Treating Hormone Imbalance : Progesterone Supplementation

Previously we have discussed that the underlying problem in an estrogen-dominant hormone imbalance is most likely a progesterone deficiency. Restoring progesterone levels is the beginning to correcting hormone imbalance and further improving your overall health. And as most people reading this article are struggling with some unwanted pounds, creating the appropriate hormone balance can be crucial to getting rid of those extra pounds.

Hormone Replacement Therapy (HRT) is something that most any woman over the age of 45 years has discussed with her healthcare provider. Unfortunately that HRT is typically aimed at replacing Estrogen. What can be missed by healthcare providers is the fact that if estrogen levels are deficient, progesterone levels are even lower. By replacing estrogen only, and not addressing the progesterone levels, the underlying estrogen-dominant state is worsened. This can lead to even greater medical, metabolic, psychological, and weight-loss issues for women. Therefore it is imperative that any woman seeking hormone replacement therapy get a complete evaluation of all of her hormones and not just her estrogen levels. A basic hormone panel should include: Estrogen (estrone-E1, estradiol-E2, estriol-E3 ), Progesterone, Testosterone, Thyroid Hormone, DHEA, Cortisol, as well as a complete blood count (CBC) and metabolic panel (BMP/CMP). Ideally this workup should be a combination of both blood and saliva testing. Cortisol levels should be evaluated at different times over a 24 hour period for the best assessment.

Before discussing HRT, let us first review a little about the types of hormone replacement products available.

• Natural Hormones – the actual hormones produced within the body that serve a specific set of functions. Each hormone has a unique shape, and will fit only the receptors on the cells that it is supposed to fit. So a progesterone molecule does not fit into a receptor for estrogen. Because natural hormones are made within the body, they function perfectly and create have a predictable response.
• Bio-Identical Hormones – hormones that are derived from plant (usually yam or soybean) sources. The have a structure that is identical to the natural hormones made in the body, and therefore fit perfectly into the hormone receptor. Because of their perfect “fit”, the body recognizes bio-identical hormones as natural, and they have an identical response as the naturally produced hormone. This makes bio-identical hormones ideal because they are relatively safe and they are effective.
• Synthetic Hormones – hormones that are manufactured and not found naturally in nature. They fit poorly into hormone receptors and the cause unreliable or unpredictable responses in the body. Also, because they have an unnatural shape and donot bind strongly to the receptors, they have an increased amount of negative side effects. It is these side effects that increase the health risk associated with hormone replacement therapy. There have been many large studies that substantiate the health risk associated with synthetic hormone replacement. This risks include such things as breast cancer, cardiovascular disease and stroke, and the development of blood clots. Chances are if you have received hormone replacement therapy from physician, you were prescribed a synthetic hormone - Premarin, Prempro, Climera, to name a few.
  In addition, synthetic hormones are patented by pharmaceutical companies and dosages vary from person to person as prescribed/disctated by a physician. This is unlike bio-identical hormones, which are prescribed precisely based of your own levels of circulating hormoness

 

Now that we understand a little more about the terminology used to identify hormone products, we can can better understand hormone replacement therapy.

Let's begin with Estrogen.

It is important to remember that estrogen fuels cell growth and if unchecked, increased cell proliferation can be a precursor for cancer. The body produces three metabolites of estrogen, estrone (E1), estradiol (E2), and estriol (E3).

• Estrone (E1) – increased in postmenopausal women. It is primarily derived from fat cells in the body (rather than ovaries). Rarely used at replacement treatment.
• Estradiol (E2) – the major estrogen found during the reproductive/pre-menopausal period. It is produced by the ovaries and the most stimulating to breast and uterine tissue (increased risk of cancer).
• Estriol (E3) – the weakest of the three estrogens, has potential protective properties against the production of cancer cells.

Estrone (E1) and estradiol (E2) might be considered the “bad estrogens” because of their increased risk of developing cancers, and estriol (E3), might be considered the “good estrogen”, as it has an anti-cancer effect on cells.

The three most common forms of bio-identical estrogens are Biest, triest, and Estradiol.

1. Biest is a combination of E3 + E2. This combo provides some protection against cancer (E3) while also providing the cardiovascular, vasomotor (hot flashes), and osteoporosis benefits of E2.
2. Triest contains all three estrogen metabolites. It is predominantly E3 (80%).
3. Estradiol is is simple E2, although very effective in treating the symptoms of estrogen deficiency, it also has an increased potential to cause cancer.

When considering estrogen replacement, it is important to assess the benefits of use compared to the the potential risks, such as breast/uterine cancer and increased cardiovascular disease.

         After addressing estrogen deficiency, DONOT STOP THERE! Remember, the ovarian production of progesterone decreases 70% more than that of estrogen after menopause. Therefore, a woman who is estrogen deficient is still likely to be estrogen-dominant. Both must be replaced in order to restore hormone balance and get back on track to to feeling healthy and well.

     Progesterone has many functions including regulation of other hormones, such as estrogen, testosterone, and cortisol. When it is deficient, well-being and health are threatened. It serves to produce a calming effect (are you feeling irritable), it impacts memory (can't remember at thing?) and effects cognition (do you need to read this again?). It reduces water retention and bloating and reduces cell growth (protective against cancer). And importantly, progesterone has a positive effect on weight loss.

     Bio-identical progesterone is available in multiple forms – a cream, a capsule, sub-lingual drops, or suppositories. Creams have been found to be the most effective route. They are effectively absorbed and allow for lower dosages to achieve optimal levels of progesterone in the blood to be utilized.

     Bio-identical progesterone is available without a prescription, as they may be purchased at compounding pharmacies or can even be found over the counter at many health food stores. The issue with over the counter formulations is that some of them are better than others, and therefore a compounding pharmacy would be the better option.

