Book Review – Depression After Childbirth by Dr. Katharina Dalton

Book Review – Depression after Childbirth by Dr. Katharina Dalton

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Dr. Katharina Dalton was a pioneer in women’s health, coining the term “premenstrual syndrome” (PMS) and recognizing that progesterone may relieve PMS symptoms. She then turned her attention to the complicated issue of depression after childbirth. Her book Depression after Childbirth: How to Recognize and Treat Postnatal Illness was first published in 1980 and categorized postpartum depression (PPD) according to its degrees of severity.

Causes and Characteristics of Postpartum Depression

As mothers experience hormonal fluctuations during and after childbirth, both their physical and emotional wellbeing are affected. Postpartum depression shares many symptoms in common with other forms of clinical depression, including:

  • Lethargy or unusual fatigue
  • Irritability
  • Increased appetites
  • Feel achy all over
  • Isolation
  • Increased risk of suicide
If you think you might be suffering from postpartum depression, contact your medical practitioner right away or go to the nearest emergency room.

In the mid-1960s, a group of physicians at the North Middlesex Hospital in London performed a survey of 500 of their pregnant patients before and after delivery. They found the women who were happiest, elated, and euphoric during the later months of their pregnancies had the highest risk for PPD. The mothers who developed PPD had two noticeable characteristics: a favorable attitude to motherhood, and labile emotions. Although PPD often begins early on after giving birth, it may also start when the mother stops breastfeeding, as another dramatic change in hormones occurs at that point. Postpartum depression may also occur after miscarriages, stillbirths, and terminations of pregnancies.

Levels of Severity in Postpartum Depression

Mild Postpartum Mood Changes: The “Blues”

Known as the “maternity blues,” “baby blues,” or “postnatal blues,” the mildest form of mood changes after a woman gives birth is also the most common. It often begins within three to ten days post-delivery but is usually subsides within one or two weeks. One of the main symptoms of the “blues” is excessive crying that begins suddenly and with no apparent reason.

In the early 1900s, women would usually stay in the hospital for 14 days after giving birth. This was generally enough time for this milder form of depression to fade away while having plenty of support from the hospital staff. Today, most women are sent home within 48 hours, often with little to no assistance unless family and friends pitch in.

Moderate Postpartum Depression: Postnatal Exhaustion, Depression, and Irritability

Tiredness and lethargy is another manifestation of PPD that may persist as long as six to nine months. Although difficulty in sleeping may be a symptom in other forms of clinical depression, women with PPD experience no problem sleeping and indeed, no amount of sleep seems to be enough. On the other hand, some patients may experience irritability that may be very difficult or impossible to control. The irritability may present in swings from anger to distress.

Dr. Dalton suspected that the plunge of hormones that occurs at delivery may be involved, and pointed out that low thyroid might be a factor along with low potassium and iron levels. A woman who has recently given birth should have her thyroid function tested if she exhibits one or more of the following symptoms:

  • Falling asleep at any time day or night
  • Experiencing lank and thinning hair
  • Feeling cold
  • Having a slow pulse

Fortunately, thyroid and other hormone levels can be evaluated by a woman’s healthcare provider, who may determine the use of hormone therapy necessary to correct any deficiencies or imbalances.

Severe Postpartum Depression: Psychosis

Psychosis is the most severe form of PPD that many times begins within two weeks after a woman gives birth. In psychosis, a woman may lose contact with reality and become unaware of her surroundings. She may have auditory hallucinations in which she hears voices or visual hallucinations in which she sees imaginary people, animals, or things. She may have ruminating thoughts, during which she can’t stop thinking about something.

Postpartum psychosis may require more drastic forms of treatment or even hospitalization. According to Dr. Dalton, progesterone therapy may prove helpful in addressing even these severe symptoms. As with any concern for mental wellness, it’s important to consult a medical professional in order to form a personalized treatment plan.

Similarities between Postpartum Depression and Premenstrual Syndrome

Dr. Dalton pointed out that the main features of PPD–tiredness, irritability, and depression–also characterize PMS. Both conditions also occur during a time of hormonal decline – prior to menses and following labor and delivery. Since these symptoms may arise from hormonal changes, proper supplementation with hormones such as progesterone and thyroid may provide relief. Dr. Dalton states: “The aim is to control the sudden drop in progesterone that normally occurs at delivery and prior to menses and convert it to a more gradual and slow fall.”

Another similarity between PPD and PMS is that fluctuations in blood sugar may occur. Low blood sugar brings on a surge of adrenaline (the “flight or fight” hormone), causing reactions such as fury or aggression. Appropriate diets may help stabilize blood sugar levels.

Preventing Postpartum Depression

Dr. Dalton concluded that the best practice for treating PPD is to prevent it from occurring in the first place. She suggested a treatment using progesterone (in injectable or suppository form) beginning at the completion of labor, and that progesterone supplementation should continue until a woman’s menstrual cycle resumes. Progesterone supplementation may be beneficial during breastfeeding, when the pituitary hormone prolactin increases, as excessive levels of prolactin may interfere with progesterone’s effectiveness.


