How do I approach my doctor?
We suggest women go with information in hand. Take your book, information and, if possible, a Drug Sheet showing contraindications and indications which really blows these doctors out of the water because they can see that it has indications, use, dosage, guidance.
Australian women who previously had difficulty getting their doctors to write a script for natural progesterone can breathe a little easier. Pro-Feme is now listed on their doctor’s computer as a recognised prescription drug with dosage clearly defined. This DOES NOT lock you into buying Pro-Feme. What cream you end up purchasing is entirely up to you! It simply means you have fulfilled your legal obligation to obtain a doctor’s prescription.
Tell your doctor you have done your research and you would like the opportunity to try this form of hormone replacement therapy. Remember it is hormone replacement therapy - it is not natural alternatives. Tell him you are aware that it is a form of hormone therapy and that, in some countries, it is deemed an S4 drug by prescription only. In Australia, for example, it is illegal to buy or import for personal use natural progesterone cream without a script. This will impress the doctor because you have done your homework and are not asking for some herbal preparation. You are asking for a molecular structured progesterone. Be firm in the way you ask but don’t TELL him. Doctors hate being told how a woman expects to be treated. It is almost a stroking procedure.
Explain how you are fully aware this is not test trialled, that there is little supporting data, and people believe it is only one man’s opinion yet to be proved. However, tell him how your research states that because it is a natural occurring molecule in the body it has a huge safety margin and the body does not react as it does to the altered synthetic progestogen version. The body can assimilate it better because it recognises this molecule as already existing in the body, rather than introducing a foreign derived molecule that has the potential to cause serious side effects, health risks, and is harder on the liver.
Natural progesterone, given topically, is more absorbable, more effective, bypasses the liver, and doesn’t have the same metabolic end result as synthetic HRT. This has strong data back-up. You are stating to your doctor the reasons why you would prefer to take this form of progesterone. Perhaps you’ve had a bad experience on HRT. You should point out that you are not referring to wild yam or synthetic progestogens. You are asking for something that will be safer to use and promises better end results than the synthetic variety. If you have, in the past, reacted to the contraceptive Pill, have a family history of blood clots, breast cancer or stroke, or HRT has caused you to become depressed, gain weight, retain fluid etc., one would expect your doctor to embrace your decision to trial natural progesterone.
The next approach to take with your doctor is to explain: “I recognise that, as my treating physician you need to err on the side of caution when there is no listing of this drug in your manual. However, as your patient, I take full responsibility for this form of treatment and I’m prepared to sign a disclaimer (which some doctors have insisted their patients undertake here in Australia). I would like to involve you in the progress of my treatment, and to that end I’m willing to chart my symptoms and report back to you if there are any problems".
How can they argue when you are taking responsibility and over-ridden all their objections? If the doctor then proceeds to tell you that you don’t know what you are talking about or that he wants to prescribe you progestogen for endometrial protection etc., you restate that before you go down that track you want to at least have this opportunity to trial natural progesterone. That all you are asking for is six to twelve months (of your time), and you will be receptive to synthetic hormone replacement therapy if the proposed natural hormone replacement therapy doesn’t go according to plan.
We find that this approach often works. You are a woman on a mission. Your mission is to get your script. Get your doctor to respect your choice and listen to what your needs are, not tell you what you ought to have. A good many women who go in with this expectation walk out with that script.
If you failed to get your progesterone script and walked out with another doctor’s bill wondering what went wrong, we suggest you re-evaluate why you allowed yourself to be (a) intimidated, (b) made feel insignificant such that your needs were not worthy of acknowledgement, (c) disempowered by your doctor’s presumption of knowledge on natural progesterone, and (d) why perhaps the approval of your GP was more important than your right to have a say in what goes into your body.
There are occasions when a woman seeking natural progesterone can be ‘out foxed’ by her doctor. By asking for progesterone, the doctor may see an opportunity to impose synthetic HRT on you regardless of your request. Because you have stated you need hormone supplements, you’ve exposed your vulnerability and been cornered. You have unwittingly strengthened your doctors position to administrer HIS/HER choice of HRT - not yours. We’ve seen women walk out of the surgery with HRT scripts instead of natural progesterone, submitting to their doctor’s wishes - and been billed for it.
