Progesterone Cream and Adrenal Fatigue Recovery

By: Michael Lam, MD, MPH

Hormone Basics

Progesterone cream is useful in Adrenal Fatigue recoveryThe two main sex hormones in women are estrogen and progesterone. Both are produced in men and women, although in different quantities. Progesterone is made from pregnenolone, which in turn comes from cholesterol. Let’s explore progesterone and progesterone cream.

Production of progesterone occurs at several places. In women, it is primarily produced in the ovaries just before ovulation and increases rapidly after ovulation. It is also produced in the adrenal glands in both sexes and in the testes in males. Its level is highest during the ovulation period (days 13 to 15 of the menstrual cycle). If fertilization does not take place, the secretion of progesterone decreases and menstruation occurs. If fertilization does occur, progesterone is secreted during pregnancy by the placenta and acts to prevent spontaneous abortion. About 20-25 mg of progesterone is produced per day during a woman’s monthly cycle. Up to 300-400 mg are produced daily during pregnancy. During menopause, the total amount of progesterone produced declines to less than 1% of the pre-menopausal level. This drop is extreme.

progesterone occupies an important position in the pathway of hormone synthesis. In addition to being the precursor to estrogen, it is also the precursor of testosterone and the all-important adrenal cortical hormone cortisol. Cortisol is essential for stress response, sugar and electrolyte balance, blood pressure and general survival. In short, progesterone serves to promote survival and development of the embryo and fetus. It acts as a precursor to many important steroid hormones and helps to regulate a broad range of biological and metabolic effects in the body. During chronic stress, progesterone production is reduced as the body favors cortisol production to reduce stress. This is an important point, which we will look into later.

Estrogen is produced in the ovaries. It regulates the menstrual cycle, promotes cell division and is largely responsible for the development of secondary female characteristics during puberty. In non-pregnant, pre-menopausal women, only 100-200 micrograms of estrogen is secreted daily. However, during pregnancy, much more is secreted. Estrogen is produced in the ovaries, adrenal and fat tissues. During menopause, the amount of estrogen in the body declines by about fifty to sixty percent. Production, however, is augmented in the adrenals and in the fat cells.

Estrogen and progesterone work in synchronization with each other. They oppose each other in their actions and check and balance each other to achieve hormonal harmony in both sexes.

Functions of Progesterone Cream

progesterone acts primarily as an antagonist (opposite) to estrogen in our body. For example, estrogen can cause breast cysts while progesterone protects against breast cysts. Estrogen enhances salt and water retention while progesterone is a natural diuretic. Estrogen has been associated with breast and endometrial cancer, while progesterone has cancer preventive effects.

Some of the functions of progesterone include:

  • Breast, uterus, and ovarian cancer protection
  • A natural diuretic
  • A calming, anti-anxiety effect
  • Contributing to formation of new bone tissue

Most significantly, it is shown that high amounts of estrogen can induce a host of metabolic disturbances, and the body’s way of counterbalancing estrogen is progesterone. When this balancing mechanism is dysfunctional, a multitude of health related problems can arise.

Hormone Replacement Therapy (HRT)

Progesterone cream and menopauseMenopause is often a time when the hormonal balance between estrogen and progesterone is off.

Symptoms of such imbalance include hot flashes, vaginal dryness, water retention, weight gain, insomnia, mood swings, short-term memory loss, wrinkly skin appearance and osteoporosis. The breakthrough in treatment of menopausal symptoms came in 1964, when Dr. Wilson first reported that the lack of estrogen causes menopause. Pharmaceutical companies introduced a synthetic estrogen hormone called Premarin. With this drug, symptoms of menopause such as hot flashes were greatly reduced. There was little doubt then that menopause was solely due to estrogen deficiency. Few doctors knew then that estrogen deficiency alone did not explain many of the symptoms of menopause.

For example, how does one explain the fact that women who are post-menopausal but cannot take HRT can experience relief from their menopausal symptoms when using progesterone replacement alone? Clearly there is more to the menopausal picture than deficiency of estrogen.

In fact, many women on HRT with estrogen alone are unhappy with fat accumulating at their hips and abdomen, osteoporosis, loss of sex drive and often swollen breasts. The common perception is that estrogen is the primary regulator of libido, but in reality, estrogen replacement often does not restore their previous sex drive. What is needed is progesterone and in some cases, testosterone. While the exact mechanism is not known, it is postulated that estrogen primes the brain cells but progesterone turns on the sex drive. This has been studied and clinically observed in laboratory rats whose ovaries are removed. Supplementing with estrogen alone does not increase sex drive, but supplementing with progesterone together with low doses of estrogen does.

During menopause, the absolute level of estrogen decreased by 50% to a level below what is needed for pregnancy and enough for other normal body functions through the golden years. This is the way nature intended it to be. Menopause is therefore a normal physiological adjustment that does not produce any undesirable symptoms. It is not a disease. The current menopausal problem is an abnormality resulting from the relentless insult on the body’s hormonal system from industrialized cultures and deviation from a wholesome and healthy lifestyle. We shall examine this in more detail.

Dr. John Lee – Pioneer on Natural Progesterone Cream

Dr. John Lee was a world-renowned authority on natural hormonal balance and author of the book Progesterone: The Multiple Roles of A Remarkable Hormone. He treated thousands of menopausal women in the 1980s and 1990s with a program that was contrary to popular medical thinking at that time. Instead of prescribing estrogen alone (the standard of medical practice then), Dr. Lee prescribed natural progesterone alone for treatment of menopausal symptoms. In addition to relieving the menopausal symptoms, the treatment was able to reverse osteoporosis and prevent cancer. Studies had confirmed that Dr. Lee’s approach using progesterone alone had vast palliative effects.

Progesterone cream and weight gainThe key to Dr. Lee’s approach is to understand the balance between estrogen and progesterone. In pre-menopausal women, estrogen is always in balance with progesterone. When these two important hormones are out of balance, hormone related illnesses emerge. Symptoms include weight gain, fatigue, auto-immune disorders, fibrocystic diseases, loss of libido, depression, headaches, joint pain and mood swings. These are just some of the common symptoms experienced during menopause, peri-menopause and pre-menstrual periods.

According to Dr. Lee, what is commonly perceived as an absolute estrogen level deficiency during the menopausal years is in effect estrogen dominance caused by an extreme low progesterone level. Since progesterone’s role is to balance estrogen, the extremely low level of progesterone experienced after menopause leads to a relative dominance of estrogen, despite a 50% drop.

Dr. Lee treated menopause as an estrogen dominance syndrome. His treatment was simple – reduce the estrogen to progesterone ratio by increasing progesterone. When the opposing force of progesterone is increased, the toxic effect of estrogen is decreased. Fortunately for many women who followed Dr. Lee’s advice, their menopausal symptoms reduced remarkably.

Why is Estrogen and Progesterone Out of Balance?

Our body normally functions in perfect homeostasis. With the advent of modern society and industrial state, in the past 70 years, our body has been subjected to unprecedented insult from environmental estrogen-like hormones. In less than one hundred years, we have managed to turn our diet from whole fruits and whole foods to fast and processed foods. In the past, cattle were raised on grass and natural organic feed and chickens were allowed to run free. This is in stark contrast to the commercialization of the cattle and poultry farms of today where animals are in cages most of the time. Worse yet, feeds laced with pesticides and hormones, both of which have estrogen-like activities, are routinely given to animals, which in turn is passed to humans.

Women in non-industrialized cultures, whose diets are whole food based and are untainted with modern processed foods and pesticides, seldom suffer a deficiency in progesterone and the signs of estrogen dominance manifested as menopausal symptoms as described by Dr. Lee.

Some of the reasons for increased environmental estrogen are:

  • Commercially raised cattle and poultry fed with estrogen-like hormones.
  • Commercially grown vegetables that contain pesticide residues whose chemical structure is similar to estrogen.
  • Synthetic estrogens & synthetic progesterones (Progestin, progesterone Acetate and birth control pills).
  • Exposure to xenoestrogens. Petrochemical compounds found in general consumer products such as creams, lotions, soaps, shampoos, perfume, hairs spray and room deodorizers. Such compounds often have chemical structures similar to estrogen and act like estrogen. They are fat soluble and non-biodegradable.
  • Hormone replacement therapy with estrogen alone without progesterone. This increases the level of estrogen in the body.
  • Overproduction of estrogen from ovarian cysts or tumors.
  • Stress, causing adrenal gland exhaustion and reduced progesterone output. Stress is one of the most frequently overlooked causes of estrogen dominance.
  • Obesity Fat has an enzyme that converts adrenal steroids to estrogen. The higher the fat intake, the higher the conversion to estrogen.

Progesterone cream and cirrhosis

  • Liver disease such as cirrhosis that reduces the breakdown of estrogen.
  • Deficiency of Vitamin B6 and Magnesium, both of which are necessary for neutralization of estrogen in the liver.
  • Increased sugar intake leading to a depletion of magnesium.
  • Intake of process and fast foods that are deficient in magnesium.
  • Increase in coffee intake. Caffeine intake, from all sources, was linked with higher estrogen levels regardless of age, body mass index (BMI), caloric intake, smoking and alcohol and cholesterol intake. Studies have shown that women who consumed at least 500 milligrams of caffeine daily, the equivalent of four or five cups of coffee, had nearly 70% more estrogen during the early follicular phase than women who consume no more than 100 mg of caffeine daily, or less than one cup of coffee.

Hormones and Lifestyle

Overeating and under-exercising is the norm in developed countries. The populations from such countries, especially in the Western hemisphere where a large part of the dietary calorie is derived from fat, have much higher incidence of menopausal symptoms. Studies have shown that estrogen and progesterone levels fell in women who switched from a typical high fat, refined carbohydrate to a low fat, high-fiber and plant-based diet even though they did not adjust their total calorie intake. Plants contain over 5000 known sterols that have progestogenic effects. People who eat more wholesome food and exercise more have a far lower incidence of menopausal symptoms because their pre and post menopause level of estrogen does not drop as significantly.

In non-industrialized societies, not subjected to environmental estrogen insults; progesterone deficiency is rare. During menopause, their diet produces sufficient progestogenic substances to keep their sex drive unabated, strong bones and symptom-free passage through menopause.

Therefore, lifestyle is the single most important factor in causing estrogen and progesterone imbalance.

Imbalances of Estrogen and Progesterone in Females:

  • Progesterone Deficiency

    Symptoms: Premenstrual Syndrome (PMS), insomnia, early miscarriage, painful or lumpy breasts, infertility, unexplained weight gain and anxiety.

    Discussion: This is the most common hormone imbalance among women of all ages.

    Solution: Estrogen free diet, discontinue birth control pill and use natural progesterone cream to increase the progesterone level.

  • Estrogen Deficiency

    Symptoms: Night sweats, mood swings, depression, hot flashes, sagging breasts, vaginal dryness, osteoporosis, fibrocystic lumps, night sweats, painful intercourse and memory problems.

    Discussion: This hormone imbalance is most common in menopausal women; especially with petite and/or slim women.

    Solution: Progesterone is a biochemical precursor to estrogen. progesterone cream alone is sufficient to restore estrogen balance and relief of many of the symptoms. If after three months of progesterone cream, proper diet, nutritional supplementation of magnesium and B6 do not relieve the symptoms, then low-dose natural estrogen may be considered. 2.5 mg of natural tri-estrogen cream ( 10% estrone, 10% estradiol and 80% estriol) provides the equivalent action of 0.625 mg conjugated estrogen such as Premarin. Herbs like black cohash have weak estrogenic effect. Isoflavone extracts and cruciferous vegetables extracts such as DIM may be considered as well.

  • Excessive Estrogen:

    Progesterone cream and bloating causesSymptoms: Bloating, rapid weight gain, heavy bleeding, migraine headaches, foggy thinking, insomnia, red flushing of face and breast tenderness during the first 2 weeks of menstrual cycle.

    Discussion: This often comes about from excessive estrogen intake as part of a hormone replacement therapy program.

    Solution: Discontinue estrogen replacement therapy that uses estrogen alone.

  • Excessive Androgens (Male Hormones):

    Symptoms: Acne, polycystic ovary syndrome (PCOS), excessive hair on face and arms, thinning hair on the head, infertility and mid-cycle pain.

    Discussion: Excessive sugars and simple carbohydrates in the diet often cause this. Excessive sugar stimulates androgen receptors on the outside of the ovary. Androgens also block the release of eggs from the follicle, causing polycystic ovary disease.

    Solution: Dietary adjustment to reduce sugar and grains and proper exercise are important. Natural progesterone cream can be used to maintain hormonal balance and discontinued when symptoms are resolved. If progesterone levels rise each month during the luteal phase of the cycle, a normal synchronal pattern of estrogen and progesterone is maintained and excessive androgen seldom occurs.

  • Estrogen Dominance:

    Symptoms: Acceleration of the aging process, breast tenderness, depression, fatigue, foggy thinking, headaches, hypoglycemia, memory loss, osteoporosis, PMS, pre-menopausal bone loss, thyroid dysfunction, uterine cancer and fibroids, water retention, fat gain around abdomen, hips and thighs

    Discussion: This is the result of low estrogen but even lower progesterone, resulting in a relative excess of estrogen. Up to 50% of western women, especially those who are obese between the ages of 40 and 50, suffer from estrogen dominance.

    Solution: Reduce stress, sugar and coffee from diet. Adrenal function is normally compromised in a person with estrogen dominance. Normalization of the adrenal function should be considered first, as well as relief of stressors. Follow a natural whole food diet, application of stress reduction techniques and natural progesterone cream in physiological doses (20 mg a day).

Estrogen Dominance: Key to the Puzzle

Estrogen dominance commonly occurs during menopause when progesterone production falls to approximately 1% of its pre-menopausal level while the production of estrogen falls to about 50% of its pre-menopausal levels. The lack of progesterone, to oppose the toxic effect of estrogen dominance, results in a myriad of undesirable symptoms.

In the west, the prevalence of estrogen dominance syndrome approaches 50% in women over 35 years old as they enter the transitional phase of aging (ages 35 to 45). Definitive diagnosis can be made with a thorough history and physical examination, together with laboratory tests of estrogen and progesterone levels. Yet few doctors actually do this. Synthetic estrogen is often prescribed out on the premise that symptoms presented are due to estrogen deficiency without any consideration for the progesterone part of the equation while in reality, many are suffering from relative estrogen dominance.

What the body needs is natural progesterone as a first line defense and not more estrogen, which it already has a relative oversupply. It is no wonder many women given estrogen for these menopausal symptoms do not get well.

Premenstrual Syndrome (PMS)

Progesterone cream and PMSIn addition to menopausal symptoms commonly blamed on estrogen deficiency instead of relative estrogen dominance, researchers noted that many women suffer a similar set of symptoms associated with estrogen dominance during the menstrual cycle of each month. Dr. Katherine Dalton published the first medical report on PMS in 1953. She observed that administration of high dose progesterone, via rectal suppository, relieved symptoms of PMS.

These symptoms often occur during the two weeks before menstruation and are associated with unopposed estrogen and progesterone deficiency during this time. The most common complaints are weight gain, bloating, irritability, depression, loss of sex drive, fatigue, breast swelling or tenderness, cravings for sweets, and headaches. This is called Premenstrual Syndrome (PMS). It is important to note that not all PMS symptoms are caused by progesterone deficiency. Hypothyroidism can produce similar symptoms. Stress, leading to adrenal exhaustion and low adrenal reserves, commonly seen in working mothers, for example, can also cause similar symptoms. A low fiber diet can cause estrogen to be reabsorbed and recycled. Excessive intake of xenoestrogen laced beef and poultry contributes to relative estrogen dominance associated with PMS. Natural progesterone has been used effectively to treat many PMS patients, according to Dr. Lee and Dr. Hargrove.

Elimination of coffee, sugar and alcohol, together with proper exercise, avoidance of dairy products and the usage of natural progesterone replacement, frequently reduces the symptoms of PMS. A diet, high in phyto-estrogen or supplementation of isoflavone extract or DIM, as well as nutritional supplementation with nutrients high in fatty acids, such as evening primrose oil or fish oil, to reduce the inflammatory response, also helps. Avoidance of food high in a special kind of fatty acid called arachidonic acid, commonly found in fatty fish like salmon and mahi-mahi, should be considered, as arachidonic acid contains pro-inflammatory prostaglandin.

Premenopausal Syndrome

Scientists have also identified a chronic condition similar to PMS, which is called premenopausal syndrome. The symptoms are similar to that of menopause, but often occur in the mid-thirties to early forties and years ahead of menopause. In addition to primary ovulation failure and the resulting drop in ovarian progesterone output, most often this is due to stress induced adrenal gland exhaustion which leads to a reduction of adrenal progesterone output. The reduction in progesterone level leads to a relative increase of estrogen or estrogen dominance.

The picture that emerges is clear–what is commonly perceived as menopausal, premenstrual and premenopausal symptoms in women often reflects a state of relative estrogen dominance due to an absolute progesterone level deficiency.

The Progesterone Solution

Once the concept of estrogen dominance is understood, the cure is simple–reduce estrogen load and/or increase progesterone load.