Dr. Katharina Dalton correlated the similarities between PMS and PPD and argued that these were real medical conditions rooted in endocrine disorders. The marked mood changes a woman experiences after giving birth are not imaginary or “in her head.” On the contrary, Dr. Dalton’s groundbreaking work showed that these changes can be traced back to real physical causes, and may be remedied if the signs of postpartum depression are promptly identified and properly treated.

Additional Resources:

Postpartum Depression and the Potential of Allopregnanolone

For more information on depression and mental health in general, visit our Mental Health Resources page

© 2019 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at

Book Review – Depression After Childbirth by Dr. Katharina Dalton2019-07-05T12:23:04-05:00

Postpartum Depression and the Potential of Allopregnanolone

Postpartum Depression and the Potential of Allopregnanolone

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Postpartum depression (PPD) is a widespread complication of pregnancy and childbirth that can affect a woman’s emotional, mental, and overall health. It is characterized by feelings of sadness, anxiety, apathy, fatigue, and being overwhelmed with day-to-day activities, and can affect a mother’s ability to bond with her infant, cause her to lose interest in things she usually enjoys. This article outlines the possible causes and risk factors for PPD and explores a potential hormone therapy using allopregnanolone, a treatment recently approved by the FDA.

As with many forms of depression, PPD is not as straightforward as it may initially seem, presenting itself with various symptoms and levels of intensity. Many women experience mild and short-lived mood swings after delivery, in what often is termed as the “baby blues.” By contrast, PPD is usually more serious and prolonged; in one of its most severe forms, postpartum psychosis, suicide and homicide pose real dangers.

If you think you might be suffering from postpartum depression, contact your medical practitioner right away or go to the nearest emergency room.

A Possible Cause of Postpartum Depression

The sudden, dramatic change in reproductive hormones after delivery occurs is thought to be a cause of PPD, though some medical practitioners argue that this type of depression can occur during pregnancy as well as post-partum. Additionally, investigations show that blood levels of hormones in women with postpartum depression may not be so different from those women who do not suffer from depression after childbirth.

It’s possible that a more complex interaction of various bodily systems may be involved, including:

  • Thyroid function
  • The immune system
  • The signaling from the hypothalamus to the pituitary to the adrenal glands (HPA axis)
  • Hormones involved in breastfeeding
  • Genetics

All of these systems are affected by the reproductive hormones, specifically estrogens and progesterone.

Risk Factors

Many factors may predict post-delivery mood issues, including:

  • A family history of PPD
  • Depression after a previous birth
  • Depression during the pregnancy
  • Gestational diabetes
  • Little or no partner support
  • Instrumentation during birth
  • Cesarean delivery
  • Low socioeconomic status
  • Lower education
  • Single motherhood
  • Unemployment
  • Unintended pregnancy
  • Partner violence
  • Traumatic childhood
  • The number of previous pregnancies

Neuroactive Hormones

The hormones produced by the sex and adrenal glands and circulated throughout the body are only one part of the hormonal equation. Adrenal and sex hormones are also made in the brain and neuronal tissues, where they are used directly by the tissue making the hormones. The brain has the advantage of being able to use both the hormones it produces independently and those that are in general circulation. These hormones have an impact on brain function and mood.

A Potential PPD Treatment with Allopregnanolone

Allopregnanolone (ALLO) is a metabolite of the hormone progesterone. In fact, the levels of ALLO produced in the body parallel those of progesterone:

  • During the menstrual cycle – ALLO rises and falls in the same way progesterone does during the menstrual cycle
  • During pregnancy – ALLO and progesterone both rise to high levels during gestation and drop at delivery
  • In the brain – ALLO can affect the same receptors as progesterone

On March 19, 2019, the US Food and Drug Administration (FDA) announced the approval of an intravenous form of ALLO with the brand name Zulresso and the generic name brexanolone. This is the first drug approved by the FDA specifically for the treatment of postpartum depression. ALLO treatment involves an intravenous administration over 60 hours shortly after delivery. Because of concerns about serious risks, including excessive sedation or sudden loss of consciousness during administration, access to this treatment will be limited and strictly monitored.

Could Progesterone Have the Same Effect on PPD?

In 1980, Dr. Katharina Dalton published Depression after Childbirth. This book describes PPD’s identifying features and the possibility of treating it with progesterone. She was the first to consider the unpleasant symptoms that plagued some women just prior to menstrual bleeding as a syndrome, calling it premenstrual syndrome (PMS), Dr. Dalton argued that progesterone could be used not only to alleviate PMS symptoms, but she also found that it could help with toxemia of pregnancy (now known as preeclampsia) and PPD.

Even though ALLO is promoted as a breakthrough for PPD, progesterone might be just as useful. Studies have shown that progesterone administered orally increased ALLO levels in the body, and other studies have shown progesterone binds to many of the same receptor sites as ALLO.

Evaluating Postpartum Depression

The Edinburgh Postnatal Depression Scale (EPDS) illustrates the mood problems associated with postpartum depression. Below is an adaptation of their questionnaire.

