PRO-HM Questions and Answers

1. What is progesterone?

Progesterone is a steroid hormone made by the ovaries at ovulation, and in smaller amounts by the adrenal glands. On average, women produce approximately 4-24 mg of progesterone daily, during the second two weeks of the menstrual cycle.

2. Why would a women need to take progesterone cream?

Progesterone deficiency affects countless numbers of women worldwide. Women most affected by low progesterone are women their mid 30s when progesterone production drops as much as 75% during that time until they reach menopause. By the age of 35, at least half of all women are progesterone-deficient according to some research. When progesterone levels begin to drop, women often notice symptoms such as:

* PMS
* Fatigue
* Hot Flashes
* Weight Gain
* Night Sweats
* Food Cravings
* Irritability/ Mood Swings
* Anxiety
* Water Retention
* Heavy Menstrual Cycles
* Cramps
* Sleep Disturbances
* Irregular Menstrual Cycles
* Hair Loss
* Breast Tenderness
* Low Body Temperature
* Hormonal Headaches/Migraines

There are several health conditions that are associated with progesterone deficiency, such as; infertility, endometriosis, breast cancer, uterine fibroid tumors, bone loss, Fibrocystic Breast Disease, heart disease and miscarriage.

3. Does progesterone cream have side effects?

There are no known long-term adverse effects noted for supplemental natural progesterone in amounts that replicate physiological levels of progesterone made by the female body. It is not recommended to use more than the suggested amount of progesterone cream, unless under the direction of your health care provider.

4. Can I use too much progesterone?

Progesterone has a calming effect on the body. Excessive amounts may have a relaxing effect on the brain or cause drowsiness.

5. What is USP Progesterone?

United States Pharmacopoeia (USP) Progesterone is bio-identical progesterone. That simply means it is progesterone that exactly matches the progesterone naturally produced in the body. The title "USP Progesterone" differentiates natural progesterone from synthetic versions of progesterone.

6. Why should women be concerned about synthetic progesterone?

Natural Progesterone is preferable to the synthetic progestins such as Provera, because it is natural to the body and has no undesirable side effects when used as directed. The synthetic progestins can cause many side effects, including partial loss of vision, increased risk of breast cancer, an increased risk of strokes, fluid retention, insomnia, anxiety, migraine headaches, asthma, cardiac irregularities and depression, etc.

7. What is estrogen dominance?

Dr. John Lee coined the phrase "estrogen dominance." Estrogen dominance is the condition in which progesterone levels are low and estrogen is too high relative to progesterone. Estrogen is a potent hormone when not balanced by adequate progesterone. Women of all ages can experience symptoms of estrogen dominance. These symptoms can occur in women with PMS, peri-menopause, menopause, and even post-menopause. Symptoms of estrogen dominance include: weight gain, bloating, mood swings, irritability, breast tenderness, headaches, fatigue, depression, hypoglycemia, uterine fibroids, endometriosis, and fibrocystic breasts. Estrogen dominance increases the risk of cancer of the breast, ovary, endometrium (uterus), and prostate. Additionally, estrogen dominance may contribute to the growth of uterine fibroids, and inhibit the use of thyroid hormone in the body.

8. What is progesterone made from?

The natural progesterone used in progesterone cream comes from plant fats and oils, usually a substance called diosgenin which is extracted from a very specific type of wild yam that grows in Mexico or from soybeans. In the laboratory, diosgenin is chemically synthesized into a molecule that exactly matches real human progesterone.

9. Why should we use progesterone cream transdermally (through the skin) rather than take a pill?

Hormones used on the skin, including progesterone, have been found to be highly absorbable. When taken orally, hormones go through the digestive tract. As much as 90% of hormones taken orally are converted to other metabolites which have different actions in the body than the original hormone. Some metabolites may contribute to side effects. On the other hand, when hormones are applied to the skin, they are 20-50 times more efficiently absorbed, passing through the skin right into the capillaries, at which point they travel throughout the entire body. Therefore, all of the hormone applied remains in its original form in the body.

10. Where should I put the progesterone cream?

Because progesterone is very fat-soluble, it is easily absorbed through the skin. Sites of application are; face, neck, chest, breasts, inner arms, inner thighs, and behind the knees.

11. How do you cycle the progesterone cream according to your menstrual cycles?

PRO-HM is best used according to your menstrual status. The following are general recommendations that should be confirmed or modified in concert with your health care provider.

Women in their reproductive years:

PRO-HM is best used during the second half of your menstrual cycle, for the two weeks prior to menstruation.

Days 1 (first day of bleeding) -13: do not use PRO-HM
Days 14 - 28: use 5 pumps twice a day

The suggested use is based on a 28-day cycle. If your cycle is shorter or longer you may need to adjust the timing of use, earlier or later than day 14, to fit with ovulation. If your period begins early, STOP using the PRO-HM while you are bleeding. Count the first day of bleeding as day one, and begin the cycle again.

