Progesterone is a female sex hormone produced in the ovaries, and in smaller quantities, in the adrenal glands. During the last two weeks of the menstrual cycle, progesterone becomes the dominate female hormone as it prepares the body for pregnancy.
Progesterone is the counterbalance of estrogen and regulates the effects of estrogen in a woman’s body. Progesterone and estrogen are designed by nature to work together. This is why many physicians treating hormonal problems include it in their regiment guidelines. We do not prescribe estrogen without progesterone.
When it was found that Estrogen replacement alone, without concomitant progesterone supplementation, could increase a women’s chance of contracting uterine cancer, researchers and physicians thought to counteract this risk by prescribing progesterone in the form of a synthetic version called “progestin.”
Why? The issue of patentable versus non-patentable. Progestins can make a lot of money for the manufacturer, progesterone can not. It didn’t take long for the side-effects of progestins to become known: Weight gain and bloating, anxiety and high-blood pressure, PMS-like symptoms and more.
Is Progesterone safer?
Not all doctors and researchers agree that progesterone is any better or any safer than progestins.
Progesterone and hormone supplementation.
Progesterone is almost mandatory in many women, progestins are not.
In July 2002 when the Woman’s Health Initiative released their findings that hormone replacement therapy (HRT) was dangerous, somehow, progesterone was singled out as being the cause of excessive breast cancer risks by the general media. This was not the case at all. A portion of the study cited above, was discontinued because of breast cancer risk in those women using a combination of synthetic hormones; that derived from horse urine mixed with progestins, not progesterone.
How different are progestins from progesterone?
In pregnancy, progesterone protects the human fetus and maintains a healthy pregnancy. Progestins cannot be taken during pregnancy because they can cause birth defects. Progestins are used in birth control pills to prevent pregnancy.
Do progestins and progesterone sound like the same hormone to you?
Further, the side effects of progestins can include breast tenderness, depression, edema and bloating. Progesterone does not seem to cause any of those side effects. In fact, it usually reduces such symptoms.
Continue Article >>> Segment 1 2
Researchers writing in the medical journal Maturitas say that there is no significant association between hormone therapy and risk of total stroke in women during 10.5 years follow-up.
Lia C, Engströma G, Hedblada B, Berglundb G, Janzona L. Risk of stroke and hormone replacement therapy. Maturitas Volume 54, Issue 1 , 20 April 2006.
From the abstract:
The purpose of this study was to examine the risk of first-ever stroke in relation to use of hormone replacement therapy (HRT) among middle-aged and older Swedish women.
A total of 16,906 women, 45–73 years old, from the ‘Diet and Cancer’ study in Malmö, Sweden were examined. Women were considered as HRT users if they took systemic hormone therapy regularly. Incidence of stroke was followed for a mean period of 10.5 years.
In all, 2148 (12.7%) women used HRT. A total of 461 stroke cases occurred during follow-up, 48 of them in HRT users. Incidence of total stroke and ischemic subtype had no significant relation to HRT use. However, an increased risk of hemorrhagic stroke was found in women taking unopposed estrogen or un-native estrogen regimens. Although not significantly, the risk of stroke was 33% lower in women who started their treatment before menopause. Among HRT users, the risk of stroke was associated with advancing age, smoking, excess body weight and hypertension.
There is no significant association between hormone therapy and risk of total stroke in women during 10.5
Researchers writing in the medical journal Climacteric say that “Women who receive 2-3 years of HRT after menopause do not have increased all-cause mortality, and results of the present study suggest relative cardiovascular benefits compared to those who had not used hormones.”
Alexandersen P, Tanko LB, Bagger YZ, Qin G, Christiansen C.The long-term impact of 2-3 years of hormone replacement therapy on cardiovascular mortality and atherosclerosis in healthy women. Climacteric. 2006 Apr;9(2):108-18.
From the abstract:
OBJECTIVE: The effect of hormone replacement therapy (HRT) on cardiovascular risk is intensely debated. The aim of this study was to investigate the long-term effects of HRT given for a few years on all-cause and cardiovascular mortality and the severity of atherosclerosis.
METHODS: This analysis was based on a cohort of 1,458 postmenopausal women (55.8 +/- 6.1 years old) who previously participated in a number of randomized, placebo-controlled, clinical trials assessing the efficacy of 2-3 years of therapy with various estrogen plus progestin combinations for preventing bone loss.
Women were followed on average for 9.8 years and came for a follow-up visit. Outcome variables were all-cause and cardiovascular mortality and the severity of atherosclerosis, as estimated by semi-quantitative scoring of vascular calcification in the lumbar aorta on lateral radiographs.
CONCLUSION: Women who receive 2-3 years of HRT after menopause do not have increased all-cause mortality, and results of the present study suggest relative cardiovascular benefits compared to those who had not used hormones.