Select the answer that comes closest to how you have felt in the past 7 days:

  • I have been able to laugh and see the funny side of things
    1. As much as I always could
    2. Not quite so much now
    3. Definitely not so much now
    4. Not at all
  • I have looked forward with enjoyment to things
    1. As much as I ever did
    2. Rather less than I used to
    3. Definitely less than I used to
    4. Hardly at all
  • I have blamed myself unnecessarily when things went wrong
    1. No, never
    2. Not very often
    3. Yes, some of the time
    4. Yes, most of the time
  • I have been anxious or worried for no reason
    1. No, hardly at all
    2. Hardly ever
    3. Yes, sometimes
    4. Yes, very often
  • I have felt scared or panicky for no very good reason
    1. No, not at all
    2. No, not much
    3. Yes, sometimes
    4. Yes, quite a lot
  • Things have been getting on top of me
    1. No, I have been coping as well as ever
    2. No, most of the time I have coped quite well
    3. Yes, sometimes I haven’t been coping as well as usual
    4. Yes, most of the time I haven’t been able to cope at all
  • I have been so unhappy that I have had difficulty sleeping
    1. No, not at all
    2. Not very often
    3. Yes, sometimes
    4. Yes, most of the time
  • I have felt sad or miserable
    1. No, not at all
    2. Not very often
    3. Yes, sometimes
    4. Yes, most of the time
  • I have been so unhappy that I have been crying
    1. No, not at all
    2. Only occasionally
    3. Yes, sometimes
    4. Yes, most of the time
  • The thought of harming myself has occurred to me
    1. Never
    2. Hardly ever
    3. Sometimes
    4. Yes, quite often

These ten questions are used to measure the severity of the depression using a range from 0 to 30, with 30 being the most severe form of depression. According to the EPDS, any score over 10 may be considered depression.


PPD can be complex, involving multiple hormones and body systems. Successful treatment is critical to the health of a new mother and her child. Treating PPD with ALLO is a great advance over antidepressant drugs because as a bioidentical hormone, it comes closer to addressing the root cause of the symptoms in a way that is natural to the body. While access to ALLO treatment is limited, based on the work of Dr. Katharina Dalton and others, progesterone might have the same positive effects for women struggling with postpartum depression.

Additional Resources:

Book Review – Depression After Childbirth by Dr. Katharina Dalton

For more information on depression and mental health, visit our Mental Health Resources page.

© 2019 Women’s International Pharmacy

Edited by Michelle Violi, PharmD; Women’s International Pharmacy

For any questions about this article, please e-mail

Carol Petersen at

Postpartum Depression and the Potential of Allopregnanolone2019-07-05T12:22:47-05:00

Ovulation is Crucial

Ovulation is Crucial to Women’s Health

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

ovulation is crucial to women's healthMany of us, including medical practitioners, think that if we are having monthly, regular periods, then our reproductive system is healthy. Dr. Jerilynn Prior believes we haven’t studied ovulation closely enough. She details her position in a series of newsletters from the Centre for Menstrual Cycle and Ovulation Research (CEMCOR). Dr. Prior estimates that, among regularly menstruating women whose cycles have been normal for 10-30 years after menarche (one’s first period), one third do not ovulate. She suggests that ovulation is “a missing link in preventing osteoporosis, heart disease and breast cancer.”

Let’s Start at the Beginning

Let’s refresh our memories with a little physiology review. Ovulation is the release of an egg from an ovary. Once the egg leaves the ovary, the corpus luteum (a temporary endocrine gland) forms in the ovary and begins to produce progesterone. The egg travels down the fallopian tube to the uterus where it can be fertilized by sperm. If fertilization does not occur, the egg is swept from the uterus along with the thickened lining of the uterus during a woman’s monthly period, also known as menstruation.

The release of the egg at mid-cycle and the formation of the corpus luteum are necessary for the abundant production and release of progesterone, which is the hallmark of the second half of the menstrual cycle known as the luteal phase.

As a young girl reaches menarche, estrogen influences her body. Breasts start to develop and body fat is redistributed, rounding the body’s contours gradually into a “womanly” shape. However, ovulation doesn’t start immediately and therefore, neither does the release of progesterone. It could be as long as a year before ovulation actually starts, and only after ten years does ovulation occur 95% of the time. One indicator that ovulation has begun, Dr. Prior explains, is the size of the areola around the nipple. When ovulation starts the areola becomes larger and darker.

Ovulation may be disturbed by stress, emotional upset, inadequate nutrition, and over-exercising without adequate food intake. Dr. Prior writes that there are two types of ovarian disturbances. One is an anovulatory cycle when no egg is released by the ovary. The other is luteal phase defect when an egg is released but there is insufficient progesterone produced by the corpus luteum in the ovary, leading to a shortened luteal phase. Both ovarian disturbances result in an inadequate production of progesterone.

Testing for Ovulation

No test actually “sees” the egg being released from the ovary, so medical practitioners have developed tests that use indirect methods to detect when ovulation has occurred.

  • One test requires a daily ultrasound of the ovaries to track the formation of the pre-ovulation cyst on the ovary and the eruption that occurs when an egg is released.
  • Another test involves taking a biopsy of uterine tissue, which can show cell proliferation caused by estrogen exposure and cells that have matured under the presence of progesterone.
  • Blood tests can verify that progesterone levels are rising to expected levels during the luteal phase.
  • Ovulation predictor kits, available online and at drug stores, test for a release of LH (luteinizing hormone) from the pituitary gland (a precursor to ovulation), but do not establish that ovulation has actually taken place.

