Decreased hormone production is the primary cause of bone loss amongst women in the first 5-10 years of menopause. Progesterone and osteoporosis supplements work together to address the cause of poor bone health.
Although conventional medicine assumes that women after menopause are estrogen-deficient, the literature on hormone levels before and after menopause indicates that over two-thirds (66 percent) of women up to age 80 continue to make all the estrogen they need but are deficient in progesterone.
The interest in natural progesterone and osteoporosis increased when the 2002
Women's Health Initiative
(followed by the Million Women Study in the UK) reported a statistically significant decrease in the rate of hip fractures in women who were taking synthetic hormone replacement therapy (HRT). But it also reported an increased risk of
heart attacks and strokes. As HRT refers to medications that artificially boost hormone levels through the use of estrogens, progesterone (or progestins) and sometimes testosterone there was growing interest in which of these hormones was most important for bone health and whether a safe application could be found.
The person most commonly associated with progesterone and osteoporosis treatment is Harvard-trained Dr. John R. Lee, author of the best-selling What Your Doctor May NOT Tell You About Menopause. Dr. Lee studied 100 women in various stages of osteoporosis ranging in age from 38 to 83 over a three year period. Participants engaged in a treatment program that included dietary changes, nutritional supplements and exercise in addition to either estrogen/progesterone or progesterone only.
Dr. Lee found that bone density increased every year by 3-5% until it stabilized at the
bone density levels
expected for a 35-year old woman. He also observed that the women who had experienced the most bone loss increased bone density the fastest when using natural progesterone. Other changes included increased libido, diminished hot flushes, reduced joint pain, and increased mobility and energy. There was no difference noted between the estrogen/progesterone and progesterone only groups-nor any side effects during the treatment.
In 2006, actress Suzanne Somers released the book Ageless: The Naked Truth About Bioidentical Hormones, which endorsed the use of bioidentical hormones such as natural progesterone. More recently, Dr. Phil featured Anne Louise Gittleman, nutritionist and author of the book Before the Change: Taking Charge of Your Perimenopause on the use of natural hormones prior to menopause. The publicity resulting from these books combined with concerns about HRT have resulted in a growing public interest in natural progesterone and osteoporosis treatment.
SYMPTOMS OF LOW PROGESTERONE
Dr. Lee found in his research that the fall of progesterone levels at menopause is proportionately much greater than the fall of estrogen levels. While estrogen decreases 40 to 60 percent from baseline on average, progesterone can decline to nearly zero. Dr. Lee coined the phrase “estrogen dominance” to describe this imbalance and identified a variety of symptoms associated with the condition. These symptoms include:
Headaches and migraines
Mood swings, irritability and depression
Bloating, gas and constipation
Facial hair, dry hair and dry skin
NATURAL PROGESTERONE VS HRT
The Endocrine Society, American College of Obstetricians and Gynecologists, United States Food and Drug Administration and Mayo Clinic have all released position statements stating that there is no research demonstrating that bioidentical hormones (including natural progesterone) offer superior results compared to synthetic HRT.
However, in January 2009, a review paper on natural hormone therapy (including estradiol, estriol and progesterone) concluded that “bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease” and are the preferred method of HRT. It also suggested the need for further research. (See PMID: 19179815 for more details on this article in Postgrad Med. 2009 Jan;121(1):73-85.)
NATURAL PROGESTERONE: PRESCRIPTION OR PREPACKAGED?
Natural progesterone cream can be purchased on-line and in health food stores and may also be compounded in a pharmacy according to a doctor’s prescription. Some argue that the prepackaged creams may not have the appropriate level of progesterone to produce the desired result while a doctor’s prescription can be adjusted to the specific needs of the patient.
When buying a commercial cream it is important to look for United States Pharmacopeia (USP) natural grade progesterone (rather than yam cream) as only a USP grade can be properly absorbed by the body.
Commercial creams may contain different amounts of progesterone depending on the brand. Dr. Lee recommends the creams that contain 450-500 mg of progesterone per ounce-which is 1.6% by weight or 3% by volume. This means that 1/4 teaspoon daily would provide about 20 mg/day.
In the United States, Meno-Ease provides a natural progesterone cream without paraban. This cream is particularly popular because it has a refreshing lemon scent and is both cooling and moisturizing with its aloe vera based gel.
Some manufactures add pregnenolone to their formula...which has been described as the "mother of all hormones". While Dr. Lee didn't like to mix progesterone with anything else, other doctors believe that a deficiency in pregnenolone may be a cause of inadequate progesterone. People who suffer from seizure disorders are advised not to take pregnenolone. And it is always important to consult with a physician before using any nutritional supplement.
In Canada, many health food stores carry progesterone behind the counter. You may also ask your doctor to write a prescription for 3% progesterone cream so that you can have it specially prepared for you.
ORAL OR TRANSDERMAL
Natural progesterone can be administered in a variety of ways including skin and vaginal creams, pills and tablets. Creams and gels applied to the skin enter the blood directly and are unmodified while swallowed progesterone can result in 77-80% of the progesterone being removed by the liver. People who take tablets must take larger doses in order to get the desired amount within the bloodstream.
Progesterone tends to peak in two to three hours after an application and wear off after 12 hours. Applying the cream twice a day allows a patient to experience the full benefits of the progesterone for a longer period.
Dr. Lee recommended massaging 1/8 to 1/4 teaspoon of cream (about the size of a garbanzo bean) into areas of thinner skin where you blush such as the neck, face, chest, breasts, inner arms or thighs, palms of the hands, or soles of the feet (unless your hands or feet are heavily callused). The optimal approach is a divided dose with a larger dose at bedtime and a smaller dose in the morning, or as directed by your healthcare provider. Rotate areas daily to avoid saturation.
Note that progesterone pumps generally dispense the cream in 20 mg doses...so adjustments must be made to apply the recommended 20 mg/day in two applications.
Women may be interested in taking natural progesterone both to treat PMS as well as prevent bone loss. Women who are still menstruating are advised to apply progesterone cream twice a day starting approximately 10-12 days into their cycle until menstruation begins. People suffering from severe migraines with PMS may want to use the cream into the first day of their menses. Women who are still trying to get pregnant are advised to take the progesterone creams later in the cycle…usually beginning on the 14th or 15th day of the cycle.
Women who have entered menopausal and are no longer menstruating are advised to use progesterone cream every day and then take a break for five days. The progesterone appears to be more effective with a 5 day break. For many, the benefits are improved sleep; reduced hot flashes and an improved libido.
Dr. Lee found equal bone density improvements in both the estrogen/progesterone and progesterone groups. He also found that 2/3 of his patients found relief from hot flashes from progesterone alone. The remaining third of his patients benefited from additional estrogen when seeking relief from hot flashes.