Researchers writing in the Journal of the British Menopause Society say “Many women have been denied or have discontinued HRT because of the fear of risks, which may not have been put in perspective or fully understood.”
Davey DA. Hormone replacement therapy: time to move on? J Br Menopause Soc. 2006 Jun;12(2):75-80.
Hormone replacement therapy: time to move on?
The risks and benefits of hormone replacement therapy (HRT) need to be put in perspective. In the analysis of clinical trials, emphasis is often placed on relative risks, statistical significance and 95% confidence intervals, whereas, from a clinical perspective, more may be gained from a consideration of the absolute and attributable risks of therapy.
The Council for International Organizations of Medical Sciences recommended that the frequency of adverse events be categorized as ‘rare’ if less than 1/1000 but more than 1/10,000, and as ‘very rare’ if less than 1/10,000. In the analyses of the Women’s Health Initiative (WHI), the attributable risks were ‘appreciable’ (i.e. more than 1/1000) only in women aged over 70 years, with the exception of the risks of venous thromboembolism and stroke. The women in the WHI trial do not represent the relatively younger, healthy, postmenopausal women most commonly prescribed HRT, who are probably at much lower risk.
Moreover, the WHI trial did not take into account the benefit of relief of menopausal symptoms, which is, for many women, paramount and outweighs the ‘rare’ long-term risks. Age may be a useful guide to risks and some simple guidelines for management, based on age, are suggested. Many women have been denied or have discontinued HRT because of the fear of risks, which may not have been put in perspective or fully understood. The care of postmenopausal women is not static, and sufficient has now been learned to enable each menopausal woman, with the help of her medical adviser, to come to a balanced and reasonable decision.
One of the things our media is very good at is blowing a story way out of proportion at the expense of presenting all the facts. So it was with the world-wide reporting of the dangers of Hormone Replacement Therapy in the aftermath of the JAMA article. News reports circled the globe in nearly every news outlet, that a protocol taken by millions and millions of women in the United States, estrogen and progestin, when taken in combination, greatly increased the chances of serious health problems and even death.
As part of the Woman’s Health Initiative (WHI), a very large scale study which sought to examine potential health strategies to “reduce the incidence of heart disease, breast and colorectal cancer, and fractures in postmenopausal women,” researchers studied the effects of Hormone Replacement Therapy, (Estrogen and Progestin). Originally designed as an eight year study, the study was halted three years early when the researchers accumulating their findings and discovered that HRT was responsible for increases in incidences of breast cancer, heart attack, stroke, and blood clots in the lungs (pulmonary embolism) and legs (deep venous thrombosis).
What the media failed to mention was that taking estrogen in a synthesized version, distilled from pregnant horse urine plus a synthetic progestin, when taken in combination, greatly increased the chances of developing breast cancer, heart disease, strokes and blood clots. So instead of saying the drug Prempro (an estrogen-plus-progestin therapy) was found to cause a greater incidence and certain cancers, it was Estrogen and Progestin! (In the section about Progesterone, read about the differences between Progestin and the naturally occurring Progesterone).
Years before the risks of synthetic hormone replacement therapy was made known, medical pioneers such as New York Times best-selling author John Lee, M.D., spoke out about these very same dangers, in his book What your Doctor May Not Be Telling You About Menopause. Dr. Lee says quite plainly “(there are…) reams of evidence that synthetic estrogens are highly toxic and carcinogenic.”
Dr. Lee and others took a skeptical view of the pharmaceutical industry that pushed synthetic hormones, because they are produced by companies who hold exclusive patents on these drugs and as such make billions of dollars. Bio-identical hormones are not patentable and are therefore incapable of being a huge profit maker.
What are Bio-identical hormones?
As mentioned earlier, bio-identical hormones are not “Natural Hormones,” even though they are derived from plants such as the Wild Yam and soy plants. During the process to convert plant derivatives to bio-identical hormones, a chemical or synthesizing process must be performed to the highest standards by a reputable laboratory.
The synthesized product becomes a bio-identical hormone, a product whose molecular structure exactly matches that of human hormones and is processed by the human body as a “naturally” occurring hormone.
The difference between synthetic estrogen and the body’s own hormones stresses the difference between synthetic and bio-identical hormones. Synthetic estrogen derived from horses contains 30 or 40 different estrogens types that a horse needs, but a human female does not. The human female only produces estrone (E1), Estradiol (E2), & Estriol (E3). Bio-identical hormones replicate the human estrogens.
But I thought no hormone replacement therapy was safe!
Opponents of bio-identical hormones point out that there are no long-term studies that show bio-identical hormones are any safer than the synthetic hormones.
Bio-identical hormones should be prescribed in the smallest dose possible to restore the body to its natural level of hormone. Regular blood or saliva or urine level monitoring and physical examination will help the physician administer the right dosage for each woman.