In Dr. Prior’s studies, she documented the effectiveness of monitoring molimina to predict ovulation. Molimina is the set of symptoms that appear before the menstrual period that indicate ovulation has occurred. These symptoms include:

  • The onset of pain high up in the underarm region
  • Fluid retention
  • Mood sensitivity
  • Appetite increase

These symptoms may be mild and not reach the severity of PMS symptoms. Dr. Prior notes that nipple pain and general pain in the breast indicate high estrogen levels, but not necessarily ovulation. If a woman has no awareness of an oncoming period, ovulation has probably not taken place.

Another way to track ovulation is to monitor body temperatures first thing in the morning. The progesterone produced following ovulation acts on the hypothalamus and increases body temperature. Temperatures will be above average for 10-16 days if ovulation has occurred. To monitor body temperatures, use a digital thermometer to record readings every day. Add up all the temperatures for the month and divide by the number of days to get the average temperature, and then count how many days have been above average.

Ovulation and Our Health

Few researchers have tracked the effects of ovulation and its related hormones on the body over the course of a lifetime, but Dr. Prior shares findings from a number of studies addressing specific aspects of women’s health, as well as her conclusions from this information.

  • A recent study demonstrated that the greatest increases in bone density for young women don’t occur until about one year after menarche, when ovulation starts and progesterone is produced from the ovaries. Progesterone has been seen to be active at the bone building sites, the osteoblasts. On the other hand, menstrual cycles without ovulation, especially during the perimenopause years, may account for increased bone loss.
  • For many years, researchers have observed that both estrogen and progesterone can contribute to breast cell growth and proliferation. However, initial observations were usually only made over a day or two. After a few days in cell cultures, estrogen continues to stimulate cell growth, but progesterone contributes to breast cell maturation and differentiation. These mature cells are less prone to become cancerous in the presence of progesterone.
  • A common myth about heart disease is that it is the same disease in women as in men. For example, cholesterol levels in women do not appear to correlate with heart disease as they do in men, and taking a daily aspirin for preventing a heart attack may work for men but not for women. It was thought that estrogen prevented heart disease because HDL levels were increased with adequate estrogen levels, but repeated studies demonstrate that this is a myth.
  • Progesterone may affect heart health in a number of ways. It may decrease blood pressure, and it doesn’t appear to be associated with clot formation. While restriction of blood flow in the arteries can increase heart attack risk, progesterone may reduce this risk by increasing blood flow as well as or better than estrogen. Progesterone also appears to help prevent insulin resistance and obesity, two important cardiovascular risk factors. Cycles without ovulation and progesterone production, therefore, could be considered a risk for heart disease.

What can we do to support ovulation and progesterone production? Reducing stress and a healthy, balanced diet are good first steps. In order to detect if ovulation is occurring, monitor pre-ovulatory days for symptoms, chart morning temperatures, or use ovulation predictor kits. If ovulation isn’t occurring, progesterone levels may become depleted. In this case, progesterone may be supplemented to achieve optimal levels. Dr. Prior recommends 300 mg of progesterone used in a cyclic fashion (use for two weeks, stop for two weeks) to restore progesterone lost from lack of ovulation.

As it turns out, we can’t assume everything is well just because we are having a monthly period. Much is going on behind the scenes. However, as stated above, we can pay attention to what our body is trying to tell us. By listening to our body, we can keep our body strong and healthy for years to come.

Ovulation is Crucial2017-12-12T15:35:51-05:00

Book Review – An MD’s Life Saving Health Solutions by James A. Schaller

Book Review – An M.D.’s Life-Saving Health Solutions by James A. Schaller

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Although not apparent from the title of this book, An M.D.’s Life-Saving Health Solutions: A Gynecologist’s Advice, Dr. James Schaller shares some very interesting thoughts about hormones from his long clinical practice in obstetrics and gynecology. He writes in an engaging fashion, almost like you were sitting in his office and having a conversation with him.

He is very clear that progestins (which he calls castrating drugs) are not progesterone. He calls the large Women’s Health Initiative (WHI) study ill-conceived and and says it fails to answer the question that that they sought. The question asked by the study was “Can hormones delay the onset of chronic disease in women?” Because the study used only Premarin and Premarin with medroxyprogesterone (progestin), we only learned that the synthetic or non-human identical hormones do not delay the onset of chronic disease in women.

Dr. Schaller discusses the relationship between hormone balance and body fat at great length. He states ideally, a woman should have about 22% body fat. Less than 13% body fat and low estrogen at menopause is a real concern because there is not enough fat to allow for adequate estrogen storage. Consequently, very thin women have more sensitivity to swings in estrogen which occur throughout the cycle or in perimenopause. “Fat cells store, produce and release estrogen. The number of fat cells affects all hormonally-related effects,” Dr. Schaller claims.

