Can I Use Natural Progesterone While on HRT?

Conventional Hormone Replacement Therapy (HRT), once prescribed to millions of women to ease the immediate symptoms of menopause and to prevent osteoporosis and heart disease, has been found to increase the risk of heart disease, cancer and blood clots.

These chemically-altered hormones can shut down or reduce our production of natural hormones. Because the molecules have been changed, the synthetic hormones used in the Contraceptive Pill and conventional HRT do not have the same effect on the mind and body as our natural hormones do. In fact, many of the effects of synthetic hormones are the exact opposite to the natural hormone they so ineptly replace.

The aim of hormone replacement therapy is to put back into the body those hormones that are either missing, or the body is not producing in adequate amounts to offset hormone imbalance. And our network has, over time, recognised that synthetic HRT is toxic to some women, and that these women tend to respond marvellously to bioidentical hormones.

‘Natural to the body’ is what you need to consider as being most important when contemplating hormone replacement therapy.

Women requiring individualised hormone replacement therapy are discovering that bioidentical hormone replacement therapy (BHRT) which includes natural progesterone is relatively free of side effects, non-addictive and, when used wisely and under the care of a competent physician, appears to be quite safe.

Estrogen replacement therapy

There are three ‘classes’ of natural estrogen produced in our body by the adrenal glands and our ovaries: estrone (E1), estradiol (E2) and estriol (E3). But there is only one ‘class’ of progesterone produced by the body.

Estradiol is the most stimulating to breast tissue, estrone is second, and estriol by far the least.

Estradiol is the proliferating hormone which encourages multiplication of cells. It is known to initiate and promote certain types of cancer, particularly of the breast, ovaries and uterus.

As you have probably already guessed, estrone and estradiol are relatively potent estrogens that can relieve menopausal symptoms, but can also produce very nasty side effects, possibly leading to an increased risk of breast cancer if given in high doses, and over a long period of time, say more than five years.

Let’s mention here for good measure, cancer of the breast and/or in the uterus most often occurs with a progesterone (P) to estradiol (E2) ratio of less than 200 to 1. According to Dr David Zava of ZRT, who has amassed a database of tens of thousands of saliva samples and questionnaires, these cancers occur very rarely in women with a healthy P/E2 ratio.

Premarin - made from pregnant mares urine

You might be prescribed a combination of all three types, or perhaps just the one in the treatment of hormone imbalance. Estradiol seems to be the most popular amongst doctors.

Several man-made estrogens are available on on the market, although doctors refer to estrogen as if it is one specific hormone - which as you can see above it is not.

Some estrogens are natural-to-the-body in configuration while others are synthetic. For example, Premarin® including Prempro, Premphase, Prempac, and Premelle) is a drug made up of conjugated estrogens obtained from the urine of pregnant mares — put out in many forms (pills, creams, injections, patches, vaginal rings) and is used to reduce the symptoms of menopause in women or women who have had a hysterectomy.

Demand for Premarin® has fallen off drastically since the National Institute of Health announced in October 2002 that it was halting the Women’s Health Initiative HRT study due to a suspected link between hormone replacement therapy and an increase in incidence of breast cancer and other serious health risks occurring in the control group.

Safer options

Since all estrogens compete for the same cell receptor sites, it is probable that sufficient estriol impedes the carcinogenic effects of estradiol and/or estrone.

Therefore, the safest estrogen to use is estriol applied to the vulva and lower vagina to help ease vaginal dryness and painful intercourse, severe hot flashes and other associated symptoms.

Note here, you do need to include progesterone to balance the estrogenic effect. And, occasionally there is call for the addition of testosterone to help with flagging libido.

Most of us know that in conventional medicine, women who have an intact uterus should be given progesterone along with their estrogen to protect us from uterine cancer. Yet, in spite of the many negative side effects of artificial progestins, many doctors continue to hesitate in prescribing bioidentical progesterone cream as a safer alternative for fear it might not protect the endometrium.

Well, Dr. Helene Leonetti’s fairly recent study effectively proved that progesterone cream protects the uterine lining (the endometrium) as well as synthetic progestins do. Her study comparing PremPro with Premarin and progesterone cream was published in a major peer-reviewed medical journal (JAMA 2002; 287:216-220. Anasti JN, Leonetti HB, Wilson KJ. Topical progesterone cream has antiproliferative effect on estrogen-stimulated endometrium. Obstet Gynecol 2001; 97 (Suppl 4): S10).

