When do I have a break from my progesterone cream?

Hi Catherine,

I had a total hysterectomy last October and was immediately put on an estrogen patch. I experienced weight gain and felt crummy for quite a while. I took the patch off 3 weeks ago and felt immediately better. I had been using progesterone cream earlier for PMS, and am now using it full time and it’s been terrific.

Understanding that there is supposed to be a “break” I tried this weekend after 3 weeks of being on the cream. There was an immediate shift to becoming weepy and a bit depressed or detached from my surroundings. I put the cream back on and things got back into focus for me. Having read the information on this site I see that for the first 6-8 weeks it may not be necessary to take a break.

My question is DO I have to take breaks down the road? Why is a break in the cycle necessary?

Thank you for your help!

Kim

Dear Kim,

Assuming a woman’s body is low on progesterone - which is likely to be the case for you after a total hysterectomy - she can actually continue applying cream without a break in the first 2 months because a majority of the hormone is being soaked up into fat tissue. This is also the reason why a higher dose is well tolerated.

After 8 weeks, saturation has most likely been achieved, so it’s important you begin taking a break from cream to establish a rhythmic (on/off) pattern in your body. This is also the time to initiate weaning back to physiological doses, as determined by symptom relief and charting.

Cyclic breaks from cream must eventually be taken:

• a menopausal woman would follow a calendar pattern of 3 weeks on, 1 week off


• a premenopausal woman would follow a 2 week on, 2 week off routine according to her cycle (day 12 to day 26).

Failing to break from cream in the first 6-8 weeks will not, based on anecdotel evidence, adversely affect a woman’s period. She will continue to menstruate. And it’s likely, during this time, she’ll remain in a state of estrogen dominance. In fact, double doses help negate the estrogen dominance wake-up symptoms exacerbated by the introduction of progesterone back into the body that stimulates the estrogen already present in her body.

Our aim is to achieve balance using progesterone as close to physiological doses (’least is best’ principle) as possible to relieve symptoms while making sure we adequately oppose our estrogen load. Talk about a juggling act!

We need to be mindful of the fact it could take months, perhaps more than a year to achieve hormone balance without experiencing the ill effects of too little progesterone available to the body when we break from cream.

It’s so important to have at least a 3-day break from cream to restore receptor sensitivity. To do otherwise is to risk losing the full effectiveness of your progesterone cream (down-regulation of cell receptors).

If lengthy breaks aren’t possible when you first start progesterone therapy, work towards increasing the duration of your breaks each month.

Cream utilises fatty and cellular tissue as ‘reservoirs’ for storing progesterone. Unless you carry little or no body fat, over a period of time, you’ll build up stores of progesterone such that a two-week break from cream is unlikely to cause any discomfort or trigger a resurgence of estrogen dominance symptoms.