Very thin women can experience stopped monthly periods because there is not enough estrogen available to build up the endometrium. Recall that cycling begins in a young woman who has at least 13% body fat. These women are also at higher risk for osteoporosis.

On the other hand, women who are overweight with more than 30% body fat, store plenty of estrogen in their fat cells. They have a life-long imbalance in progesterone needed to balance the estrogen they accumulate and store. Periods may also stop for obese women but they will likely experience abnormal bleeding.

It is important women understand normal ovarian function. Young girls usually experience pain during the first one to two days of their periods indicating that an ovulation has occurred. After a vaginal delivery this pain may stop. Pain can also occur at mid cycle or two weeks before bleeding begins. This pain can be stabbing or a dull ache and represents the pain of the follicle bursting through the ovary wall. He recommends avoiding strenuous activity when this happens. The ovaries can actually sway with rigorous exercise and prevent healing of the rupture in the ovarian wall.

Dr. Schaller’s book contains many more practical hints. He warns against using psychoactive drugs, medications that have an effect on mood, behavior, or thinking processes, for PMS when progesterone addresses the underlying issue and is less expensive too. He says statins are very dangerous. He notes that cholesterol-lowering drugs do not save lives but actually increase mortality and produce depression and memory problems.

Dr. Schaller is accepting of some doses of NSAIDS (non-steroidal anti-inflammatory drugs) for ovulation pain; however, he says using NSAIDs in excess can cause serious problems because of their potential for gastric ulceration. Drugs which are used for excess stomach acid actually prevent absorption of critical nutrients and bisphosphonate drugs used for osteoporosis interfere with normal bone metabolism.

It was a privilege to read this book and reap the benefits of the observations of a physician in practice for over 40 years. I am sad to see our medicine system turning into one which allows patients only a few minutes with a practitioner and uses treatment plans based on algorithms instead of treating people like individuals and tapping into the vast stores of knowledge and experience from physicians such as Dr. Schaller.

Book Review – An MD’s Life Saving Health Solutions by James A. Schaller2018-01-22T10:56:17-05:00

A Tribute to Dr. Katharina Dalton

A Tribute to Dr. Katharina Dalton

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Even though they’re not really funny, PMS jokes abound in today’s society. It’s very likely that most of us toss around the acronym of PMS (for premenstrual syndrome) without giving a thought as to where or how it originated.

In 1994, there was a movie titled Tom and Viv about the relationship of the American poet T.S. Eliot and his wife, Vivienne Haight-Wood Eliot, whom he married in 1915. Upon their marriage, he became the custodian not only of her money, but also of her physical being. Vivienne suffered terribly each month from what we now would recognize as PMS. After unsuccessfully trying to help her, T.S. Eliot had his wife committed to an asylum where she spent the remainder of her days. He never saw her again after she was committed. This movie reflected the thinking at that time. Women who suffered from hormone disturbances were thought to have mental rather than physical problems.

Dr. Katharina Dalton made a huge contribution to our understanding of hormone disturbances, and she is also the one who named the syndrome PMS. She identified and successfully treated many problems that were uniquely female. As we explore the mysteries and benefits of hormone therapies today, we are standing on the shoulders of her achievements, which include a tremendous amount of observation and study.

On her death at the age of 87 on September 17, 2004, Dr. Dalton’s life and work were reviewed by many major newspapers in Great Britain, where she practiced, and in the United States, where she also made a huge impact by identifying physical reasons for issues that had previously been dismissed as hysterical or only a figment of the mind. The concept of a women’s health movement may very well have started with her work.

At age 32, Dr. Dalton was still a medical student and pregnant when she wondered why she was suddenly free of the severe headaches she had experienced monthly. She took her observations to Dr. Raymond Greene, an endocrinologist, and speculated that progesterone, which is abundant during pregnancy and also should be abundant during the luteal phase (the second half of the menstrual cycle), might be the key. She and Dr. Greene first published their clinical experiences and theory in British medical journals in 1958, and proposed the term premenstrual syndrome. By then, Dr. Dalton had successfully treated premenstrual asthma, epilepsy, and migraine headaches with progesterone.

Progesterone, which has an effect throughout the body, is produced in the adrenal glands in addition to the progesterone produced by the ovaries. Dr. Dalton used progesterone that was equivalent in structure to the hormone found naturally in the human body. She was adamant that other synthetic derivatives of progesterone could not be used, contrary to what her medical colleagues believed.

Throughout her career, Dr. Dalton carefully examined her patients, collected data, posed theories, and tested her ideas. She developed a system of charting to help monitor the large number of symptoms that could present with PMS. An adaptation of the Symptoms Chart is available for download from our website.

One of Dr. Dalton’s observations was that some of the symptoms of PMS (including edema, hypertension, and albumin in the urine) seemed to also occur as early signs of toxemia in pregnancy. She began trials of intervention with progesterone, in collaboration with a maternity hospital. The hospital records showed an average incidence of toxemia to be 9%. After the first patients who were treated delivered babies in 1955, the incidence dropped to a low of 1.0%. Each patient was given a test dose of progesterone when early symptoms occurred, and then treated continually if symptoms resolved, while moderating the doses according to symptom relief.

