Many women are also prescribed birth control pills as an attempt to reduce symptoms of premenstrual syndrome (PMS), a hormonal condition primarily related to the timing of the spike of progesterone levels during the menstrual cycle. However, the progestin in these pills can actually cause PMS-like symptoms.
According to Dr. John Lee, PMS occurs when progesterone is low in relation to estrogen, and that additional progesterone is needed to balance the estrogen excess or “estrogen dominance.”
This concept is clearly demonstrated by the fact that PMS symptoms generally ease during pregnancy when high levels of placental progesterone are present, and recur almost immediately after pregnancy when a sudden loss of placental progesterone occurs.
Some practitioners believe that PMS does not occur in anovular cycles (that is, one without menstruation), so they recommend treatment by suppressing ovulation with birth control pills. Dr. Dalton promotes correcting the cause of the progesterone imbalance rather than subjecting women to the side effects of suppressed ovulation.
Polycystic ovary syndrome (PCOS) is another potential result of a hormone imbalance, whereby a woman’s menstrual cycle is dominated by increased androgen (i.e., testosterone) production and a lack of progesterone. In this situation, the ovary does not release the egg, no progesterone is produced, and the follicle could become a cyst. Dr. Lee notes that “If progesterone levels rise each month, as they are supposed to do, this maintains the normal synchronal pattern…and PCOS rarely, if ever, occurs.”
PCOS may start during adolescence, but is usually not detected until women are in their late 20s or 30s because it takes a long time for symptoms to develop. It is the most common cause of infertility in women today.
Bioidentical progesterone (not progestin) has been proven effective for inducing fertility when there appears to be some sort of ovulatory dysfunction. Evidence indicates that this therapy poses no risk, may benefit those wishing to become pregnant, and may help maintain a pregnancy through the early months. Dr. Beer notes that women who have low levels of progesterone tend to suffer from infertility or miscarriages, and suggests that they “require progesterone supplementation to bring them into the safe levels.”
Bioidentical progesterone has recently been heralded in the field of in vitro fertilization, where it is essential for successful implantation, and where progestin cannot be used. The progesterone used has exactly the same molecular formula as the natural progesterone produced by the body’s own placenta and ovaries, so there are no adverse effects.
The Transitional Years
Irregular menstrual bleeding typically occurs at the beginning or end of a woman’s reproductive phase, when hormones are in a state of flux. During these life phases (i.e., puberty and perimenopause), irregular bleeding is usually caused by insufficient levels of progesterone and sometimes the estrogen hormones, resulting in no ovulation. The lack of ovulation means that there is no progesterone production during the second half of the menstrual cycle, resulting in irregular bleeding. Women who do not ovulate tend to have more irregular periods.
Progesterone (sometimes combined with estrogen hormones) helps prevent erratic periods and heavy bleeding. According to research conducted at the Mayo Clinic, this therapy is effective in treating irregular bleeding, especially for women in perimenopause. Dr. Susan Lark concurs that progesterone is “the most effective medical treatment available for women in menopause transition.”
In a study on the role of bioidentical progesterone in maintaining “quality of life” in women at mid-life, Dr. Phyllis Bronson reported that anxiety was “more extreme during the luteal phase or latter two weeks of the menstrual cycle. Even though objectively this is when there is a gradual natural increase in progesterone production. There is often too much estrogen to be mediated by the body’s available progesterone.” This deficiency contributed to “mid-life anxiety patterns” and the “changes in serum levels clearly correlated with the qualitative input” provided by the women. In other words, when progesterone and estrogen were in balance, the perception of the quality of life improved and contributed to emotional well-being.
Researchers at the Mayo Clinic also examined the quality of life between two subject groups, one of which received a progestin (medroxyprogesterone acetate), and the other received micronized bioidentical progesterone. The group receiving the bioidentical progesterone reported significant improvements in their symptoms, including “vasomotor symptoms, somatic complaints, and anxiety and depressive symptoms.” The findings demonstrate significant differences in how progestins and bioidentical progesterone behave in the body, and how that behavior affects how women feel.
