Overdosing does not present a health risk

Feedback provided to this Network suggests overdosing can occur when women apply cream a little too liberally without monitoring progesterone uptake, and fail to reduce their dose to the least amount of progesterone they can manage while achieving sustained symptom relief.

When a woman’s bioavailable progesterone levels exceed the corresponding reference range captured on their saliva assay, they simply need to go off cream until readings suggest they are once again estrogen dominant.

Rudel and Kincl (International Encyclopedia of Pharmacology and Therapeutics: The toxicity of progesterone, 405-409), in their review of the international literature, noted that “Nowhere … is the oral toxicity of progesterone reported.” They therefore undertook a study with rats, administering various doses of progesterone both orally (via gavage) and by subcutaneous injection for 26 weeks. Their only finding was an increase in the body and liver weight of female rates receiving parenteral progesterone.

Dr Jane Murray writes, “Not infrequently, women complain of drowsiness, headache, dizziness, or nausea just after ingesting an oral dose of micronised progesterone or transmucosal lozenges. Intravenous administration induces sleep at doses of 250 to 500mg. Synthetic progestins, on the other hand, often cause androgenic side effects (acne, body and facial hair), depression, and weight gain.”

Progesterone creams contain the hormone identical to that produced by the human ovary. And because you’re not going against Mother Nature, women report minimal, apparently benign side-effects. If experienced these may include breast tenderness and swelling, fluid retention or slight vaginal bleeding. Dizziness, nausea, fatigue, headaches and light headedness have been reported occasionally and usually disappear with adjustment of dose.

Women in the some countries, for example the United States, do not require a doctor’s prescription to source cream. Natural progesterone cream can be legally purchased over the counter or via on-line distributors.

Empirical evidence suggests the self-medication of micronised progesterone creams only poses a concern when women:

• are not made aware of how much progesterone is contained in their jar (or tube) of cream
• use cream that is supplied without the manufacturer’s application instructions
• require a more individualise approach to hormone balancing
• have a medical condition that is contraindicative of progesterone use
• are using prescription medication and opt not to inform their doctor that progesterone supplementation is now part of the equation
• or when cream quality, safety and efficacy are not of the highest standard.

To be perfectly candid here, the Natural-Progesterone-Advisory-Network.com website seems to be the place women flock when trying to make sense of natural progesterone’s action in the body, suggesting women aren’t always capable or want the responsibility of balancing their hormones without help and guidance of a healthcare professional, which is where we recommend they turn if in the slightest doubt they DO NOT have a handle on progesterone supplementation.

A ‘one size fits all’ approach to natural progesterone is just not always realistic. One needs to individualise dosage and application methods according to her medical and family history, lifestyle considerations, diet, metabolism, etc. This fact is sometimes over-shadowed by cream availablity and apparent simplicity of cream application.

Women ought to be given the choise on this one. Many women use progesterone cream effectively and responsibility, and although the jury is still out, the growing body of evidence suggests we run a very small risk of actually dangering ourselves self-medicating with progesterone. We stay healthy, we visit our GP once or twice a year for the odd check-up, basically we go to great lengths to make sure we are NOT a burden to our country’s often time floundering healthcare system.

For those women who struggle to come to terms with the whole concept of hormone balancing using bioidentical hormones, they need their GP on side.

When asked, “Can a woman ever have too much progesterone?” Dr Katarina Dalton responded, “No, I don?t think she can. A normal menstruating woman can?t have too much because she can?t get up to that ?normal? level that she has in pregnancy. As a general rule, is it safe to say that it?s better to overdose than underdose. There?s no harm in overdosing. You can?t reach it. Very definitely overdose.”

Doctors have no idea about BHRT, and those that do are hard to find

It’s understood we need our doctor’s cooperation in order to get a prescription to purchase cream from a compounding pharmacists or pharmaceutical company in Australia. But here’s the rub! The Australian RX Drug Guide written by Dr. Jonathon Upfal, does not even have a listing for natural progesterone, only progestogens and progestins.

Because of its unfair drug classification, natural progesterone is only available ‘S4 Prescription Only’. The irony here is, even though presently classified as a “drug”, doctors are unlikely (or unwilling) to prescribe natural progesterone, because they know little or nothing of it’s applications. Why? Because progesterone is not a drug and most doctors only know about drugs!

Our doctors have not been brought up to speed on bio-identical HRT and, therefore, haven’t the faintest idea what we’re talking about when we come to see them requesting a safer alternative to synthetic HRT, given it’s more recent bad press.

Doctors are encouraged to prescribe a potentially harmful drug (which may give you cancer), but see absolutely no reason why they ought to remain open-minded (at least!) to a safer alternative - progesterone - which may actually prevent cancer!

Natural progesterone cannot be purchased over the counter, and because it is not a drug, women are unlikely to be offered anything other than artificial estrogens or progestins by their doctor. The vast majority of doctors are ‘drug fixated’ and adhere rigidly to their profession’s traditional prescribing habits. Unless you are fortunate to have a doctor who believes drugs are not always the best or only option, or unless you specifically request it, you are unlikely to ever be offered natural progesterone!

It is common knowledge that pharmaceutical companies aggressively market HRT to doctors, often over expounding its virtues by stretching the truth a little here and there, which effectively distorts the facts. In our opinion, ?playing down? the known risks to women’s health should be viewed as criminal negligence, yet our health authorities do nothing to stop this nonsense, and won?t give us access to safe hormones!