Women who are perimenopausal (still menstruating, with cycle changes):

Days 1 (first day of bleeding) - 7: do not use PRO-HM
Days 8-28: use 5 pumps of PRO-HM twice a day

If your period begins early, STOP using the PRO-HM while you are bleeding. Count the first day of bleeding as day one, and begin the cycle again. If your period is late, use the cream for up to 3 weeks (day 28 of your cycle), then take a week off. If your period has not started by the end of the week off, resume use of the cream as described above for days 8-28 or until your period starts. STOP the cream when your period begins. Count the first day of bleeding as day one of your cycle, and begin the cycle over again.

Women who are menopausal or post-menopausal (no longer menstruating):
Choose a calendar day (e.g. first day of the month) as day one.

Days 1-7: do not use PRO-HM
Days 8-30 (or 31): use 5 pumps of PRO-HM once or twice a day.

**If needed, you may use up to 10 pumps of PRO-HM twice a day according to the same schedule.

12. Should a woman take progesterone cream more than two times a day if she does not get results?

Increasing the amount of pumps would be more appropriate than increasing the number of times per day that you apply the cream. There are 4mg of progesterone per pump. Average dosing amount can vary from 10mg to 40mg twice a day. Progesterone has been shown to stay in the body 24 hours or more. For some women that may mean they only need progesterone once daily after the first few months.

13. What if progesterone cream does not help with hot flashes?

If a woman’s hot flashes do not respond to progesterone cream for the relief of hot flashes:

1 she may need to increase her dose (keeping to the average 20 mg to 40 mg)
2 she may need some estradiol or estriol (bio-identical estrogens)
3 her androgens (testosterone and DHEA) may be low
4 her Cortisol (stress hormone) may be elevated
5 she may be zinc deficient as ( zinc is needed for the estradiol receptor to use estradiol)

This is not to say that she doesn't need progesterone. She just needs additional therapy. She could try something over-the-counter along with the progesterone, such as isoflavones or black cohosh, or see her health care provider for saliva hormone testing.

14. Will using natural progesterone with oral birth control pills alter their effectiveness?

Using natural progesterone should not alter the effectiveness of oral birth control pills. Progesterone cream should be used only after day 14 of the cycle if used with birth control pills. Many practitioners use progesterone cream along with birth control to help ease PMS symptoms; however, the results may not be optimal. Talk with your doctor for further information.

15. Should a woman take progesterone cream with HRT?

It is not recommended.

16. Can progesterone replace my HRT patch or work in conjunction with it?

You would not use progesterone cream in conjunction with HRT consisting of some type of estrogen and synthetic progesterone. ** You would need to consult with your physician to discontinue your prescription. Progesterone cream may or may not be able to replace HRT. In many cases, progesterone is all that is required to manage symptoms. This would apply if the woman makes enough estrogen on her own and then adds progesterone cream. Research has demonstrated that as many as 2/3 of post-menopausal women make adequate estrogen. With the cessation of ovulation only minimal amounts of progesterone are produced. Progesterone helps prime the cells in the body that use estrogen. Simply stated, the body needs progesterone to use the estrogen it makes. That is why one study published in 1999 in "Obstetrics and Gynecology," found that progesterone cream relieves hot flashes in 83% of menopausal women. If your body makes adequate estrogen, progesterone alone may suffice. If it does not make enough estrogen, progesterone alone will not raise estrogen. Symptoms of low estrogen typically are hot flashes, night sweats, depression, insomnia, and vaginal dryness. If progesterone alone does not alleviate low-estrogen symptoms, you may need to take natural bio-identical estrogen such as estriol and or estradiol. Additionally, if progesterone does not help with low-estrogen symptoms and the estrogen level is normal, it could be that you have excess cortisol (stress hormone) which blocks estrogen. It’s also possible that testosterone levels are low.

**Progesterone can and should be used by women taking ERT, which is estrogen only therapy. In the past synthetic progesterone was not prescribed for women using ERT after a hysterectomy. However, now that so many beneficial properties of progesterone have been discovered, we now know that all women need progesterone in adequate levels.

17. Can a woman who is taking Premarin and Provera in combination as HRT quit taking them and go on Pro HM without a weaning process?

It is recommended that women check with their physicians. Many women have tried this strategy often and suffer the return of symptoms. There are some practitioners who do suggest a weaning process. Sometimes that does work, but it is better for these to be handled by a medical professional trained in Bio-identical Hormone Replacement Therapy. Done correctly by a doctor, the switch from those two non-bio-identical hormones is very easy, if they know how. However, should a woman decide on her own, I would put this after HRT to wean off her HRT, this is how it may possibly work. She should begin to take the HRT every other day, adding progesterone in the normal dosing. Add progesterone cream in the normal dosing. After 2-3 weeks if all is well she should skip 2 days for 2-3 weeks, then 3 days and continue in this fashion until she has weaned off it and does not notice any symptoms. This method works for some women, but if the woman gets hot flashes at any point while reducing her HRT, it that could be an indication that she also needs estrogen along with the progesterone cream. In that case, bio-identical estrogens, in the form or BIEST, estriol or estradiol, are recommended.

If women take a non-bioidentical estrogen and synthetic progesterone as HRT as in two separate pills, progesterone cream can be substituted for the synthetic progesterone. The estrogen can be continued if needed. Consult with your physician regarding the switch.