The best way is first through normalization of adrenal function that is commonly compromised in most people with estrogen dominance. If this fails, one can replenish the body with physiological doses of progesterone (approximately 20-30 mg/day) to overcome the estrogen dominance and reestablish hormonal balance. Progesterone cream oral alternativesOne can also raise the level of progesterone by supplementation (orally, by injection or topically). Taking phytoestrogen rich food, such as soy products, is another alternative way of reducing estrogen as these foods contain weak estrogens that competitively take up the estrogen receptor site, making estrogen less available for use. Foods that have estrogenic activities include: oats, peanuts, cashew nuts, wheat, apples and almonds. Interestingly, ginseng also has a weak estrogenic effect. Phytoestrogens also appear in a host of herbs, including black cohash, alfalfa, pomegranate and licorice. While widely promoted as the miracle food in recent years by the soy industry, it should be noted that soy products have their own set of problems. Unfermented soy products, such as tofu, contain acid, thereby robbing the body of many valuable nutrients and should not be eaten in large quantities. Fermented soy products, such as miso, do not have this problem and are the way to go.

Benefits of Natural Progesterone Cream Include:

  1. Stimulates osteoclast bone building (osteoporosis reversal)
  2. Helps use fat for energy
  3. Natural diuretic
  4. Natural antidepressant
  5. Restores sex drive (libido)
  6. Normalizes zinc and copper levels
  7. Facilitates thyroid hormone action
  8. Prevents endometrial and breast cancer
  9. Protects against fibrocystic breasts
  10. Normalizes blood sugar levels
  11. Normalizes blood clotting
  12. Restores proper oxygen cell levels
  13. Normalizes menstrual cycles

Natural vs. Synthetic Progesterone

The natural form of progesterone is derived from wild yam. It is very different from the synthetic unnatural form made in a laboratory (the widely prescribed Provera). The synthetic version is a chemical compound called progestin. It is a prescription drug commonly used in small amounts to balance the estrogen effect in a hormone replacement program. Being a drug, progestin is far more powerful than a woman’s natural progesterone. It is metabolized in the liver into toxic metabolites which, if excessive, can severely interfere with the body’s own natural progesterone. This creates other hormone-related health problems and further exacerbate estrogen dominance.

The structural differences between natural and synthetic progesterone are significant with direct bearing on their functionality. Whereas natural progesterone causes a reduction in water and salt retention, synthetic progesterone does the opposite. This is why some women taking synthetic progesterone in their birth control pills, or estrogen pills combined with synthetic progesterone during menopause, experience bloating and fluid retention. In fact, studies have shown that administration of synthetic progesterone lowers the blood level of the body’s natural progesterone.

Reported side effects of synthetic progesterone include an increased risk of cancer, increased risk of birth defects if taken during the first four months of pregnancy, fluid retention, abnormal menstrual flow, nausea, acne, hirsutism, mental depression, nausea, insomnia, masculinization, and depression. It is contraindicated in those with thrombophlebitis, liver dysfunction, known or suspected malignancy of the breasts and genital organs. One of the metabolites has an anesthetic effect on brain cells. A woman on high doses of synthetic progesterone is often lethargic and depressed.

Progesterone cream from wild yam sourcingNatural progesterone is obtained by extracting diosgenin from wild yams and then converting this component into natural progesterone in the laboratory. Natural progesterone is referred to as natural because it is the identical molecule to that which the human body manufactures. Such yam-derived natural progesterone should not be confused with yam extracts commonly sold in health food stores. Our body easily converts natural progesterone into the identical molecule made by the body. It cannot convert the yam extracts into progesterone. There is no evidence that such extract is converted into progesterone once it enters into the human body and unlike natural progesterone, no conclusive formal studies have ever been conducted that identifies any particular benefits from wild yam extracts.

Side Effects of Natural Progesterone Cream

No known side effects exist when using natural progesterone cream in physiological amounts (20-30 mg a day for women and 6-10 mg a day for men) under normal conditions. It is therefore very safe. However, as with most substances, too much of a good thing can cause problems. Too much progesterone is actually counterproductive, as chronically high doses of progesterone over many months eventually causes progesterone receptors to turn off, reducing its effectiveness and possibly leading to toxic side effects. Some possible side effects include:

  • An anesthetic and intoxicating slightly sleepy effect. Excess progesterone down-regulates estrogen receptors, and the brain’s response to estrogen is needed for serotonin production. Simply reduce the dose until the sleepiness goes away.
  • Some women report paradoxical estrogen dominance symptoms for the first week or two after starting progesterone. It is also common for those who have been deficient in progesterone for years, in the initial application of progesterone, to experience some water retention, headaches, and swollen breasts. These are symptoms of estrogen dominance, but paradoxically exhibited in the initial stages of progesterone application, as the estrogen receptors are being re-sensitized by the progesterone and waking up. This usually goes away by itself and is not a sign of toxicity.
  • Edema (water retention). This is likely to be caused by excess conversion to deoxycortisone, a mineralcorticoid made in the adrenal glands that causes water retention.
  • Candida. Excess progesterone can inhibit anti-Candida white blood cells, which can lead to bloating and gas. Systemic candidiasis can be treated with a grain-free diet for two weeks, followed by 40 mg of progesterone (using 3% progesterone cream) a day applied vaginally and to the breast. More is applied gradually elsewhere to areas such as the neck, face, brow, and inner arms. If side effects worsen, reduce progesterone dosage.
  • Lowered libido. Excess progesterone blocks the conversion of testosterone to DHT. This primarily happens to men.
  • Excessive progesterone can also lead to the increase in androgen production and ultimately increase in estrogen production within the adrenal hormonal synthesis pathway as the body shunts the excessive progesterone to these other hormones.

Progesterone cream use instructionsExcessive progesterone is normally caused by the excessive built up of progesterone in the body. This is more commonly seen in those who are self-administering topical progesterone cream in the wrong area. Progesterone cream should be applied to areas of the body that have good circulation but are not high in fat. These areas include the wrist, back of the neck, and under part of the upper arm because areas such as the abdomen, buttocks and breasts are high in fat and will retain progesterone faster than other parts of the body.

Absorption of progesterone from topical application is about 20% to 30% for the first day. A residual amount is left behind at the site of application, and this can accumulate in the subcutaneous fat tissue over time.

Routes of Progesterone Delivery

Natural progesterone can be administered orally, topically, sublingual or by injection. Oral administration is relatively ineffective as it is quickly metabolized in the liver. Injection is very effective, but can cause irritation to the injection site and it can be quite painful. To achieve a physiological dose (and not a higher pharmacological dose), the best method is sublingual or topical. Progesterone is easily absorbed by the skin and is 5 to 7 times more effective in reaching the blood stream than oral forms of progesterone. In other words, 100-200 mg of oral progesterone is needed to obtain the equivalent benefit of 20-30 mg of transdermal progesterone. Sublingual progesterone offers the best and most direct delivery route, as it is well absorbed directly into the blood stream. However, the required alcohol based for sublingual drops may not be tolerated by some.

Salivary levels go up in 3 to 4 hours and come back down by 8 hours while blood levels go up in a matter of a few weeks, for some

For best stabilization of progesterone absorption and effectiveness, natural progesterone should be taken or applied in divided doses, two to three times a day.

Delivery Systems of Topical Progesterone Cream

To pass the skin barrier and achieve maximum absorption, natural progesterone cream should be carried in an oil/water emulsion that contains the same fatty acid composition as the skin. Mineral oil will prevent the progesterone from being absorbed into the skin if topical progesterone is used. Oral progesterone is micronized.

There is a wide variety of dosages available. Topical cream should contain at least 400 mg to 600 mg of natural progesterone per ounce. Each one-half teaspoon application would supply a minimum of 26 mg of progesterone (women usually produce about 20 mg of progesterone daily during normal circumstances). To simplify matters, the better suppliers use a pump, with one pump delivering about 20 mg of progesterone. To get the physiologic dose, women should usually apply one full pump a day (20 mg), while men can apply one-half pump a day (10 mg). Common low dose sublingual drops usually contain about 1.2 mg per drop.

Progesterone cream and topical applicationThe consumer should read the label carefully. Studies have shown that many commonly used topical commercial progesterone formulations contain less than 15 mg of progesterone per ounce. In fact, some of these creams contain as little as 2 mg of progesterone.

The way to make sure that progesterone is present and not simply “wild yam extract” is to look for “U.S.P. Progesterone” on the label. U.S.P. stands for United States Pharmacopoeia, which is the international standard of purity. It confirms that the progesterone is the identical molecule as produced by the human body.

Progesterone and Adrenal Gland Optimization

The adrenal gland has two components: the inner medulla modulates the sympathetic nervous system through secretion and regulation of two hormones called epinephrine and norepinephrine that are responsible for the fight or flight response.

The outer adrenal cortex secretes three classes of hormones – glucocorticoids, mineralcorticoids and androgens. The most important glucocorticoids are cortisol and hydrocortisone. Reduced output of these hormones often results from chronic stress of the adrenal glands or malnutrition. Symptoms include fatigue, low blood sugar, weight loss and menstrual dysfunction. Mineralcorticoids such as aldosterone modulate the delicate balance of minerals in the cell, especially sodium and potassium. Stress increases the release of aldosterone, causing sodium retention (leading to water retention and high blood pressure) and loss of potassium and magnesium. Magnesium is involved in over 300 enzymatic reactions in the body. Its deficiency is widespread and has been linked to a variety of pathological conditions, including cardiac arrhythmias, uterine fibroids and osteoporosis.

The adrenal cortex also produces all of the sex hormones, although in small amounts. One exception is DHEA, a weak androgenic hormone that is made in large amounts in both sexes. DHEA, together with testosterone and estrogen, are made from progesterone, which in turn comes from cholesterol.

progesterone is therefore at the top of an important hormonal metabolic pathway. Deficiency in progesterone leads to reduction of both glucocorticosteroids and mineralcorticoids such as cortisol. Symptoms of cortisol deficiency include fatigue, immune dysfunction, hypoglycemia, allergies and arthritis. Symptoms of mineralcorticoid deficiency include high blood pressure and mineral imbalances. Progesterone supplements often effectively resolve these problems.

Chronic stress is commonly seen in the western society and career women often cause the adrenal glands into overdrive, with excessive secretion of cortisol. Excessive cortisol can block progesterone receptors, making them less responsive to progesterone. High cortisol levels also occur with trauma and inflammatory responses such as the flu. Inflammatory bowel disease, for example, has been shown to induce high levels of cortisol, leading to reduction of progesterone efficacy and resulting in estrogen dominance. With chronic stress, eventually the adrenals are exhausted and production of these important hormones are drastically reduced.

Women frequently have exhausted adrenal glands by the time they reach the mid-thirties or early forties. Their adrenal glands have nothing left to give. Production of progesterone by the adrenals comes to a halt as the body focuses on producing cortisol and not progesterone or other sex hormones. Insufficient progesterone production leads to estrogen dominance.

Progesterone cream and adrenal glandsThe adrenal glands therefore deals with the daily stress of life. To have total body hormonal balance the first thing to do is to normalize the adrenal glands. In fact, replacement of deficient hormones alone without addressing the overall health of the adrenal gland is a band-aid approach and ineffective in the long run. The normalization process starts with stress reduction by increasing rest. A good nights sleep is a good start. Go to sleep early and make sure you sleep in a completely dark room to maximize melatonin production.

It is prudent to optimize the adrenal gland function prior to or concurrently with progesterone supplementation. Multiple hormonal supplementations such as DHEA, pregnenolone, low dose natural cortisol or cortisol enhancing agent such as licorice root extract should also be considered. An optimal and balanced intake of vitamins and minerals serves as a good foundation, including 500 mg to 3000 mg of vitamin C, 400 I.U. of vitamin E, 10,000 to 25,000 I.U. of beta-carotene and other important minerals such as selenium and magnesium as well as important amino acids such as lysine, proline and glutamine. Supplementing with natural hydrocortisone or cortisone acetate in doses of 2.5 to 5 mg two to four times a day can be a safe and effective way to replenish depleted adrenals. This should be done under the guidance of a physician.

Progesterone and Osteoporosis

For more than half of a century, estrogen was given routinely with the hope that it would prevent osteoporosis. It is now well established that estrogen replacement therapy does reduce osteoporotic fractures by 50 percent. Estrogen works by preventing increased bone resorption during menopause. Estrogen has no effect on bone formation; therefore, it does not reverse osteoporosis. Furthermore, when estrogen is discontinued, the rate of bone resorption resumes and the rate actually is accelerated. To be successful, estrogen replacement should be started early (before significant bone loss has occurred) and be maintained indefinitely.

It is important to note that a lack of estrogen does not cause osteoporosis. For example, it is proven that there is significant bone loss during the 10 to 15 years before menopause, despite an ample supply of estrogen during this period. But during that same period, there is often a shortage of progesterone. Although estrogen inhibits the bone-destroying osteoclast cells, it cannot rebuild bone. progesterone, on the other hand, is a bone builder. It does so by stimulating the osteoblast cells that rematerialize and restore bone mass. Supplementing with natural progesterone has proven useful in the prevention and reversal of osteoporosis. In other words, progesterone is the key to healthy bones, in addition to magnesium (and not calcium alone).

In the July, 1990 issue of the International Clinical Nutrition Review on the effectiveness of natural progesterone, Dr Lee reported healthy 35 years-olds were administered natural progesterone cream. In the first six to 12 months, subjects had a ten percent increase in bone density instead of an annual decrease of three to five percent. Progesterone cream and bone densityReversal of osteoporosis is indeed possible through the use of natural progesterone alone. Instead of a projected 4.5 % loss of bone density, subjects had a 10% increase in bone density after 6 to 12 months of natural progesterone therapy alone. Some patients had up to a 20 to 25% increase within a year. Just as significant, the beneficial effect of progesterone is not affected by age but more related to initial bone density status. Those with the lowest bone density scores showed the most improvements. It is apparent that progesterone can help any women, no matter how far the bones have degenerated. Dr Lee’s study also showed that the addition of estrogen to natural progesterone does not make the progesterone more effective. Dr Lee only uses estriol for relieve of menopausal symptoms and not for treatment of osteoporosis.

The effect of estrogen can be mimicked by selected foods. Compounds called phytoestrogen, contained in the food, act as weak estrogens. While consumption of phytoestrogen has been linked to reduce symptoms of menopause, it is unclear if osteoporosis is prevented.

Progesterone or Estrogen and Cancer

40% of cancer incidents in women in the United States are in the breasts, ovaries and uterus. Breast cancer is a silent epidemic, striking 1 in 9 women; up from 1 in 30 women in 1960, before estrogen replacement therapy was popularized.

FDA-approved estrogen drugs have been documented to cause cancer. Published studies have shown that women taking estrogen and a synthetic progesterone drug had a 32% to 46% increase in their risk of breast cancer. This was based upon a large pool of data from the famous Nurses’ Health Study conducted at Harvard Medical School. The study showed that the carcinogenic risk of estrogen-progestin replacement therapy became most pronounced when it was used for 10 or more years. However, recent data from the Breast Cancer Detection Demonstration Project suggests that the relative risk is increased by 20% even after four years of use compared to no hormone treatment, and that, surprisingly, there is a 40% increased risk of breast cancer using both estrogen and synthetic progesterone (called progestin) combined, compared to only a 20% increase for estrogen alone. Clearly, the progestin that is supposed to counter-balance the estrogen is not what the body recognizes as good. The body needs natural progesterone to counter the estrogen effect. Synthetic progesterones are far from the natural form. Some studies show that estrogen does not cause cancer in the short-term; however, in women taking estrogen and/or a synthetic progestin for more than 10 years, there appears to be a significantly elevated risk of breast, ovarian, and uterine cancers.

In addition to breast cancer risk, long-term estrogen replacement therapy increases the risk of fatal ovarian cancer. A large 7-year study, including 240,073 pre- and post-menopausal women, focuses on this. After adjusting for other risk factors, women who used estrogen for 6 to 8 years had a 40% higher risk of deadly ovarian tumors, while women who used estrogen drugs for 11 or more years had a startling 70% higher risk of dying from cancer of the ovaries.

Progesterone cream and breast cancerThe risk of cancer therefore has to be considered carefully when it comes to any hormonal replacement therapy. Extensive studies have been conducted on two oncogenes, BCL2 and P53, and their effect on female-specific cancers and prostate cancer. First, it is important to understand that estrogen in our body comes in three forms – estrone (E1), estradiol (E2), and estriol (E3). Our body makes the three estrogens in the following ratio: 10% E1, 10% E2, and 80% E3. E1 and E2 are potent estrogens. They relieve symptoms of hot flashes, but also promote cancer. E3 is the weakest of the three forms. Not only is it non-carcinogenic, but it actually prevents cancer.

Laboratory studies have shown that when E1 or E2 is added to cells of the prostate and breast, the BCL2 gene is regulated, causing the cells to grow rapidly and not die (cancerous). The BCL2 gene, therefore, stimulates the growth of cancer cells and thus increases the risk of cancer. In fact, many studies now show that E2 actually causes breast and prostate cancer. When progesterone was added to the cell cultures, cell reproduction stopped and the cells died on time (apoptosis). Progesterone counteracts the BCL2 gene by stimulating the production of the P53 gene, causing cancer cells to die. To put it simply, according to Dr. Lee, estrogen increases cancer risks while progesterone reduces cancer risks for cancer of the ovary, uterus and small cell lung cancer.

