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Progesterone and Breast Tenderness, Q&A with Dr. David Zava

by Dr David Zava on 17/11/09 at 5:06 pm

Progesterone and Breast Tenderness, Q&A with Dr. David Zava

Dear Dr. Zava,

I am a 63 year-old woman who had a total hysterectomy at age 42. I am osteopenic and want to take bioidentical progesterone. I love the feeling I get from taking it, but I get a lot of breast tenderness. I even decreased the dosage to 5 mg and still got the breast soreness. I also have fibrocystic breasts and low thyroid. I was taking Synthroid and recently changed to porcine thyroid.

I have had fatigue issues for years and the natural hormones made me feel so much better. I would really like to take the progesterone but am worried about the breast reaction. I also got the DHEA, and testosterone cream. These were very low dose preparations as well, but I had to quit taking them due to the breast problem.

I had a blood test years ago and was very deficient in all hormones. I eventually decided that I must be converting everything to estrogen and maybe I could not process the hormones. I have also been thinking I have adrenal fatigue as well. I am taking some adrenal support capsules that have some adrenal tissue in them. I am really trying to find a solution and wonder if you have ever encountered this problem in your experience.

I thank you in advance for any insight you might have.  –Nancy

Dear Nancy,

It would seem that your breast tissue is very sensitive to hormones, including progesterone.

If you have not tested your hormones during hormone therapy it’s not possible to know if they are in excess, or the breast tissue is just extra sensitive to normal levels of hormones, or both.

Women who have had a total hysterectomy usually have very low levels of hormones. However, you do complain of fibrocystic breasts, which is usually due to estrogen dominance, but some also say an iodine deficiency. You are probably right in saying that you convert hormone precursors to estrogens, which is probably why androgens like testosterone and DHEA (estrogen precursors) cause the same problem.

In some women with estrogen excess, progesterone therapy, when first used, can cause breast soreness. At the cellular level, progesterone works in synergy with estrogen to stimulate normal breast cell proliferation and differentiation, and then inhibits proliferation. This is how progesterone works in synergy with estrogens to allow the tissue to specialize and stop dividing. However, if estrogen is in excess for a prolonged period of time it is more difficult for progesterone to be growth-inhibitory. The growth-inhibitory properties of progesterone may also depend on the cellular levels of progesterone receptors, which can vary from one person to another.

My guess is that your breast cells have just seen too much estrogen for too long, and that when you first use the progesterone it has more of the growth-promoting actions, which cause the soreness.

Some have suggested that breast tenderness can be due also to iodine deficiency. Normal breast tissue is iodine dependent and when levels are low, the tissue is hypersensitive to estrogens. So part of your problem might be due to iodine deficiency.

Vitamin D is also important for normal breast function, so this may also be an issue for you. You should check your Vitamin D level and consider supplementation if low.

Many of the physicians I have worked with have said they find that in women with estrogen dominance it is best to lower the estrogen burden first before using natural progesterone. Otherwise, progesterone can cause the problems you mention.

All this said you need to discuss this with your doctor and consider means to lower the apparent estrogen burden in your breast tissue. I say apparent because we don’t know for sure if you have excess estrogen in your bloodstream, or in your breast tissue. There are many natural ways to lower your estrogen burden, including weight loss, exercise, and more fiber in the diet. You can find out more about this in What Your Dr May Not Tell You about Breast Cancer.

I would also suggest you look at your hormone levels, particularly estradiol, progesterone, testosterone, DHEA(S), and cortisol before you begin any hormone therapy.

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5 Responses to “Progesterone and Breast Tenderness, Q&A with Dr. David Zava”

  1. avatar


    Dec 7th, 2009

    I have been told that I have osteopenia, the start of osteoporosis. I recently had a total knee replacement and my lower leg cracked. I want to do something to strengthen my bones, but I am not convinced that Boniva is the way to go. What about progesterone cream? Can you explain?

  2. avatar

    Karen Thompson

    Nov 19th, 2009

    I am a 61 year old diagnosed with Breast Cancer 1992.
    Exhausted use of most Aromatase Inhibitors.
    I have been using natural progesterone to oppose estrogen dominance for about 3 years now. Had same problems with adrenals this past Summer and really had probelms getting everything balanced again. Adrenals can take up to 6 months to
    heal after an “episode”…not fun!!! I refered to Dr. Wilson’s book
    on Adrenal Fatigue, wonderful. Using low doses of hydrocortisol
    and will gradually decrease from 5mg to 2.5 then off completely.
    I would encourage Nancy to try using the iodine and also to take
    theraputic doses of DIM and calcium d glucarate. Also helpful is infra red sauna to
    help detox the system. Sweating is good!
    Everyone is different…important to do testing of hormones including cortisol and thyroid. It all works together!!!

  3. avatar

    Lynn Woolf

    Nov 19th, 2009

    This is excellent information. I only wish I would have had this knowledge sooner as I had extremely tender breasts for a good 5 yrs and lived with it. Then entered perimenopause , started the sweats and ended up with an ovarian cyst at age 47. Gyno got scared when he took my CA125 and it was 54 and sent me to an oncologist gyno at MD Anderson in Orlando, FL. He only did a sonogram and CA125 which came back on the edge at 36 and next thing I knew, I was having ALL of my female organs removed. I am 49 yrs old and sick to my stomach that I allowed this “butcher” to do to me what he did when I believe all I was dealing with was an hormonal imbalance. My life has literally been hell ever since and I am on all the hormone creams. I also had extremely low adrenals, etc. I am doing everything I can to feel good and look good and try not to look back. Looking back makes me feel as though I was violated. I was 47, good health other than peri menopause but vulnerable and scared being sent to a cancer Dr. and cancer hospital. It was only the 2nd visit in which surgery was highly suggested. Most in conventional medicine don’t want to get to the source of the matter and for me, I was sent down a narrow path and what oncologist gyno doesn’t cut? He knew I did not have cancer but would not even do a biopsy. It is the only regret of my life and I would give anything to have not let that hapen. I trusted and you think you will be handled properly both morally and ethically!

  4. avatar


    Nov 19th, 2009

    Hi Doctor. I never see this anywhere and wonder am I alone. About 5 years ago I began a pattern of monthy yeast infections, starting the 18th day of every cycle. I was 40 years old and suspected a hormonal issue because of the cyclical nature of the infections. Repeated visits to the doctor only gave me different, painful yeast infec creams. No one could tell me why these came on the 18th day of each month and didn’t seem to care. Here’s your cream, be on your way. I wanted to stop the infections not keep treating them. I stubbled upon progesterone information and wondered if I was estrogen dominate and if that was causing the infections. Low and behold, I started natural progesterone and never had another infection. My concern is that if I miss a dose, I know it immediately because I feel irritation begin. While on vacation, I once forgot my cream and ended up with full blown infection. Is this normal to be so sensitive. I am 46 now and without progesterone will get a full blown yeast infection. Is this normal? Could there be something else wrong that I am missing and ignoring because progesterone stops the infections. Have you ever heard of this. Thank you.

  5. avatar

    Brenda Vogel

    Nov 18th, 2009

    Dr. Zava for years I have been using progesterone cream. I don’t eat poorly but yet can’t seem to lose weight for years! I had a saliva sample done recently and to my surprise it showed a value of 3 times more than normal! What could possibly cause this? HELP!