Often times, though, your average doctor is absolutely convinced he or she is prescribing an oral form of bioidentical progesterone when the medication it actually a patented synthetic progestin.

So how does this happen? How can a GP, of all people, be confused? Quite simple really. Doctors derive information and training on the drugs they prescribe from the pharmaceutical companies who manufacture them. If a drug is not produced by these multi-national companies, it’s unlikely your GP will hear about it.

Go easy …

Women who withdraw from HRT do experience very distressing side effects as a result of estrogen levels dropping and the brain being conditioned to what our Network refers to as "an estrogen conditioned threshold". The body appears to be conditioned to these high levels of estrogen, and any variance appears to trigger a reemergence of symptoms. Depression and anxiety may surface, often peaking at around 3 months after discontinuing estrogen.

Therefore, women who have been on estrogen therapy for a long time need to know that it’s not wise to go "cold turkey" and stop their estrogen while their body is conditioned to a high threshold of estrogen. A sudden drop in estrogen can actually cause hot flushes and can contribute to rapid bone loss as the body tries to adjust. We suggest women begin by cutting their estrogen dose in half, and then again by half in a few months time, until they find the lowest possible dose that keeps them free of symptoms.

Just be aware that progesterone will amplify estrogen receptors, which is why it’s a good idea to initially halve your dose of estrogen when introducing progesterone back into the body. In effect, the body still interpreting estrogen at high levels. As progesterone becomes more effective and your body adjusts so, in turn, will the body synchronise with the gradual reduction of estrogen.

A tried and tested approach is to tackle estrogen dominance symptoms with progesterone cream, and any residual problems after 4-7 months such as continual hot flushing and dry vagina may warrant estriol supplementation. Petite, slim and small-boned women exhibiting signs of osteoporosis may need to consider intelligent use of estrogen in conjunction with progesterone.

Women without ovaries continue to make estrogen from their body fat and, because natural progesterone makes the estrogen receptors more sensitive, they may find that they can stop estrogen replacement therapy completely after 5-6 months.

Conventional Hormone Replacement Therapy (HRT), once prescribed to millions of women to ease the immediate symptoms of menopause and to prevent osteoporosis and heart disease, has been found to increase the risk of heart disease, cancer and blood clots.

These chemically-altered hormones can shut down or reduce our production of natural hormones. Because the molecules have been changed, the synthetic hormones used in the Contraceptive Pill and conventional HRT do not have the same effect on the mind and body as our natural hormones do. In fact, many of the effects of synthetic hormones are the exact opposite to the natural hormone they so ineptly replace.

The aim of hormone replacement therapy is to put back into the body those hormones that are either missing, or the body is not producing in adequate amounts to offset hormone imbalance. And our network has, over time, recognised that synthetic HRT is toxic to some women, and that these women tend to respond marvellously to bioidentical hormones.

‘Natural to the body’ is what you need to consider as being most important when contemplating hormone replacement therapy.

Women requiring individualised hormone replacement therapy are discovering that bioidentical hormone replacement therapy (BHRT) which includes natural progesterone is relatively free of side effects, non-addictive and, when used wisely and under the care of a competent physician, appears to be quite safe.

Estrogen replacement therapy

There are three ‘classes’ of natural estrogen produced in our body by the adrenal glands and our ovaries: estrone (E1), estradiol (E2) and estriol (E3). But there is only one ‘class’ of progesterone produced by the body.

Estradiol is the most stimulating to breast tissue, estrone is second, and estriol by far the least.

Estradiol is the proliferating hormone which encourages multiplication of cells. It is known to initiate and promote certain types of cancer, particularly of the breast, ovaries and uterus.

As you have probably already guessed, estrone and estradiol are relatively potent estrogens that can relieve menopausal symptoms, but can also produce very nasty side effects, possibly leading to an increased risk of breast cancer if given in high doses, and over a long period of time, say more than five years.

Let’s mention here for good measure, cancer of the breast and/or in the uterus most often occurs with a progesterone (P) to estradiol (E2) ratio of less than 200 to 1. According to Dr David Zava of ZRT, who has amassed a database of tens of thousands of saliva samples and questionnaires, these cancers occur very rarely in women with a healthy P/E2 ratio.

