Progesterone misconceptions

The web is riddled with what may be called 'progesterone misconceptions', for instance... women complaining that progesterone makes them feel worse, or they put on weight, or they retain water, or their hair falls out, ad nauseum. Or progesterone has made their Candida worse, or that candida feeds off progesterone!

There's more... that they must rotate the areas they rub it on, or only use it on thin skinned areas. That using progesterone at ovulation will prevent it, or too much will 'make' oestrogen. That only progesterone in oil should be used, that you shouldn't start it until you have removed all forms of phytoestrogens or oestrogen mimics from your food, skin care, makeup etc, that if you get any adverse symptoms to reduce or stop the progesterone.

So progesterone gets a bad name. There are plenty of complaints on this site too, so one gets an idea of the problem.

You only have to look at the function the two hormones have, to realise progesterone is not the culprit it's made out to be, but oestrogen is. Yes oestrogen is a vital hormone, but it's extremely potent, a little goes a long way.

In fact, to give you an idea, in serum tests oestrogen is measured in pg/ml or pmol/L, whereas progesterone is measured in ng/ml or nmol/L. A pg or pmol is a thousand times smaller than a ng or nmol.

Without oestrogen women would not have the female shape they have, one which men get too if they have excess circulating. Oestrogen stimulates subcutaneous fat cells to proliferate, hence the change in shape at puberty. But in excess it causes weight gain, which is very difficult to loose unless the excess oestrogen is suppressed.

It causes water retention, the cause of immediate weight gain if it's suddenly stimulated. This is invariably the case if low levels of progesterone are used. The two hormones stimulate each other, as they do in men too. In fact the three hormones, testosterone included, interplay. This stimulation leads to Oestrogen Dominance.

When symptoms of oestrogen dominance occurs progesterone is blamed, and many reduce or stop using it. Ironically it does help, as it's no longer stimulating oestrogen. But it defeats the purpose, which is to suppress excess oestrogen. It's essential to increase the amount of progesterone if oestrogen dominance occurs, not lower it.

Oestrogen causes the proliferation of all hormonally sensitive cells, particularly breast and endometrial cells. Hence the development of the breasts during puberty, but in excess it increases the risk of gigantomastia in women, gynaecomastia in men, and breast cancer in both.

It's vital for the development of an egg and for the proliferation of endometrial cells each month. But in excess it can disrupt the cycle, preventing ovulation and increasing the risk of heavy bleeding and endometrial cancer.

Oestrogen is a mitogen, causing cells to proliferate. It's also an excitatory, inflammatory hormone. Progesterone reverses mitosis, hence it's benefit in Endometriosis, Fibroids, Cancer, endometrial hyperplasia, heavy bleeding and more.

Even the phytoestrogens found in food have an oestrogenic effect on cells. It's impossible to avoid them all, but it's best to avoid all grains and legumes which have the highest amount.

There are now over 100 oestrogen mimics in the environment. They are found in food, water, air and skin care, particularly sunscreens. There is no way to avoid them, but eating organic food, and avoiding toxic skin care, can reduce their burden. Using progesterone can protect from their influence.

Progesterone is a calming hormone. Plus it's a potent anti-inflammatory and an exceptional diuretic, amounts in excess of 1200mg/day are given via IV transfusion to Traumatic Brain Injury victims.

So many sites comment about receptors becoming insensitive, and therefore a break is essential. Another one is the story doing the rounds about build up in fatty tissue. Which would imply of course that the receptors would become insensitive.

There don't appear to be any studies showing it builds up in fatty tissue, there to stay, but there is one paper which says it's not.

The paper states" Despite the low serum progesterone levels achieved with the creams, salivary progesterone levels are very high, indicating that progesterone levels in serum do not necessarily reflect those in tissues." If the fatty tissues were indeed saturated, and little progesterone was entering the circulation, the study would have found the reverse, i.e. low saliva levels.

Saliva Tests show it's evident the progesterone is circulating. A before and after test is done for comparison, levels rise dramatically, but more to the point the women were feeling well.

And yet another story is to only rub it on thin skinned areas and to rotate the application. This is impossible if high levels of progesterone are needed. It's absorbed well anywhere. The skin comprises 95% kerotinocytes, these have ample progesterone receptors. Even the hair follicles and sebaceous glands absorb it well.

A 1970 paper is fascinating, showing that the tissues in which progesterone is found seems to change with the menstrual cycle.

It appears that during the proliferative phase, ie follicular phase, progesterone is concentrated in fatty tissue. This is understandable when one realises that progesterone is not produced during the follicular phase, so it's sequestered in fatty tissue. Levels are very low as it plays no part in the follicular phase.

It's produced after ovulation in the secretory or luteal phase, where it's found principally in the skin and uterus. Plus of course the ovaries.

