My OB/GYN has just prescribed Progesterone Cream because I have not had a period for 12 months.

Hi Catherine,

My OBGYN has just prescribed me ‘Progesterone Cream 100MG.Gm CR to apply 1 gram twice daily’ because I have not had a period for 12 months. Do you think this is too high of a dose, and do I need to stop taking it for a week every month?

Thank you,

Krista

Dear Krista,

First of all, it’s refreshing to read that you have found an OB/GYN who is willing to embrace the use of bioidentical hormone replacement therapy (BHRT) in his or her practice. I would, therefore, like to think that your specialist is competent in the administration of natural hormones.

The medical term for lack of menstruation, Krista, is amenorrhea.

Based on the assumption you are still young and expecting to see a period each month, administering a high dose of progesterone, in this case using a 10% cream to ‘kick start’ a period, is quite normal and logical.

In cases where we fail to ovulate each cycle, our ovaries may be releasing the hormone estrogen but not producing progesterone, a hormone necessary for periods to occur.

Continued exposure to estrogen without the presence of progesterone the last two weeks of our menstrual cycle to ‘trigger’ a shedding of the uterine lining, places us at risk. Keep in mind also, our uterus is not the only organ exposed to estrogen, month after month.

Your physician, in raising your progesterone levels as quickly as possible with a relatively high dose, is in fact using progesterone’s natural anti-estrogen properties to protect you.

Unopposed estrogen will continue to stimulate thickening of the uterine lining until progesterone is present in the body at sufficient levels as to prevent excessive growth (endometrial hyperplasia).

I’m assuming your specialist does not consider a gynaecological D&C (dilation and curettage) necessary at this juncture.

Expect your periods, when they do arrive, to be heavy and clotty as your body attempts to expel the build up of bloody tissue. This will settle in time, once you return to a regular cycle that is achieved with hormone balancing.

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.

Talk candidly with your specialist, Krista, sharing whatever concerns you might have.

As a patient advocate, I always encourage women to do their homework. It’s been my experience, good information leads to good choices!