It is advisable to seek a professional to discuss hormone testing and treatment, but it is possible to Google Bioidentical Hormone Replacement Therapy for some guidelines if you are considering visiting a compounding pharmacy. Below is a plan that may be utilized based on my readings:

1. Menstruating women (regular cycle): apply cream twice daily from days 8 to 26 of your cycle. Donot not apply during menstrual period.
2. Non-menustrating (menopause/hysterectomy) or irregular menstrual cycle: apply cream twice daily for twenty five-days, followed five five days off.
3. If you are also using estrogen replacement (as prescribed by your physician), apply progesterone cream twice daily, everyday. This should be discussed with your physician.

If you donot notice any improvement in your symptoms after a 6 week period, I would strongly suggest getting further evaluation from your medical doctor.

      Although replacing progesterone levels is only one key in the steps to creating hormonal balance, it is a very important one. By decreasing an estrogen dominant state, many of the negative aspects associated with “getting older” can be improved or even alleviated. A woman's overall health and quality of life may be drastically improved and thereby give her the ability to get back into life and start enjoying herself. So if you having been thinking that something just isn't right and you have been having difficulty with weight loss in spite of a healthy lifestyle and nutrition plan, perhaps you should look beyond your perceived lack of estrogen and get to the root of the problem. Any primary care physician can order the necessary testing, however it is important to have a healthcare provider who is experienced in interpreting these labs and understands how to treat hormonal imbalance for the purpose of wellbeing and bio-identical hormone replacement.

I hope that this information helps some of you. Please feel free to send me a message or leave a comment with any questions you may have or if there is any further information that I can provide to you. You may contact me directly by email at: sbogard08@yahoo.com

As always, this article is for informational purpose only. It does not serves as replacement for or evaluation by your own physician, nor does it constitute medical advise for treatment of any medical diagnoses that you may have.

If You're Not on Stage You Shouldn't Be Judged

     Today was Update Picture time.   The day that always creates a certain level of anxiety for me and today was no different.  To add to that stomach turning series of quarter-turns-to-the-right and auto timer set photos was the fact that I knew my weight was up.  For the first time I am following a diet designed to add some muscle, rather than one with restricted calories for the purpose of leaning out for an upcoming competition.  The whole notion of being on "a diet" with the purpose of maintaining or even gaining weight is foreign and just weird to me.  My mind just can't quite wrap around that concept.

     Before I realized it my heart began to sink as I downloaded the images and they popped up on the computer screen.  And I slid into that dark place of self judgment.  The negative thoughts that steal my focus away from my goals.  The negative thoughts that tell me I am kidding myself to think that I am good enough and have what it takes to go to the next level.  The negative thoughts that zap my enthusiasm and motivation.  The negative thoughts that create self doubt.  But having been at this point multiple times in the past, I have the experience to know not to dwell in that negativity too long.  In fact, these days those thoughts are fleeting at best.  I laughed at that very small voice and first reminded her how far I have come.  How each and every time she said that I couldn't, I showed her that I was stronger than she ever will be.  I then turned my attention to the place it belonged - my goals. 

     At this point I am working to build some muscle.  My conditioning persistently has been the quality that has catapulted me on stage.  In my very first OCB competition years ago, the write-up pronounced, "Bogard bought a conditioned physique that was unmatched.....".  And with each competition my conditioning has steadily improved.  What I have not been able to accomplish is adding some muscle to fill out my physique.  This has been secondary to many factors; never having an adequate diet to support muscle growth, a reluctance to decrease cardiovascular training, age/hormones, multiple surgeries, and simply not having the structure necessary during the "off-season".  After deciding that it is time to compete on the national level, I realized that if I want to do well I am in need of a fuller physique. 

     I had surgery in November, and I after getting clearance to get back into the gym, my coach Kim Oddo, and I started preparing for the 2013 season.  Rather than jumping into a cutting and leaning out plan, we are starting with a program to add some size.  So my calories are higher than I have ever had on any previous plan and my cardio has been minimized.  And in spite of being committed to following my plan, I gained weight in the first few weeks.  Initially I freaked out, but rather than skipping meals and doing extra cardio to get the results I wanted, I took the scale out of my bathroom and continued to follow the plan created by my coach.  At my first check in, Kim did make some minor changes to the diet, and I will likely respond accordingly.  As with any plan, it is only as good as your willingness to stick to it.  I have a long term goal that requires that I go through a process.  Even when the steps along the path aren't what I desire, if they lead me to the goal, they are steps worth taking.

     So I am turning off my critical eye and not judging myself based on those images on the computer screen - I will leave that to the judges in June at NPC Jr. Nationals.  Today I am staying positive and staying focused. 

 

These pictures were taken first thing in the morning. I had a lot of difficulty with posing because of a very painful lower back spasm. My goals for improving are putting on some overall muscle in general. My posterior delts are lagging compared to anterior, but in order to improve the balance between upper and lower body, I will need to round out my delts a lot. My lats definitely need some density as well as width. From waist down, tightening is key, but I am working to fill out my glutes and quads.

Every goal that you set out to achieve will require a process to attain it.  You must lay out a plan that includes the necessary steps to get there.  Along the route there is guaranteed to be multiple twists and turns, hills and valleys, and triumphs and failures.  Some days everything will seem to be right on target and that goal will be clearly in your viewpoint.  Other days the skies might not be so clear and it may even seem as though you are moving in a total opposite direction than planned.  It is during those time that you have to buckle down and stay committed to the journey.  Your compass may require some realignment, but donot jump ship and attempt to swim back to shore!  Steady yourself, remember why you are on this journey and let that keep you rowing ahead. 

Stay focused, be consistent, be persistent, and success will be yours!