One thing which seems to be overlooked by all, is that progesterone is broken down into metabolites. It doesn't remain as progesterone locked up in fatty tissue. It is important in it's own right, but it's metabolites are just as important.

One in particular is allopregnanolone (3-hydroxy-5-pregnan-20-one or 3,5- tetrahydroprogesterone or THP), it's a potent analgesic, anxiolytic and anti-inflammatory.

Studies found significantly lower levels of allopregnanolone during the last few days of the luteal phase in women with PMS. Low levels have been found in women with PSTD, and men with lower back and chest pain.

In fact progesterone is broken down into many metabolites. 5-dihydroprogesterone (the precursor to allopregnanolone), 17alpha-hydroprogesterone and 20-hydroxy-5-pregnan-3- one. Three mono-hydroxylated products, 6-, 16-, and 21-hydroxyprogesterone, and a dihydroxy product, 4-pregnen-6, 21-diol-3, 20-dione, plus more.

As the body is designed to metabolise progesterone, and other hormones, it seems highly unlikely for it to get shunted into fat cells, and there to stay. Or for the receptors to become insensitive.

One paper says...

"The ephemeral nature of the corpus luteum makes it even more remarkable that this tissue is able to synthesise upwards of 40 mg of progesterone in the human on a daily basis."

Even more remarkable, it's also been found that progesterone is capable of stimulating it's own synthesis. The typical negative feedback system seen in other endocrine tissues does not operate in the corpus luteum, and at the end of the luteal phase, in spite of LH secretion, the corpus luteum regresses and progesterone secretion declines.

In fact there is a progesterone surge about fifty hours before ovulation. This surge comes from the brain, and is thought to initiate the LH surge which in turn initiates ovulation.

So using progesterone at ovulation will most certainly not inhibit it. On the contrary, it will enhance the early rise in progesterone so vital for successful implantation. In fact using it within the 50 hours of the pre-ovulatory surge will enhance ovulation.

Although progesterone is the precursor to both testosterone and oestrogen, using high amounts will not make more. It will in fact suppress any excess oestrogen and testosterone. The converse is also true. Using high amounts of either testosterone or oestrogen will suppress progesterone.

The typical 20-40mg/day that is recommended does not raise levels to that found in the luteal phase. One study found that using 40mg/day...

"only low plasma progesterone levels were found (median 2.5 nmol/l)"

The ranges for the luteal phase are 15.9 - 63.6 nmol/L (5 to 20 ng/ml). Men secrete <3.18 nmol/L (<1 ng/ml).

For more information on hormone levels, please see the page on Hormone Testing.

Many women have a defective luteal phase, where little to no progesterone is secreted. These are the women who are more likely to suffer problems. Many also secrete excess oestrogen, testosterone too, these women will not be helped with a low amount.

Peri-menopause is a time of dropping progesterone levels due to anovulation. This usually begins round about age 35, and increases in frequency throughout peri-menopause, until Menopause, when the ovaries stop producing viable eggs.

But during peri-menopause ovarian production of oestrogen and testosterone do not stop. After menopause the ovaries become androgen secreting organs. The adrenals produce some, so too do the kidneys. And adipose cells secrete oestrone, the two principle metabolites are 2-hydroxyestrone (2-OHE1) and 16-alpha hydroxyestrone (16alpha-OHE1).

16alpha-OHE1 is regarded as a potent oestrogen, whereas 2-OHE1 is a weak oestrogen. 16alpha-OHE1 is implicated in the increased breast cancer incidence in menopausal women. Adipose cells do not secrete oestradiol, understandably as it's an ovarian oestrogen, and yet it's the only oestrogen tested for in menopausal women.

If the secretion of these two hormones is excessive, or anovulation or a defective luteal phase is experienced, or with dropping or very low progesterone levels in peri-menopause and menopause, adverse symptoms will occur.

Therefore 100-200 mg/day progesterone should be used, often more is required. The amount to use is entirely dependant on symptoms, the more severe they are, the more will be needed. If adverse symptoms occur, do not reduce the amount as many do, blaming the progesterone. It can stimulate oestrogen if insufficient is used, and the only way to overcome the adverse symptoms is to increase the progesterone.

There are many Delivery systems, but the most effective are injections, suppositories or creams. A comparison of topical gels, oils and creams found a higher plasma peak in an emulsion type cream.

For more information see the page on How to use progesterone cream.

Before using progesterone it's essential to read the page on Oestrogen Dominance.

Reference websites for progesterone misconceptions...

Medline Progesterone
BNET Menopause: Understanding the reproductive cycle
Medscape Oestrone
Medline Oestradiol
Our Stolen Future

Progesterone misconceptions references

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