Extensive studies have been conducted in the past 25 years on E3 and breast cancer. They show that women with breast cancer have a lower relative level of E3 in comparison to E1 and E2. In fact, some doctors use E3 as treatment for metastasized breast cancer. A dosage of 2.5 mg to 15 mg a day is used. Studies show that 37% of those receiving E3 had remission or no further progression of the metastatic cancer. For relief of menopausal symptoms, more E3 is required in comparison to E2. Dr. Jonathan Wright is a pioneer in the use of natural estrogen. He formulated a natural compound called “tri-estrogen” composed of 80% E3, 10% E2, and 10% E1. According to Dr. Wright, 2.5 mg of this tri-estrogen, a prescription item available at compounding pharmacies only, is equivalent to 0.625 mg of conjugated estrogens or estrone.

Natural progesterone therefore has cancer prevention properties. It helps to reduce the risk of ovarian, endometrium and breast cancer, while unopposed E2 causes these same types of cancer.

Does synthetic progesterone have a cancer prevention effect? The answer is no. Natural progesterone stimulates activation of the anti-cancer P53 gene by attaching itself to progesterone receptors, found in abundance in the ovaries, breasts, and endometrial cells. Synthetic progesterone (commonly found in birth control pills) or any of its variant forms such as progesterone acetate or medroxy-progesterone acetate competitively occupy progesterone receptors and prevent natural progesterone from occupying these sites. Synthetic progesterone therefore not only fails to stimulate the P53 gene but also prevents its activation by blocking natural progesterone from occupying the progesterone receptor.

How Much Topical Progesterone Cream to Use?

Using progesterone cream in the proper amountThe goal of progesterone replacement is to restore the normal physiological progesterone level in the body for two to three weeks out of a month; the way it was designed by nature. An ovulating woman makes about 20 mg a day for about 12 days each month after ovulation. That works out to about 240 mg per month.

One should locate a progesterone cream that supplies 480 mg per ounce (960 mg per 2 ounce). This means that each two-ounce jar or tube will contain 3% by volume or 1.6% by weight of U.S.P. Progesterone. Using one ounce over two or three weeks will provide about 240 mg if the absorption is 50%. This is the ideal target dose to apply. This works out to 1/8 to 1/2 teaspoon of the cream per day, or three to 10 drops of it in oil form. For creams that come in pre-set metered doses, one full pump normally contains the equivalent of 20 mg progesterone. This is the simplest for most people to remember – one full pump a day for women and half a pump a day for men in divided doses. If sublingual drops are used, make sure that the drops are applied sublingually and washed in the mouth for best absorption. Do not take in more than 6 drops at a time as it can be swallowed easily and lose its effectiveness.

Sublingual progesterone drops are 99% absorbed, while micronized progesterone in a capsule is only about 40% absorbed, and some studies even report an absorption of less than 15%.

Low vs. High Dose Progesterone Cream

Progesterone cream comes in a variety of concentrations. Which is best? According to Dr. Lee, low dose cream costs a little bit more, but it is the better way to go. There are two important reasons.

First, excessive progesterone in high dose (10%) cream is metabolized in the liver and some of the metabolites may have anesthetic properties on the brain, causing lethargy and depression. Secondly, progesterone is rapidly absorbed from the skin and there is a danger that the release of progesterone into the blood stream is not smooth. Since progesterone has a half-life of only 5 minutes once in the blood, its effectiveness is limited.

Other physicians favor a higher potency progesterone cream ( up to 10%) because they have better results. Regardless of whether it is high or low dose, the key is that your progress is monitored by a qualified health care professional.

Laboratory Measurement

Salivary or serum hormonal testing will provide information on your current level of progesterone and assess the amount of natural progesterone that you need.

Serum level of progesterone will rise in about three months after proper use of progesterone cream. It measures the total available and is not the much smaller biologically active portion. The normal post-menopausal, untreated patient will show an initial serum progesterone level of 0.03 to 0.3 mg/ml. After 3 months, this level rises by about 10 fold to 3 to 4 mg/ml. In normal pre-menopause women during midcycle (luteal phase); the progesterone level reaches 7 to 28 mg/ml. In the treatment of osteoporosis, good results are obtained at progesterone levels of 3 to 4 mg/ml.

Progesterone cream and saliva testingSaliva testing is gaining popularity due to its ease of use, faster indication of free progesterone level and good accuracy. It is more accurate than serum testing because it measures the amount of free progesterone that is bio-available to the cell and active. The challenge is to obtain a good salivary sample free from contaminants. The normal range depends on the stage of the menstrual cycle. Normal physiological range is 100-500 pg/ml, there is usually no reason to exceed this range because that is how high the endogenous production usually gets.

Interpretation of laboratory results is confusing to many health professionals. To properly interpret the meaning of salivary test result, the following parameters should be followed:

  • Does the progesterone level fall within range normal for the menstrual cycle period? For example, pre-menopausal range is from 50-400 pg/ml, post-menopausal range is from 5-95 pg/ml.
  • Does the progesterone level stay within the normal physiological range of 100-500 pg/ml? This is especially important during hormonal replacement therapy.
  • What is the progesterone to estradiol (E2) ratio? The minimum ratio is 22 to 1 during the follicular phase and 30 to 1 during the luteal phase. If the ratio is low, it is a sign of estrogen dominance.
  • What is the total progesterone to total estradiol ratio? The minimum ratio should be 26 to 1.

Is there an upper limit of progesterone to E2 ratio? Provided the total amount of progesterone does not exceed the normal physiological range at any time, there is no limit to the progesterone to E2 ratio.

In general, it takes about 3 to 4 months for progesterone in the body fat to reach physiological equilibrium for those who are menopausal, and about 1 to 2 months for those who are pre-menopausal.

How to Apply Progesterone Cream

It is important to be as accurate as possible when applying progesterone. The best low dose progesterone cream should contain 1.7% progesterone and yield 20 mg progesterone per application. The simplest application method is through the use of metered pump that measures the exact amount (20 mg), each time the pump is pressed.

progesterone is best absorbed where the skin is relatively thin and well supplied with capillary blood flow. Areas such as face, neck, upper chest, and inner arms are good areas. Spread it out to as big an area as possible for maximum absorption and allow as much time for absorption as possible. Therefore, bedtime application is best if you are applying it once a day. Twice a day application is best but it may be too troublesome for most. Rotate to different areas to avoid saturation in any one particular site.

Here is a sample rotational application protocol:

  • Day 1 morning: Apply to the right side of the back of the neck.
  • Day 1 before bed: Apply to the left side of the back of the neck.
  • Day 2 morning: Apply to the right wrist area, with palm facing up.
  • Day 2 before bed: Apply to the left wrist area, with palm facing up.
  • Day 3 morning: Apply to the underside of the right upper arm.
  • Day 3 before bed: Apply to the underside of the left upper arm.

Application of progesterone cream on the back of the neckRepeat this cycle from day 4 onward. In other words, day 4 will be the same as day 1, and day 5 will be the same as day 2, etc.

Practically speaking, the best gauge for the ideal dose should not be determined by any laboratory test alone. It is important to rely on relief of symptoms when figuring out the ideal dose. The right dose is the dose that works.

The following are general recommendations for topical progesterone cream application that may need to be modified for specific situation:

  • Women in premenopause – still ovulating:
    • Use: progesterone cream can be used to relieve PMS, painful cramps with periods, menstrual irregularities, prevent cancer and to protect against osteoporosis later in life.
    • Directions for those on no hormonal supplementation: Count the day the period begins as the first day. Apply 20 mg (one full pump when properly dosed) of natural progesterone every day from day 12 to day 26. Those with longer cycles may wish to use from day 10 to day 28. Begin the cream after ovulation that usually occurs about 10 to 12 days after your period begins. If bleeding starts before day 26, stop the progesterone and start counting up to day 12, and start again.
    • Directions for those on synthetic progesterone (progestin) supplementation: Taper off the synthetic progesterone gradually and replace with natural progesterone over a 3-6 month period. Synthetic progesterone can be reduced to every other day and then further taper off.
  • Women in peri-menopause (still menstruating with menopausal symptoms and/or PMS but not ovulating):
    • Use: progesterone cream can be used to relieve PMS symptoms and prevent osteoporosis.
    • Directions: Count the day the period begins as the first day. Apply 20 mg of natural progesterone (one full pump when properly dosed) from day 7 to day 27. If your period begins early, stop using progesterone cream while you are bleeding.
  • Women in menopause (not menstruating):
    • Use: For prevention or reversal of osteoporosis and relief of menopausal symptoms.
    • Directions for those who are not on estrogen replacement therapy: Choose a calendar day, such as the first day of the month. Apply 20 mg of natural progesterone (one full pump when properly dosed) of natural progesterone daily from day 1 to day 25. Let the body rest the rest of the month. If a woman has not been making progesterone for a number of years, the body-fat progesterone is probably low. In this case, double up on the application for the first 2 months, and return to normal physiological dose thereafter.
    • Directions for those who are on estrogen replacement therapy: Reduce the dosage of estrogen supplementation to half when starting progesterone. Those women who fail to do so will likely experience symptoms of estrogen dominance during the first one to two months of progesterone. Progesterone cream and estrogen replacementEvery two to three months, reduce the estrogen supplement again by half. Estrogen and progesterone can be used together during a three-week cycle each month, leaving a rest period of 7 days without either hormone. The estrogen dose should be low enough that monthly bleeding does not occur but high enough to prevent vaginal dryness or hot flashes.
    • Directions for those taking estrogen and synthetic progesterone (such as Provera) combination: Stop the synthetic progesterone immediately when progesterone cream is added. Estrogen should be tapped off slowly.
    • Low dose natural estrogen (estriol) may be added for 3 weeks out of the month in cases of menopausal symptoms such as vaginal dryness and hot flashes unrelieved by progesterone cream alone.
  • Other Special Uses
    • Osteoporosis: Apply 20 mg daily from day 1 to day 25 of the menstrual cycle. Baseline bone mineral density (BMD) test should be obtained. If after 1 year bone density increases, the amount can be reduced by half. If BMD does not increase, other factors such as exercise, diet and optimization of nutrition should be undertaken together with a full medical workup to identify other underlying causes.
    • Severe PMS or Endometriosis: Apply 20 mg from day 12 to day 26.
    • Uterine Cramps: Apply above the pubic area at onset of cramps.
    • Hormone Related Headaches: Apply creams to the sides of the neck just behind the earlobe at onset of headache. Do not use on day 28.
    • During Hot Flashes: Apply a small dab to the inside of the wrist at the onset of hot flashes.
    • Premenstrual Migraine Headaches: Apply 20 mg progesterone cream during the 10 days before the period begins. Be alert to the aura that usually precedes these headaches. You can apply a small glob (1/4 to 1/2 teaspoon) every 3 to 4 hours until symptoms subside.
    • Polycystic Ovary Disease: Apply 20 mg of progesterone cream during day 14 to 28 of the menstrual cycle. Adjust accordingly if for longer or shorter cycle. As the hormonal balance is regained, facial hair and acne, two commonly associated symptoms, will disappear.
    • progesterone Cream and Pregnancy: According to Dr. Lee, one of the chief causes of early pregnancy loss is the failure of the body to increase progesterone production sufficiently during the first several weeks after fertilization. Women who are having difficulty conceiving or who may be at risk of a miscarriage may wish to speak with their physician about natural progesterone supplementation after ovulation.
    • Breast Cancer Prevention: Breast cancer occurs most often during estrogen dominance. Dr. Graham Colditz of Harvard postulated that unopposed estrogen is responsible for 30% of breast cancer. Preventive low-dose progesterone supplementation (12-15 mg per day) can be used 24 to 25 days a month and should be considered, especially for those at risk.
    • Breast Cancer Patients: progesterone supplementation should be maintained for life with all breast cancer patients, before, during and after surgery.

    Progesterone cream and uterine fibroids

    • Uterine Fibroids: 20 mg of progesterone cream can be used from day 12 to day 26. You can start as early as day 8 and go through day 30. Ultrasound tests can be obtained initially as baseline and after 3 to 6 months of use. A 10-15% reduction in size is generally expected or at least the size should not increase further. Continue this treatment until menopause if it is successful. At menopause, progesterone application can be reduced. Fibroids normally atrophy after menopause as estrogen level reduces.
    • Breast Fibrocysts: Apply 20 mg of progesterone cream from ovulation (day 12 to 14) until a day or two before the period starts. Normal breast tissue will return within 3 to 4 months. Also, take 400 IU of vitamin E at bedtime, 600 mg of magnesium and 50 mg of vitamin B6 a day. Do also refrain from coffee and reduce sugar and fat intake.
    • PMS: Apply 20 mg of progesterone cream from days 10 to 12 to days 26 to 30. This is best done in two divided doses, with a small dab at night starting on days 10 to 12 and gradually increasing to two dabs per day, morning and night. Finish off the last 3 or 4 days with bigger dabs. Each day total should not exceed 20 mg.
    • Pre-Menopausal Women with Hysterectomy or Ovaries Removed: Apply 20 mg of progesterone for 25 days of the calendar month and rest from day 26 to the end of the month.
    • Menstrual Migraine: Apply 20 mg of progesterone cream during the 10 days before your period (days 16 to 26). Apply a small amount every 3 to 4 hours when you sense the “aura” coming until symptoms cease.
    • Increase Libido: progesterone and testosterone are both important factors in libido. Testosterone is much more potent. Natural progesterone is the preferred choice.
    • Hair Loss: When progesterone level drops due to ovarian follicle failure (lack of ovulation), the body responds by increasing the synthesis of androstenedione, an adrenal cortical steroid. This has some androgenic properties, resulting in male pattern hair loss. Natural progesterone supplementation for 6 months may be helpful to reduce the androstenedione level, at which time normal hair growth will resume.
    • Hypothyroid: Thyroid hormones and estrogen have opposing actions. Progesterone also opposes estrogen. Symptoms of hypothyroidism occurring in patients with unopposed estrogen or estrogen dominance (progesterone deficiency) become less symptomatic when progesterone is replaced.

Progesterone and Men

Men also produce estrogen and estradiol (E2), but in much lower amounts than women. Males also produce progesterone, but about half the amount from that of females. It is produced in the testes and in the adrenal glands. While the level of progesterone in males is significantly lower than in females, some womens’ progesterone levels fall below that of men of the same age during menopause.

Progesterone cream and testosteroneThe male hormone, testosterone, is an antagonist to estradiol (E2). Like progesterone, testosterone can stimulate new bone formation, increase bone density, and a lack of it causes osteoporosis. It is made from progesterone. Men normally continue to produce a relatively normal level of testosterone for their age and well into the seventies. Contrary to common perception, testosterone does not cause prostate cancer. Studies have shown that men with the highest level of testosterone have the least prostate enlargement. Conversely, men with the highest level of estrogen have enlarged prostates. Declining testosterone from aging, together with increasing levels of estrogen, is the most likely reason for prostate enlargement and cancer in men. Since progesterone has an antagonistic effect on estrogen, application of progesterone cream would indirectly enhance the effect of testosterone.

In addition to the use of progesterone cream to offset the negative effect of estrogen leading to increased testosterone levels, use of zinc should be considered. Zinc inhibits the action of aromatase, an enzyme that converts testosterone to estrogen. Of all the body’s organs, the prostate has the highest level of zinc. Therefore, supplementation with 50 mg of zinc one to two times a day enhances testosterone function.

Large doses of progesterone cream inhibit sexual behavior but physiological doses appear to enhance sexual drive. Clearly testosterone alone is not the only driver of sexual function in males or females.

Male Hormonal Imbalances

  1. Testosterone deficiency in Men:

    Symptoms: weight loss, lower stamina, enlarged breasts, loss of muscle, lowered sex drive and fatigue.

    Discussion: These symptoms commonly occur in men over the age of fifty as part of andropause.


    • Take nutritional supplements such as zinc (50 mg twice a day until improvements are seen, then 50 mg once a day).
    • Take a pro-hormone such as androstenedione or pregnenolone to stimulate testosterone production.
    • Do regular strength training exercises.
    • Testosterone replacement therapy as indicated.
    • Reduced weight: obesity has a direct effect on increasing estrogen build up in the body.
    • Reduce alcohol consumption. Alcohol significantly inhibits the clearance of estrogen from the blood stream and decreases zinc levels. One or two drinks should be the maximum per day.
    • Increase consumption of plant proteins that contains phytoestrogens. Such phytoestrogens have only 1/500 the active effect of estradiol, the most active human estrogen. It acts competitively and blocks estrogen receptor sites in the body as well as stimulating the P450 system in the liver to metabolize estrogen more actively.
    • Avoid grapefruit that has a tendency to inhibit the liver’s breakdown of estrogen.
    • Increase cruciferous vegetables such as broccoli and cauliflower that stimulate the burning-off of extra estrogen. Cruciferous extracts such as DIM can be considered as well.
    • Reduce drugs that inhibit the P450 system and result in increased estrogen levels. These include non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac), aspirin, acetaminophen; certain antibiotics such as sulfas, tetracyclines, penicillins; cholesterol lowering drugs (Statins, lovastatin; heart medications such as propanolol, quinidine, methydopa and coumadin.
  2. Excess Estrogen in Men:

    Symptoms: Hair loss, prostate enlargement, irritability, headache and breast enlargement.

