In the treatment of PMS, do I have to use a natural progesterone suppository?

Hi Catherine,

On a recent episode of ‘Dr Phil’ a representative from a PMS Clinic out in California stated that Natural Progesterone is THE treatment for PMS but that it must be in suppository form as the creams do not work. What is your response to this?

Thank you,

Georganne

Dear Georganne,

My response would be … the treatment of PMS does tend to require, in the initial stages, significantly higher doses of progesterone to bring symptoms under control. And vaginal application can potentially raise progesterone levels very quickly, offering immediate relief in times of stress, mood swings, an impending migraine, or where reserves of progesterone are low.

It also offers an alternative when topical absorption appears to be poor, or in cases where women appear unable to assimilate their cream effectively.

Vaginal application rapidly elevates (spikes) progesterone levels, while offering a more direct absorption route, one that we believe has additional benefits of targeting specifically the cervix, uterine tissue and surrounding organs within the pelvic cavity.

This unique approach to progesterone application seems to have a greater impact on the specific conditions such as PMS, endometriosis, fibroids, cervical hyperplasia, thickening of the uterus, and polycystic ovarian syndrome. This is because it appears to target tissue in these areas, as well as being systemically available via the blood.

Cell receptability can be severely compromised because of chronic illness, malnourishment, auto-immune disorders, dysfunctional liver, poor skin absorbability, increased body fat (overweight), poor or sluggish circulation, etc. The list is extensive. It’s in these cases that the vaginal route has proved a successful way of getting around such health issues.

Many women, myself included, have been experimenting with VAGINAL delivery of progesterone CREAM for years with good results.

I’d like to point out here that this approach (using your progesterone cream vaginally) requires considerable caution since few drug companies endorse this unique approach to application of their cream. We do know that the product Crinone? 8% (natural progesterone) is a specially formulated gel that you insert in your vagina, and is currently used as part of a program for women who are undergoing fertility treatment.

Reported feedback from women using vaginal delivery of progesterone includes the occurrence of severe estrogen dominance wake-up, even after being stabilised using topical delivery but not having optimal effects. Our conclusion is that it tends to deliver higher levels of progesterone that up-regulates estrogen receptors thus stimulating or perhaps exacerbating estrogen dominance albeit temporarily.

Other benefits reported by women using cream vaginally include improved bladder function such a stress incontinence, thrush, normalising vaginal pH levels, secretions and vaginal dryness. Some women still need to use progesterone in conjunction with estriol cream but they may find they need less estrogen over time to maintain healthy tissue.

Vaginal daily application of progesterone could lead to significantly higher concentrations in the body, therefore, you need be monitor your adrenal and sex hormone levels at regular intervals. This is why we suggest two to three days only vaginal application if you are a woman who builds up reserved quickly.

Because of it’s effective route of absorption, vaginal application should be very gradual (small dosage to start with, and alternate your days). If you’re getting a favourable response, we suggest you apply cream once or twice a week, building up to alternate days and, if need be, progress to daily doses.

Some women alternate between vaginal and topical delivery for optimal site receptability, always allowing for regular breaks from cream in order to mimic nature. This offers the body a cross section of deliverance and has been found to be very effective.

There is good medical evidence that vaginally administered progesterone is well absorbed. It also substantiates that for those women who feel they must use an estrogen supplement, vaginal progesterone, in adequate doses will protect their endometrium from the estrogenic effects. But make sure your doctor keeps an eye on the thickness of your uterus just to be safe.

If, however, you choose to work with natural progesterone cream applied vaginally, this is strictly a personal choice and one you must be prepared to take full responsibility for, always erring on the side of absolute caution. This would or should include an all-important call to your cream manufacturer or distributor prior to pursuing this form of progesterone therapy to ask if there is any ingredient that might be harmful if applied vaginally.

Ensure the cream is of the highest quality. Vaginal tissue is very delicate and sensitive, and can be thin, dry and atrophied, particularly for post-menopausal women. So check with your cream manufacturer or compounding pharmacist that there are no irritants or ingredients that contraindicate this form of usage. Be very gentle using an applicator as it may traumatise vaginal tissue because of the above reasons.

Please do not attempt this approach without full knowledge of your condition, particularly if it’s of a bleeding nature. Or if you have not undergone a recent medical checkup that included an internal examination or ultrasound.

Indications when NOT to use cream vaginally: recent surgery, signs of infection, active thrush, cystitis, you suspect you are pregnant, history of STDs, or any condition that is being treated by a doctor.

Dr Lee, when he was alive, recommended applying cream topically over vaginal delivery to achieve sustained physiological progesterone levels with a single daily application. He certainly did not encourage us to accumulate high concentrations of progesterone in our body which could contribute to further hormone disruption.