Men, women, and children all have progesterone receptors in operation throughout their lifetime. Dr. Dalton focused her attention on progesterone receptors and, because only natural progesterone fits the receptors, she felt this was the only appropriate hormone to use. She also understood that, if there was too much adrenaline being produced, progesterone would not be able to be picked up by the receptors. Similarly, if women were experiencing swings of low blood sugar, progesterone would also not activate the receptor.

Dr. Dalton used very generous doses of progesterone to treat women; often a 400 mg suppository would be the minimum dose. Tests to measure levels of progesterone in the body using various means were immaterial, in her opinion, because the only meaningful test would be at the receptor sites. Successful treatment would be verified by a positive response to supplementation.

Dr. Dalton observed that progesterone has a very positive effect on hair growth in women. After delivery of a baby, many women experience significant hair loss because of the sudden drop in progesterone. When progesterone is supplemented for those women, the hair regrows luxuriantly.

Progesterone has also proven to be effective for brain trauma because of its protective effect on the myelin sheath, which covers nerve tissue. Additionally, progesterone can reduce swelling in the brain and has even been used by neurosurgeons prior to surgery.

Dr. Dalton also claimed that there was no unsafe dose of progesterone. In high enough doses, started before ovulation, progesterone could be used as a safe contraceptive. It was also safe to use with breast cancer, even concurrent with breast cancer treatments.

Prior to menopause, Dr. Dalton noticed that progesterone would typically start to become deficient for at least two years. During this time, women would develop symptoms that were similar to those she identified as PMS, which we now identify as symptoms of perimenopause.

She also identified the onslaught of symptoms some women experience after childbirth as having a pattern similar to PMS. She advocated for using large doses of progesterone immediately after childbirth, especially in those women with a history of PMS, to cushion them from the effects of the huge drop in progesterone that occurs at delivery.

Unlike current conventional thinking, Dr. Dalton claimed that women who have had a hysterectomy need more than the amount of progesterone needed by a woman who has undergone a natural menopause. The reasons behind most hysterectomies are consistent with a long-term progesterone deficiency; thus, so much more progesterone is needed to relieve symptoms afterwards. Ignoring the considerable research on progesterone receptors throughout the body, many practitioners today still believe that women with a hysterectomy do not need any progesterone because they maintain that it is only the uterus that benefits from progesterone and, because the uterus has been removed, progesterone no longer has any function.

As an active advocate in the justice system, Dr. Dalton also published a book titled Premenstrual Syndrome Goes to Court. She studied women serving time in prison and found that a large majority of the violent crimes committed (such as manslaughter, baby battering, and assault) occurred during the luteal phase in women who had a history of PMS symptoms. As part of her study, Dr. Dalton devised a menstrual chart indicating symptoms and their cyclical occurrence, helping the women establish the cyclical and hormone dependent nature of the symptoms. She appeared in court in about 50 trials in defense of women suffering from PMS and claiming a state of diminished responsibility if their criminal actions occurred during the luteal phase of their cycle.

She tried to find an independent marker for PMS and studied sex hormone binding globulin (SHBG). In the groups studied, she found that SHBG, which would bind estrogens and testosterone tightly, was low in the women suffering with PMS. She theorized that low SHBG translated into more free estrogens, which then created inadequate progesterone activity. This premise, unfortunately, was not verified by other scientists.

Dr. Dalton practiced the true scientific method. She made her observations based on the evidence she found, devised a theory that tested the observations she made, and tested her theory. She even applied her theory to situations beyond PMS, recognizing the implications of a host of different symptoms, to further an understanding of the importance of progesterone, as illustrated by her observations of patients with post-partum depression and toxemia during pregnancy.

Today, faced with the numerous symptoms that present with PMS, scientists only look at one issue at a time. Instead of turning to progesterone, which is indeed the golden key for progesterone receptors (as Dr. Dalton has shown), we treat PMS piecemeal with diuretics for edema, with narcotics and anti-inflammatories for pain, with anti-epileptics for seizures, and with antidepressants, anxiolytics, and antipsychotics for mood disorders.

Some say it takes 50 years for a new idea to take hold in our collective minds and, since we are now more than 50 years from her first publication, the time is now ripe for acceptance of Dr. Katharina Dalton’s work with progesterone. Pointing to the current widespread use of bioidentical hormone therapies in women’s health today as proof, perhaps her ideas have at last garnered a place in our consciousness.

