I’ve pulled the following article together in response to the numerous questions I receive daily from women asking “how and when do I apply progesterone cream?”
Let me point out that the use of progesterone is not the only form of treatment for the following conditions and must be used in conjunction with a supportive healthcare professional, if one is available to you.
Progesterone often kick starts other treatments, therefore diet, nutrition, stress management, and other environmental factors need to be considered here.
Suggested dosage outlined in this article have been observed to be effective. It is unrealistic to place too much emphasis on progesterone as a miracle hormone that can fix everything. Progesterone when used intelligently and consistently has brought wonderful results for many women (and men).
Uterine fibroids / Heavy bleeding:
We are recommending conservative doses here. However, many doctors may prescribe more, or less. Use between 64-100mg for 4-7 months under supervision. Overall, an average of 7 months on high levels seems to be an effective timeframe to get some measure of control. Your barometer is reduced bleeding and reduced clotting along with other symptoms such as regular cycles if you are still menstruating. Adjust dosage accordingly.
High doses 100-200mg (suppositories) under strict medical supervision gradually reducing over a few weeks have been incorporated with successful outcomes (documented in literature). However, the Natural-Progesterone-Advisory-Network.com website does not work with doses exceeding 10%, and has no experience with suppositories.
We find that women with a history of fibroids tend to sit on a maintenance average dose of 4% (40mg). When stablised, work 2 weeks on, and 2 weeks off. In some cases, a 12 day break is too long, and needs to be adjusted.
The depletion of progesterone reserve (be it through stress< or imbalance) will not be detected until the second month / second menstrual period, indicating a need to increase dosage temporarily until symptoms settle.
When treating uterine fibroids, it’s imperative that you master estrogen dominance as fibroid growth is influenced by estrogen. See our section on ‘How can I reduce my estrogen dominance naturally?’.
We urge women who have been informed they need a hysterectomy to hang on to their ovaries regardless, unless life-threatening. Even though a hysterectomy will interfere with the blood supply resulting in complete dysfunction of your ovaries over time, leaving them where they are will benefit your overall hormonal health … providing they are healthy.
Surgical removal of ovaries in the case of an a hysterectomy will mean your body is not manufacturing adequate, if any, progesterone required to oppose estrogen dominance brought about through exposure to xenoestrogens.
Sometimes women may need to supplement bio-identical estriol and/or testosterone for vaginal dryness, hot flashes and/or loss of libido.
At commencement of progesterone therapy, initial doses of high levels between 60-100mg a day is often required, usually to compete with high cortisol and pain levels created by this disease. The body, if progesterone deficient, may take 4 menstrual cycles until symptoms begin to abate. Reduce dose according to pain management. The average maintenance seems to hover around 50-60mg between 4-7 months.
Rub onto the ovaries and pelvic ligaments, remembering to rotate the site. A good response is regular and less painful periods. If you are finding that you are bleeding heavily, possibly suffering anaemia, make sure that you work closely with your doctor. All heavy, non-cyclic bleeding should be investigated.
Women suffering endometriosis don’t cope well with long breaks from cream. But ideally, for the younger women, early diagnosed endometriosis, the goal is to mimic nature and aim for a 12-26 day cycle using cream, and eventually return to a ‘least is best’ dosage. For a young teenager/woman suffering endometriosis, a maintenance dose would range from 20-40mg a day, and often she can wean off progesterone altogether for months on end supplementing with herbs. Women with more established endometriosis appear to sit between 40-60mg daily maintenance dose for at least a year, then lower doses may be tolerated as healing progresses. Your barometer of treatment is reduction of pain, a return to regular, pain-free periods, and associated endometriosis symptoms.
Migraines / PMS:
Starting from approximately 32mg from day 10-12, gradually increasing to larger doses (up to 100mg if necessary) toward the end of the cycle. This gradual increase of progesterone levels peaking at around day 26 will usually control the onset of migraine and PMS. Rub onto your temples, neck, and back at hourly intervals to dislodge the headache or onset of anxiety or mood swings. You will probably find that one or two doses will be enough.
For severe PMS and migraines, up to 10% (100mg) levels are well tolerated in initial stages. Your maintenance dose is around 20-30mg, your barometer being symptoms relief. PMS and migraines may take months to settle, and usually disappear if managed correctly.
