How would I know if I have to use more progesterone?

To understand and appreciate the full context of this question, you need to read the above question “When Should I Use Less Progesterone”.

If reducing dosage doesn’t help or perhaps increases discomfort, then it indicates the need to increase your progesterone dosage, and pay particular attention to increasing your intake of phytoestrogens to oppose estrogen dominance crisis.

This situation of estrogen wake-up often follows an episode of stress which would account for the shortage of progesterone and the increase of estrogen levels. Drop progesterone back to your previous dose once balance has been achieved and symptoms have subsided.

To summarise the question when to use more cream [and when to use less], you have to address why you require dosage adjustments. Are you becoming more estrogen dominant or hormonally imbalanced from over use or under use?

One of the biggest players in robbing progesterone supplies and creating hormone imbalance can be STRESS, pulling progesterone into another steroid pathway to create the ’survival’ hormones - cortisol and adrenalin.

If there has been stress, high pain levels, shock, trauma, surgery, illness, or unresolved emotional issues, chances are there is a progesterone deficiency in the body requiring higher levels of progesterone cream to help compensate temporarily. When high cortisol is present in the body (our anti-inflammatory hormones) there is a competition between progesterone and cortisol for the same receptors sites, so higher-than-usual levels of progesterone is required.

Progesterone has a calmative effect and anti-stresser influence thus helping to address the stress itself, reducing the need for continued high cortisol production. Reducing stress allows the opportunity for progesterone to work its benefits in the body once again.

You can apply more cream until you reach an emotional equilibrium, that place where you begin to feel an inner sense of wellbeing and calmness, inspite of your physical symptoms (that could take a few days to settle).

But, of course, the most reliable way to ascertain whether you need more or less progesterone is to do a hormonal saliva assay. Particularly if you are struggling to reestablish balance with dosage versus symptoms.

We include here for your benefit an email addressed to the Natural-Progesterone-Advisory-Network.com website that we believe typifies the scenario we commonly face. It highlights many issues.

“… I think the burning sensation is flushes, they settled down for a little while when I first started taking progesterone (13 months ago) they happen if I’m stressed, hurrying or concentrating hard, and always if I have a drink. I usually have anywhere between 18 and 24 day cycles, used to start the cream around day 11 but have started lately around day 7 or 8 so I get enough days in with the cream. I use between 1 and 1.5 cm cream per day applied of an evening. I originally used a little more but used to get teary and emotional and sore boobs, so cut it back a bit. Decided estriol cream would be the go, because after doing some reading it seems the other 2 estrogens are more likely to cause cancers, and from what I can understand estriol doesn’t and it also has some cancer protection, so I thought that since estrogen is supposed to stop the flushes, (which it seems to for other women) maybe I might me a bit estrogen-deficient and that it would be the safest one to take, if that makes any sense! So if that was the way to see if it would help, I was wondering if you knew where to get a cream that wasn’t synthetic, Dr … has tubes of estradiol, but I don’t really want to use that, because I’m not sure if my problem is that I am estrogen-deficient. Diet hasn’t changed much, only that I have given up milk in my numerous cups of tea that I usually drink each day and have limited the amount of cheese and butter to very little - over last few weeks - but the red/purple face has really been an on-going thing for 4-5 years, just become very frequent and severe lately. I am 48. Tubes tied. Never taken pill. Same soap. Skin not itchy, has always been a bit dry. Hormonal health, much better since going on the progesterone, don’t have the PMS and long
sleepless nights like I used to. ~ Julie”

Firstly, ‘Julie’ does not understand ‘hot flushes’, she hasn’t mastered the use of progesterone nor has she completely understood the role of progesterone in her body. Julie probably doesn’t realise that progesterone therapy works in stages, and often needs reassessing at 12 months to re-evaluate dosage according to symptoms. We believe, given that Julie is 48 years old with a history of tubal ligation and PMS, that she needs to increase her dose because clearly 16-20mg (1.0-1.5cm) per day is not addressing and settling her hormone fluctuations.

We don’t believe Julie has incorporated phytoestrogens into her diet which would help stimulate estrogenic benefits and sensitise progesterone receptors. She has attempted to reduce saturated fats from her diet (dairy products) but has not, to our knowledge, increased her intake of essential oils (Omega 3-6). In the past, Julie’s experience of estrogen dominance symptoms such as tears, emotional and sore boobs led her to believe she should reduce her dosage. While this may have worked in the past, the dose level is obviously not holding her any longer. She needs to increase her dose, and be prepared to work through the estrogen dominance wake-up barrier until her symptoms abate.

By incorporating nutritional supplements in adjunct with liver work, she will go a long way to restoring hormone balance and fine-tuning her cream dosage to suit her individual profile. Julie can become more aware of these subtle hormonal changes through charting and comparison.

We wouldn’t recommend estrogen supplementation until Julie has maximised the benefits of progesterone and, if there is a deficiency confirmed by blood tests and saliva assays, then and only then consider estrogen supplementation. Clearly the doctor prescribing and supplying cream has very little understanding and, through lack of support, has left Julie no choice but to self-medicate and seek out answers elsewhere.

We suggest you refer to our section titled ‘Formula for Hormone Harmony’.