A ‘cookie-cutter’ approach to progesterone supplementation

Hello Catherine

First of all – a little background. I’m 34 and prior to 4 years ago had regular 35 day cycles. Four years ago i had a miscarriage, followed by an extremely stressful year. During that time my cycles became erratic and my periods become shorter with clotting. They are still erratic – I even skipped 2 periods this year. I have also gained a lot of weight, mostly around my middle (I had prior to this always been a “pear” and gained weight aroud my hips).

There is one doctor in my area who deals with BHRT. I went to her and she ordered the saliva test = low progesterone. My problem – she prescribes all of her patients the same usage pattern (her front office and her website both state this). She prescribes natural progesterone cream for days 1-25 of the menstrual cycle. I have read Dr. Lee’s books, along with several other books on estrogen dominance, and not one of them suggests using cream this way.

I actually went in for another appointment just to ask her about the usage – telling her that if my cycles were 35 days – the cream wouldn’t even supplement when I was supposed to have progesterone in my system. Her response was that she tells everyone to use it for days 1-25 and that she was hoping it would regulate my cycle to 28 days. Do you think she’s correct or is she wrong?


Dear Sarah,

Heavy, irregular periods are pretty typical of low progesterone levels. Our body needs to see a spike in progesterone towards the end of our period so that withdrawal of progesterone triggers a ‘healthy’ sloughing of the uterine lining. If you don’t naturally have adequate levels to create this ‘spike’, then the lining tends to build up, causing heavy, irregular and clotty periods. Get your progesterone levels back into line with your estrogen levels, and you won’t know yourself!

I did a little digging around and found this very helpful article “The Importance of Fertility Awareness in the Assessment of a Woman’s Health, 2012. It states, “The length of a normal cycle may fluctuate between 24 and 36 days”.

Menstrual cycles can be classified into 6 main categories which follow a certain order during the development of fertility at the onset of a woman’s reproductive life:

  • Cycles with no ovarian activity (i.e., amenorrhea)
  • Anovulatory cycles with fluctuating estrogen levels
  • Cycles with anovulatory ovarian activity with constantly increased estrogen levels
  • Cycles with a luteinized unruptured follicle
  • Cycles with ovulation followed by a deficient luteal phase
  • Ovulatory cycles with adequate luteal phases (ie fertile)

At your stage of life when progesterone would normally, post ovulation, dominate only the last 2 weeks of your menstrual cycle, then that’s the ‘template’ you would adopt (as per Mother Nature). You would apply cream AFTER the day you believe you have ovulated – not before – because that might actually interfere with ovulation (FSH). So if your cycle is 35 days, then 2 weeks prior would be around day 20-21, again depending on when you estimate you will ovulate (fertility detectors very helpful here!). If you’re not ovulating at present, still adopt this approach to ‘facilitate’ a natural cycle kicking in with a little help from progesterone supplementation.

I have to agree with your logic here, Sarah. Your current usage recommendations would not, in any way, help ‘support’ YOUR individual cycle. And you are right – when you should be perhaps increasing your progesterone towards the end of your cycle, you’re being told to stop using cream. That doesn’t make sense. You’d use cream right up until Day 33 – 2 days before your period is due.

And do keep in mind that you probably have a build-up of the uterine lining due to estrogen dominance. Therefore you may need to use 100mg> of progesterone per day towards the end of your cycle, split into 2 x 50mg doses, to successfully ‘oppose’ estrogens’ action on the uterus. High doses of progesterone (100mg per day>) in those early months when you are progesterone deficient will help get your progesterone levels back to where they should be, and are usually well tolerated. You’d ease back your dose as your symptoms improve. High doses are NOT recommended long term.

Can I say a cookie-cutter approach to BHRT, which is what your ‘specialist’ is prescribing, is never recommended. When to individualise progesterone dosage is so easy to do, why wouldn’t you? Determine the client’s needs, and prescribe accordingly.

Clearly some doctors ‘deal out’ bioidentical HRT in the same fashion as they do/did synthetic HRT – one size fits all.

Well, that’s just not going to “cut it” for women like yourself, Sarah, who are intelligent enough to do a little research of their own, and rightly follow their intuition with the knowledge they have gained.

I would suggest you do continue your research, and while you’re on this site access our Bioidentical Hormone Supplementation Articles Library.

In love & gratitude,

Catherine P. Rollins
Founder & CEO
Ethically Supporting Women’s Choice of BHRT Since 2001