Serious Progesterone Side Effects and Brittle Adrenals – Part 1

By: Dr. Michael Lam, MD, MPH; Dr. Justin Lam, ABAAHP, FMNM



Understanding progesterone side effects are not always easyThe widespread and common use of natural progesterone (hereafter referred to as progesterone) for hormone balance and menopausal symptoms, especially estrogen dominance, has potentially important negative clinical implications when used by those with a weak body – such as those with Adrenal Fatigue Syndrome (AFS). Excessive progesterone can cause imbalances with many other hormones in the body, making progesterone side effects and toxicity both serious and hard to identify. Extreme caution should be used when considering progesterone, and this article details why.

Although a natural compound, inappropriate use of natural progesterone can worsen sub-clinical liver congestion, trigger multiple progesterone side effects and toxicity symptoms, and worsen adrenal fatigue. Abrupt withdrawals can also result in adrenal crashes and potentially cause irreparable damage. In the extreme, it can lead to a state that is known as brittle adrenals, where the body exhibit fluctuating symptoms resembling both extremes of cortisol level (too high and too low). Fortunately, this affects only a small number of AFS sufferers, but if you are one of them, life is downright miserable.

Short-Term Improvement and Progesterone side effects

When a patient complains of fatigue or menopausal discomfort to a doctor, the typical medical workup consists of investigating thyroid function, anemia, and metabolic issues. Female and male hormones are often investigated by way of saliva or serum laboratory tests. Functional or alternative medicine practitioners commonly obtain diurnal cortisol, estrogen, progesterone, DHEA, and testosterone as baseline hormonal information through laboratory studies. While most laboratory studies are normal, DHEA and progesterone level are often low.

At this point, patients are told they have a hormonal imbalance and will need natural hormone replacement that can include estrogen, progesterone, and sometimes also testosterone. Typically, patients are also given thyroid support, vitamin C, vitamin B, glandulars, herbs, DHEA and pregnenolone at the same time. Such a multi-hormone approach is designed to replace diminishing hormones the body may be experiencing. The key to success or failure of such an approach lies largely in the dosage and delivery system of the hormone replacement. Some doctors tend to be quite aggressive, while others are more conservative.

This symptom patching “shotgun” approach often produces positive results in the beginning. For most sufferers, the fatigue of unknown origin improves. Anxiety tends to improve as well, due largely to progesterone effects. There is a general increase in energy, with fewer energy slumps. Sleep tends to improve from natural progesterone’s sedative effect. A sense of calm returns. Symptoms consistent with estrogen dominance, include: PMS, water retention, brain fog, anxiety, and heavy menses. Because progesterone opposes estrogen, these symptoms may subside if a person is indeed in estrogen dominance. For some, the benefit is significant and remarkable. They are given what appears to be a new lease on life. For the first time in years, many report feeling vibrant and energetic with a positive outlook on life.

Long-Term Decline

Unfortunately, for most this honeymoon does not last indefinitely. While some people continue to do well on such a program, many report this multiple hormone replacement approach gradually loses effectiveness over time. Those who are already in advanced stages of adrenal fatigue prior to beginning such program are particularly vulnerable. Over months or years, there is a slow but gradual loss of the positive clinical outcome as compared to the initial benefit. As time progresses, many return to their doctor for more help.

It can be unpleasant dealing with progesterone side effectsTo achieve the same effect, physicians generally recommend more hormone replacement by way of stronger dose. Thyroid replacement, for example, progresses over time from primarily a low dose T4 replacement program, to a combination of T4/T3 replacement, then finally to a high dose strong T3 replacement. In like manner, the dosage of transdermal natural progesterone may start at a 20 mg dose, but ultimately can be much more. Sufferers may be switched to other delivery systems, such as sublingual forms, to enhance absorption. Oral progesterone favored by most physicians may start at 100 to 200 mg per day but can be increased significantly over time.

Is this the right strategy? Let us take a step back and understand what progesterone actually do first physiologically in our body.

Natural Progesterone 101

Progesterone is one of the major female hormones, along with estrogen, produced by the ovaries. These two hormones work together to regulate a woman’s menstrual cycle. Natural progesterone has an identical chemical structure to that made in a woman’s body by the ovarian corpus luteum. It is not the same as the synthetically derived progesterone referred to as progestins, which are chemically modified and recommended by conventional doctors. Progestins have the opposite effect to natural progesterone. They are used as morning after pills to trigger abortions and in birth control pills. To be clear, this discussion deals only with natural progesterone.

Progesterone is a calming hormone. It opposes estrogen. It is known as a lipophilic hormone. In other words, it “loves fat” such as adipose tissues. It tends to stay in areas of the body where such tissue is prominent, such as the abdomen and organs. All steroid hormones love fat, including estrogen and testosterone. However, progesterone loves fat the most out of them all. When hormones are trapped in fat, the body can only metabolize a limited amout a day. One study reported that it took four months for women to clear half of the 42 mg per day dose they used for 40 days. Excessive progesterone therefore may lead to accumulation in the body. This accumulation can have negative effects.