    Solution: Reduce estrogen in diet and male hormone replacement. Progesterone cream will act as an antagonist of estrogen in the body. Apply 10 mg a day.

Progesterone Cream and Prostate Health

Progesterone cream and prostate healthThe prostate is the male equivalent of the female uterus. When prostate cells are exposed to estrogen, the cells proliferate and become cancerous. When progesterone or testosterone is added, cancer cells die. During the aging process, progesterone levels fall in men, especially after age 60. Interestingly, progesterone is the chief inhibitor of an enzyme called 5-alpha reductase that is responsible for converting testosterone to di-hydrotestosterone (DHT), a much more potent derivative that is linked to prostate cancer. When the level of progesterone falls in men, the amount of conversion from testosterone to DHT increases. Unfortunately, DHT is not as powerful an inhibitor of cancer cells compared to testosterone. Benign prostatic hyperplasia (BPH) and prostate cancer do not appear in men when the level of testosterone is high. Both conditions come 20 to 30 years after the onset of declining testosterone levels associated with the aging process that commences in the mid-twenties.

Testosterone is also an antagonist to estradiol. When the level of testosterone decreases, the relative level of estradiol in men increases. Estradiol, as we have seen earlier, turns on BCL2 oncogenes and increases the risk of prostate cancer if an adequate amount of progesterone is not there to counteract its effect by stimulating the P53 cancer protection gene.

Prostate cancer is the most common cancer in men. It is slow growing, with a doubling time of 5 years. Breast cancer is much more aggressive, with a doubling time of a few months. Dr. John Lee, Dr. Jesse Hanley and many other progressive doctors now believe that excessive estrogen is a primary cause of prostate enlargement and prostate cancer. Numerous anecdotal reports of reduction of BPH and reversal of prostate cancer through use of natural progesterone supplementation have been reported. It is apparent that progesterone protects the prostate gland.

PSA is a widely available prostate cancer marker. Studies have shown that PSA levels return to normal upon application of natural progesterone cream before or after prostate surgery.

Benign prostatic hyperplasia (BPH), a prostate enlargement condition, is a common condition affecting the majority of males above age 50. progesterone cream can help to reduce prostate size. progesterone’s inhibitory effect on 5-alpha reductase is far more effective than Proscar and Saw Palmetto, which are standard agents, used in traditional and natural medicine to cure BPH. Concurrent use of progesterone cream can reduce the amount of saw palmetto needed to achieve the same effect.

All men over age 40 should consider natural progesterone replacement therapy, or even earlier if there is a history of prostate cancer or BPH. The amount needed is 10 mg a day, approximately half of that used in women. No rest day is needed and men should apply it on a daily basis.

One benefit is that there is a reasonable chance that natural progesterone supplementation decreases male balding due to the corresponding rise in testosterone. More research is needed in this area.


Modern society has brought with it many external hormonal insults to our body. Such insults exhibit themselves in symptoms associated with menopause, PMS and pre-menopause. It is apparent that the common thread of these symptoms is often relative estrogen dominance rather than absolute estrogen deficiency as traditionally thought.

Progesterone cream and lifestyle adjustmentsThe vast majority of these symptoms can be avoided by lifestyle adjustments alone in many cases. These include stress reduction and a comprehensive exercise program. Good nutrition can go a long way to reduce estrogen in the body. Estrogen levels can be lowered by calorie restriction, avoidance of sugar and refined carbohydrates, maintaining a high-fiber diet and supplementing with high-fiber products such as psyllium or rice bran. Intake of an optimum amount of antioxidants is needed together with the avoidance of environmental estrogenic toxins. Since the liver is where estrogen is metabolized, protecting the liver function with herbs such as milk thistle should be considered for those with impaired liver function. Supplementation with weak estrogens such as isoflavone, DIM, and selected herbs can be useful as well. Natural progesterone cream should be used as indicated to relieve symptoms. The risk is extremely low in physiological doses. Most menopausal symptoms normally respond well with lifestyle changes and natural progesterone supplementation alone. If not, women may need very low dose natural estrogen supplementation for several years, which can then be gradually discontinued without recurrence of symptoms.

In men, progesterone cream can have health enhancement effects, from increasing sex drive to prostate cancer prevention. Any male who is in the clinical phase of aging (above 45 years old) should consider using progesterone cream.

Supplementation with natural progesterone cream is part of a total hormonal balance program and indeed an invaluable anti-aging tool when properly used. It is virtually free from side effects. When estrogen is required, the use of anti-carcinogenic estriol may reduce the cancer risk associated with estrogen treatment. The concurrent and judicious use of other hormones such as natural cortisol in case of adrenal stress, DHEA, pregnenolone, androstenedione, and melatonin should also be considered as part of an anti-aging total natural hormonal replacement program. Not to be forgotten are lifestyle factors that can enhance total body hormones and normalize important adrenal function.

These include:

  • Avoidance of hydrogenated oils and most vegetable oils in the diet with the use of olive and canola oil instead.
  • Eat whole, unprocessed food in accordance to the anti-aging food pyramid of 50% complex low glycemic carbohydrates, 25% proteins (preferably from plant sources) and 25% fat.
  • Optimize nutritional supplementation with vitamins, minerals, enzymes and amino acids, including 1000 to 3000 mg of vitamin C, 400 IU of vitamin E, 500 to 1000 mg of magnesium and 50 mg of vitamin B6.
  • Drink at least 10 glasses of pure filtered water a day.
  • Maintain a smooth and regular bowel movement with enzymes and probiotics as needed.
  • Reduce stress to normalize the adrenal gland.
  • Avoid cigarette smoking, coffee and alcohol.

Dr. Lam’s Key Questions

First-trimester miscarriage is usually due to low progesterone. This is associated with AFS.

If a woman’s hormones are balanced, there should not be any symptoms like hot flashes.

Progesterone cream can be used to balance the estrogen load in the body. Depending on many conditions, such as adrenal health, weight issues, stress issues, etc. you may or may not need to use it.

It is best to consult your doctor first before starting progesterone cream. Sometimes you may have other health related issues such as AFS or Thyroid imbalance that may affect the ovarian hormones.

Some people with AFS feel great during pregnancy due to progesterone’s calming effect, while others are not so fortunate. They tend to crash and become sluggish as the pregnancy progresses. If it is more severe, a first-trimester miscarriage that tends to be more prevalent. With those who are in advance stages of AFS before becoming pregnant.

Progesterone cream
5 - "First let me thank you"
First let me thank you so much for your most informative, excellent article about progesterone. It offers me a great deal of hope, as I recognize myself in the list of symptoms you list under estrogen dominance. I am a new comer to your site and I am looking forward to reading it more thoroughly over the next few days and becoming more acquainted with your many contributions to healthful living.


  • Sara says:

    Almost 2 years ago I had a pulmonary embolism caused by the desogestrel in my birth control pills. I was taking the BC pills due to high (but not PCOS high) levels of testosterone. I was tested and found negative for any clotting factors so the estrogen was found to be the root cause. I am not allowed to take any hormone therapies for the rest of my life due to concern of another embolism. However, my cycles are out of whack – coming every 40-50 days. I am 38 and still break out. I get overly emotional at least once per month. My hormones are clearly out of whack. Is it safe for me to use Progesterone cream with my history of PE?

  • Rusen says:

    Is there any side effects for man between 45 and above to use a physiological doses of 6mg of progesterone? No complaints,only to restore suggested decline!

  • Jeri says:

    I’ve read that many chemicals can act like estrogen in the body (xenoestrogen I think?) but can the same happen with natural compounds and progesterone? (like a xeno progesterone effect?)

  • Susan says:

    Just gathering information right now – Dr. prescribed oral progesterone for estrogen dominance (I have lots of symptoms – hair loss, menorrhagia, cycles that range from 14-55 days between them, migraines, etc..) ) but I really do not want to take progesterone orally. There is family hx of breast cancer so I am wary about any hormones anyway. Took Vitex and it worked wonderfully for about 6 months until I stopped responding to it. The question I have is do I consider sublingual, vaginal or transdermal and which is the safest for what I need? I am concerned about potency of non-FDA approved products but want a natural progesterone. I will not take synthetic. I am also concerned about progesterone being stored on fat cells over long periods of time and creating more issues than it is solving. Any advice or clarification on the different routes of administration to help me guide my discussion with my Dr?

    • Dr.Lam says:

      Progesterone has pros and cons. There are many factors to consider. There is no “safest” route as each has pro and cons. With your concerns, your best bet is to talk to multiple doctors and then make up your own mind. The fact that you stop responding to vitex after a while is concerning. Potency is generally not an issue as far as standardization, but the dosage does vary from person to person. If you have AFS, the story is also very different. Click Progesterone Side Effects and Brittle Adrenals for more information.

      Dr. Lam

  • Elaine says:


    Many thanks for this wonderful article.

    I am wondering if the Progesterone cream could be of benefit to me now.

    I had breast cancer at age 39, I am now 62. Previous to this I used Progesterone Pessories for severe PMT.
    After I finished the cancer treatment I carried on with the Pessories whilst I went through the menopause then stopped.

    Seven years ago I was diagnosed Hypothyroid and take medication but still struggle with symptoms.
    I had a 24 hours saliva adrenal test which showed I had just over top of the cortisol first am. sample and the other samples were in range, but it also showed I had extremely low DHEA.
    I do not want to use DHEA supplementation as I am concerned it could have an oestrogen effect so was wondering if I would be O.K. to use the Progesterone Cream instead, if so what would be a good dose to start with.
    Any advice would be gratefully received.

    Thank you Elaine.

    • Dr.Lam says:

      Many factors have to be considered in a case like your with cancer history before using progesterone. It is not straight forward, and you need to be very careful. The physiological dose is 20 mg transdermal, but again, it may need to be adjusted to fit your needs. I would not recommend self-navigation. Click Progesterone Side Effects and Brittle Adrenals for more information.

      Dr. Lam

  • Anonymous says:

    I have an important thought…when women enter menopause and shows signs of receding gums does progesterone cream usage without enough estrogen increase receding gums? Sincerely thankful for time.

  • Salena says:

    I’ve been using progesterone for a few months now.. and I am happy to say it’s helped me tremendously!

  • Linda says:

    When having high estrogen levels can I increase my progesterone to counteract it?

  • Dana Evans says:

    What is the link between sex hormones being low and Hashimotos in women? I developed a goiter around age 6 but was euthroid until my early 30’s when a full thyroid panel showed antibodies, so I know I have had it since childhood and I have never had much of a libido. Bio identical progesterone cream didn’t phase it but testosterone did….a little too much! My goal is not to increase my libido but rather to find the root cause of my hormone imbalance which may have always been there since I’ve never had one, even when I was younger. Serum tests 5 or 6 years ago revealed they were all low, testosterone could have been lower than the sensitivity of the test, and estrogen was the next lowest. Progesterone was probably the lowest possible normal level. Three or four years later, a saliva panel showed progesterone as very low, especially compared to estrogen which was a little low, which created a ratio that caused me to be eatrogen dominant ( which according to your article would explain the slightly low dhea and cortisol levels also present at that time). Testosterone was low but not as much as the others. My insurance doesn’t allow me access to an endocrinologist so for now, the mystery and management is up to me and my GP who doesn’t practice holistic or functional med.

    • Dr.Lam says:

      All hormones in the body are interconnected. Progesterone low is often seen in estrogen dominance which is also common in Hashimoto’s. However it important not to draw too close a direct connection. A very detailed history is needed to put all the pieces together, and usually, we do find some connection. Whether these connections result in your symptoms are a different matter.

      Dr. Lam

  • Joan says:

    While trying to conceive is it a good idea to start progesterone to increase your chance of getting pregnant?

    • Dr.Lam says:

      A proper amount of progesterone is essential for successful retention of the fetus. The exact amount differs from person to person. Excess can lead to problems as well, so you have to look at both sides of the coin if you have concurrent AFS. This is a delicate area where lots of expertise is required. Click Progesterone Side Effects and Brittle Adrenals for more information.


  • catrina says:

    This article is fantastic,I have used natural progesterone in the past and present but now I fully understand how it all works and how to deal with it overall.
    I am 47 and have had chronic menopause symptoms,but I now feel with all your information I can use it in the correct way.
    Thank you so much

  • Babs says:

    Are there any “healthy” vices you can recommend? It’s hard to follow all the rules with AFS! Thanks Dr. Lam!!

  • Kika says:

    I had exhaustion, sleep disturbances, sweating and fatigue from progesterone cream, natural ,
    I stopped 5 days ago. before period, still have problems with sleep , exhaustion and dizziness, palpitations
    when would these normally wear off?. I know it may be a paradox effect but I want to quit it for now so how long does it take to wear off for these effects.??

    • Dr.Lam says:

      You should read this. Click Progesterone Side Effects and Brittle Adrenals for more information.


      • Kika says:

        Oh thank You very much Dr Lam, I did take it only for 10 days and the dosage was max 20 mg or less , I hope I will recover to better energy soon, anything you would recommend to help with this recovery?? does it take long after 10 days with low dose of progesterone to recover from the down episode. I should always follow my gut , sorry, for moaning , it is just very uppseting , dr does not understand adrenal fatigue .. sorry Thank you

        • Dr.Lam says:

          I wish I can tell you how long, but everyone is different, and there is no set range. The stronger your body, the shorter it is.


  • Millie says:

    Thank you! Understanding that it’s not about the absolute value but the ratio is absolutely insightful!

  • Kathryn says:

    Thank you for this incredibly informative article. It was my impression that natural progesterone (hormone replacement cream) is best applied vaginally. I didn’t see this information in your article. Can you comment?

    • Dr.Lam says:

      Different delivery systems have pros and cons. It depends on what you want to do. Vaginal is a fast delivery system, but not everyone can tolerate it. You do need to be careful and select what is right for your body.


  • Yvette says:

    Hello Dr Lam. Some background info, I am full hysterectomy (ovaries removed) 12 years ago. This year i had an episode where i was diagnosed with early stages of adrenal fatigue (high cortisol, low DHEA) and low sex hormones Estrogen, Progesterone and Testosterone, was prescribed a course of bio-dentical hormones… after a month was found to be of the top of the scale and suffering with Estrogen Dominance… spent the next 6 weeks detoxing and getting the hormone levels back done.
    Latest result now show slightly low Estrogen and low Progesterone, getting Estrogen dominance symptoms. Was prescribed Emerita Pro-Gest cream 1/4 tsp (20mg) twice a day , did start this but made my symptoms worse… so stopped for a couple of days and started again with a ‘smudge’ and built up to 1/8 tsp (10 mg) twice a day, there were slight improvements… had a couple of day break and started again on 1/8 tsp twice a day and then increased to 1/4 tsp twice a day. Everytime i increase to 1/4 tsp twice a day symptoms get worse…e.g. anxiety, depression, generally feeling unwell. Is this too much progesterone for me ? Is the Pro-gest cream any good ? should i be using something else or reduce dosage ? Many thanks

    • Dr.Lam says:

      your history of swings usually point to underlying weakness that has not be resolved but instead made worse by bHRT over time. we do see this in people who have a sensitive body. the focus should be at the root cause. reducing dosages etc may be benfitial but often not longn term in cases like yours. we have to get to the root of this. i dont know what else are you on, and if you want a more detailed response, you can repost in the ask the doctor section of my website .

      Dr Lam

  • Olivia says:

    Thank you for the information Dr.Lam!! i have PCOS and i have always wondered about progesterone and how it would affect my body. This was so helpful

  • Aj says:

    Sorry forgot to add that I don’t really ovulate.but i get my period every month but no ovulation. My Dr told me it might be be part of the reasons why i don’t ovulate……can low progesterone be the reason i don’t ovulate? Secondly can using progesterone cream help in any way?? I have been on LCHF diet since over 6months bcos of PCOS and wight gain… it ok for me?

  • Aj says:

    Hello Dr, I have been ttc since 2010 without know luck.2011 i did a fibroid surgery from that time till 2014 i couldn’t take in not to talk of July 2014 i did 2nd fibroid surgery again …between 2015/2016 i have done 3 ivf without any luck am so very tired with life…before the last ivf my Dr asked me to go check my DHEA level which i went to check and found out it was low as in low 0.1 after taking DHEA for 6months it came back to 6.something,anyway i was thinking it will help with my ivf but i still came out with nothing. I turned 36 years on the 24th of January 2017.25th January was my cd 21st which i went to check my progesterone level it came out to be 8.0 which my Dr said it was low that i have to be on progesterone.i just left and since then i have been lookin for second opinion and secondly the natural way of fixing it be honest am feeling left alone. Pls any advice will be highly appreciated. Peace

  • Angie Vogt says:

    This is so comprehensive and helpful. I especially appreciate the explanation of the three types of estrogen and the metabolic processes from cholesterol to progesterone. Thank you so much!

