Health Watchers' News and Views

Dr. Leonetti Q&A – Progesterone side effects and allergies, timing, and more…

by Helene Leonetti MD on 03/10/09 at 2:59 pm

Side effects from progesterone?

Q: I am 59 years old and have been experiencing hot flashes and night sweats as well as abdominal weight gain for the past couple of years. What causes me the most upset is insomnia. I tried progesterone cream a couple of times and found that my breasts became cystic and painful. I do have fibrocystic breasts which, when I was having periods, filled with fluid premenstrually. I also felt I was feeling down and depressed while using the progesterone cream. I thought that progesterone would prevent these estrogen-like symptoms. I had my uterus out in my 30s but still have my ovaries. I would really like to ease my symptoms. Any advice?

A: One to three out of 1000 patients of mine experience what you describe. This is because for a transient time the progesterone is traveling down an alternate biochemical pathway toward aldosterone, which causes the swelling and symptoms you describe. If you patiently use a tiny amount (as little as 1 mg) and slowly over 3 to 4 months increase to 10 mg once or twice daily, those symptoms should vanish.

Sleep is a vital antioxidant of sorts, where we heal, and deal with our stresses, so making sleep a joyful and not stressful ritual is vital: chamomile tea, passionflower tea, and Natural Calm magnesium powder are all good helpers. Before going to sleep, with TV and radio off, lie peacefully in a darkened room on a pillow where you have sprinkled essential oil of lavender, and state all your blessings, offering gratitude for family, friends in your life.

Q: I want to thank you for your advice. It seems to be working. I started slowly and now am up to 6 mg a day. Some days I get the swelling in my breasts and some days I don’t. Should you take progesterone every day after menopause or take a five day rest once a month? Thanking you in advance.

A: Take the cream days 1 to 28 of each calendar month, then stop for 2 to 3 days to down-regulate the hormone receptors so it works better, and has less of a chance to accumulate in the tissues, as some critics would say. Happy to hear you are slowly getting balanced. Keep nurturing your breasts with loving thoughts and care, and they will be happy, hurting you less.

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

An allergy to progesterone?

Q: Having tried transdermal, bioidentical progesterone a few times over the past several years, I found that it seemed to make me feel worse, increasing hot flashes, headaches, “allergy-type” symptoms. (In my younger years, I complained to my physicians that I felt like I was allergic to myself, which was met with the conclusion that I’m nuts.)

Earlier this year, I stumbled upon a book written by Russel Roby, MD, Maybe It is All In Your Head and You Are not Crazy, wherein his studies and clinical experience treating allergy and hormone imbalance patients has revealed that a significant number of people are, in fact, allergic to their hormones (with progesterone being the biggest culprit). I strongly believe this is the case with me as my experience with natural transdermal progesterone has yielded negative results. I have been unable to find anyone (especially in the midwest) who is familar with desensitization to this type of reaction, and wonder if you are familiar with using diluted, sublingual progesterone drops to overcome this sensitivity to progesterone and other hormones. I am curious to know if you have had experience in dealing with those patients who did not respond favorably to the use of bioidentical progesterone (and/or other bioidentical hormones), and how you have been able to assist those in need of progesterone (and other hormone) therapy who are unable to tolerate it.

A: We are often considered crazy when the conventional paradigm does not include our reality. That being said, in the nearly 20 years I have worked with transdermal progesterone cream, I have one lady (out of approx 100,000 patients) that has an allergy to progesterone. This is known in the medical literature as autoimmune progesterone dermatitis.

Your point about using small doses and building up holds validity. Remember, homeopathy is based on “like cures like” so a very slow process can be considered. I also know, because we are spiritual beings having a human experience, that the practice of Nambudripad’s Allergy Elimination Techniques (NAET), started by a physician who herself had many allergies, can help. I hope this can be of some assistance to you.

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

Progesterone didn’t work, phytoestrogens did

Q: My naturopath does not believe in the hormone creams. He prescribes troches and his instructions are also to start at day 10 until day 28. There are increases and then decreases in the amounts starting at around day 15. I had significant hot flashes, many times during a 24 hour period. I had insomnia that was fairly significant and I had horrible vaginal dryness. I kept fiddling with my progesterone timing and amounts. Nothing worked. Finally, I bought some over-the-counter phyto-estrogen cream and started using that. Voila! No more hot flashes, vaginal dryness completely gone, insomnia much improved, libido back. (I am 44). I cut down on my progesterone as I have completely eliminated xenoestrogens from my daily routine.

Bottom line, progesterone is not the be all and end all. It eliminated my fibroid with the right health routine, but doing all that must have made me estrogen deficient as well. So getting your hormone levels tested and not eliminating phyto-estrogen treatment are very important.

A: This is a perfect summation: nothing works for everyone, and there are many ways to achieve a desired end. The beauty about such diversity is that it gives us perspective, and helps us not claim exclusivity with any one modality. Your comments about how the troches didn’t work for you, and about using phytoestrogens and avoiding xenoestrogens are important, and I appreciate your comments.

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

When to start and stop using progesterone cream each month

Q: I have a question about when, and how long, to stop taking the bioidentical progesterone cream each month. I was advised to start taking it 10 days after the 1st day of my period, then use it for 20 to 21 days. Stop, and repeat again.

However, my period is irregular, making it impossible to stick with a 10 day after period routine, and still take 10 to 11 days off, and be on track again when my next period starts.

Is there a better way? Thanks!

