosterone.  Upjohn, one of the manufacturers of Progesterone USP, has admitted that this is true, perhaps due to the laboratory processing.  Therefore, if a woman takes in more than she needs, she can develop excessive amounts of progesterone. This fact is very often missed even by holistic doctors and health practitioners, and certainly by those selling and promoting natural progesterone.

What are the effects of excess progesterone?  Symptoms can begin in a very subtle manner, and can mimic many other types of conditions.  The first sign could be depression and/or lethargy. Women who are still menstruating may have anovulatory cycles, perhaps because too much progesterone can actually block estrogen.   Memory loss, fluid retention, and protracted menstrual hemorrhaging have been observed in some cases.  Joy Bucknell from Dr. Lynn August's office in New Fane, Vermont, has written about the problem of progesterone excess.  To quote from her article:

"Initially, most women feel a calming effect when they use progesterone.  However, after approximately eight months of high active progesterone levels a clinical depression may develop.  Often times the cause of this depression is not attributed to the use of the progesterone cream.  The second downside of high active progesterone is its effect on active cortisol levels in the body . . . High levels of active progesterone . . . cause a significant increase in free active cortisol . . . High active cortisol over the long term can result in hunger and sugar or carbohydrate cravings, weight gain around the waist, reduced muscle mass, bone thinning, food sensitivities and allergies, reduced athletic endurance, yeast overgrowth, reduced thyroid function, insomnia, PMS, and if not corrected, eventual exhaustion and chronic fatigue." 

Strangely enough, the worst cases of this problem that I have personally encountered were two women who were both using a moderate strength non-prescription Progesterone USP cream.  In both cases, they had felt so much better when they started on the progesterone, that when they began to feel worse, they assumed that more progesterone was needed.  There has been a great deal of press in recent years about estrogen dominance, to the point where some women believe that this is the cause of all hormonal ills.  Thinking that they were still estrogen dominant, therefore, these women kept increasing their dosages until they were using very large amounts of cream.  Symptoms resolved when they stopped the progesterone and/or switched to wild yam cream.  (Wild yam is a plant-derived, progesterone-like substance which provides many of the benefits of natural progesterone.)

For women using progesterone creams, saliva hormone assays will often show excessively high progesterone levels.  Some laboratories are not helpful in helping a woman determine whether she is actually using too much progesterone or not.  For example, the well-known Great Smokies Diagnostic Laboratory insisted that women abstain from the use of any hormones before taking their saliva tests, as "there is no reference range for women using hormones, particularly the transdermal creams".  Other testing facilities, however, have collected enough data from women using both oral and transdermal hormones, so that they can accurately determine whether a woman has developed an excess of progesterone.  One such laboratory is North Bay Diagnostics. Saliva test kits for this lab can be found in our Hormone Tests section.  We strongly recommend that women who are using progesterone avail themselves of such testing, on a periodic basis, until an ideal usage pattern has been determined. 

Below are some further points which should be helpful.

1.  When using progesterone creams, do not apply them on areas which are underlain by fatty tissue.  It is the build-up of progesterone in the fatty tissue that seems to cause the problem.  Instead, use thin-skinned areas underlain by venous circulation, so that the hormones will be absorbed directly into the blood stream.  These areas include the sides of the throat, insides of the arms, wrists, palms and backs of hands, and tops of the feet. 

2.  When possible, select products which are not oil-based creams, but rather water or alcohol-based gels.  EST, a combination natural progesterone/phyto-estrogen product carried by The Green Willow Tree, is one such product. 

3.  Use a physiological dose.  Pharmacies dispensing USP normally recommend 200 mg./day.  However, we have noted that this is far more than the ovaries ever produce.  If we are using estrogen, we certainly want to get enough progesterone to prevent endometrial hyperplasia (a precancerous condition of the uterus caused by using estrogen alone.)  Dr. John Lee states that he found 30 mg./day of progesterone to be enough to prevent hyperplasia in women using estrogen.  Using 1/4 tsp. of a moderate strength product such as NuGest 900 twice daily will give you approximately 60 mg/day.  Given that nothing absorbs 100%, still this amount should be ample.  Dr. Lee used a non-prescription cream (Pro-Gest) in his famous study of osteoporosis reversal in 100 women, rather than the high dosages favored by pharmacies.  And Dr. Alan Gaby, author of Preventing and Reversing Osteoporosis, states that the "therapeutic window" for progesterone appears to be much less than 200 mg./day and that larger doses may be less effective against osteoporosis.  Possible excesses of Progesterone USP will be much less likely if you use a moderate dosage.  The 10% strength prescription creams from most compounding pharmacies are, in my opinion, at least three times stronger than necessary. 

4.  For those who find that they have developed excess progesterone, generally this problem resolves itself over a few months when the woman in question stops using her progesterone supplement.  In the case of women needing progesterone to balance their estrogen replacement therapy, a good solution is to switch to a pure wild yam cream, such as Progestone Ten, for several months.  Wild yam has been denigrated by many advocates of natural progesterone.  While it is true that little clinical work has been done with wild yam, particularly in key areas such as bone health, it is undeniable that a good quality wild yam extract provides progesterone benefits.  I have observed wild yam to be capable of acting in the same way that progesterone does in opposing (balancing) estrogen.  And wild yam does not build up to excess in the body.  However, small amounts may convert to estrogen, so wild yam may be contra-indicated for women who must avoid estrogen in any form. 

5.  There are a few women whose bodies do not tolerate progesterone in any form.  This is not a situation of progesterone excess, but a simple intolerance of USP progesterone.  These women generally do very well using wild yam creams.  

The information in this article is for educational purposes only, and is not intended as medical advice.