I have had a salivary assay done for progesterone and oestradiol and I am concerned.

Hello Catherine,

I live in the UK, and here it is not possible to purchase progesterone cream OTC - I get mine from America, a brand mentioned in Dr Lee’s books on menopause as being appropriate. My perimenopause started about two years ago, and I initially felt very ill. However, I have been supplementing with progesterone cream since September 2003 and am feeling much better, although still not my old self. I have had a salivary assay done for progesterone and oestradiol, and am concerned.

The laboratory have advised that a normal level of progesterone would be 100-400 picograms, but mine has come back at 2396 picograms. The normal oestradiol level is 4-7 picograms, and mine is 3.5. Practitioners knowledge of progesterone cream here is scant indeed. Although I have my GP’s blessing to use progesterone, and very much miss it on the days I have to give the cream a rest, it seems to me that something’s wrong, here.

Catherine, I feel lost in a sea of misinformation, and would appreciate your views. It has been suggested to me by a lady who is studying to be a naturopath that some possible reasons for my high saliva level could be that I have started supplementation fairly recently, and things may settle down; I have also been cycling the sites I use progesterone and have incorrectly been cycling including my tummy and breasts, which Dr Lee initially said was appropriate but has since revised his suggested sites for supplementation, to only those areas where the skin is thin - of course I’m now doing this. I know progesterone can “settle” in fatty tissue and that this, too, may lead to elevated levels.

Please share your wisdom on my quandry, although I do hope I don’t have to stop supplementing - I’m at my very worse when I can’t use my beloved progesterone cream!

Thank you for your voice of calm and reason and your wonderful newsletter.

Best wishes,
Susannah

Dear Susannah,

Can I say that balancing our hormones with BHRT is rarely ever a case of dabbing on a little progesterone each month and that’s all there is to it. Since we don’t live in a ‘bubble’, there’s always going to be something or someone to upset our apple cart!

Any number of things can and will influence how our body metabolises endogenous (produced within the body) and exogenous (from outside the body) compounds. Therefore, we need to be practical and we need to be responsible for the things we do have a degree of control over.

For example, the quality of food we put in our mouth, the amount of sleep we get each night, how we react to stressors as we go about our daily routine, the chemicals we expose ourself to, how often and to what degree we exercise our body, what lengths we go to to support proper adrenal and liver function, the cleansing of the body from impurities and wastes, etc., all have a huge impact on sex hormone balance.

So I say again, Susannah, adding progesterone cream without attention to all the ‘other’ factors will result in a less than optimal outcome.

Progesterone is normally a cyclical hormone and the body really needs to see a change in the concentration to affect a proper physiological response. If your levels of progesterone are constantly above the concentrations that it recognises as “off” or low, this is not possible.

Progesterone is a highly lipophilic (fat loving) molecule that is well absorbed through skin into the underlying fat layer. In fact, progesterone is among the most lipophilic of the steroid hormones. For this reason, it is crucial to apply the cream closest to the blood vessels where it can be transported around the body to latch itself onto receptor sites. In this manner, you can be guaranteed relatively immediate bioavailability of this hormone.

We know that progesterone cream utilises fatty and cellular tissue as ‘reservoirs’ for storing progesterone, providing a more sustained level of progesterone exposure. But an accumulation of progesterone in the body can lead to suppression of natural hormone production and can promote abnormal actions in the body.

In cases of overdosing, we need to take appropriate steps to wash progesterone from the body. This can take months … or days. I can provide a perfect example of this. Right now I’m struggling with adrenal exhaustion so my hormones are all over the place. My last salivary hormone profile confirmed progesterone levels soared to 14,270 pmol/L then plummeted down to 242 pmol/L over a 23 day period. A salivary assay of my progesterone, estradiol, testosterone, DHEA and cortisol levels helped my GP and I pull the pieces together, work out what’s happening, and come up with an appropriate form of treatment.

On that note, we are incorporating a functional liver detoxification profile, a thyroid hormone profile using blood spot testing to determine TSH and free T3 and T4, and additional salivary assays to track adrenal insufficiency. ALL these tests come in easy-to-use kits that allow me to collect timed specimens at home. My GP has referred to me on to a competent naturopath to provide much needed nutritional and botanical support.

Back to you, Susannah. That you’re on the low end of the reference range for estradiol isn’t necessarily a ‘bad’ thing. As we approach menopause our estrogen levels drop so as to provide us with a degree of protection against estrogen-driven cancers. However, too much body fat can push our estrogen levels up, as can estradiol replacement therapy.

In Australia, the (follicular) estradiol reference range sits at 2-10 pmol/L but the ideal target range in actually 1-5 pmol/L.

In healthy women without breast cancer, we find that the saliva progesterone [P] level is routinely 200 to 300 times greater than the saliva estradiol [E2] level. In women with breast cancer, the saliva P/E2 ratio is considerably less than 200 to 1. The ideal treatment ratio between progesterone to estradiol is therefore 200~300:1.

You would like to see your progesterone levels drop to within the 700~1,400 range (3.5 estradiol x 200~300 progesterone). In the event progesterone levels are beyond this P/E2 ratio, stop using cream and begin monthly monitoring of your progesterone levels.

Finally, can I say, Susannah, that it’s sometimes harder to take and act on advice than it is to give it!! I’m referring to myself here. Even when we know what we ought to do to support ourselves physically, emotionally and spiritually, walking the talk is a daily challenge…