Often women will bend to pressure purely because they feel uneducated (comparing themselves to their doctor), wrongly believing they have no right to question their doctor or state their needs. In fact, many women don’t even tell their doctors the full story in fear their doctors will think they are hypochondriacs. Some doctors have absolutely no idea the extent to which these female patients suffer or how many symptoms they actually experience, purely because they modify their list. Often women fail to get their script because they sense their physican will refuse to treat them. We hear way too many stories of emotional blackmail, particularly involving specialists (breast cancer).
Women have basically been told that if they elect to take natural progesterone, particularly if they have had mastectomies, they will be encouraging the regrowth of cancer. Any refusal to follow their doctors’ recommended treatment justified a discontinuation of his/her services. Another example of medical practitioners being behind the times is the usage of Tamoxifen. Evidence can be found in recognised medical journals that progesterone actually does confer endometrial protection, especially in the usage of the drug Tamoxifen - as Tamoxifen can promote endometrial cancer.
Progesterone, on the other hand, offers protection by opposing estrogen activity in the body.
Here’s a letter that typifies the problems and harrowing situations women are faced with:
“…I’ve just finished reading a book on natural progesterone loaned to me by a friend in New Zealand who is now using the cream and has had a remarkable improvement in her menopause symptoms. I must say, the book made interesting reading and if I had had access to the information years ago, I would never have taken synthetic hormone replacement therapy. Why didn’t my doctor assess me for hormone and progesterone levels or at least tell me about the cream!!! She put me on Ogen and just over 3 years later (1999) at the age of 57, I was diagnosed with grade III estrogen receptive breast cancer requiring 6 doses of chemo and 30 doses of radio. My life was turned upside down as you can well imagine. I don’t see that doctor now !!! My GP has reluctantly given me a prescription for progesterone cream which is hard to obtain and has suggested I speak to my breast surgeon before using it as I am taking Tamoxifen for 5 years, and although there seems to be no information as to whether the cream will affect the benefits of Tamoxifen, I need to be very, very sure. Having had cancer, I am reluctant to take even a headache tablet! And so I write to you seeking information on the progesterone cream, its benefits and its side effects. At the moment I am struggling with hot flushes, night sweats, memory loss, sort joints, bloating, disturbed sleep, complete loss of libido, and weight gain. Sound familiar? I am quite happy to pay for any information and look forward to your reply…”
This letter is all too familiar.
We encourage women to do their homework. Be firm. Be sure. Often women fail to get a doctor’s prescription purely because they are not quite sure themselves. They allow confusion to reign and their doctors to take control of the situation. Many women are not comfortable taking control of their lives, so this is a huge step for some of them. We implore you to have courage, be persistent and believe in yourself. After all, it is your body and your birthright to become well again.
Walk into your doctor’s surgery with a list of suggested guidelines. Once you’ve got your doctor on side and the script has been written, we suggest you ask your doctor to help you begin charting your progress immediately by ordering tests to establish baselines. These would include for example a blood profile, blood pressure reading, a bone mineral density reading and, if you suspect or have had a history of cervical hyperplasia, a pap smear and an ultrasound if you have a history of endometrial hyperplasia, fibroids or poly ovarian cystic syndrome. Take these tests and any other tests your doctor may suggest. This is acting intelligently and with your doctor’s help and assistance.
There is a place for medicine and there is certainly a place for very sophisticated diagnostic tools. We don’t say run into your surgery, get your script and run out the door. Rather, be intelligent and be sensible about this. Make the most out of it. Your doctor is not your enemy. Unfortunately we have put doctors on pedestals and made them God. However, doctors often don’t feel like Gods. They are open to litigation and probably have more to lose than you. Medicine is like any profession where you seek out and respect expertise. It’s like bringing in a painter to paint your house. You want the best job done but you may want a colour scheme that he doesn’t feel suits. Do you allow the tradesman to paint according to what he wants? No, you expect him to follow your instructions if he wants to get paid. It is the same principle when you go to the doctor and ask for a natural progesterone script. You are allowing him to offer advice, which we hope you listen to and take on board because GPs have a much to offer. But you are also suggesting that maybe you would like a treatment (which you have thoroughly researched) that meets your needs rather than his.