Who is calling all the shots, when drug companies are allowed to continue peddling their neatly packaged (potential killer) products to your busy doctor, but you are not permitted to purchase a cream, which will keep you well?

It’s quite obvious some doctors really struggle to come to grips with what exactly bio-identical HRT is, and why hormone profiles using salivary assays gives more accurate results than blood tests.

A flow on from this is that women often cop a ‘dressing down’ when they approach their GP for a prescription for progesterone and baseline profile. This was witnessed first hand when Catherine Rollins attended a clinical workshop on Hormone Imbalance held in Melbourne recently. She was stunned by the ‘mauling’ some doctors in the audience dished out to the presenter - a medical doctor like themselves specialising in hormone balancing - and maintains women shouldn’t have to put up with such behaviour.

Some of us may actually manage to convince our GP to write a script, and go so far as to order a saliva hormone profile kit, but then our doctor leaves the interpretation of symptom relief, saliva assays reports, dosage adjustment, etc., up to us - the patient!

If a woman happens to overdose on progesterone cream, detoxing is subsequently required to bring levels back within normal limits. This is achieved with follow-up salivary hormone profiles, and a thorough investigation to learn why her body might not be metabolising progesterone (thyroid and/or liver function, diet, etc). The fix may be a simple adjustment of dosage. Maybe not.

Technicially we’re not self-medicating. We’ve elicited the cooperation of our GP required to legally obtain progesterone thereby meeting the guidelines set down by the TGA. But why aren’t these same doctors monitoring our progress? Are they capable of monitoring our progress? Evidently not. Most doctors want nothing whatsoever to do with ‘bioidentical’ hormones, preferring instead to stick to tried and tested drugs they’re more familiar with. So … who steps in and resolves this ’stand-off’ betweem women and their family doctors?

The dilemma facing women EVERYWHERE!

June, USA

” … I went through 4 doctors before I found the one I have now. One was downright angry at me for even attempting to “self-medicate” myself and one laughed in my face when I told him I was using natural progesterone cream and said that if it had a placebo effect, then more power to me….then went on to say that if I used it for more than 5 days before my period, that I would mess up my cycle!!! Guess the placebo effect he mentioned was pretty powerful!! I finally found an OBGYN/FACOG that understands the use of natural progesterone and while I don’t think she has studied in great depth, will discuss it with me as well as be okay with me using it. Now if I just had a dr. that knew more than I did and could answer my questions, I would be in heaven!!!”

Sara, USA

” … Hi, I am a 56 yr old woman who had a complete hysterectomy at age 42. I was then put on Premarin alone since my ovaries were removed. I stayed on Premarin for 13 years and stopped it 5 months ago when I decided that it was not good for me. Breast cancer runs in my family. I called my doctor to request “bio-identical hormones” and she said, “what are they”…she would not help me. I asked for natural hormones and she would not prescribe anything and to stay on Premarin. I tried over the counter Estroven with several other vitamins … hot flashes are slowly ruining my life. I do not sleep, and daily have hot flashes. This has been going on for 5 months. Still I refuse to go back on Premarin. No one will help me. I just want to cry all day long … it seems like no one will help me get my body back on track other than taking Premarin. I felt great on it, never having a hot flash but I know it is bad for me. I ordered Progesterone cream and vitamins from the alternative medicine network and hope that they will work. I cannot afford to order the salivary test or hormone test. Is there anything you can advise me to do? I read the testimonials and nothing relates to me…Please reply to this, I am desperate for help…thanks for taking the time to read this.”

A follow up email: ” … I got my blood tests back and they indicated that everything was very low, (estrogen - progesterone - testosterone). My doctor said to stay on the Climara patch. Would you be able to tell me if the patch is a bioidentical hormone? From what I have read it is. All of the symptoms you listed are EXACTLY what I have! I have not received the Progesterone cream that I ordered yet but when I do I will start using it immediately.”

Then later on that week: ” … I called my doctor this morning and requested the “lowest” amount possible of estrogen for the patches, come to find out, she gave me the highest amount they make for them…I don’t understand her at all, she knows how I feel yet she continues to want to keep me on a high dosage of estrogen… They gave me 0.1mg per day and the pharmacist said I should be on 0.5, the lowest is 0.25 but she said I would still have hot flashes with it. I wish I know what I was doing with all this stuff!”

Despina, Australia

” … Thought I’d share my experience with you re progesterone cream. Saw my GP today re my hormone levels. She advised that she had only tested my estrogen levels and did not routinely check progesterone. When I mentioned that I had been reading about Progesterone she chastised me for ‘reading too much and asking too many questions’ and informed me quite bluntly and aggressively that she does not write prescriptions for progesterone cream! I was stunned by this hysterical response from a female GP. I’m now looking for a new GP - did you have any difficulty getting a prescription?”

I was totally shocked by my GP’s manner today. It appals me that GP’s have become so formulaic and orthodox in their practice of medicine. Despite the mantra of medicine as a partnership with the patient taking responsibility for their own health and being informed, in reality, the conventional and deferential model still seems to operate.”

Is it too much to hope our doctors ONE DAY SOON embrace a more INTEGRATIVE approach to medicine, combining mainstream medical therapies and complementary medicine therapies for which there is some high-quality scientific evidence of safety and effectiveness?