  • Kim says:

    Can using progesterone cream raise blood pressure?

  • JDavis says:

    Thank you so much!

  • Nana says:

    What’s more effective progesterone cream topically or progesterone pills orally?

  • devon k says:

    My husband and I are trying to conceive. I have had one miscarriage and one positive test with no pregnancy. I just recently started natural progesterone cream. My question is, since I do not ovulate until around day 18, shall I wait to start the cream until a positive ovulation test around day 18 or still start it on day 12 of my cycle?

  • Jill Jones says:

    Hello Dr. Lam
    First let me wish you a Happy New Year and thank you for this article. I have been searching for some answers and this article has definitely helped.

    Here is my situation: I am 56 and in menopause. I eat only a whole foods diet and very rarely have any restaurant food or grain other than rice which I tolerate very well. I train with weights 3x/week and leisurely walk 3x/week and have been doing this for over 6 years. It’s been a year since my last period. I was taking higher dose (300-400mg) Progesterone cream for about 8 months to combat estrogen dominance symptoms. After the 8 months which was about 2 months ago I felt as if I still wasn’t getting enough Progesterone. My libido began to fall again, and I started putting on weight around my belly and hips. I did some saliva testing and found my Progesterone levels to be very high (much higher than the high range). My Estrogen was within normal. I read a pretty long article from the Townsend Letter about saliva testing, which goes into why the test result numbers can be so high with saliva testing and using topical Progesterone cream. Shortly after taking the saliva test and reading the article I switched to a sublingual form of Progesterone. I did this for cost, and because I used sublingual in the past and preferred it, but could no longer find it, and because of the whole “cream building up in one’s tissue” thing. My mistake (very big mistake) was that I didn’t take into account the rate of sublingual absorption compared to topical. I still took the high dose (400 mg) of the sublingual. I began getting very tired, sleepy, I get slight headaches in the AM, and still no real libido. Thank goodness this has just been for about 6 weeks before this writing. Here are my questions (and I understand this is NOT medical advice):

    1) In your opinion would it be better to stop cold turkey for a period of time (how long??) or just lower the sublingual dose to maybe 20-30mgs 2-3 times a day? As I understand the sublingual enters and leaves the system faster, and I’ve been informed taking it more often 3-4 times per day would probably be a more steady dose.

    2) Should a woman who doesn’t menstruate still cycle progesterone (25 days on, 5 off)? And does it matter that it’s sublingual and not the cream?

    Thank you so much Dr. Lam

    PS. I hope my questions help other women because this can be very confusing.

    • Dr.Lam says:

      1. Stopping cold turkey is not recommended. There is no set time frame because each person is different. It can be from weeks to months or longer.
      2. Each delivery system has its pros and cons.

      My progesterone toxicity article is coming out in a few weeks and will be helpful to you.

      Dr Lam

  • Rose says:

    I am using a very small dose of progesterone cream but it keeps me awake at night and causes a weird tingling sensation in my head and body. Is this because the progesterone is turning to cortisol in my body?

    • Dr.Lam says:

      It could be, but there are also other mechanisms in place that could result in paradoxical reaction. Either way points to deeper underlying issues that need a detailed history to figure out.

      Dr Lam

  • Misty says:

    Is it better to start with progesterone cream or pills?

    • Dr.Lam says:

      Cream is usually the preferred route but pills can be considered if your liver is healthy.

      Dr Lam

  • Ellen says:

    I was told by my GYNO that I am not in menopause, because of a blood test she did, however I have not had a period for about 60 days. My Gyno says lets wait and see. I have hot flashes now and facial flushing. I would like to start Progesterone Cream to get relief but since I have no idea when my period will start I can not figure out when to start the cream, any help you could give would be great. This is a fanatic article!

    • Dr.Lam says:

      There is no guarantee that progesterone cream will give you relief, but it does help many. You can start anytime, but do make sure your doctor is ok and the dosage is right for your body as everyone is different.

      Dr Lam

  • Sue Lynch says:

    If this is scientific information it is the best I have read. What is written here about estrogen dominance makes sense to me. During menopause I was put on oral HRT (E&P). A few years later I developed breast cancer. I am now 4 years post cancer (surgery, chemo, radiation). Pathology indicated 90-100% estrogen receptor; 70-80% progesterone receptor. I then began 5 years of Aramatose Inhibitors. I tried them all but my body just rejected them – I was very sick; seriously allergic to one so Onco put me on Tamoxifen which gave symptoms of bipolar. Against the advice of my Oncologist I stopped taking them and I am at peace with that. What will be will be. Quality of life is more important than simply being able to breath in and out every day. When I stopped taking AIs my body returned to normal except for constant urinary tract infections and painful vaginal atrophy and incontinence. As I was told there was nothing that could be done as estrogen is the only treatment for vaginal atrophy and as I could never use estrogen again I was told to learn to live with it. I am married and in love with my husband and found that unacceptable so I went on a journey to find a solution. I tried the Mona Lisa Touch laser therapy – it worked well in so far as it stopped urinary tract infections and helped a little with the rest but not enough so off I went again to discover as much as I could. Long story short I did a raft of blood tests including hormones DHEA and Cortisol (blood test and saliva test) Estrogens, Protesterone, Testosterone etc and took the results off to a Compounding Chemist. Long story short again – he explained the difference between the 3 main estrogens, estrogen overload and the relationship between estrogen and progesterone. Basically everything you have outlined on this website was what was explained to me by the Chemist. I have been put on Ovestin Cream (Oestriol 1mg/g) and Progesterone 25mg cream 1 gram per night. I am still frightened to start using them as, after going through breast cancer and having the fear of God put into me from my Oncologist about estrogen, but after reading the information contained on this website I am more confident. Thank you……

    • Dr.Lam says:

      Glad the information is helpful for you. You do have to be careful of estrogen. Use only if really needed given your history.

      Dr Lam

  • Alice says:

    Thank you for the most concise info I have ever read on progesterone and also the adrenal connection. Your insights are a great help. Perhaps I can get my life back. I am beginning natural progesterone creme. One question: Another respected online physician recommends applying this creme directly to mucous/epithelial membranes lining the uterus and vagina for ideal delivery. What are your thoughts?

    • Dr.Lam says:

      If you wish a fast delivery, mucosal application is one way to do it. There is no “ideal” because everyone is different. Some people do better with fast, while others do better with slow like transdermal.

      Dr Lam

  • Brandon says:

    I’m a bit confused on your stance on men and progesterone cream. Do you recommend a small amount for men? Thanks!

  • mike says:

    hi Dr.Lam
    Im a male, 40 years old with low progesterone level. I used natural progesterone cream twice for about 10 days and had to stop because of conjonctivitis. Is there something I can do to avoid that ? because even within 10 days I felt I lot more energy and sex drive and I’d love to keep using the cream .


    • Dr.Lam says:

      Progesterone in male seldom trigger energy and libido increase unless it is channeled or shunted in part to make testosterone. Be careful. Talk to your doctor. You may feel good, but there may be underlying issues that you may not be aware of.

      Dr Lam

  • Jennie Swift says:

    40 years old
    polycystic ovarian syndrome
    I have been taking progesterone for approx. 5 months and my saliva results have come back
    for day 15 of a 28 day cycle
    Progesterone >1000.00 pg/ml
    Oestradial 7.07 pg/ml

    I feel so much better my skin has started to clear and my moods are also settling. My period pain has gone too. My breasts are still tender but I think this might be due to an iodine deficiency because I eat an almost vegan diet. My TSH came back at 2.5 rising from 0.95 previously. I have also developed a fibroadenoma/cyst and not sure if this is due to the initial unlocking of the oestrogen receptors when starting progesterone cream or the iodine deficiency. I feel really great! I did have some oesophageal reflux initially but this has gone too.
    I take 1/4 tsp twice a day from day approx. 9 to day 26.

  • Sara L. Wilmott says:

    This is a wonderful article. However, it appears not to apply to my age group. I am 76 years old. I bought the yam/soy cream, and have begun to apply it to the appropriate areas, but now I wonder if it is too late in life for me to do so. I have suffered from chronic intense fatigue for the past two years, and also have large nodules on my thyroid gland which the doctors want to remove. I hesitate, because I know I don’t have cancer, and besides, things can go wrong, and I have books to write and things to do before I go home to The Good Lord. The past few days, since starting to apply the cream, I have noticed my energy levels in crease. I understand too, that progesterone levels, if they drop, do not support thyroid health. Can you give me some tips? My doctor pressures me to have my thyroid gland removed, but I have begun to believe in supplements. COQ 10, D-Ribose, and L-Carnitine have definitely been helping my 40% reduction fraction of the left ventricle output. My doctor did not order any of these supplements for me, I did so myself. Thanks for any tips you might throw my way.

    • Dr.Lam says:

      Your situation, given your age, is complex and there is no simple “tips” because what is right for one person may be very wrong for another. The supplements you are on helps with the heart, but as far as progesterone is concern, it is very different. Progesterone normally has a calming effect and if you have more energy, it may be behaving paradoxically in your body.

      Dr Lam

  • Angelica M. says:

    Dear Dr. Lam,

    I am 31 and 6 years ago I had a tubal ligation. My obgyn assured me that there weren’t side effects and I trusted him. Well, he was wrong. After my sterilization I have had extreme weight gain (over 40 lbs), I have developed chronic fatigue as well as irritable bowel syndrome and endometriosis. Of course I have taken blood tests several times, and the results come back normal every time (progesterone, estradiol, LH, FSH, free T3, free T4, TSH, etc., everything is fine!). Nothing else is wrong either, and the above problems started right after the tubal ligation. I didn’t suffer from all this before my sterilization. I have a quite healthy diet, I don’t smoke, I don’t drink alcohol. I have tried acupuncture, herbal remedies etc, but it didn’t help. I have just begun to use Progesta Care (progesterone cream). Do you think it can help me with the above problems? I haven’t really noticed any difference yet… What else can I do? Thank you.

    • Angelica M. says:

      Dear Dr. Lam,

      Please read my comment above about the problems I have had after tubal ligation. After trying different treatments, I decided to try natural progesterone cream.

      I have used the progesterone cream as directed, but I have gained more weight (7 lbs within 2 weeks of use!). And I haven’t noticed any imrovement otherwise. Maybe you could explain why this is happening? I have gained so much weight after my tubal and I really don’t want to gain anymore… I thought that natural progesterone cream would help me lose some weight……

      • Dr.Lam says:

        Depending on the kind of body you have, progesterone can lead to water retention. Usually that points to underlying issues that may be concurrently happening, including receptor site issues and paradoxical reactions that can be temporary or permanant. Progesterone is NOT a good way to loose weight if that is your ultimate intent. You need to trace to why you have the weight gain in the first place after tubal. If the intent is to reduce estrogen load, it may not have acheived because estrogen is made in 3 main places in the body with ovaries being only one of the three. A detailed history with someone who know what they are doing is best to guide for you as labs are not good indicator.

        Dr Lam

  • Cathie says:

    Dear Dr. Lam:

    What is the best ratio of progesterone to E2 for a post menopause 70 year old woman. My recent saliva test that I had in August, 2016 showed Progesterone 152 and E2 4. I had been off all progesterone cream and a compounded E3 E2 vaginal cream for 6 months when the test was taken. I had stopped the progesterone cream and the vaginal cream because the previous saliva results that had been done in Feb. 2016 showed progesterone greater than 2000 and E2 at 2. I had used the progesterone cream the day before the test so I was sure if it was accurate. I was having severe anxiety, etc. All symptoms went away in a few months. I have been working with an integrated doctor off and on. She wanted me to take DHEA 5 mg because my saliva DHEA was 1. I tried it and it made me nervous, even cutting down to 2.5 mg.
    Now, I am experiencing those same symptoms again that wake me up in the early am and last a couple of hours. All my muscles tighten in my head and neck and I feel tingly all over. It dissipates as the morning goes on….diurnal of sorts. Cortisol??? Now I am wondering if I need a little progesterone again which might boost my adrenals, or try DHEA longer???Am in a quandary. I eat well and have been gluten free for 2 years. I do not consume refined sugar products, etc.
    I just didn’t know if the ratio as stated in your article was the same for post menopause. I have been using natural progesterone cream for over 20+years off and on.

    Thank you for a very informative article. I look forward to your reply.

    • Dr.Lam says:

      The pe ratio of 200 is general. When you are in menopause, you have to go by symptoms and the overall clinical picture instead of absolute numbers as there is wide variation. Low DHEA in a setting of AFS does not necessarily mean replacement is needed. IN fact, many get worse just as what happened to you. No surprise.

      Dr Lam

      • Cathie says:

        Dr. Lam:

        Thank you for your response. Do you think I should try the natural progesterone cream again…maybe start off with 1/8 teas. a day and see if it helps with current symptoms?

        • Dr.Lam says:

          I don’t know your body well enough to make recommendations. The more sensitive the body, the lower the starting dose is a good idea if one were to try.

          Dr Lam

  • Gina G says:

    I’m 43 years old. Had my uterus and cervix removed last year due to heavy bleeding. I still get sore/heaving breast monthly. Frequent headaches and horrible anxiety. Had my doctor check my hormones. Received a message back from her and all she said was ” blood work came back and you are not in menopause” and mentioned anti-depressants. I do not want to go on them! I have no idea if I’m really estrogen dominant. I have horrible anxiety over Brest cancer since I watched my Mother suffer. I wanted to start Progesterone cream for prevention but very nervous. Is this something that should/can be done without knowing how out of balance your hormones are?

    • Dr.Lam says:

      Estrogen is made from the adrenals, ovaries, and adipose tissue. No surprise to continue to be in estrogen dominance if your root causes are not all dealt with. The use of progesterone in an AFS setting needs to be very careful as it can worsen the liver congestion that most AFS may have in advanced stages. Lab test are not very good indicator at all. A detailed history is best.

      Dr Lam

  • Colleen says:

    which natural progesterone creme do you recommend? I have been oral at 100mg at night Is there a prescription progesterone creme?

  • Jo says:

    I’m a woman who is low in estrogen, yet my doctor recommended a topical progesterone cream for me to use. Does this make sense?

    • Dr.Lam says:

      It make sense generally speaking, but whether it is suitable for you is a different story. Everyone is different for delivery system, dosage, frequency, etc. Sometimes low estrogen does not mean you are low in progesterone as well. There are so many possibilities.

      Dr Lam

  • Laura says:

    This was so helpful and so comprehensive. It has been difficult to sort through all of this. I have never found such a good source and explanation.

  • Jennifer Alexander says:

    I have been using topical bioidentical hormone cream for years. i just picked up a refill from my pharmacy. i put it on and in a matter of m inutes my face was beat red and my arms as well and covered in a rash. what is happening? I have been extremely exhausted lately and also diagnosed with hashimotos a year ago. i am on armour thyroid. please help i am so scared of what is happening to me

    • Dr.Lam says:

      You need to let your doctor know and ask for instructions. there are many possible reasons, but one that is common is some form of intolerance to what you are applying.

      Dr Lam.

  • T. says:

    Thank you for such extensive information about progesterone and its benefits. I am not sure if I am clear in reading about low dose progesterone cream and whether it is effective to protect the uterus when in menopause and not using bio-identical estrogen replacement hormone. Could you elaborate?

    • Dr.Lam says:

      progesterone can be effective to offset estrogen dominance. The dosage varies from person to person, especially in AF. the normal psysiological dose dose not apply in most cases. If you have AFS, progesterone use has to be very careful. If there is no estrogen or other underlying issues, progesterone is not necessary.

      Dr Lam

  • Liz Greer says:

    I forgot to mention in my last post that my blood sugar level has been in a pre-diabetic range since my surgically induced menopause. I have also been told that my cholesterol is very high since then. Occasionally I also have a rapid heartbeat. All this despite eating healthy and exercising… Thanks again.

  • Liz Greer says:

    I am wondering if progesterone might be an option for me. I have been in post-surgical menopause for close to two years now. I have tried every other alternative suggested by my hormone doctor at Mass General to no avail–antidepressants, Gabapentin (seizure medicine), benadryl, herbal supplements, acupuncture, meditation, exercise, you name it. I have tons of hot flashes still. I don’t sleep well at all. I’m constantly fatigued. My mood swings are unbearable. I can cry for a whole day for no reason whatsoever (I do not feel depressed). I have no sex drive whatsover. My vagina is as dry as a bone. My A.D.H.D. medicine (Strattera, 25mg) doesn’t seem to be working at all anymore. I have trouble focusing and remembering important things. I’m a recovering alcoholic and have been sober 26+ years–so I don’t drink. I don’t smoke. I don’t eat refined sugar, flour, or wheat. I exercise regularly. My solitary fibrous tumors (a rare form of soft tissue sarcoma that I’ve had two of) had estrogen receptors on it, so my oncologist and ob/gyn surgeon do not want me to take estrogen. I’m at a loss. Is there a blood test that my PCP could order to find out what my hormone status is? Thank you in advance for any help that you can give me. P.S. I’m also a D.E.S. daughter and I’m 47 years old. My mother’s OBGYN gave her the estrogen steroid to not miscarry me (she had had three miscarriages before me).

