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Bio-Identical Progesterone PDF Print E-mail

Bio-Identical Progesterone

The Role of Oestrogen and Progesterone:
Oestrogens are the sex hormones that control the menstrual cycle, the growth and function of the uterus and uterine lining, and secondary sex characteristics (such as breast development, vaginal secretions and sexual interest) in women. They also affect bone, brain, heart, blood vessel and skin tissue. There are three main types of oestrogen produced by the body: oestrone, oestradiol and oestriol. These are often collectively referred to in the singular form, as 'oestrogen'. Women's oestrogen levels fall drastically during menopause, with widespread implications for long-term health as discussed in this article.

Progesterone is the hormone which, during a woman's fertile years, is produced by the ovaries and has effects which are in some ways opposite to those of oestrogens. During the menstrual cycle, oestrogens build up the uterine lining (called the endometrium), but if the egg is not fertilised the lining is not required; it is progesterone which stimulates the lining to shed, causing a period. The three major functions of progesterone in our body are:
• To promote the survival and development of the embryo and foetus
• To provide a broad range of core biologic effects
• To act as a precursor (building block) of other steroid hormones

Progesterone is also made in smaller amounts by the adrenal glands in both sexes and by the testes in males. Progesterone is a precursor of other hormones such as oestrone, oestriol, oestradiol, testosterone, and all the important adrenal cortical hormones.
A fundamental key to hormone balance is the knowledge that when oestrogen becomes the dominant hormone and progesterone is deficient, the oestrogen can potentially become toxic to the body; thus progesterone has a balancing or mitigating effect on oestrogen. Oestrogen dominance typically occurs around the time of menopause which is known as peri-menopause. If you are already on HRT, then adding bio-identical progesterone to the therapy will help to reduce the increased risk of oestrogen dominance induced breast cancer.
An important factor to remember is that cholesterol is the basic building block for the steroid hormone and gives all of the sex hormones a similar structure. Switch a few atoms around and the role of the hormone can change dramatically. Without sufficient cholesterol, we can’t make sufficient steroid hormones. Some of the more familiar steroids are oestrogen, progesterone, testosterone, the corticosteroids, and DHEA.

Safety of Synthetic vs Bio-identical Hormones
Synthetic hormones are not as safe and offer fewer health benefits than hormones that are identical to those that the body produces naturally.
A study1,2  that was published by the Women’s Health Initiative in 2002 and 2004 showed that using a combination of progestin and oestrogen for menopausal symptoms actually increased the risk of breast cancer, blood clots and cardiovascular disease by 50%. The following reasons were given for this:
• The dosage was too high. As a result of the above-mentioned study, current recommended doses have dropped to 3 times lower than the doses used before 2002.
• The types of hormones used were not identical to the hormones that the body produces naturally and they were too potent. Hormones that are identical to those that are produced in the body are thus named bio-identical hormones. These include eostradiol, oestrone, oestriol and progesterone. The types of hormones used in the study were a non-bio-identical progesterone (known as progestin) called medroxy-progesterone acetate and conjugated oestrogens called equilin which is extracted from mare’s urine.
• The hormones were administered orally as opposed to being applied to the surface of the skin. Orally administered oestrogens cause the liver to produce huge amounts of blood clotting factors, increasing the risks of heart attacks and stroke. This research was conducted by the Estrogen and Thrombo-embolism Risk Study Group and was reported in The Lancet3 medical journal. This didn’t occur when hormones were applied to the skin because topically applied hormones are absorbed directly into the bloodstream, thus bypassing the liver.

A safer alternative to conventional oral hormone replacement therapy (HRT) is to use transdermally applied bio-identical progesterone. This should be applied in the form of a liposomal cream where the hormone is encapsulated into tiny liposomal beads made from lecithin, which are then absorbed through the skin into the bloodstream. Unless progesterone is incorporated into liposomes, it will not penetrate through the skin!

Bio-identical progesterone can therefore either be used alone or in combination with conventional HRT; please do so however under your doctor’s guidance and supervision.

Reasons for using bio-identical progesterone include protection against endometriosis, menstrual irregularity, fibroids and benign ovarian cysts. It also relieves menopausal symptoms (night sweats and hot flushes), PMS, infertility, depression and insomnia and protects against heart disease and many cancers.

Apart from causing blood clots, there are other advantages to using a transdermal cream rather than the oral route. Any medicines taken orally are absorbed into the bloodstream and are taken to the liver before it is transported to other parts of the body. Up to 80% of orally delivered hormones are destroyed by the liver, before even reaching the rest of the body. This means that larger doses need to be used when taking tablets as opposed to liposomal preparations, putting huge strain on the liver. Absorbing it through the skin into the general circulation (as opposed to first going to the liver), mimics the way in which the ovaries naturally secrete progesterone, and requires a lower dose to achieve the same result.

Bio-identical Progesterone vs Synthetic Progestins
Bio-identical progesterone is exactly like the progesterone produced by the ovaries and is what the body makes naturally. Synthetic progestins (mainly found in the contraceptive pill) are made to be similar, but are not identical to the body’s progesterone. These synthetic progestins can cause many side-effects such as:
• Weight gain
• Acne
• Mood swings
• Water retention
• Depression
• Headaches

Synthetic progestins can impact negatively with cholesterol balance, can cause damage to the heart’s coronary arteries and increases the risk of cancer. Synthetic progestins do have some advantages over bio-identical progesterone in that they are more effective at stopping menorrhagia (long and heavy periods), only need to be taken once a day, are relatively inexpensive and are readily available through most pharmacies.

It is essential for ALL women to use progesterone from the age of 28, especially if you are on HRT or oral contraceptives because progesterone also helps protect against the cancer risk associated with conventional HRT. Even women who have had their uterus removed need to use bio-identical progesterone.

1. Rossouw JE, et al. Risks and benefits of estrogen plus progestin in healthy postmenopaual women: principal results from the Women’s Health Initiative randomized control trial. JAMA 2002; 288:321-333
2. Anderson GL, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized control trial. JAMA 2004; 291:1701-1712
3. Scarabin PY, et al. Estrogen and Thromboembolism Risk Study Group. Differential association of oral and transdermal oestrogen-replacement therapy with venous thromboembolism risk. Lancet 2003; 362:428-432