Premarin - made from pregnant mares urine

You might be prescribed a combination of all three types, or perhaps just the one in the treatment of hormone imbalance. Estradiol seems to be the most popular amongst doctors.

Several man-made estrogens are available on on the market, although doctors refer to estrogen as if it is one specific hormone - which as you can see above it is not.

Some estrogens are natural-to-the-body in configuration while others are synthetic. For example, Premarin® including Prempro, Premphase, Prempac, and Premelle) is a drug made up of conjugated estrogens obtained from the urine of pregnant mares — put out in many forms (pills, creams, injections, patches, vaginal rings) and is used to reduce the symptoms of menopause in women or women who have had a hysterectomy.

Demand for Premarin® has fallen off drastically since the National Institute of Health announced in October 2002 that it was halting the Women’s Health Initiative HRT study due to a suspected link between hormone replacement therapy and an increase in incidence of breast cancer and other serious health risks occurring in the control group.

Safer options

Since all estrogens compete for the same cell receptor sites, it is probable that sufficient estriol impedes the carcinogenic effects of estradiol and/or estrone.

Therefore, the safest estrogen to use is estriol applied to the vulva and lower vagina to help ease vaginal dryness and painful intercourse, severe hot flashes and other associated symptoms.

Note here, you do need to include progesterone to balance the estrogenic effect. And, occasionally there is call for the addition of testosterone to help with flagging libido.

Most of us know that in conventional medicine, women who have an intact uterus should be given progesterone along with their estrogen to protect us from uterine cancer. Yet, in spite of the many negative side effects of artificial progestins, many doctors continue to hesitate in prescribing bioidentical progesterone cream as a safer alternative for fear it might not protect the endometrium.

Well, Dr. Helene Leonetti’s fairly recent study effectively proved that progesterone cream protects the uterine lining (the endometrium) as well as synthetic progestins do. Her study comparing PremPro with Premarin and progesterone cream was published in a major peer-reviewed medical journal (JAMA 2002; 287:216-220. Anasti JN, Leonetti HB, Wilson KJ. Topical progesterone cream has antiproliferative effect on estrogen-stimulated endometrium. Obstet Gynecol 2001; 97 (Suppl 4): S10).

Often times, though, your average doctor is absolutely convinced he or she is prescribing an oral form of bioidentical progesterone when the medication it actually a patented synthetic progestin.

So how does this happen? How can a GP, of all people, be confused? Quite simple really. Doctors derive information and training on the drugs they prescribe from the pharmaceutical companies who manufacture them. If a drug is not produced by these multi-national companies, it’s unlikely your GP will hear about it.

Go easy …

Women who withdraw from HRT do experience very distressing side effects as a result of estrogen levels dropping and the brain being conditioned to what our Network refers to as "an estrogen conditioned threshold". The body appears to be conditioned to these high levels of estrogen, and any variance appears to trigger a reemergence of symptoms. Depression and anxiety may surface, often peaking at around 3 months after discontinuing estrogen.

Therefore, women who have been on estrogen therapy for a long time need to know that it’s not wise to go "cold turkey" and stop their estrogen while their body is conditioned to a high threshold of estrogen. A sudden drop in estrogen can actually cause hot flushes and can contribute to rapid bone loss as the body tries to adjust. We suggest women begin by cutting their estrogen dose in half, and then again by half in a few months time, until they find the lowest possible dose that keeps them free of symptoms.

Just be aware that progesterone will amplify estrogen receptors, which is why it’s a good idea to initially halve your dose of estrogen when introducing progesterone back into the body. In effect, the body still interpreting estrogen at high levels. As progesterone becomes more effective and your body adjusts so, in turn, will the body synchronise with the gradual reduction of estrogen.

A tried and tested approach is to tackle estrogen dominance symptoms with progesterone cream, and any residual problems after 4-7 months such as continual hot flushing and dry vagina may warrant estriol supplementation. Petite, slim and small-boned women exhibiting signs of osteoporosis may need to consider intelligent use of estrogen in conjunction with progesterone.

Women without ovaries continue to make estrogen from their body fat and, because natural progesterone makes the estrogen receptors more sensitive, they may find that they can stop estrogen replacement therapy completely after 5-6 months.