Could you please let me know how to adminster the combination of Premarin and natural progesterone?

Hi Catherine,

I am a 51 years old and have been on HRT - Premarin and synthetic Progesterone for 10 years due to the onset of early menopause. My current drug regimine is:

• 15 days of .625 mg of Premarin only
• 10 days of Premarin plus 10 mg. synthetic progesterone (medroxyprogesterone)
• 5 days of NO DRUGS while menstruating

My plan has always been to go through a natural menopause when I turned 52 (the average age for menopause) As an interim measure, I would like to try using natural progesterone cream and reduce the Premarin to .450 mg until I totally wean myself from HRT. Could you please let me know how to adminster the combination of Premarin and natural progesterone?

Thank you so much for your help!

Denise

Dear Denise,

Here are some suggested guidelines when coming off estrogen replacement therapy.

Many doctors hesitate to prescribe progesterone cream instead of a synthetic progestin for fear it will not protect the endometrium. But new emerging research published in a major peer-reviewed medical journal suggests the combination of Premarin and progesterone cream protects the uterine lining (the endometrium) as well as synthetic progestins do. So we’re not playing with fire here, Denise! There’s good clinical evidence to support the use of bioidentical progesterone in hormone replacement therapy.

A word of caution, though. Periodic biopsy of endometrial thickness or at least an ultrasound of uterine thickness needs to be conducted should you choose to use this combination of HRT.

Now keep in mind, synthetic progestins and natural progesterone are going to compete for the same receptor sites therefore you would be well advised to immediately substitute the synthetic progestin (medroxyprogesterone) with around 20~40mg/day of USP grade progesterone, adjusting dosage to correlate with how you feel. In other words, trial whether more or less progesterone cream improves your symptoms.

Also consider the fact that we are advised to keep our progesterone to estradiol ratio in the vicinity of 200~300:1 to protect ourselves against many estrogen driven cancers like breast cancer. You may therefore need to apply higher doses of progesterone to meet this ratio.

I like to warn women who have been on estrogen therapy for a long time that it’s not wise to go “cold turkey” and stop their estrogen therapy as their body is conditioned to a high threshold of this hormone. A sudden drop in estrogen levels can actually trigger hot flushes and may contribute to rapid bone loss as the body attempts to adjust.

Some women do go “cold turkey” and feel great for 2-3 months, and then fall into a hole. The reason being, they are initially over-riding estrogen dominance symptoms with progesterone and also they have reserves of estrogen in their body fat. The sudden slump comes about because when they have used up all their body’s reserve of estrogen. Symptoms such as hot flushes, teariness, anxiety, palpitations, insomnia may surface.

Be aware that upon commencing progesterone supplementation, heightened estrogen receptor sensitivity may result. That’s why doctors’ like Dr John Lee suggest you begin by cutting your estrogen dose in half, and then again by half in a few months time, until you find the lowest possible dose that keeps you free of symptoms.

Some women can come off estrogen altogether, whereas some cannot. They may require a small amount along with their progesterone. Many women prefer to try phytoestrogenic formulations and high intake of plant foods containing phytosterols and find this sufficient without the need to take estrogen replacement therapy.

If progesterone alone does not abate symptoms of hot flushes and vaginal dryness after four to seven months (incorporating phytoestrogens), it’s usually an indication that some form of estrogen is required.

Estriol, the weakest of all the three estrogens, is able to be excreted easily from the body in the urine. Estriol is water-soluble and as such does not need to be broken down by the liver; thus it does not build up in the body. For these reasons the safest estrogen to use is estriol at doses approximately 1-2mg applied to the vulva and lower vagina every day to help ease vaginal dryness and painful intercourse, severe hot flashes and other associated symptoms.

If you are using natural progesterone in conjunction with an estrogen reduction program, remember to take your break from estrogen at the same time as you break from progesterone, usually for 5-7 days of a calendar month if you are menopausal or during the week you are menstruating.

There are women who report bouts of wakefulness at night-time after applying progesterone cream. This isn’t uncommon. If you believe this is the case for you, then apply cream first thing in the morning after showering to avoid insomnia when you retire of an evening.

A little update on Premarin. What many women, and even some doctors who prescribe this hormone replacement therapy, don?t realise is that Premarin is made with estrogens extracted from PREegnant MAres? urINe ? and that tens of thousands of pregnant mares and their new born baby foals are suffering every year to produce this bitter pill. To produce Premarin, an estimated 35,000 mares are forced to stand in barns throughout Canada and parts of the Midwestern United States for about six months out of every year with urine collection devices strapped onto them.

The drug company that supports these practices, Wyeth-Ayerst, claims that Premarin “?contains a mixture of estrogens obtained exclusively from natural sources?” Natural? Of the more than 50 horse estrogens, Dr. Christiane Northrup, former Diplomate American Board of Obstetrics and Gynecology, recently stated for publication that not one “?is native to the human female body.”

Low-dose estrogen derived from yams and soy may protect women from osteoporosis just as well as today’s higher-dose pills made from horse urine. And it has fewer side effects.