I lowered by dose of progesterone and failed to menstruate this month.

Hi Catherine,

I need your help. I started using Natural Progesterone last June 29, day 12 of my menstruation with the dosage of 1/2 tsp (40mg) 2 x a day. On day 26 I had my menstruation (I was taking duphaston the month before I used natural progesterone but when I started natural progesterone, I stopped using duphaston), and I am so happy because before, if I don’t take duphaston, my menstruation is always delayed.

Because of the positive effect, I called the store where I bought the cream and I found out that it’s out of stock. So I decided to request my friend to buy for me outside our country. But since she’ll be coming home on September, I was quite worried that my available cream will not last till September. I decided to lower my dose to 1/4 tsp (20 mg) 2 x a day (I was following the 8 week plan without a break).

But August 9 until today I am very very busy and always tired and today is day 30 since my last menstruation, yet I still don’t menstruate. By the way, I expected that 48 hours after my day 26, I will menstruate and since I did not, I once again increased the dose to 1/2tsp 2 x a day. I know that I should have not decreased my dosage but due to my worry that I won’t have enough till September, I lowered my dosage. What should I do? As of now, I feel like my menstruation is already coming but it has not come yet. I need your advice.

Thanks,

Leah

Dear Leah,

Getting your dosage right isn’t easy. But I wouldn’t think there’s any need to panic. The very act of worrying will have an adverse affect on your hormone levels. So relax and go with your body for the time being.

Let’s recap on your comments above. You have been applying 80mg of progesterone per day for roughly 7 weeks. This dosage appears to be working for you for the time being. When you realised you might run out of cream, you decreased your dose by half, bringing dosage down to 40mg per day. You have not been taking cyclic breaks from cream during the initial 8 week period because this is the first time you have used progesterone supplementation and you suspect your body needs to build up its stores (saturation). Up until now, this approach has not interfered with your normal cycle. Your primary concern is that you have not had a period when you expected to. You feel intuitively that your body is ready to bleed but nothing is happening.

Leah, your daily progesterone dosage is at the high end of the scale. Nevertheless, this dosage is evidently opposing your body’s estrogen levels and contributing to your sense of wellbeing while keeping you symptom-free. All good news.

If, however, when you attempt to drop your dosage your problems come flooding back, then it might be wise to stay on 80mg of progesterone as this is obviously the dose that works for you. I would suggest you back this approach up with a salivary hormone profile just to get a more accurate picture of how your body is metabolising hormones. And if at all possible, work closely with a GP you trust.

All things considered though, women suffering pronounced progesterone deficiency tend to need 6-8 weeks on natural progesterone therapy to reach saturation levels, at which point they would adjust dosage according to symptom relief. BUT … women DO need to start taking cyclic breaks from cream otherwise receptor sites will down-regulate and they’ll end up gradually losing the benefit of progesterone.

If your levels of progesterone are constantly above the concentrations that the body recognises as “off” or low, then a proper physiological response is not possible. Therefore, after the first 8 weeks, periodic breaks from cream of no less than 3-5 days MUST follow.

Stick to what you have come to know as your typical ‘cycle’, Leah, and be sure and break from cream on Day 26 onwards. Assuming your premenopausal, a significant drop in progesterone levels should trigger menstruation.