    • Dr.Lam says:

      Your situation is very complex, starting from being DES daughter and surgical menopause. Hot flashes that are hormonally driven is often related to estrogen and progesterone dysregulation. both estrogen deficiency or progesterone deficiency can lead to hot flashes, and the sitauion is made more complex under AFS. there are ways to resolve this, but without knowing more detail, it is not possible to be accurate. A detailed history will know. Lab are not good.

      Dr Lam

  • Clay Anderson says:

    Greetings Dr. Lam,

    My wife is 42 and has a regular 28 day cycle with healthy flow. She isn’t symptom free, however and has tender/painful breasts days 21-28 and trouble sleeping. In addition, over the past year she has developed bladder irritation anytime we have sex. The irritation will last 3 to 5 days before diminishing and can severely impact her sleep. She has more than adequate vaginal lubrication, so I know that estrogen isn’t low. She tested serum progesterone on day 21 at 7 ng/ml (? units)…which her doctor says is on the “low end”. Is it possible that inadequate serum progesterone could be causing her bladder sensitivity/irritation? It is my understanding that the urinary tract has estrogen receptors and that adequate progesterone is necessary to “prime” those receptors. Could USP progesterone cream help her bladder symptoms?

    Thank you so much!

    • Dr.Lam says:

      It is not known for bladder, but it does have a calming effect for some people, but not all. serum progesterone is not the most accurate indicator. you need a more detailed history to correlate what is really going on at the root level, especially with regards to estrogenic type effect you expressed from day 21-28 . There is no conflict with serum low progeseterone you mentioned. I think something depper is gooing on and you should check further into it and the clues are there by detailed history, not lab

      Dr Lam

      • Clay Anderson says:

        Her saliva progesterone is also low per ZRT Labs. This started happening after she got off of progesterone cream and never happened before when she was on it.

  • Candy says:

    Is 21 too young to use progesterone cream to treat PMS?

  • Karen Johnson says:

    Hi Dr. Lam, I just purchased your books on Amazon (waiting for them to arrive) and was wondering if your practice offers nutritional supplements — such as asgawandha, holy basil, cordyceps, or bacopa — to support the adrenals? If not, is there a brand you trust? I am fond of Life Extension products but if your practice offers nutritional supplements I would certainly consider them. Thank you.

    P.S. Is licorice helpful or harmful to adrenal healing?

    • Dr.Lam says:

      we have a full line of supplements but I would caution you on self navigation unless you know what you are doing. There are many good brands on the market, but the key to recovery is more about timing, dosage, frequency, intensity, and understanding your stage. Its not about taking supplements and get better so simplistic unless you are in very early stages of AFS.Click Adrenal Fatigue Glandular & Herbal Therapy for more information.

      Dr Lam

      • Karen Johnson says:

        Thank you for this worthwhile caution. I look forward to reading your books and learning more. I would also like to contact your office for a consultation.

  • Karen Johnson says:

    Dr. Lam,

    Two (2) more questions (about delivery of hormones into body) I think a lot of women would benefit from:

    1) Is there any consensus on the best delivery of the hormones? I think it’s universally thought that oral delivery is bad (due to the liver effect) but there seems to be divided thought about transdermal cream. Some advocate for it as gentlest, but Diana Schwartbein, MD (an endocrinologist who wrote “Menopause Power”) argues that even transdermal delivery is suboptimal given that it produces an artificial “bolus effect” and also has a liver effect (not as bad as oral delivery, but apparently the sex hormone binding globulin test rises even with transdermal). So for these reasons, she argues against transdermal and advocates for intra-vaginal progesterone. Do you think there is a significant difference between transdermal and intra-vaginal?

    I currently take 10mg of the transdermal bioidentical progesterone cream (prepared by a compounding pharmacy) at night only. My doctor has offered to switch me to intra-vaginal delivery. Not sure whether to agree to this.

    2) I read that it’s important to take any hormone (including progesterone) twice a day, due to half life such that if you only take it at night (as I do) you are only covered for about 12 hours, and then the rest of the day you are not covered. Do you agree that splitting doses (of progesterone) between morning and night application is vital? I ask because I currently take the smallest dose possible (10mg) at night only and so far it has been working, so I am not keen on adding another 10mg in the morning as my doctor has recommended for a steadier dose. I was wondering if it is felt that a consistent 24 hour delivery of the hormone is important or whether “at night only” is good enough.

    Thank you.

    • Dr.Lam says:

      1. different delivery system has pros and cons. transdermal tend to be slower, and intravaginal has its drawbacks too. Some people need slow delivery , while others need fast or spiky delivery. Some people cannot tolerate either one so oral may be required even if it is not best for the liver. Remember we are all dealing with relative comparisons. What works for one person may not work for you. So it is very important NOT to seek the “best” protocol as there is none. What you should do is to find the one that works for your body. Some trial and error is needed, and if you dont have the experience , it is best to talk to a specialist.

      2. Splitting dosage is good but for most people is not needed. Some, however, needs to be split.

      Dr Lam

      • Karen Johnson says:

        Thank you for this helpful answer. May I ask what drawback may be present with intravaginal delivery?

        • Dr.Lam says:

          some complications including fatigue, anxiety, brain fog, candida infection, etc

          Dr Lam.

          • Karen Johnson says:

            Thank you for your gracious help. You have given me some very good tools with which to approach my doctor for answers. I may indeed contact your office for a more formal consultation. I look forward to reading your books as well. This is an evolving area of medicine (perimenopause and menopause management) which is no where near arriving at a firm standard of care and where there are (as you know) many controversies. Dr. Schwartzbein, for example, boldly makes the argument that a woman should intervene early at the first signs of the loss of the sex hormones, rather than wait until one is in her 50’s or 60’s to do so, and there is (at those ages) accumulated damage from the permanent loss of the sex hormones. This paradigm of early and permanent intervention, i.e. to the day you die, flies squarely against the “only use hormones for the shortest time possible, and only to reduce symptoms” model. Schwartzbein’s argument is for lifelong balancing therapy. As you know, the studies done for either argument all leave a lot to be desired (many are flawed by design or biased by conflict of interest), which also does not serve women. Finally, there is disagreement on the nuts and bolts of hormone management: What type of testing is necessary to prescribe? What type of testing period (saliva, serum, urine)? How much to test? How often? What interventions under what cirumstances? Like you said, it’s an art as much as a science, and the majority of doctors — including most gyn’s — simply do not have adequate training. I have obtained opinions already from some of the best places (including a Harvard hospital) and was incredibly disappointed. They will not discuss bioidentical (prepared by a compounding pharmacy) with you. They will only stick with the FDA regulated products, which come in less range of doses. In any event, all a woman can do is read as much as possible, such as the books you have written. I look foward to reading them, and thank you for writing them. Again, thank you for answering some of my preliminary questions which will surely facilitate my upcoming conversations with my doctor.

            Even if you are not having an acute hormone issue like I am, your books also have a broad application for anyone interested in greater health. The adrenals are important especially to all people in middle age and beyond, given the loss of the sex hormones.

            Thank you.

  • Karen Johnson says:

    Dr. Lam, I have 2 questions about progesterone use alone (no estrogen use) I cannot find the answer to anywhere:

    1) For women in late perimenopause who are not ovulating and have erratic periods (not menopausal but not regular periods or cycles – periods come erratically with skipped periods, no discernable schedule or cycle) and let’s say who also have symptoms of moderate hot flashes and trouble sleeping, do you recommend the 2-week a month only (roughly day 14-28) of cycle) schedule (which most closely approximates the rise in progesterone in the latter half of a normally functioning cycle) or the 25 day a month schedule with a 5 day vacation? This scenario describes me (I am 44 years old with history of high-dose chemotherapy for Hodgkin’s lymphoma at age 30 so I’m headed into an early menopause) and I am very afraid to make a mistake by taking a 25 day schedule rather than a 14 day schedule. It seems the 14 day schedule more closely approximates a woman’s normal intended cycle, but my doctor has ordered a 25 day schedule. It seems to me there is a big difference in the 2 approaches. I would be so grateful to know if you feel there is a risk or disruption to a woman’s intended functioning by agreeing to a 25 day schedule with a 5 day vacation monthly.

    2) Depending on the answer to the question above, should progesterone at any dose (I take 10mg only at night presently, as I wanted to start at the lowest dose possible) be used ever during the week a menstrual period comes? In other words, is it dangerous to use progesterone the week one gets a menstrual period, since there is normally a normal rise in estrogen during the first half of the cycle, and I worry that taking progesterone during this same week (a menstrual period week) would blunt the normal rise in estrogen which is supposed to happen during this time? In other words, if you are on a progesterone schedule (like the 2 named above) and you get a menstrual period, do you need to “reset” your schedule to avoid taking progesterone during the period week?

    I think it would help a lot of women to have the answers to the 2 questions above.

    Thank you.

    • Dr.Lam says:

      Until you are in menopause, the last 2 weeks application tend to do well for most. this is not universally true as some needs modification, depending on a variety of factors. As far as frequency, the theory of twice a day is standard, but my clinical experience is that once a day do well for most at night, but there are many exceptions, and each person is different. you do have to reset the progesterone schedule if you have extra ordinary circumstnaces. Generalization is what it is and it applies to most , but not all people. That is why you need specialist when your situation is special. your doctor will usaully factor in all the issues and should be able to give you a good answer.

      Dr Lam.

      • Karen Johnson says:

        Dr. Lam, This is helpful because most of the literature addresses either purely premenopausal women who are still menstruating regularly and/or ovulating, but having problems for one reason or another, vs. menopausal women who meet the medical definition of menopause (no periods for 12 months) but there is a big in-between category — Women like me, usually in their 40’s who are not menstruating regularly and not ovulating, and who have symptoms like hot flashes and trouble sleeping, yet do not meet the medical definition of menopause either. We’re the in-betweens.

        For the purely premenopausal group, the recommendation is using progesterone just for the last 11-14 days of the cycle – usually a maximum of 14 days of cycle. For the purely menopausal group, the recommendation is 25 calendar days a month with a 5 day vacation.

        Given I was having frequent hot flashes and trouble sleeping, even though I am not yet menopausal (I have erratic periods, skipping sometimes 1-2 months) my doctor offered me the menopausal schedule of 25 days a month with a 5 day vacation. I am new to the bioidentical hormone scene: I started on the 25 day a month schedule 10mg twice a day in August 2016, decreased to 10mg once a day at night, then got a period this month in September after having skipped June, July and August. Surely the period was in response to beginning the progesterone. The progesterone has helped a great deal with the hot flashes and sleep, and as said this month (Sept) I even got a period. I did notice during this period — my first after a 3 month skip — the worst bloat and breast swelling I ever had. I could not fit into my clothes, and I am not at all overweight. I’m currently on Day Six (period is tapering off) and bloat and breast swelling a bit better but not fully resolved. I am concerned about a paradoxical reaction if the initial schedule when I began the progesterone in August was too much for my body to handle. I was on about 20mg a day for the first week or so, then went down to 10mg a day, and kept this up for the 25 days then took a 5 day vacation. It did help with the hot flashes and sleep, but then when I got my period really horrific breast swelling and bloat, so I am worried the breast swelling and bloat was a paradoxical reaction.

        But here’s my biggest concern, which is about taking progesterone during my period: My doctor said to take the first day of the period as “Day One” and use the 10mg of progesterone at night from Day One until Day 25 — this includes the week of the period! I told her I thought you had to take a vacation from the progesterone during the period.

        In summary, I am leaning toward reducing back the current 25 day schedule to a 14 day schedule given I had a period this month, and am doing well except for the horrific breast swelling and bloat I had on my first period after beginning progesterone. Your email tends to support that it would be OK for a woman having any periods at all (who is not strictly menopausal) to at least try the lesser schedule (14 days) and then progress to a 25 day schedule only if necessary. This will be my plan.

        But I am still not clear on whether I should treat Day One of my schedule as including the menstrual week or not? It would be very helpful if you could comment on this. I ended up taking my 10mg of progesterone twice during my period week this week (I am currently on Day Six) because I couldn’t decide whether to take it or not during my period. (My doctor recommended, but most sources online say no.) I am very confused on this. Furthermore, what do I do if I am following a schedule — whether a 14 day cycle as we discussed or a 25 day schedule with a 5 day vacation — and then your period comes unexpectedly? Do you stop the schedule, and consider the arrival of your period like the arrival of a new Day One, essentially resetting your schedule?

        I would greatly appreciate any commentary you have. I am very confused by this.

        Many thanks.

        • Dr.Lam says:

          A bit of estrogenic effect resulting in heavy period etc occurs in a small number of people. it reflects the progesterone molecules sitting in the estrogen receptor sites, causing symptoms that looks estrogenic like heavy flow. this usually points to underlying issue if it does not resolve by itself. the rest of your question deal with specific situation that I cannot address without knowing much more about your body on a clinical basis because the too much individual variation. Optimum Hormone balance is an art that comes from years and years of experience and not a straight science. The use of natural progesterone was started in 1980s by Dr Lee who has passed away. We were fortunate to pick it up and have lots of experience over the past decades to see for ourselves when to follow “the book” and when to deviate from the book, so to say.

          Your questions are best dealt with by your doctor who knows your body the best. Remember when it comes to hormones, what works for one person may not work for another. Even in the best of hands, some trial and error may be inevitable. If you are a sensitive person, try not to self navigate and figure this out yourself as not only could you be wrong, but you could doing the right thing at the wrong time and not realize or masking underlying problems.

          Dr Lam

          • Karen Johnson says:

            Hi Dr. Lam,

            1) You already know after taking low-dose progesterone (with no other hormones) since August 12th (it’s about 6 weeks now) — at first 20mg daily for the first week, then cut back to 10mg daily with a 4 day vacation, then a menstrual period which came after the vacation was over, the first period I had since May or June, and it was robust (robust bleeding for 5 days tapering off today on day 6), but unfortunately lingering, persistent abdominal distention and breast swelling like I’ve never experienced, and I am trying to form a plan whether to keep trudging ahead with the progesterone (hoping this is like an initial effect which will normalize) or scale back from the current 25 day schedule (with 5 day vacation) to 14 days a month maximum.

            2) I am very undecided what to do. The schedule I was doing (25 day a month with 5 day vacation) progesterone really helped the hot flashes and sleep issues nicely. So I think overall I should stick with it. The question is the persistent abdominal distention and breast swelling. I am a slender woman who looks 5 months pregnant and my breast cup size has increased a full size. It’s also uncomfortable and feels all wrong. I also feel very “hormonal”. You said these are estrogenic effects.

            3) Are there any clues which would inform me whether to keep trudging forward with the current 25 day a month (5 day vacation) schedule which has been helping with the hot flashes and sleep, or whether the abdominal distention and breast swelling rather represents an overdose or reaction to progesterone which should not be ignored, i.e. I should scale back? If not for this really severe abdominal distention and breast swelling, I was ready to commit to the 25 day schedule for the following reason: Even though I am BRCA negative, my mother, grandmother and great grandfather all had breast cancer. I had a full medical genetic profile done and it found…nothing. They think my family may have a genetic issue not yet identified or discovered, because it’s a remarkable 3 generation family history. I have to get a mammogram every year, and ultrasounds every 6 months, and sometimes they add an MRI. So far all they have found are multiple breast cysts, possible fibrocystic disease and 1 episode of calcifications which were benign on MRI. So I was thinking the 25 day schedule might offer broad prophylaxis against breast cancer risk. But what if this crazy abdominal distention and breast swelling persists on the progesterone? If this is a reaction or overreaction to the progesterone, wouldn’t it be hard to un-do it? That’s my question. I am debating whether to scale back if not abandon the progesterone, as it seems we could always add more later, while a detox from it might be a lot harder (to give my body a period where the goal is to get the stored progesterone in fat out of my body if it is causing issues). My doctor said it’s unlikely my current dose of 10 mg at night only would cause true havoc. But I have never had abdominal distention or breast swelling like this. I’ve had it for 10 days straight — it started a few days before my period through today day 6 of my period — so about 10 days total I’ve had it. I know it could resolve on its own even if I take progesterone but what if it doesn’t?

