Why do you recommend we NOT use progesterone and cortisone together?
I’ve been receiving cortisone injections recently for a painful foot condition. I also recently started using BHRT and noticed that your newsletter indicated that the two should not be used together. Can you explain why that is so? I was unable to find any information on the web.
Thanks so much,
Linda
Dear Linda,
Cortisol and progesterone compete for common receptors in your cells. Therefore, cortisol impairs progesterone activity, which reduces the effectiveness of progesterone therapy or may lead to a condition called “estrogen dominance.”
The body has two triangular adrenal glands, one on top of each kidney.
The adrenal glands have two parts, each of which produces a set of hormones and has a different function. The outer part, the adrenal cortex, produces hormones called corticosteroids that influence or regulate salt and water balance in the body, the body’s response to stress, metabolism, the immune system, and sexual function. The inner part, the adrenal medulla, produces catecholamines (pronounced: kat-uh-koh-luh-meens), such as epinephrine. Also called adrenaline, epinephrine increases blood pressure and heart rate when the body experiences stress.
While the secretions of the adrenal medulla provide quick and short-term responses to immediate stress, the adrenal cortex hormones provide longer-term responses for stress and homeostasis, the maintenance of balance in bodily functions. The adrenal cortex hormones are often considered essential for life.
The cells of the adrenal cortex secrete a variety of steroid hormones. These fall into three classes:
- glucocorticoids (e.g., cortisol & hydrocortisone)
- mineralocorticoids (e.g., aldosterone)
- androgens (e.g., testosterone)
The glucocorticoids get their name from their effect of raising the level of blood sugar (glucose). One way they do this is by stimulating gluconeogenesis in the liver: the conversion of fat and protein into intermediate metabolites that are ultimately converted into glucose.
Cortisol and the other glucocorticoids also have a potent anti-inflammatory effect on the body. They depress the immune response, especially cell-mediated immune responses.
The mineralocorticoids get their name from their effect on mineral metabolism. The most important of them is the steroid aldosterone. Aldosterone acts on the kidney promoting the reabsorption of sodium into the blood. Water follows the salt and this helps maintain normal blood pressure.
The adrenal cortex secretes precursors to androgens such as testosterone. In females, the adrenal cortex is a major source of androgens. Their hypersecretion may produce a masculine pattern of body hair and cessation of menstruation.
In fact, the adrenal cortex makes all of the sex hormones, but in very small amounts. One cortical hormone, DHEA, which is weakly androgenic, is made in relatively large amounts in both men and women; its production is greater than that of any of the other corticosteroids. Its full range of functions is yet to be understood.
Progesterone is the precursor to the hormones aldosterone, the minerialcorticoid that regulates fluids in your cells, and cortisol. Imagine what havoc a deficiency of progesterone can wreak on hormone balance and bodily functions.
Progesterone and all glucocorticoids share the same receptor site. However, the message brought to the molecule by each of the two hormones is quite different. In the case of osteoporosis, progesterone stimulates new bone formation whereas the message of glucocorticoids is to suppress that action. People placed on long-term use of large (pharmacologic) doses of glucocordicoids will invariably develop osteoporosis. But, intesteringly, when glucocordicoids are given in smaller, physiologic dosages (which the body needs to function normally) no cases of osteoporosis were reported over a twenty year period - The Safe Use of Cortisone, by Dr William Jefferies.
The more potent drugs used today (for example, prednisone) are going to upset that delicate balance between progesterone and our glucocorticoids.
Another point worth mentioning while on the subject … there is a small amount of progesterone in everyone?s body, both men and women. Everyday our bodies make that small amount. And everyday, our body converts this little bit of progesterone into a little bit of cortisol and cortisone. We would literally drop dead in about 48 hours from a lack of cortisol and cortisone. And since these hormones are manufactured from progesterone and beyond that, from pregnenolone, our bodies must turn out these precursor molecules every day.
All sex hormone, adrenal hormone, and kidney hormone (aldosterone) production comes from cholesterol. Cholesterol, an essential chemical in our body, provides the necessary cofactors for a hormone called Pregnenolone. In a non-stressed individual, pregnenolone flows in a downward direction for the production of DHEA. DHEA is then converted to either testosterone, or the 3 different estrogens (estradiol, estriol, or estrone) depending on the body?s demand. Some of this pregnenelone is always shunted in a secondary fashion to progesterone which, as needed, will convert to cortisol. Cortisol is then free to carry out its biological activities as discussed above. When estrogen, testosterone, and progesterone are being produced in normal amounts, this indicates a healthy and balanced hormonal system. However, in our fast-paced, stress filled society this normal scenario very rarely occurs leading the way for hormonal imbalances and a predisposition to ill health.
When our body is placed in a stressful situation it responds by producing various stress hormones such as adrenaline (epinephrine, norepinephrine) and cortisol. This demand for stress hormone production is a normal response to help prepare our body for action, achieve the necessary physiologic function, and protect our body from damage. In an acute event, such as a traumatic injury, stress hormones are mobilized to stimulate muscular activity, blood sugar for brain and muscle fuel, inflammation control, and increase in heart and lung function necessary for dealing with the situation at hand. After the stressful event has subsided, these hormones should return to the level they were prior to the stressful event. Unfortunately, our lives have become an ongoing stimulus of perceived stress leading to persistent demands on our adrenal reserves for ongoing energy production
When the body is under stress, we tend to produce more and more cortisol. Over time we enter a phase called ?pregnenolone steal? in which our body is stealing pregnenolone away from its normal hormone production in preference of cortisol. Eventually the stimulus on our adrenal gland for stress hormone production (cortisol) is so great that our adrenal gland begins to weaken. Over time, this scenario leads to adrenal fatigue and eventually adrenal exhaustion. In the adrenal exhaustion phase we have lost our ability to compensate for acute stressful events and we are left feeling fatigued, lethargic, and susceptible to chronic illness.
Chronic stress comes in many patterns and phases depending on an individual?s lifestyle, diet, sleep patterns, genetic and hereditary factors. We all have stress, but the people that generally deal with stress in a positive emotional and mentally balanced fashion remain the healthiest with regard to their adrenal hormone function. However, stress is a multi-factorial issue and its causes are a multitude of varying emotional, dietary, and lifestyle factors. Injuries, nutrient poor diets, chemical toxicity, disturbed sleeping patterns, drugs, infections, electromagnetic exposure, psychological stressors such as doubt, lack of self worth, fear, and anxiety all lead to demands on your adrenal reserves. If not balanced these reserves are lost and the manifestation of a wide variety of symptoms and ill-health conditions arise. Early Menopause, PMS, irregular menses, emotional lability, chronic pain, insomnia, immune system dysfunction, osteoporosis, heart disease, and cancer can all be attributed to a breakdown of our adrenal reserves.