Severe migraines may take up to 12 months to control but, with each cycle, severity, duration and debilitation lessens. PMS is slightly easier to resolve, usually over 4-7 months.
The normal dose would be 20-30mg for 4 months and usually positive changes are observed in this timeframe, confirmed with another pap smear. For a quicker result progesterone pessaries or lesser dose via intra-vaginal application may be of benefit.
We would expect that you are under the care of a physician, and all other tests have been performed to eliminate likely causes such as cancer, STDs, etc. Progesterone is not the only factor here. Nutrition and attention to hygiene needs addressing. You might also consider moving away from tampons (bleaching chemicals) during your treatment.
Progesterone has been reported to correct abnormal cervical cells (a-typical) where a pap smear reading indicates the need for further investigation and possible surgery. Get a second opinion and consecutive pap smears following 2-3 months on progesterone therapy.
This range depends on the degree of you condition. Begin at 30mg and assess you progress. High levels of 60mg are often required initial 8 weeks or more to compete with the cortisol output because there will be competition for the same receptors and progesterone has to work harder under these conditions (progesterone steal). Reduce dose as your symptoms improve.
Absorption of progesterone can be very poor in these women, particularly when associated with chronic fatigue or fibromyalgia. Intra-vaginal application very gradually has proved far more effective in conjuction with nutritional supplementation aimed at rebuilding their immunity.
These women often qualify for additional steroid hormones. This is why a saliva assay is imperative to assess possible depletion of other hormone to, and fine tune levels.
The average dose that most women with PCOS use to remain asymptomatic is around 60mg of progesterone cream daily from day 12-26 of your cycle (adjust accordingly) for at least the first 7 months if there is a regular cycle. In the initial few months, however, many women take 60-100mg of progesterone cream from day 5-26 to address extreme progesterone deficiency and estrogen dominance symptoms. And after your body has settled down, you may wish to wean back to a lesser dose or to extend breaks to fall into line with a day 12-26 cycle. Get as close as you can to a ‘least is best’ dosage, long term, and remain asymptomatic. Some women have reduced dosage levels as low as 20-30mg, day 12-26, or 14-28 on a longer cycle, and enjoy optimal health.
It’s important that you have regular ultrasounds to assess the condition of your ovaries, and an indicator of treatment progression.
If you are using a regime day 5-26 in the first 4-7 months until symptoms settle, please be aware you are using a program suggested to enhance fertility.
Dosage barometer would be improvement of symptoms such as reduced facial and body hair, no further weight increase, clearer looking skin if suffering acne, less cravings for sugars and refined carbohydrates, regular cycles, absence of ovulatory pain, elimination of PMS and other estrogen dominance symptoms.
Nursing Mothers – Postnatal depression:
To treat severe depression, doses of around 60mg for 4 months have been used successfully (depending on the degree of depression), then wean back gradually to 15-20mg physiological dose. Once their period returns, these women have adopted a cyclic 12-26 day regime to maintain hormone balance.
The advisable dose of 15-20mg, based on observation, hasn’t affected prolactin levels. If this dose is inadequate, increase gradually until you arrive at a level where you feel relaxed, getting a sound sleep at night, general improved sense of wellbeing and not feeling depressed.
If you wish to use high levels and feel it is necessary, the barometer is your absence of symptoms. If your milk production is effected, it is an indication that progesterone may be interfering with the hormone prolactin (responsible for producing milk). We have not had any reports of this, even at 60mg per day used short term.
Physiological dose of 15-20mg, rubbing some cream on to the breast tissue daily and the remainder of cream for that dosage rotated around the body. Your breasts will respond favourably to this dose regardless of what else you do. You can remain on this dose indefinitely (with regular breaks) to maintain breast tissue softness and cyst-free breasts.
Barometer would be diminished cysts. Success of treatment is usually seen within a few months. Women who are highly stressed, or who have a high intake of caffeine may take longer to respond.
As a general guide, Dr Lee recommends using 20mg of progesterone from day 5-26 for 3 months to rest the ovaries (turn off ovulation). Then the next month which is the fourth cycle use 20mg from day 12-26 or 14-28 (AFTER ovulation is confirmed using ovulation detector) if you are on a longer cycle.
Should you become pregnant continue to use the cream increasing dosage to 30-40mg in the first month, after which increase dose to 60-80mg. If you are uncomfortable about stopping the progesterone, continue until one week before delivery. If you are going to stop the progesterone never stop suddenly. Cut down gradually, using a little less each day, around Week 20.
