Tuesday, February 10, 2015

Progesterone: The Flip Side of the Estrogen Coin

Women who have an intact uterus and are taking estrogen replacement therapy must also be on some form of progesterone. Estrogen, with all of its benefits, stimulates the tissues of the uterus and can set up the body for uterine cancer. The use of progesterone reduces this risk to that of a woman who is not on hormone replacement therapy. Progesterone can also minimize the impact of estrogen on any estrogen-dependent tumors; therefore, women on oral or topical estrogen therapy must be on progesterone also. This does not apply to women using vaginal estrogen cream or inserts, as the absorption seems to be minimal in the body.

Progesterone can be given as either medroxyprogesterone or micronized progesterone. Micronized progesterone is the bio-identical form of progesterone and is the preferred choice. It is manufactured from plants (Mexican wild yam and soy) and seems to have a lower side effect profile than medroxyprogesterone.

Besides the cancer protective benefit, progesterone can also:

-improve sleep

-decrease anxiety

-build and maintain bone density

-increase HDL, the "good" cholesterol component

Micronized progesterone helps to avoid the "first pass" effect that we discussed with estrogen; however, studies indicate that levels of micronized progesterone given orally return to baseline after approximately 8 hours. There is evidence that giving progesterone in a sublingual form allows levels to last for 24 hours when the sublingual tablets are compounded using cyclodextran, available by prescription through your compounding pharmacy. Progesterone cream is also an option and is also available through your compounding pharmacy.

There are recent reports of "dermal fatigue" with progesterone cream. In simple terms, this means that the tissue becomes oversaturated with progesterone that is stuck in a storage form, and a change to another dosage form of progesterone could be necessary. Symptoms may include breast tenderness and moodiness. Rotating the application sites with progesterone cream helps with this, and having a strong working relationship with your gynecologist is essential in gaining the maximum benefit..

Hormone levels fluctuate. I know….This is a "sky is blue; grass is green" statement! What is important about this is that your hormonal needs will change over time. This is why a great working relationship with your physician and pharmacist creates a healthier patient: keep those annual appointments!

As an additional note, situations can change and impact hormones also. I have been maintained on HRT, doing quite well with the generic oral micronized progesterone; however, our insurance changed resulting in a change of pharmacy. The new pharmacy carries a different generic brand. It has taken about two and a half weeks, but I am now having trouble sleeping through the night on the new form. I left my gynecologist’s office today with a prescription for sublingual micronized progesterone tablets. I will let you know how this works!

Healthy for life with John Hollis Pharmacy!

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