Why am I not seeing the benefits from natural progesterone cream like I used to?

Hi Catherine,

I have been on Natural Hormone Replacement cream for about a little over a year. We have a pharmacy that compounds the cream formulas. The pharmay contacts the doctor with the amount they think should be prescribed.

All has gone very well until last April when the dosage needed to be changed. I have now had the dosage changed 3 times. Recently I have been reading that it is Progesterone that is the essential hormone and not Estrogen. I asked the pharmacist to increase the Progesterone and decrease the estrogen as my “hot flashes” were starting again. The level that I am currently on is “Triest” @ 1 MG, Progest. @ 40 MG and Test. @ .5 MG per CC.

The problem is that I am continuing with (what I am terming as) severe “hot flashes, especially @ night. After two weeks of starting the cream last Oct, my hot flashes disappeared … now they’re back and sleep is becoming constantly interrupted throughout the night. Can you shed any light on this?

Thank you for your time,

Julie

Dear Julie,

There are a few things going on here that you need to be aware of.

For starters, you need to determine what is causing the decline in benefit from your dose of progesterone.

Has your pharmacists changed the formulation in any way?

Are you taking regular breaks from cream? Women are very reluctant to take a break from cream for fear of symptoms returning. But they fail to realise that they need to take regular breaks (no less than 3 days) from cream to prevent down-regulation of cell receptors. If we do not rest cell receptor sites, progesterone will become ineffective. You then end up rubbing on twice as much cream but get only half the benefit.

Have you been under stress lately? High levels of external /internal stress, such as pain, anxiety or illness, will take progesterone down the corticosteroid pathway to produce cortisol - the survival hormone - which negates the action of progesterone in the body (because progesterone is being converted into another hormone that competes for the same receptor).

Get your GP to order a savilary hormone profile to check your existing hormone levels. Is your body metabolising progesterone? Thyroid function affects liver clearance of progesterone. A Liver function test would also be of tremendous value here.

In excess, progesterone can cause lethargy or sleepiness which is often reported when women use oral progesterone. However, even in an excessive dose, high progesterone levels causes no particular side effects other than a decrease in potential progesterone benefits. This loss of effect due to excessive dosing is not uncommon. In fact, overdosing generally leads to a reimmergence of estrogen dominance symptoms. What you need to do here is restore a normal progesterone to estrogen ratio (200~300:1).

Hot flashes and night sweats generally relate to a drop in estrogen levels. Again, this picture will become clearer with a Salivary Hormone Profile.