If you withdraw progesterone suddenly it could potentially trigger a miscarriage.
If the liver is not functioning properly chances are you will feel very nauseous with progesterone usage in the initial stages. This is the only time we recommend minute amounts of cream (maybe as small as 5mg), gradually increasing as tolerated.
Start supporting you liver function with a premium liver formulation and detox regime. Also, if progesterone is not helping you for various problems, one must wonder what other factors are at play here. A liver assay would be advisable in this situation.
The liver is the organ that eliminates ALL the hormones after the body has utilised them. The liver is also where synthetic HRT is metabolises making it available for the body to use. Natural, bio-identical hormones bypass the liver and gut and are taken directly into the blood stream.
This is fairly controversial with Dr Lee recommending a more physiological dose, three weeks on, one week off if post menopausal, and if peri-menopausal a physiological dose 12-14 days if asymptomatic.
For the first 8 weeks if you are estrogen dominant work on the principal of saturation up to 60mg. If you are post-menopausal you can go for 8 weeks and then come back to physiological doses between 15-20mg as a maintenance dose if asymptomatic.
A good number of menopausal women do not show signs of estrogen dominant symptoms, but still need to have high doses initially because the body is so deprived of progesterone. If women are peri-menopausal, still menstruating and have osteoporosis, then the principal of saturation and pulling back to maintenance doses 15-30mg for bone building, depending on their estrogen dominance and other symptoms. Arriving at a physiological dose where you are symptom-free other than treating osteoporosis may take months in adjunct to diet, nutrition, phytoestrogens, etc.
We emphasize more progesterone dosage does not make more bone, in fact it can retard the benefits of bone building, because it can down regulate if used at high dosages for long periods of time unnecessarily. Higher than physiological doses of progesterone is only beneficial to the body when it is addressing problems at hand (excluding osteoporosis).
In summary, if you are post menopausal and have osteoporosis you are not going to see immediate results and may not see results for quite a few years. Adopting a ‘least is best’ approach will still have the same favourable outcome as opposed to high or random dosage.
Barometer is improvement of Bone Mineral Density (BMD) reading – 3 to 4 year comparison of results.
From our research and understanding, these are really a marker for estrogen and progesterone deficiency. This results in a huge ratio difference between the estrogen and progesterone levels, sending the body’s biofeedback mechanism into ‘overdrive’ to prompt ovulation (wake up the ovaries).
Initially you can use high levels of progesterone between 60-100mg a day in the first 6-8 weeks, depending on severity and occurence of night sweats and/or flushing. The body will settle in time. Using the principle of saturation seems to help to override estrogen dominance wake-up crisis quicker. Severe flushes usually indicate radical fluctuation of estrogen so it’s important to stabile the ratio between estrogen and progesterone. Incorporating phytoestrogens are helpful in addressing hot flushes successfully.
Hot flushes can range from seconds to minutes, and can be very debilitating. Women find that often regular doses throughout the day and night delivers a more consistent message to the brain and evens out ratio imbalance. Consistent doses are far more effective in the initial stages than a day and night application. It is important to keep you fluids up, and helps prevent dehydration from excessive sweating. Continue with this approach and the hot flushes will gradually subside as the body adjusts to the progesterone input into the body. Once the hot flushes subside, reduce this dose accordingly, working back to asymptomatic doses.
The average dosage most effective to control hot flushing, menopausal or peri-menopausal state, is approximately 30mg, usually achieved around the fourth month. If hot flushes haven?t subsided within 4-7 months on progesterone there may be a call for administration of some estrogen (estriol cream).
Your Ultimate ‘Step-By-Step’ Guides to Using Progesterone
Ever worry that you’ll ‘do it wrong’? It’s only because you can’t know what you don’t already know! But by the time you’ve finished reading these strategic ‘tell you exactly what to watch for…and what to do’ guides, I promise you will!
For more comprehensive guidance around many of these topics, check out my library of Self-Help Consumer Ebooks which step you through dosage and usage techniques, tips and traps.
And as always, if you have any questions – I’m here to help.
In love & appreciation,
Catherine P. Rollins
Founder & CEO
Ethically Supporting Women’s Choice of BHRT Since 2001
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