            4) You talked about the possibility of an “underlying problem”. I am concerned here too. It so happens I was under recent, atypically high stress (a family conflict where I was accused of something unfairly) right around the week leading up to my period so right around when my symptoms of abdominal distention and breast swelling began. Also, I have allowed myself to have 2 cups of caffeinated coffee a day even though I am extremely caffeine sensitive. I gave up all caffeine today. For the record, I am also extremely alcohol sensitive. I don’t drink at all, but recently I went out to dinner with my husband (who is a doctor by the way) and barely 1 glass of wine and I really, really felt it to the point I was worried about walking straight when leaving the restaurant. So very sensitive reaction to alcohol. (That’s why I don’t drink.) I don’t have trouble managing my weight, but this is only because I am religious about not eating any sugar, limited very high quality carbs, healthy lean proteins (wild salmon, etc), healthy fats (olive oil, avocado, etc) and exercise 5-6 times a week. I am very careful. I take a lot of supplements including DIM (for estrogen metabolism), Indole 3 carbinol, saffron, turmeric/curcumin, green tea, etc. I’m a healthy eater who eats lots of cruciferous and leafy veggies. FYI: The day before my period began this week (so Day 30, I guess of a cycle) I had a cortisol (non-fasting, at 10am) measured at 15. My estradiol was 141 and my doctor was happy with that and said she does not want to give me estrogen. My FSH (again the day before my period began, so Day 30 essentially) was 22. Because of my abdominal distention and breast swelling, they did a pelvic U/S which showed nothing except a 1.5 cm possible cyst/possible collapsed follicle/possible collapsed corpus luteum. My Ca-125 was 13. I was worried about ovarian cancer given the abdominal distention/bloat for 10 days straight. They do not feel it is this. The likely explanation is hormonal — the fact I started progesterone about 6 weeks ago for the first time.

            5) So I am back where I began. I guess there is a chance it will resolve on its own, even if I trudge forward on the 25 day schedule. If it doesn’t resolve, I am looking at the possibility I overdosed (even on such a small dose of 10mg daily) and that too much progesterone has stored in my fat (even though I am not overweight). Or you could be right — perhaps this is an underlying issue, i.e. adrenal weight gain. Here’s a question: Can starting progesterone if your adrenals are not functioning right cause problems? How likely is this scenario?? Is this something you talk about in your books (which I have ordered)? Perhaps there is an underlying issue. As mentioned, right around the time my symptoms began I had a terrible stress (a family conflict) and show extreme sensitivity to caffeine and alcohol. I am sleeping better with the progesterone but before beginning the progesterone 6 weeks ago I was having sleep issues for about 6 months.

            Any thoughts are truly appreciated. Also I would appreciate if you could answer the question about if it’s dangerous to use progesterone during one’s menstrual period. I am still unclear if “Day One” of my 25 day schedule is the first day of an actual period? Do you see any drawbacks to using progesterone in this manner during the first half of the cycle when estrogen normally goes up?

            Thank you – I really appreciate your thoughts.

          • Dr.Lam says:

            underlying issues can include stress which in general can increase estrogen load. progesterone use during advance AFS is a complex matter – some people do well, but not everyone . Those who are in early stages usually do not have a big problem, but minor issues can arises . With your complex history and concerns, the best person to answer your questions is your treating doctor. Using progesterone during menses is not advised for most people but it does not mean it is dangerous. This forum is for general educational purposes only and unable to go in depth due to individual variation in a complex subject.

            Dr Lam

    • Mimi says:

      Thank you for this informative article. I am 35 and have been suffering from premenstrual spotting every cycle since going off birth control pills two years ago. I had serum progesterone levels checked on peak + 5, 7 and 9 and it was normal. Prometrium 200mg was offered as a solution and I declined. I started working with a Naturopathic MD who sent me for saliva testing and we discovered my ration of estrogen to progesterone was off (estrogen dominance), as well as high normal DHEA, and evolving Phase 2 HPA Axis dysfunction. She started me on 12.5mg bio-identical progesterone cream daily. My OB and NApro Creighton Model practitioner are against progesterone’s usage every day and say it should only be used during the luteal phase, and are prompting me to use Prometrium 200mg as a vaginal suppository. I’m interested in your thoughts on using progesterone cream daily instead of cycling?

  • Patricia Taylor says:

    Dear Dr. Lam,
    I have been suffering brutal insomnia over the past 6 months, no hot flashes but other menopause symptoms with anxiety. I just started using natural progesterone cream 20mg before bed to help with sleep. I did have a current estradiol blood test and my estriol was 15pg/ml. My Dr. put me on the combi patch synthetic HRT which was progesterone and estrogen. I had breakthrough bleeding , cramps and other uncomfortable issues. I couldn’t stand it and had to come off the HRT I was on it for just 6 weeks. Can you please tell me if I should be using an estriol cream in combination with progesterone to help with my sleep issues, or should I just use the natural progesterone cream. Also I did have a saliva test before starting any hormone replacement therapy my estriol was (6) depressed, Estradiol (13), Progesterone (44), DHEA (3) borderline. Please Help! Thank you !!

    • Dr.Lam says:

      E3 replacement is for very specific reasons. IT does not help with sleep unless you are estrogen deficient. REmember that estrogen deficient and progesterone deficient can give rise to similar symptoms. We really need a detailed history by phone to sort this out. otherwise, you can be doing what feels good but masking the underlying problem. If you are doing well on natural progesterone alone, estrogen may not be needed. Laboratory test for E3 being low, and borderline DHEA are only some of the considerations. Do not place over emphasis on lab. I am glad you are off regular HRT.

      Dr Lam

      • Patricia Taylor says:

        Dr Lam
        Thank you for your quick response! I would like to do a history ( consult) by phone with you, please send me the details and how to set up an appointment by phone.
        I have been using just the natural progesterone cream for the past few nights and have noticed a bit of a difference. I also read that you have said less is more in the article so I cut back to 10 mg of the progesterone cream and feel less cramping, just getting a mild headache.I am also supplementing with a low dose vitamin d 2000 iu with k… well as magnesium before bed. I am also very active in yoga and meditation, and I eat extremely healthy. Unfortunately all my obgyn and primary care physician tell me the other options is to take drugs or push through it knowing that I will feel awful. I look forward to a phone consultant.


  • Julianna G. says:

    Dear Dr. Lam,
    I have been using progesterone cream to balance estrogen dominance. While it has helped greatly with many pms symptoms I am still experiencing some problems like very tender breasts and mood swings around the start of my period. This month I applied the cream on day 12 and started menstruating on day 18 – I have severe nausea and my blood sugar is hard to regulate. Any advice? What does it mean when you start menstruating so early while using the cream?

    • Dr.Lam says:

      Many variables are involved in cycle length, and progesterone load is one of the variables. Without much more clinical history , it is not possible to tell. Tender breast and mood swings are generally estrogenic in nature fyi.

      Dr Lam

  • T. says:

    Thank you for this article. Progesterone cream may work different than other forms of progesterone, therefore about how long of a time do women using the low dose progesterone cream feel its benefits? (ie. once applied is the symptomatic relief about 4 hours or closer to twelve or twenty hours)

    • Dr.Lam says:

      it really varies, especially if you have AFS because multiple organs are involved. Sorry unable to give you a range.

      Dr Lam

  • T. says:

    Thank you for this article. I am hopeful that you are able to be reached but that you offer a variety of resources. It is especially helpful for the statements in bold black letters. I feel better with the cream when applied in the morning than in the later part of the day. HMMM. Therefore, I wonder since the results are inconsistent, when would sublingual progesterone be worth pursuing? Or how to achieve consistent relief, that is always the goal. I still seek….balance 🙁

    • Dr.Lam says:

      Consistent results can be achieved through proper balance in harmony with the body. Call my office if you need further help.

      Dr Lam

  • Mali says:

    What’s more effective – progesterone cream or progesterone pills?

    • Dr.Lam says:

      the different delivery system has different characteristic. effectiveness depends on the goal. your doctor will have to decide which is best based on your body, history, sensitivity and a host of other questions. Conventional docs tend to like to use pill as they are prescription called Prometrium, and they are not very familiar with other delivery forms.

      Click Progesterone for more information.

      Dr Lam

  • Claire says:

    Thanks so much for the great info! I’m 35 yrs old, fit, eat healthy, exercise & take no other meds. Used to be on birth control for over 10years. Finally stopped using it. Got very tired of having a nonexistent sex drive & started using natural progesterone cream. How long till libido starts to come back? I know it’s probably different for everyone but, days, weeks, months? Praying this works one way or another.

    • Dr.Lam says:

      progesterone itself does not increase libido.It is a balancer of estrogen. Libido is a function of many issues, including estrogen and testosterone etc. You should see your doctor for more in depth workup if libido is your concern.

      Dr Lam

  • T. says:

    Thank you for this article. I will re-read the information too. I am so glad to know that progesterone may stabilize blood sugar but does that mean progesterone cream must only be applied twice a day or with each meal to help stabilize blood sugar when in menopause? I can not use 20mg. of cream at one time. Its effects only last about 7 hours depending on the dose. : (

    • Dr.Lam says:

      Progessterone’s blood stabailizing effecct is indirect. It is usually taken or applied in the am and at bedtime. if you cannot tolereate progesterone, there are other issues involved that need to be looked into.

      Dr Lam

  • Tammy says:

    Thank you for writing about the effects of progesterone cream, they are inconsistent. I am considering sublingual progesterone drops. I am cautious about its effects including on teeth and gums. What are the effects on teeth and gums? Perimenopause and Menopause do affect my gums. Also what dosages are needed for oral progesterone when estrogen is not taken? Finally, is it true that progesterone can not be metabolized?

    • Dr.Lam says:

      Sublingual delivery system is good for those who wants a fast delivery and avoid the gastric system. It is not for everyone . The normal oral progesterone dose is about 200 mg, but everyone is different. Progesterone can be metabolized like any hormone, and it is done primarily in the liver.Those who have congested liver or very weak should be very careful with oral progesterone due to the first pass through the liver will effectively make the liver work harder. there are other delivery systems , including transdermal, that should be considered. your doctor should be able to give you the pros and cons of each for you to decide.

      Dr Lam

  • Lucy says:

    Dr Lam, thanks for this very informative and insightful article.
    Due to the results of a blood profile check up , I recently began using bio identical progesterone cream (20 mg once a day) and since I have been on it , I have had chronic insomnia , extreme drowsiness which in turn leads to low moods. Why is it having this effect on me?

    In addition I have been taking DHEA (15 mg once a day) and I am not sure whether this has also been contributing to the symptoms. I have stopped taking both for now as I cannot function with the side effects I had experienced.

    Any advise would be great, thank you

    • Dr.Lam says:

      Not everyone do well on progesterone, even if lab say it is low. Many factors are involved. Paradoxical reactions such as what you experience can indicate multiple underlying problem. DHEA can also be excitatory but if you take it in am, it usually wears off by nighttime. You should go back to the doctor who makes these suggestions. Self navigation is not easy because you need to understand the underlying physiology to make sense. The body does behave logically so that is good.

      Dr Lam

  • KL says:

    I had heart palpitations from a progesterone cream , bio identical , made for me @ chemist , is there any explanation for this ??

    • Dr.Lam says:

      That can happen to a small number of people who usually have already intrinsic sensitivity or paradoxical reacton indictive of something deeper that is not right. You need to focus on tracing it to the root cause by way of detailed history as lab is usually not fruitful.

      Dr Lam

      • KL says:

        Thank You dr Lam for your reply, could this be connected with sugar issues somehow / anyhow ?? Something that speeds up digestion ?? i had similar things from iron supplements, and some sulphur veggies, although there are other things that cause it and tracing it is a challenge. That is why I asked if this somehow can be connected with insulin / sugar etc? My saliva is still acidic as well … ach , anyway thank you , at least I know I am not crazy nad this can happen, as I was told it is in my brain, well it is not, I get irritated after small dose of a cream, like I was about to explode, itching , and then the palpitations. and I need to go to the loo very often ,

  • Debbie Stewart says:

    Dr Iam, I was on a Combipatch for a few months, but quit it about a month ago. All the menopausal symptoms have returned. I also have thrombocytopenia, and have tested positive for autoimmune, but, to date, remain undiagnosed. I am also supposed to be having a hysteroscopy and a D&C in the next week or two. Would any of these circumstances prevent me from using the progesterone cream? Thank you for this wonderful article.

    • Dr.Lam says:

      Your hormones are not well balanced. Progesterone consideration in a case like your needs to take into consideration your age, height , weight, consitituion etc. Thrombycyopenia is unrelated issue, but the fact that you may need D and C alraedy indicate the body likely to be in estrogen dominance. Textbooks would point to progesterone being more likely benefitial, but you really need to talk to a doctor who really knows because your situation is more complex that what meets the eye and sometimes progesterone can make matters worse.

      Dr Lam

  • Hannah says:

    Dr lam I can’t shut off my adrenaline.. I’ve been told to take magnesium as I am deficient. My symptoms occurred after trauma from a car accident . I wasn’t hurt physically but my hormones may have gone out of wack . Do u think progesterone would help? If I take it to combat my estrogen/ adrenaline dominance , do I need to take it for like or until my hormone levels are restored ? I’ve read that longterm
    Application is not good. Thank you!

    • Dr.Lam says:

      Progesterone have a calming effect. It simply helps with symptoms control. Reducing adrenaline output should be your long term focus and it is not easy without a very comprehensive program because once you are in a positive cycle with adrenaline, the situation gets worse over time if not reversed.

      Dr Lam

  • Stephanie says:

    Thank you for the informative article! how long does a person have to be on progesterone for?

    • Dr.Lam says:

      it really depends on the purpose and your age. For example, some people use it for sleep, others for estrogen dominance, and others for anxiety. Without knowing your body , it is not possible to tell. If you have AFS, you have to he extra careful.

      Dr Lam

  • Kimberly says:

    I’m 59 and went through an early menopause at 45. I was on biodentical hormones off and on during this time. Tri-est, estradial and Estriol. My middle & hips and I’ve always been super thin until this life change. I finally just got off all 6 months ago & am looking for better answers. I’m sure I’ve probably got stored up estrogens for many sources including from chemicals. What can you suggest for me to do with progesterone be able to sleep better, lose puffiness/weight gain around my middle & thighs and feel less foggy headed? My skin is sagging on my legs now and I’m tired of feeling this way.

    • Dr.Lam says:

      many people use natural progesterone to offset excessive estrogen, but it is not universally good for everyone, especially if you have AFS in advance stages. Hormonal balancing is a complex issue requiring detailed history. Tri-est may not work for you for a variety of reasons. I am not sure you have it sorted out in detail. your weight , height and previous history also makes a big difference on the dosage and degree you do well or not well on hormones. progesterone has sedative effect but it can also increase brain fog. Click Brain Fog for more information.

      Dr Lam

  • Marie says:

    Dr. Lam,

    Thank you for this very informative article.

    In my late 40’s…rapid sudden weight gain of 12 lbs within two months. Eat well and exercise consistently…weight gain literally hit from out of the blue and is mainly concentrated in stomach. Hypothyroid managed well with Armour and all thyroid numbers (Free T3, T4, Reverse T3, etc,) in range. Ultrasound normal.

    Estradiol (day 3) 60 pg/mL
    Estrone (day 3) 32 pg/mL
    Progesterone (day 25) 5.1 ng/mL
    FSH (day 3) 14 mIU/mL
    Vitamin D 52.4 ng/ml

    Before I follow-up with physician, wanted to get your thoughts just looking at the numbers and if boosting that progesterone level may be a possible avenue to discuss with doctor.

    Thank you very much. So glad I came upon your website!

    • Dr.Lam says:

      there is no reason to boost progesterone unless you are in estrogen dominant state. Central weight gain is a sign of metabolic imblanace. If you have associated AFS at the root and unresolved, using thyroid replacment to achieve normal lab will only mask the underlying issues. you need to take a deeper look at what is really going on by detailed history ( and not lab) and outside the box if you want to get to the bottom of this.

      Dr Lam

      • Marie says:

        Thanks for your response Dr. Lam. It is much appreciated.

        I wish it was easy to find more physicians like yourself…ones that are willing to think “outside the box”. Unfortunately, most doc’s don’t and finding an AFS literate doctor in my area is impossible.

        Any suggestions on how to approach a traditional doctor to start thinking “outside the box”? Or is that wishful thinking??

        • Dr.Lam says:

          It difficult because most are too busy and have no time to focus on learning things outside their regular speciality. You need to look around and if you need to, you can call my office. Most hormonal balancing can be done naturally and is not complicated if one understand the physiology behind as the body does behave logically.

          Dr Lam

  • Estefani says:

    I have not had a regular period in 2 months .. I’m suppose to start my period on the 11 of August .. I had brownish reddish period but very light and then super light in the beginning of August ..I had an abortion in November but my period came back regular then this happen .. I’m not sure if because I have a yeast infection .. I’m not sure if I should go ahead and use the progesterone cream or see a gynocologist ?

  • Laura says:

    Hi there,

    Progesterone blood test showed high (above luteal range) progesterone on day 21 of cycle, and very low (very bottom of follicular range) on day 4. I am wondering if natural progesterone cream would still help in my situation? And when I should apply it. My adrenal fatigue symptoms seem to be worse each month right before and during my period. I have been suffering with debilitating adrenal fatigue for just over two years. It all started when I went off of birth control after a decade, so I am wondering if progesterone cream might give me some relief. I have not made much progress with other things I have tried. Thank you so much for all of your great information.

    • Dr.Lam says:

      We have found that the best indicator of natural progesterone in a AFS setting really depends on the history and what the body is trying to tell you. Blood test are not very indicative, and if you have AFS, other components of your body, such as the liver, may affect the metabolism of progesterone greatly so it is rather complicated process of sorting things out and not as simple as trying to “normalize” lab values which actually can backfire on you.