After the Reproductive Years
After menopause, once the menstrual cycle stops, the ovaries no longer produce progesterone. However, the body still needs it continues producing it in the adrenal glands and nerve cells. The same is true for women who undergo a hysterectomy. Many healthcare practitioners prescribe only estrogen, with no progesterone, for a woman who has had a hysterectomy, with the mistaken belief that progesterone’s only role is protection against endometrial cancer. While she may no longer need that protection, her body still needs progesterone after a hysterectomy.
In a presentation for the International Congress of BioEnergetic Medicine in 2005, Dr. Mitchell Fleisher stated that women who use estrogen supplementation should also use progesterone, whether or not they have a uterus. Estrogen promotes the overgrowth and enlargement of hormone-sensitive cells, and progesterone is essential to slow this proliferation and promote normal cell development. Thus, progesterone provides an important estrogen-balancing, anti-cancer effect.
Non-Reproductive Effects of Progesterone
Although it is considered primarily a “reproductive hormone” associated with menstrual cycles and pregnancy, progesterone provides benefits to all cells in the body, including those in the brain, heart, nerves, skin, and bones.
Research indicates that “maternal progesterone” is at least partially responsible for gender differences in the human brain. Male and female brains have significant structural and neurobiological differences, including the number of progesterone receptors, which affects sensitivity to progesterone. These differences may be related to why progesterone has been a successful treatment for reducing seizures in some women, and why women’s brains tend to heal more easily after an injury.
Progesterone protects the brain against excitotoxins (substances that excite the brain cells to the point of death), including estrogen-induced “brain fog” and research is underway to understand progesterone’s potential for protection against Alzheimer’s disease. Together, estrogen and progesterone also directly affect the neurotransmitters that regulate mood, appetite, sleep, and pain perception.
Progesterone is also produced by cells in the body’s nervous system, where it helps form the protective layer around nerve endings known as the myelin sheath. The nervous system depends on the myelin sheath for insulation and for neurotransmission speed. Progesterone promotes myelin repair in both the central and peripheral nervous systems.
Progesterone provides significant protection against cardiovascular disease by lowering high blood pressure, reducing arterial spasms, and inhibiting cholesterol buildup. These protective benefits are unique to bioidentical progesterone, not synthetic progestins. In fact, progestins actually increase the risk of coronary spasms and are now associated with an increased risk for cardiovascular disease.
Progesterone also offers protection against osteoporosis. Current research indicates that progesterone has (at least) a dual role in bone health: it stimulates osteoblast production, which results in new bone growth, and it interferes with glucocorticoids, which cause bone loss. Dr. Lee’s research demonstrates that progesterone not only prevents osteoporosis but, more importantly, can reverse it so that bones regain their normal bone mineral density.
Another significant benefit of progesterone is that it is antiproliferative, meaning it may offer protection against some forms of cancer, such as breast cancer. Breast tissue is highly sensitive to hormones, especially estrogen, which encourages breast cells to proliferate. Progesterone provides a counterbalance to that proliferation. Dr. Lee reports that the protective benefits are clearly indicated by the results of a study in which “premenopausal women with low progesterone levels were found to have 5.4 times the risk of developing breast cancer when compared to premenopausal women with normal progesterone levels.”
Progesterone’s contributions to a lifetime of overall health and well-being are numerous. In addition to the benefits mentioned above, it is also necessary for balancing or facilitating many other hormones and nutrients, and it is a component of almost all other hormone activity in the body. With such far-reaching repercussions, it seems obvious that the need for progesterone spans the entire lifetime, affecting all life stages, and that a chronic deficiency can lead to a wide range of health issues, including breast cancer, osteoporosis, and cardiovascular disease. Fortunately, a progesterone deficit can be treated.
Furthermore, a review of the literature reveals hundreds of studies where progesterone has been shown to have beneficial effects. For example, evidence suggests that it has “neuroprotective” characteristics that offer hope for treating neurodegenerative conditions such as multiple sclerosis and the lingering effects of a stroke or head injury. In fact, an ongoing clinical trial offers promising therapeutic results when progesterone is administered shortly after a traumatic brain injury. Please contact your healthcare practitioner or compounding pharmacist for more information about progesterone supplementation.