Natural progesterone is available in pill form, as a topical gel, vaginal gel, sublingual spray, or as an oil. Under normal conditions in healthy individuals, 20 to 30 mg a day for women and 6 to 10 mg a day for men is considered a physiological amount. There usually are little, if any, progesterone side effects.

However, the same cannot be said for those with adrenal fatigue or those who take high doses. Many in advanced stages of adrenal fatigue cannot tolerate natural progesterone, even in small amounts. Healthy women on high dose progesterone can develop toxicity symptoms over time.

This occurs for many reasons, including progesterone’s own intrinsic properties as well as it being a precursor to many other hormones. A flow-through to other hormones includes estrogen and its metabolites, testosterone and its metabolites, DHEA, aldosterone, and ultimately, cortisol can occur.

Improper Use of Natural Progesterone

To understand this, first it is helpful to know how natural progesterone should be used and the many ways its inappropriate use can be problematic.

Progesterone in the Wrong Place

Progesterone side effects can be caused by hormonal pillsProgesterone Side Effects Mimic Estrogen Dominance

Estrogen dominance exhibits symptoms such as: water retention, anxiety, breast tenderness, spotting, dizziness, hot flashes, fatigue, headaches, nausea, and irritability. These symptoms may become worse when first beginning natural progesterone.

Because estrogen and progesterone receptor sites are very similar at the cellular level, estrogen receptor sites can ‘wake up’ when occupied by progesterone molecules, enhancing the action of estrogen for a short period of time. It is easy to draw the conclusion that this is a sign the body is responding well to the progesterone, and sufferers are encouraged to “brave through” this estrogenic effect, as it is supposed to eventually go away. However, ignoring the underlying dysfunction when alerted by the body is a recipe for disaster.

Fortunately, this is usually short lived for most, lasting a few days to a few weeks. For some, however, this is just the beginning of their nightmare. The more advanced the adrenal fatigue, the higher the risk of this phenomena. Clinically, this is more prevalent in those with sensitive or thin bodies as well. It points to underlying receptor site dysfunction or liver congestion.

Stress Interferes with Progesterone

If there is concurrent stress that activates the body’s stress handling HPA hormonal axis, as is the case in adrenal fatigue, natural progesterone can make matters worse. In other words, if your body’s ability to deal with stress is compromised, progesterone does not improve symptoms.

Stress triggers the body to put the adrenal glands on overdrive to increase output of the anti-stress hormone cortisol. This is what happens in the early stages of adrenal fatigue. Cortisol, unfortunately, competes for progesterone receptors. The higher the level of stress experienced, the more cortisol the adrenals produce. This means that those receptor sites may be occupied by cortisol rather than progesterone. This leads to reduced progesterone availability to cells. Also, progesterone is a precursor to the synthesis of cortisol. In times of stress, progesterone may be shunted to make more cortisol, resulting in less progesterone being available to the cell as well. Multiple mechanisms therefore can result in lower than normal levels of free progesterone during stress, while estrogen dominance symptoms rise. This may be reflected in laboratory test showing lower than normal progesterone levels in absolute terms, or a low progesterone to estrogen ratio. Physicians not alert to this lowered progesterone level in times of stress may prescribe progesterone in their best intention to increase the progesterone level.

Stress can increase progesterone side effectsIn other words, if you are not managing your stress levels properly, the natural progesterone cream you are currently using may not be effective. Physicians may then prescribe cortisol. Sometimes it can be helpful, but cortisol has its own set of problems, including tolerance, resistance, dependency and withdrawal issues. In addition, cortisol can also lead to loss of magnesium and potassium, further complicating the clinical picture and triggering electrolyte imbalances. Menstrual bleeding may increase as estrogen dominance symptoms worsen. High dose progesterone is often prescribed to control or offset estrogen overload and excessive bleeding. This can trigger a host of side effects and toxicity issues.

Long-Term Overdose is Possible

While a one-time overdose of natural progesterone cream is rare (except in people who are very weak or sensitive), the body’s ability to handle excessive progesterone can be overwhelmed over a long period of time. Progesterone side effects and toxicity are eventually triggered due to a cumulative saturation effect of progesterone in the cells. The common belief that natural progesterone is “harmless”, even in high doses, is quite naïve.

Abrupt cessation can trigger withdrawal

Stopping progesterone abruptly without proper titration can also be problematic. Many have experienced a huge wave and additional surging of progesterone as it comes out of our tissues soon after abrupt withdrawal. It is a very unpleasant experience. An aldosterone surge can occur that leads to electrolyte imbalances – which in severe cases requires hospitalization.

Read Part 2

 
© Copyright 2017 Michael Lam, M.D. All Rights Reserved.


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