  • Gilbert B. Tom & Viv. Oxford, Oxfordshire, England, UK; Miramax Films; 1994.
  • Oliver M. Katharina Dalton, 87; First Doctor to Define, Treat PMS [obituary]. Los Angeles Times. September 28, 2004.
  • Dalton K, Holton W. Depression after Childbirth: How to Recognise, Treat, and Prevent Postnatal Depression (4th Edition). Oxford, United Kingdom: Oxford University Press; 2001.
  • Allen LV Jr, et al. Interview: Katharina Dalton, MD: Progesterone and Related Topics. Int J Pharm Compd. 1999 Sep/Oct:332-9.
  • Dalton K, Holton W. Once a Month: Understanding and Treating PMS (6th Edition). Alameda, CA: Hunter House Publishers; 1999.
  • Dalton K. Premenstrual Syndrome Goes to Court. Droitwich, UK: Peter Andrew Publishing Co Ltd; 1990.
  • Dalton K. Should Premenstrual Syndrome be a Legal Defense? In: Ginsburg BE, Carter BF, eds. Premenstrual Syndrome: Ethical and Legal Implications in a Biomedical Perspective. Boston, MA: Springer-Verlag US; 1987:287-300.
  • Dalton ME. Sex hormone-binding globulin concentrations in women with severe premenstrual syndrome. Postgrad Med J. 1981 Sep;57(671):560-1.
  • Dalton K. Toxaemia of Pregnancy Treated with Progesterone during the Symptomatic Stage. Br Med J. 1957 Aug 17;2(5041):378-81.
A Tribute to Dr. Katharina Dalton2019-05-22T10:15:52-05:00

Progesterone May Help Control Perimenstrual Seizures

Progesterone May Help Control Perimenstrual Seizures

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


Progesterone, a neuroactive steroid hormone, produces profound effects on brain function. It not only protects nerve tissue after traumatic injury, but can act as an anti-epileptic as well. It is particularly beneficial when used in women suffering from perimenstrual seizures.

The anti-seizure effects of progesterone were first reported in 1942, and have since been substantiated by both animal and clinical human studies. The rapid drop in female progesterone levels prior to menses may precipitate seizures in susceptible women.

Andrew Herzog studied a small group of women who suffered seizures between day 25 and day 2 of the menstrual cycle. They all had low progesterone levels during the mid-luteal phase. When progesterone was administered daily prior to seizure activity, 18 of the 25 women saw a decline in their daily seizure frequency. Herzog later treated a group of 294 subjects with the same dose. Post-study results found a therapeutic benefit for those women who experienced higher levels of perimenstrual seizure activity.

  • Herzog AG. Progesterone Therapy in Women with Complex Partial and Secondary Generalized Seizures. Neurology. 1995 Sep;45(9):1660-2.
  • Herzog AG, et al. Progesterone vs Placebo Therapy for Women with Epilepsy: A randomized clinical trial. Neurology. 2012 Jun 12;78(24):1959-66. doi: 10.1212/WNL.0b013e318259e1f9. Epub 2012 May 30.
Progesterone May Help Control Perimenstrual Seizures2018-04-05T11:49:44-05:00

Dr. Katharina Dalton’s Impact on Women’s International Pharmacy

Dr. Katharina Dalton’s Impact on Women’s International Pharmacy

– Written by the Women’s International Pharmacy Staff

Dr. Katharina Dalton’s studies, and other studies like hers, provided the basis of knowledge for many pharmacists including our founder, Wallace (Wally) Simons. Wally used his scientific understanding of progesterone to benefit the women coming to his pharmacy from the “PMS Clinic” next door. Wally knew the importance of creating a progesterone formulation that would be absorbed via the lymphatic system into the blood stream rather than immediately being broken down by the liver when taken orally. Today, 28 years later, WIP pharmacists are still utilizing and expanding upon the core compounding practices Wally developed. One of our pharmacists, Carol Petersen, was recently recognized in Pharmacy Today‘s June profile edition in an article titled Compound interest: Petersen shares expertise on women’s health, leads APhA-APPM Compounding SIG. The legacy of Women’s International Pharmacy’s mission to find solutions to meet patient-specific needs endures.

Dr. Katharina Dalton’s Impact on Women’s International Pharmacy2019-05-22T10:16:32-05:00

Can Estrogen Help Migraines?

Can Estrogen Help Migraines?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Forty percent of women and 20% of men experience migraine headaches in their lifetime. Up to 60% of female migraine sufferers have headaches associated with menstruation. According to the International Headache Society, menstrual migraines without aura (a pre-headache visual, sensory, motor or verbal disturbance) can begin two days before to three days after bleeding starts.

Possible triggers include a decrease in estradiol, release of inflammatory substances from the uterine lining, low magnesium, decreases in certain brain chemicals like serotonin and GABA, dehydration, suspected foods and insufficient sleep. Some migraine specialists believe that a decrease in estradiol levels is the most likely trigger.

According to Dr. E. Anne MacGregor, raising premenstrual estradiol levels can help to avert or minimize the effect of these migraines. Maintaining estrogen in a range of 45-75 pg/ml may reduce the intensity and frequency of migraine headaches. Estradiol 1.5mg gel, applied six days prior to bleeding and continued through day 2 of menses, has been shown to effectively decrease the number of migraine days in some women. Extending this time period beyond day 2 and tapering the dose may help prevent “withdrawal” headaches caused by stopping estradiol abruptly. Progesterone may also help decrease these headaches because progesterone helps regulate pain and pain perception through GABA receptors in the brain.

Additional Resources:
Can Estrogen Help Migraines?2018-04-02T17:23:55-05:00

Progesterone Therapy Then and Now

Progesterone Therapy Then and Now

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy
The Beginning of Progesterone Therapy

During the 1930s, several independent research groups were exploring the effects of a substance now known as Progesterone. The first supplies were extracted from human placenta and consequently extremely expensive. The first semi-synthetic supplies were derived from steroid-like plant components at Parke Davis in 1940.  From that point on, the drug companies have been in a race to improve on nature. They began looking for derivatives that would behave like progesterone but could be taken less frequently, or absorbed more efficiently, and—most importantly of all—be a brand-new molecule that would be eligible for patent protection.

