The Natural Hormonal Approach to Treating Menopause


Many patients suffer untoward symptoms during their mid to late 40s because they simply do not have enough progesterone to counter-balance their own estrogen. I am not talking about synthetic progesterone, such as Provera or Medroxy-Progesterone, which most physicians are prescribing at the present time. I am talking about Natural Progtesterone, the very same natural hormone that was provided by the body throughout menstrual history.

These women may experience symptoms such as cramps, migraines, mood swings and fibrocystic breasts, all secondary to the fact that these patients have unopposed estrogen and very often during those cycles they do not have enough progesterone to counter-balance that estrogen. In fact nature works always in balance Ñ it balances having estrogen in the first half of the cycle and progesterone along the second half of the cycle after the receptor sites have been prepared by the estrogen.

This also happens at different ages when patients suffer from PMS for in truth PMS starts off as a physiological event whereby estrogen stimulation causes a panic in the adrenals and the adrenals pour out more adrenaline and noradrenaline which causes the patients to have irritability, anxiety and water retention symptoms of PMS.

It is the use of natural progesterone that was first suggested by Dr. Katherine Dalton that is the true beginning of the treatment of PMS. I have been successfully treating PMS with the use of natural progesterone cream using it as a transdermal cream rather than the vaginal applications that were first suggested by Dr. Katherine Dalton.

I feel, as Dr. John Lee* feels, that natural progesterone is best provided to the body using the transdermal route. One of the biggest debates about natural progesterone has been whether or not wild yam, which is the usual precursor source of the natural progesterone, is effective. I personally found that using the actual progesterone is far more effective than using wild yam cream. In fact, I now write prescriptions for natural progesterone that is made by a compounding pharmacist. Although this natural progesterone does have its source from wild yam, you know the exact amount of the progesterone being prescribed and can adjust the amounts of progesterone both up and down depending on the patient’s symptoms.

I have found that using a three per cent progesterone cream 1/4 tsp twice a day has been the most effective method of starting therapy both for PMS and for menopausal symptoms. I realize this is a higher dose than first suggested by Dr. Lee in the United States, but I’ve found that the three per cent progesterone cream has served me very well in my practice. The three per cent progesterone cream provides approximately 30 mg of progesterone transdermally on each application, provided that you are given 1/4 tsp of cream at each given dose.

PMS patients do very well if the progesterone is given to them before the rise of estrogen. I usually ask them to apply the three per cent progesterone twice a day starting approximately day 10 to 12 of their cycle and using the progesterone cream up until the day of menstruation. Some people who suffer from severe migraines with the PMS do very well if they use the progesterone cream right into the first day of their menses.

Patients who are trying to conceive but feel that they would benefit from the natural progesterone cream are usually asked to take the progesterone cream later in the cycle, approximately day 14 or 15 of the cycle. Menopausal patients who do not have a menstrual flow find the progesterone cream most effective every day of the calendar month except for the first five days allowing them the time to clean off their receptor sites. Some patients however enjoy the use of the cream so much that they are reluctant to stop during those five days. In fact the progesterone cream helps them sleep at night, it improves their libido and it certainly makes the menopausal flushes a thing of the past.

I do agree with Dr. John Lee’s statement that approximately two out of three patients can be treated for their menopausal flushes with progesterone alone. The other third of the patients who require added estrogen are best served if they use a natural estrogen from a soy base such as Tri-Est which is 80 per cent estriol, by far the safest estrogen and perhaps the most protective estrogen for breast cancer. This estrogen is placed together with 10 per cent estradiol and 10 per cent estrone which are the two most potent estrogens and these are the estrogens that are used in allopathic medications in 100 per cent concentrations.

The fascinating thing about natural progesterone is that it has been forgotten by gynecologists for many years. In fact, when I carried out hysterectomies on patients 15 to 20 years ago I would place patients on estrogen alone and forget about the fact that progesterone had always protected not only the uterus but also it protected the breasts and the bones of the patient. I now have every patient who has had a hysterectomy on not only just natural estrogen, but they certainly are given natural progesterone and in some cases they are given only natural progesterone, especially the patients who have a contraindication to estrogen such as a past or family history of breast cancer.

I am now documenting cases of patients who are on progesterone alone, whose bone densities have improved dramatically during the use of natural progesterone. It has not worked in every case, but certainly allopathic medication hasn’t worked in every case for osteoporosis as well. I hope to publish the results of the use of natural progesterone and the prevention and treatment of osteoporosis. The other major issue regarding the use of natural progesterone is whether it is safe to use in patients with previous histories of breast cancer. I now have patients who are taking natural progesterone and have had tremendous relief of the symptoms of menopause such as dry vagina, dyspareunia and insomnia, and these patients are extremely thankful for the use of natural progesterone. I do follow their blood levels of estradiol and estrone to make certain that these levels are not increasing with the use of natural progesterone. Natural progesterone is a 21 carbon steroid and theoretically could be transformed into natural estrogen within the body cascade of hormones.

Another one of the fascinating uses of natural progesterone is to help benefit the libido. As you may know, the libido seems to be driven by testosterone in women far more than we ever thought in the past. Progesterone being a 21-carbon product can provide a precursor to make the 19-carbon product of testosterone within the body’s mechanism. However, if the progesterone does not provide enough of the increase in libido my patients are now very comfortable with the use of transdermal testosterone.

The mechanism of action of the progesterone is basically once the transdermal cream is placed into the skin, the progesterone then usually peaks between two to three hours and is worn off by twelve hours. That is why the progesterone is used twice a day and allows for the patient to have the full effect of the progesterone throughout those twelve hours.

At the present time I am trying to convince my medical colleagues to use more natural progesterone when they are using their hormonal replacement therapy. There are so many advantages of using natural progesterone in the ability to manage the patient’s peri-menopauasal symptoms that as a gynecologist for 25 years, I now have found over the last five years that there is not a gynecological condition that does not improve with the proper use of natural progesterone.

Many of my patients ask me why there are not more studies being done on natural hormones and the answer is very clear. Drug companies can only make money by selling drugs and you cannot patent a natural product. However, compounding pharmacies are now becoming a very strong voice in the medical community and many papers are being produced through the compounding society by investigators who have revealed that it makes eminent sense to use natural hormones, especially in the light of the fact that they appear to be far more protective and less dangerous than synthetic drugs.