      Dr Lam

  • Elizabeth Cross says:

    Hi there,

    I live in Australia and am wondering what progesterone cream you recommend that can be shipped here? Thank you!

  • Lisa says:

    Thank you very much for this very informative and easily “digestible” information on progesterone and it’s use. What you covered made so much sense and rang true as I read it, from the symptoms to the solutions. I felt relieve knowing there is a simple natural solution to what I am experiencing with menopause as I also consider this a natural progression of the body and want to address it naturally. Again, thank you and please continue to pass on your information and solutions.

    • Dr.Lam says:

      thanks for your kind words. natural progesterone is a very important natural hormone for women. Some people, however, do not respond well so you do have to be careful as well.

      Dr Lam

      • Dee says:

        I am sensitive to medication. I just started microionized progesterone pill and although it helped me sleep, it made me extremely bloated abd constipated.

        How do I know if I’m a candidate fire natural progesterone? What happens to those who don’t respond well to it?

        • Dr.Lam says:

          Progesterone delivery system comes in many different forms for different reasons. you should talk to your doctor. We seldom use micronized progesterone in the setting of AFS dues to many possible side effects and unintented consequences.

          Dr Lam

  • Janice Morgan says:

    My daughter is 20 years old. She is a div. 1 soccer player. She attends a very rigorous university and has suffered from high stress and anxiety. She recently suffered 4 tonic clonic seizures in the last 6 months, all of them during ovulation. All her life since puberty, she has suffered debilitating menstrual cramps and leg cramps while running. They found a large hole in her heart along with 3 smaller holes which they fixed, but everything was normal with her brain scans. I am having her progesterone levels and other hormone levels checked, but was curious if all these things can be linked, and if progesterone cream can help?

    • Dr.Lam says:

      You need to make sure you can interpret the lab as it can be misleading,especially if it is serum. Natural progesterone ( not progestin ) is calming in nature, especially in high dose. Unfortunately, conventional docs are not going to support your appraoch. Seizure usually have deep seated reasons, so it is important not to simply suppress unless you already know the reason, no matter what you take. She is very young and I urge you to take some time to find out what is really going on, and a detailed detailed history is best as labs are usually not going to tell you much until very late.

      Dr Lam

  • Andrea Harvey says:

    A most informative article and information. I am in full menopause and on prescribed Evorel 75 patches and Provera, both of which cause concern to me for the obvious risks. I am in the UK. Both HRT was prescribed by my own GP and then private consultant. I have no idea what brands of natural progesterone are available in the UK or otherwise? What/which natural progesterone should I be asking my Consultant about please? Many thanks

    • Dr.Lam says:

      You can consider P balance available at and shipped worldwide.

      Dr Lam.

  • Thea says:

    How fast will supplemental progesterone show up in blood tests?

  • julie says:

    Thank you for this information. It is hard to find accurate and complete information about this subject and the rationale behind it.

  • Lindsay says:

    I am a 34 year old female with 2 childen, 7 and 3. I have recently been diagnosed with hypersomnia and put on Vyvanse. Even with the 40mg of that, I’m still extremely fatigued. I also have menstrual migraines so I take Topamax. I have endometriosis, which when they ‘tied my tubes’ in 2013, they removed a lot of built up scar tissue. They have me on a ‘moose stabilizer’, Lamictal for mood swings. Then to top it all off, Trazodone to help me fall asleep at night. The last year and a half, my libido is almost nonexistent and when I do have sex, I tend to get dry quickly. I would love to stop taking as much medication as possible. I have my yearly pap exam in 2 days, would it be a good idea to talk to her about testing my hormones? I have had my cortisol tested back in 2010 and according to my doctor at the time, it came ‘normal’. What are your thoughts, any advice or comment is welcome.
    Thank you!

    • Dr.Lam says:

      The conventional medical approaches you have gone thru are quite standard,and unfortunately, the outcome far from desirable. Do think outside the box. Laboratory test are not very accurate. Click Laboratory Testing for more information. Concentrate your effort to find an AFS literate doctor is your key to recovery. Your problems are real, but conventional medicine cannot find the root problem, but we know it is there. A detailed history is needed.

      Dr Lam

      Dr Lam

  • Marissa says:

    Thank you for this thorough and highly informative article. I am 4 months postpartum and I suffer from terrible anxiety and insomnia. I would rather not take antidepressants or chemical sleep aids. Would natural progesterone help, especially with my lack of sleep. I find that when I am sleep deprived, tossing and turning, all night it exacerbates my other postpartum anxiety issues. I stopped breastfeeding at 3 months. Thank you.

    • Dr.Lam says:

      Natural progesterone has a calming effect, but everyone has different degree of effect and is dose dependent. Those who have AFS may have paradoxical reaction . You do need to be careful if your doctor is ok for you.

      Dr Lam

  • Tricia says:

    Thank you for an excellent and very informative article. I am menopausal (without periods for 7 years). I have osteoporosis and suffer from hot flashes. I avoid coffee and alcohol. I have been using a natural progesterone cream topically for 10 days, so am at the early stage of use. The products website advised rotating the application sites between; inner wrist, inner upper arm, inner thigh, hips, buttocks and lower abdomen. I would like to know if all of these locations are OK to apply the cream? Also can I apply the cream viginally? If so can this be done daily and are their any risks involved when applying progesterone directly into the Virginia? One of my friends recommended I apply it in this way, but I want to check if this is safe. Please advise. Thanks

    • Dr.Lam says:

      Different delivery route offer different clinical results. Transdermal cream is most gentle. Sublingual and intravaginal offers faster absorption which is good for some people but not good for others. You also need to be careful of Candida if you use vaginal delivery system. Post menopausal program typically involves 25 days on and 5 days off. If you have multiple questions on what to do, you should consult a professional. What works for some people may not work for others. Every one is slightly different.

      Dr Lam

  • Christine says:

    Hi. I have been taking Provera since April for heavy bleeding due to fibroids and endometrial thickening. I still have had heavy bleeding and am now wondering after reading all the information that you have given if Provera is helping or doing more harm. I want to ask my doctor about using he natural progesterone cream but not sure how receptive she would be. My question is are most doctors educated in the use of natural progesterone vs. synthetic. Is natural progesterone prescribed by doctors?

  • Saba says:

    This was such a thorough and informative article. I truly appreciate the time you took to write this and share with your audience.

    Thank you!!

  • Karen says:

    Appreciate any advice as I’m not sure if I should go ahead with progesterone cream myself and monitor my symptoms for signs of improvement. I have autoimmune issues, leaky gut and have had a number of hormone issues such as lumpy breasts, uterine fibroids, micro benign pituitary tumour. I know my issues started with stress in my 20’s and had low blood sugar, anemia, glandular fever etc. About 6 years ago I crashed with severe adrenal fatigue and since then have never been the same. I know allt about leaky gut, eating well, supporting adrenals and supplements, however I am still struggling with fatigue, hair loss, low libido and general struggle with energy levels. I feel I need a boost and wonder if progesterone cream would help alot. I was dianosed with Hasimotos about 10 years ago and take thyroxine but my adrenals were never addressed by any doctor and my endocrinologist is only watching for Addisons etc.
    My stress levels are good but I still cant get on top of the issues mentioned above and as I am now 46, I would like to get my hormones balanced so I can feel confident going into menopause.
    Do you think I should give progesterone cream a go for 6 months and monitor myself or get a hormone test done with a natropath and hope for the best?

    • Dr.Lam says:

      There is a lot of factors that need to be considered before you embark on a progesterone program. Like other hormones, it has to be metabolized. If you have issues with metabolism, which is frequently associate with adrenal fatigue and thyroid issues, you may not tolerate it well or it can make matters worse. On top of that , in small number of people, progesterone can actually enhance fibroid growth. Most people , including naturally oriented doctors, are not alerted on the connection between progesterone and AFS. Given your long and complex history, I would not recommend you self navigate. Remember also that laboratory test is not very helpful in cases like yours for a wide variety of reasons as well, so it is imperative that you or your practitioner really knows before embarking. Progesterone has its place, but has to be properly titrated for maximum effectiveness.

      Dr Lam

      • Karen says:

        So which tests do you recommend for me to start with right now?

        • Dr.Lam says:

          Salivary progesterone and estrogen tests can be considered but that is not necessary all the time. If you suspect you have hormonal issue, the first step is to talk to someone who knows what they are doing. A detailed history is the first thing to do. There are so many possible tests and some are confusing and can be misleading. Knowing which one to do , if any, will save you a lot of confusion.

          Dr Lam.

  • Stephanie says:

    I am amazed at all the information provided, you have definitely put my mind at ease. The how to apply progesterone cream part of the article was especially helpful to me. It is great to have info. on how to use progesterone based on each situation. TY!

    • Dr.Lam says:

      Thanks for your kind words. Please do remember that in a small number of people, regualar protocol do not work and have to be customized to fit the body.

      Dr Lam

  • V says:

    I used progesterone cream to minimize uterine fibroids symptoms (extremely heavy bleeding and cramps) but it makes bleeding WORSE. So much worse that I’ve had to get two blood transfusions. What’s causing this? What should I do?

    • Dr.Lam says:

      In a small number of people , such as those who are consitutionally weak or thin and small framed, for example, progesterone tend to have an estrogenic effect and behave estrogenically. Thus bleeding can increase. Sometimes it goes away after a while, others it may linger on . You should not be self navigating in such situation because other body system may have similar “paradoxical effect” in different ways, and this is just one of the many symptoms you may encounter from a broad based perspective. Everyone is different. Use this opportunity to look for the root cause. That is the key, and laboratory test is not helpful due to lack of sensitivity. A detailed history by a knowledgable clinician will paint the picture.

      Dr Lam

  • D Jane Kennedy says:

    I am a little confused, l understand the estrogen dominance etc. in fact l wS fortunate to hear Dr. Lee speak in the 90’s. My question is this. Are phytoestrogens a beneficial supplement or do they add to the estrogen dominance. Thank you.

    • Dr.Lam says:

      If you are already in estrogen dominance, phytoestrogen would add to your estrogen load.

      Dr Lam.

  • Charles Stewart says:

    Can a male use a small amount of progesterone to increase libido ?

  • Mary says:

    Hi there – I have low progesterone and unexplained fertility issues. I have been supplementing with topical progesterone for 3 months. It has been hugely helpful – very reduced PMS, better sleep, libido, skin, and no more swollen breasts after ovulation. I’d like to know how long I can continue using progesterone cream (I currently use day 13 to when period starts) i.e. should I use for 6 months and stop or can I continue indefinitely. And is it OK to use it intravaginally? Or rather topically as your article suggests. Thanks.

    • Dr.Lam says:

      If your body’s progesterone level is low, reproduction is challenging. Click Reproductive System Disruptions & Adrenal Fatigue Syndrome for more information. The long term use of progesterone depends on many factors, with age, menstrual pattern, estrogen level, systemic equilibrium etc to be considered. the normal physiological dose is 20 mg. Some people need more, while others need less. Too much progesterone can be sedating and candida thrive in that environment. Also because progesterone is metabolized by the liver, you should be careful if you have liver congestion etc. So you can see that proper use of progesterone requires expertise especially if you want to use it long term. There are different ways of delivering , including sublingual, vaginal, topical, oral etc. Each has its benefits and down side to consider. Topical are slower in release as compare to sub-lingual, for example. You have to know the purpose prior to beginning. The most common is cream form.

      Dr Lam

  • Ruth Gauld says:

    I had the Mirena IUD since 2008 (first one removed and second one inserted in 2013) and finally had it removed in March 2016 due to many nasty side effect: weight gain (30+lbs) headaches, fatigue, brain fog/word salad, swollen/sore joints, hair loss, loss of libido, mood swings, breast tenderness. I thought I was peri menopausal but the blood test came back ok. Anyway after lots of research I decided to get it removed however I am struggling to rebalance my hormone levels. I am eating clean – no grains or legumes, no refined carbs or added sugar, no dairy. I am getting exercise too but somehow I still feel sluggish, tired, lethargic, fat and grumpy. I am taking supplements of Vitamin C, B complex, D3, K2, Adrenal Health support, Maca Root extract, flaxseed oil and calcium with magnesium. I am now looking into using a natural progesterone cream. Please advise if you think that this might help in my case??
    Thanks in advance

    • Dr.Lam says:

      Glandular and herbals like what you are taking ramps up the body to increase energy. Using this appraoch to reduce tiredness has short term benefit but long term issues, so you need to be careful. Click Adrenal Fatigue Glandular & Herbal Therapy for more information. Natural progesterone is used to balance estrogen, but whether it is suitable for you or not depends on the underlying imbalance to begin with . Intolerance to IUD and subsequent hormonal imbalances and adrenal weakness often will resolve by itself over time, but this varies from person to person.

      Dr Lam

  • Mary says:

    Hi, I have PCOS and have had 2 miscarriages last year. I haven’t had a period in 6 months but a couple weeks ago I started having symptoms that made me think I was either about to have it or I was pregnant. I took a test yesterday morning and there was a faint positive line! I am worried that if I really am pregnant that I will miscarry again. Is there a progesterone cream I can take while pregnant? I don’t have a primary DR and haven’t had any bloodwork done yet to check my HCG levels.
    Thank you!

  • Wendy says:

    Thank you for such an informative article! I’m a little different and I am having trouble finding any articles on women that have had hysterectomies at age 40. It’s been six years and I take 20mg (2) x day of natural progesterone, Maca, Licorice root, magnesium, zinc, fish oil. I’m almost non-existent in my sex hormones and my Dhea was 85 at my last blood test. My head is very heavy as well as my eyes, eyes are also very dry, my ears crackle all day, and my balance if off, like I’m going to fall. I sleep 7-8 hours a night but I yawn all day but still have energy to do a lot. My diet is clean as well. Your input is greatly appreciated! Thank you!

    • Dr.Lam says:

      The normal physiological dose of natural progesterone is 20 mg a day, and depending on your age and menstrual cycle, the days you apply. Too much natural progesterone can cause a sedative and lethargic type effect, so that is one concern. Maca, zinc etc are stimulatory and can have long term issues if you dont titrate properly. If your adrenals are weak and liver sluggish , then collectively these compounds can make the body internally even weaker. A more detailed history is required to put the clinical picture together. you should be careful because after hypsterectomy, the body’s hormonal status changes and what works for one may not work for you.

      Dr Lam

  • Cynthia says:

    Thank you for your informative article. I’ve been taking progesterone cream (20 mgs.) since my last period in October. I’m peri menopausal, and it’s helped greatly with my sleep. I keep hoping it will help with my weight gain, but no such luck. Since I am already eating healthy organic whole foods, exercise daily, no processed foods or sugar, and I try to get my 7 to 8 hours of sleep, do you think more progesterone would help me lose the 22 pounds I’ve gained around my waist?

    • Dr.Lam says:

      progesterone does not help you to loose weight, especially around the waist, as that is a metabolic driven event more related to cortisol.

  • Autumn says:

    Does using progesterone cream stop our bodies from making their own progesterone? If we take progesterone and then stop, do our progesterone levels go back to where they were before we started using the cream? Thank you!

  • Heather Lovekin says:

    Wow Im impressed with all the information you have provided. Ill have to inform my MD about this article. Thank you.

  • Amy says:

    I feel SO much better when using my bio-identical progesterone cream, but I suffer from headaches during my menses and also sore breasts. Can I just take a lesser amount of Progesterone during these days? I’m 42 years old, and do have AF, treating under a dr with low dose Hydrocortisone.

    • Dr.Lam says:

      headache and sore breast usually indicate estrogen dominance. More progesterone may be needed during such time, but there are exceptions, such as when you are on hydrocortisone which can clinically upset the normal outcome. A detailed history will tell the whole story and put the puzzle together. Laboratory test are usually not helpful.

      Dr Lam

  • Nigel says:

    My wife takes progesterone but it seems she’s overdoing it a bit. I’m worried she’s going to crash. Is there a level of progesterone that is unsafe?

    • Dr.Lam says:

      Overuse of natural progesterone can lead to candida overgrowth and have a sedative effect. Those who are sensitive can also become estrogenic and may have adrenal crashes triggered as a result. While it can be helpful for those with estrogen dominance, it can also make fibroid worse. Those with advanced AFS should be very with the use of natural progesterone and factor in all the pros and cons. It is often not straight forward, unfortunately. Going by laboratory value alone without factoring in many other issue can lead to the misuse of progesterone and resulting in retarded AFS recovery. Experienced professional guidance should be considered.

      Dr Lam

  • Jules says:

    Are there any negative effects if a man comes into contact with progesterone cream?

    • Dr.Lam says:

      Progesterone cream will be absorbed through the man’s skin. Man can use a small amount of progesterone cream ( 5 mg or less) to offset the estrogen dominance society we live in. Tip: wear pajamas to cover yourself if your spouse is putting the cream on their skin that you may come in contact with

      Dr Lam.

      • Silvia Matos says:

        Dr Lam
        My son has adrenal fatigue, he is 18. Will progesterone cream help?

        • Dr.Lam says:

          I am not sure what the reasons you have to think this will help. progesterone is generally used for hormonal balance in female.

          Dr Lam