By 1948, Dr. Katharina Dalton, a medical pioneer working in England, was already treating patients with different formulations of progesterone. She demonstrated success with injectable progesterone and, later on, with large doses delivered vaginally or rectally, providing relief even in some of the most severe cases of premenstrual syndrome (PMS).

It was not until the 1980s, when new technology of that era provided the ability to mill hormone powders into very tiny particle sizes that researchers began to challenge the belief that steroidal hormones were poorly absorbed when taken orally. In a breakthrough discovery, Joel T. Hargrove and Wayne S. Maxson found that this micronization process created more surface area, allowing for better absorption. They also found that progesterone was best absorbed when it was combined with edible oil.

Yet many practitioners were still skeptical. Generally speaking, most everything that survives stomach acid and is absorbed from the small intestine then passes through the liver for rapid breakdown. Little of the original substance makes it into the bloodstream. However, this is not how fats are absorbed. Rather than breaking down, fats are emulsified in the liver and then delivered via lipoprotein into the lymph system, and eventually into the bloodstream. In fact, Hargrove and Maxson documented very rapid absorption of oral progesterone in oil, peaking approximately two hours after ingestion.

The Beginning of Women’s International Pharmacy

Wallace L. Simons, RPh, President of Women’s International Pharmacy

In 1985, Wallace (Wally) Simons, RPh, founded Women’s International Pharmacy (WIP) with the goal of treating women with PMS using oral progesterone, based on the research being done by Hargrove and Maxson. According to Wally, there was so much controversy at the time that no one wanted to believe that PMS was a real problem, that progesterone had anything to do with it, or that oral doses of progesterone could be absorbed. Nonetheless, he jumped in—starting with one condition, one doctor, one preparation, and only one dosage strength—and thousands of women soon found relief.

In those early days, prescribed treatments consisted of large doses of oral progesterone, with an initial recommended dose of 100 mg taken four times daily. Some prescribers would recommend additional progesterone in the form of lozenges, suppositories or rectal solutions to provide further relief. In fact, some patient reports indicated that extremely severe symptoms, such as suicidal thoughts and tremendous headaches, were relieved very quickly with such high doses of progesterone. Patient reports also confirmed that progesterone could be absorbed from creams and gels on the skin and, in critical cases, via injection as Dr. Dalton first described.

Dr. Guy Abraham was also researching treatments for PMS in the 1980s, with a focus on the nutritional needs of women who suffered from PMS. He developed a vitamin and mineral supplement called Optivite, which contained a generous supply of vitamin B6, and which became a helpful adjunct to other PMS treatments. Not surprisingly, vitamin B6 is beneficial to the metabolism of progesterone.

A Fork in the Road

Fast forward to the late 1990s when Eli Lilly was about to lose the patent on their blockbuster drug Prozac , one of the first of a new class of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs). In 1998, Lilly sponsored a meeting between FDA officials and Lilly representatives, in which they came to two pivotal conclusions:

  • First, they agreed upon a new disorder that would be called Premenstrual Dysphoric Disorder (PMDD). Dysphoria is an emotional state marked by anxiety, depression, and restlessness, which meant that PMS was now considered a psychiatric disorder.
  • Second, they agreed that it was appropriate to treat this new disorder with antidepressants.

In December of 1999, FDA advisors voted unanimously to not only validate PMDD as a new disease, but also approved Prozac as a treatment for it. Soon after, Prozac was remodeled and repackaged with lavender and pink colors, and given the name Sarafem. A massive advertising campaign ensued to make this new treatment appeal to “smart” women. The FDA also approved three other SSRIs for treatment of PMDD, which set the stage for long-term treatment of many women, during their child-bearing years, with SSRIs.

Around 2007 (less than ten years later), reports started appearing in medical journals linking long-term use of SSRIs with osteoporosis and bone fractures.  While the cause or mechanism for this troubling association is still unclear, it certainly raises a red flag concerning the potential risks for long-term treatment with SSRIs. Perhaps it is time for progesterone to claim its position as the treatment of choice for PMS/PMDD symptoms.

Today, Here & Now

We have come a long way since the early 1990s when we recommended high doses of progesterone for treating PMS. We now know more about the relationships among progesterone and other hormones, particularly estrogens and thyroid. We also know that lifestyle choices, as well as interventions with food and nutrient support, can greatly influence PMS symptoms and treatment. We have better tools for assessing both physical and mental health conditions.

Here at Women’s International Pharmacy, we believe that each individual should be assessed by their practitioner for their unique needs. When applicable, customized bioidentical hormone therapies can be a choice and progesterone is still an important option for PMS relief.

P.S. – Another new progestin was just recently approved by the FDA but, as with other progestins, it is still not identical to the body’s own version of progesterone.  We’ll keep you posted as we learn more …

Progesterone Therapy Then and Now2018-04-09T14:02:28-05:00