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.