A: The perimenopausal roller coaster often creates confusion on how to use progesterone. When this happens, I simply advise my patients to use the cream from days 1-25 of each calendar month, stopping for the last 5 or 6 days. We no longer have to concern ourselves with stimulating our ovarian cycles, for truly, we are rarely ovulating, and we are using the progesterone cream for balance of the estrogen dominance. Many times, though not all, patients will find their cycles more regulated.

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

For how long can I use progesterone cream?

Q: I would like to know if we can use the progesterone cream indefinitely. An Applied Kinesiology doctor said the cream would become a problem as with estrogen if used too long. My nails, hair, and sex life were all enhanced. Please let me know as I really got great results from it.

A: The only problem with progesterone being used “indefinitely” may be the theoretical concern that some have that it deposits in the fat and accumulates to unacceptable levels. This of course is intimately connected to our cortisol levels, as they vie for the same biochemical pathway. So, it behooves us to keep our cortisol levels in balance by eating, sleeping, and exercising in the ways we all know how to do—and importantly, by being peaceful with the very precious practice of meditation. Stopping the progesterone for 2 to 3 days each month as Dr. John Lee taught me to do has assured healthy levels. I have personally been using it for 17 years and my levels are perfect, because I honor my body/mind/spirit triad with attention to all of the above. Any concern not answered by my comments can be laid to rest by testing the salivary levels, using my favorite, ZRT Lab.

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

Do I need estrogen with my progesterone?

Q: I thought I would comment on the subject of progesterone. I was going through a stressful time in my life (16 year old pregnant daughter). I was crying non-stop over everything, even seeing the American Flag flying in a parade. I went to my daughter’s psychiatrist with her and discussed my issues. I started taking Wellbutrin, an anti-depressant. This helped stop all the crying and I even lost some weight.

Then I started taking a progesterone/estrogen cream. Wow, what a difference. I feel wonderful and stresses like that don’t bother me anymore. However, I noticed if I forget to use it for awhile, the tears start coming again. Within one day of resuming the cream I am back on deck, feeling myself again.

My question is… I am post-menopausal, 64 years old. I had my tubes tied 24 years ago. Should I be taking progesterone by itself? I was told my Ob/Gyn that I should use an estrogen suppository for two weeks before any vaginal examinations to prevent trauma to my vaginal. wall.

I am grateful for the information I received on this website.

A: So happy to hear that you are feeling better with the progesterone. You see, with the estrogen dominance in our lives, from food sources, to plastics, to fertilizers, we are swimming in a sea of estrogen. If your vagina feels comfortable, and if your pap smears and exams continue to be normal, there is no need for the estrogen. You may take progesterone alone for the long haul, remembering to stop for a few days each month, but you must not ever take unopposed estrogen [estrogen without progesterone].

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

Progesterone cream for vaginal dryness?

Q: Can progesterone cream be applied directly to the vagina for vaginal dryness? Anything else besides estrogen that would work? I seemed to be allergic to a topical hormone cream with estrogen. (A compounding pharmacist made it for me.)

A: Yes, you can apply progesterone cream directly to the vagina. You can also ask the compounding pharmacist to use a hypoallergenic cream base and see if that relieves your allergy symptoms. I often recommend using estriol and testosterone cream vaginally, but again, if put in a cream with no fragrance or allergens this would be helpful. Lastly, another recommendation for moisture and a source of healthy vaginal lubricant: organic unrefined coconut oil. Not only does it smell and taste and feel heavenly, but it also contains lauric and caprylic acids that prevent yeast infections.

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

Is too much calcium harmful for menopausal women?

Q: I am aware that too much iron in our system after menopause is harmful. I was not aware, however, as you mentioned, that as we age our bodies no longer need calcium for growth and that it becomes oxidative, damaging our cells. What does that imply for those of us who take between 1200 and 1500 mg of calcium for our bones after menopause—are we doing cell damage with these recommended amounts?

A: This is a perfect example of the paradigm shift appearing in medicine. I have felt intuitively that so much calcium, especially not balanced with the precious and all too deficient mineral, magnesium, can be harmful. John Lee, MD, in his visionary teachings [read Dr. Lee's Optimal Health Guidelines], reminded us that getting calcium primarily in food is safer. I recommend that my patients take approx 600 mg calcium with 300 mg magnesium, and then to eat a handful of almonds daily, consume preferably wild caught salmon 1 to 2 times weekly, and have several servings of green vegetables daily, preferably organically farmed.

Most of the calcium available in supplements truly does not have optimal absorptive properties, and is finding its way into deposits in breasts and joints. Of course I will be passionately disputed. I love the quote by the German philosopher Arthur Schopenhauer: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

Niece with a follicular cyst

Q: I would like to ask your advice for my 29-year-old niece. She is looking to get pregnant and has discovered that she has an ovarian cyst the size of an apple. I know that some women have follicular cysts that need no treatment. The complaint that led her to this diagnosis is pain on defecation. She has been advised to go on the pill for 2 months. What do you think in general with no real knowledge of her particular case?

A: Generally, if it is a follicular cyst, and not a benign tumor, they will respond to 2 to 3 months of suppression by means of the birth control pill. I always remind my patients on birth control pills to take a good quality multivitamin and extra B complex, because the pill inhibits the absorption of these many important nutrients as women prepare to conceive. You can also have her put castor oil packs on her belly. Edgar Cayce was a famous medical intuitive who spoke extensively about the benefits of this approach. Put some castor oil on a peace of wool flannel, cover it with plastic wrap, place it on the belly and then put a very mildly warm heating pad on top of the wrapped flannel. This will remove toxins from deep and superficial lymphatics. And, have her visualize the cyst shrinking and disappearing.