18. Can women who have had breast cancer take progesterone cream?

Many oncologists would advise against it without comparing the difference between natural and synthetic progesterone. Synthetic progesterone increases breast cancer risk. Bioidentical progesterone protects against breast cancer as demonstrated by numerous published medical studies. There is an excellent book by John Lee, MD and David Zava, PhD, called, “What Your Doctor May Not Tell You About Breast Cancer.” This book discusses the role of progesterone in breast cancer prevention and its use during and after surgery. It is well referenced and suitable to take to any physician for his or her review. Presently, there is an oncologist that has put a breast cancer patient on PRO-HM in Canada along with Tamoxifen.

19. Can teenagers use progesterone cream?

Teenagers who have menstrual cycles can take progesterone cream. They may only need progesterone from days 21-28 of their cycle.

20. Can a woman who has had a hysterectomy use progesterone cream? What if they are on estrogen only?

Yes, to both. These women absolutely do need natural progesterone to protect them from the effects of estrogen only. Estrogen is a stimulatory hormone by nature. Progesterone is responsible for keeping estrogen from over-stimulating tissue such as breast tissue. Additionally, progesterone is needed by the body to use estrogen.

In the past, doctors prescribed estrogen only in the belief that these women did not need progesterone. It is true that synthetic progesterone is NOT needed. However, now that we are aware of so many vital roles and properties of progesterone, we realize that these women do need progesterone too. In fact, the estrogen alone without progesterone can over-stimulate breast tissue, reduce thyroid function, etc. Please review the DVD and product review to see the many important areas of a woman's health that for which progesterone is so absolutely essential. Also, women without ovaries have no mechanism for producing significant levels of progesterone.

21. Is it safe to take progesterone cream if you have high blood pressure?

Yes, progesterone does not raise blood pressure.

22. Why did the progesterone cream cause a woman to have trouble sleeping?

In some women progesterone can increase energy levels and alertness due to the effect of progesterone on thyroid hormone in the body. In this case, a woman could try using a smaller amount of progesterone and only use it in the morning and note her response. As the metabolism rate differs among people, the amount of progesterone they require can vary as well. There is a small group of women who need very low amounts of progesterone. More often than not, progesterone helps improve sleep and has been shown in research studies to do so.

23. Is there ever a need to discontinue use of progesterone cream post menopausally? Should one take a rest from it?

Women should take progesterone as long as they want the benefits of progesterone, like the breast cancer protection, bone building property, slowing of aging of the skin, heart disease protection, and the list could go on. Personally, I desire those benefits for the rest of my life. As for taking a rest from it, some authorities do recommend that once women are post-menopausal (not having menstrual cycles) that they use progesterone for three weeks and then take one week off. The reasoning for that is to maintain receptor sensitivity to it. The reason for the rest period is to maintain receptor sensitivity. Other experts do not insist that post-menopausal women take a week off. Women still having menstrual cycles use the progesterone in such a way that there is a break, so the question does not apply to them.

24. Can progesterone cream help endometriosis?

Since estrogen does play a role in endometriosis, balancing the estrogen with progesterone can help women with endometriosis. Many women find significant relief from the pain associated with endometriosis with progesterone cream. Other women need additional natural therapies along with the progesterone, such as supplements and acupuncture, for complete cessation of pain.

25. Can women take progesterone cream if they are trying to get pregnant?

Progesterone is necessary for conception and for fetal brain development. Therefore it is okay to use when trying to conceive. If fact, if a woman is low in progesterone she may have difficulty getting pregnant. Many practitioners have had patients having trouble conceiving have success once they add progesterone.

26. Will progesterone cream help prevent miscarriage?

In some cases, progesterone can help prevent miscarriage. It is used commonly by physicians to do so.

27. Can progesterone cream be used while breast feeding?

Progesterone can be used as recommended while breast feeding. Unlike estrogen and testosterone, progesterone is not gender specific. While the babies are in the womb they are surrounded by very high levels of progesterone. During the third trimester women make around 300 milligrams of progesterone a day compared to 4-24 milligrams during the menstrual cycle.

28. Does progesterone cream help with post-partum depression?

Progesterone can help with the hormonal imbalance that leads to post-partum depression.

29. Can progesterone cream be used while women are taking oral contraceptives (the birth control pill) ?

Unfortunately, there is no research to provide a definitive answer to this question. However, there are numerous practitioners that do tell patients that they can use the cream while on "the pill." One concern is that progesterone cream may interfere with the contraception effect of "the pill" since progesterone is necessary for many aspects for pregnancy. Oral contraceptives work by blocking ovulation. It is not known whether or not progesterone will interfere with the contraception effect of oral contraceptives. To avoid any interference with contraception, progesterone cream is often recommended starting on day 14 once ovulation has definitely been blocked. The other issue of using progesterone cream in conjunction with oral contraceptives is that oral contraceptives contain some form of synthetic progesterone. This could interfere with the optimal effectiveness of progesterone cream. However, clinicians have reported beneficial effects of adding progesterone cream for their patients on "the pill," anecdotally.

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