How do I use progesterone cream in relationship to my menstrual cycle?

How do I use progesterone cream in relationship to my menstrual cycle? I can not seem to get the dose right or know the answer to how many days on and how many days off the cream. I know I feel better on it and would like to use more. Should I only be on the cream 14 days or can I use it longer during my cycle?

Thank you,

Paula

Dear Paula,

I hope you didn’t missed our newsletter last month where we opened up discussions around why we believe a ‘one size fits all’, cookie-cutter approach to HRT is out-dated, dangerous, and invariably falls short of the mark. How, when we override our natural cycle with continuous hormone supplementation, we may be inviting trouble.

Let’s now learn how to map out an individualized monthly progesterone and estrogen supplementation program that draws upon our unique reproductive cycle.

Step 1: What is the length of your menstrual cycle?

This can be determined by counting from Day 1 of your period to Day 1 of your NEXT period.

Obviously, this will vary. Some women menstruate on a 28 day cycle, others are on a shorter cycle (eg. 21 days) while it’s not unusual for women to have longer gaps between their period (eg. 35-40 days).

If it’s been some years since you menstruated, then try to recall your cycle as best you can. You want to determine a functional equivalent of your unique menstrual cycle.

Step 2: When do you ovulate?

Once you have an idea of the length of your cycle, it’s relatively straight-forward figuring out when ovulation would have taken place.

While the days leading up to ovulation will vary for each woman, typically menstruation will follow about 2 weeks after ovulation occurs. You would, therefore, chart ovulation by counting back 14 days from the first day of your period.

Why is it important to understand your ovulation phase? Because progesterone production begins to rise dramatically after ovulation, peaks and then quickly falls. Your body actually cycles progesterone production from ovulation until 2-3 days before your next period. If you were to follow Mother Nature’s template, you would supplement progesterone for approximately 2 weeks each cycle.

May I add here that this ‘common-sense’ approach to progesterone replacement therapy has served me well these past nine years.

Step 3: How long do you bleed during menstruation?

Understanding the length of your menstrual bleed is particularly important for women supplementing estrogen. Where medically indicated via salivary profile, estrogen supplementation should be according to your body’s output of estrogen (E1, E2 & E3).

Estrogen production is produced by the developing follicle before ovulation. Estrogen levels begin to rise the day after you stop menstruating and peak in mid-cycle at the time of ovulation. Where medically indicated, you would supplement estrogen for approximately 3 weeks each cycle.

Triest is the name for the combination of all three estrogens often use in estrogen replacement therapy. The optimum ratio for the estrogens is:

• estriol / E3: approx. 60-80% of circulating estrogen


• estradiol / E2: approx. 10-20% of circulating estrogen


• estrone / E1: approx. 3-5% of circulating estrogen

Find yourself a supportive doctor

Paula, if you are unsure when to apply progesterone cream, or perhaps you are experiencing menstrual irregularities, you might benefit from a treatment protocol (as outlined above) that mirrors your ‘natural’ cycle.

May I recommend you work closely with a collaborative physician competent in bioidentical HRT to ensure the best possible outcome while keeping you safe and well informed. This is particularly relevant when supplementing estrogen in combination with progesterone and other steroid hormones (eg. DHEA, cortisol, testosterone).

Please also refer to our suggested BHRT guidelines.

An excellent website that can help you understand female reproductive health is the World Organisation Ovulation Method Billings (WOOMB). I was a patient of Dr Evelyn Billings in my 20s. I highly recommend the new 2003 edition of ‘The Billings Method:‘ Using the body’s Natural signal of fertility to achieve or avoid pregnancy by Dr Evelyn Billings & Dr Ann Westmore.