The Estrogen Controversy
Harman SM, Anatolian F, Brinton EA, Judelson DR. Is the Estrogen Controversy Over? Deconstructing the Women’s Health Initiative Study: A Critical Evaluation of the Evidence. Ann. N.Y. Acad. Sci. 1052: 43–56 (2005).
From the article abstract: The Women’s Health Initiative (WHI) hormone trials have been widely interpreted as demonstrating that combined menopausal hormone therapy (HT) fails to protect against—and may increase—cardiovascular disease (CVD), stroke, and dementia in menopausal women, regardless of whether initiated early in the menopause or later. This conclusion does not agree with results of large epidemiological studies showing protection by HT and by estrogen replacement alone (ET) against CVD and dementia. One possible reason for this inconsistency is that the epidemiologic data are confounded by “healthy user bias.” Another possible explanation is that most women in the observational studies initiated ET or HT at or near the menopausal transition, at which point there is little or no arterial injury, whereas, in the WHI studies, older women, averaging approximately 12 years postmenopausal, many of whom would have had significant asymptomatic atherosclerosis, were treated. Substantial data demonstrate atheropreventive effects of estrogen before vascular damage occurs, whereas adverse effects of oral estrogen on thrombosis and inflammation may predominate once complex atheromas are present. Similarly, the excess of dementia observed in older WHI women treated with oral conjugated estrogen could be due to cerebral thromboses (multi infarct dementia). Given the uncertain relevance of the WHI (and other published randomized clinical trials) to initiation of HT in perimenopausal women, and its subsequent continuation for atheroprevention, new trials will be needed to resolve whether early intervention with estrogen may prevent CVD and/or dementia. The Kronos Early Estrogen Prevention Study (KEEPS), which began in mid 2005, is a randomized, controlled multicenter trial of HT in recently menopausal women. It will examine surrogate end points as well as risk factors for atherosclerosis.
Estrogen for Bone Density/Osteoporosis
Lafferty FW, Fiske ME. Postmenopausal estrogen replacement: A long-term cohort study. Am J Med 1994;1:66-77.
Study: A long-term study to determine the success of estrogen replacement in bone loss.
The researchers stated: “The mean cortical bone density at the distal third of the radius was significantly greater among the ERT subjects compared to the control subjects with the difference representing a 12.0% higher bone density with ERT.”
Estrogen for Cognition
Greene RA, Dixon W. The role of reproductive hormones in maintaining cognition. Obstet Gynecol Clin North Am. 2002;29:437-453.
Study: The researchers sought to show the relationship between hormones and cognition citing that “Estrogen has the most profound impact on brain functioning. ”
The researchers stated: “Although skeptics may believe that more definitive proof is necessary before recommending hormone replacement for their patients to preserve their cognitive health, it seems prudent to discuss the evidence available to empower the patient further to guide their own treatment options and validate their symptoms.
Postmenopause, periodontal disease and estrogen
A recent study in the Journal of Periodontology says that in an 11.7 year follow up, 57.5 percent of women lost at least one tooth after menopause. Bone loss is to blame!
The American Academy of Periodontology’s press release on ths study says “Estrogen deficiency after menopause and consequent loss of bone mineral density have been shown to be associated with increased rate of tooth loss. These relationships may be explained by increased severity of periodontal disease in estrogen deficiency.”
Maintaining Muscle Strength – Postmenopausal Bone Loss
Hot Flashes and Insomnia
Hot Flashes and Sleep
Menopause and Heart Disease
Hormones, Oxidative Stress, Menopause
Walking off Postmenopausal decreases in bone mineral density, aerobic fitness, muscle strength, and balance
Hormone Replacement Therapy – Study Comments
More research in segment 3
Studies show that when we restore endocrine balance by augmenting hormone levels to their optimal ranges, quality of life improves and degenerative diseases decline.
Is hormone supplementation and age management medicine right for you?
Hormone supplementation has been practiced for decades. Commonly we hear of people who have been on “Thyroid” for over 30 years, and millions of women have been prescribed estrogen.
The typical patient who wants their hormones optimized are healthy middle-aged people that have started to notice some declines in their level of energy, who maybe for the first time in their lives “just didn’t feel like having sex,” who had lost some of the ambition and drive that they enjoyed only a few years ago.
They also notice that their waist line was getting a little wider and that things were sagging lower than before.
Is hormone replacement therapy right for you?
This is a decision you need to make with your physician. Before entering into hormone supplementation, please discuss the benefits, realistic goals, risks, dangers, and side-effects with your physician.
What are hormones?
What is hormone supplementation?
How does it enhance vitality even as we age?
Hormones are chemicals within our bodies responsible for many things including the regulation of our metabolism, immune function, blood pressure, sugar levels, body temperature as well as a host of other things including regrowth and repair of damaged tissue. They are produced by our glands, namely the Thyroid (Thyroid), Adrenals (DHEA, Pregnenolone), Pituitary (Human Growth Hormone (HGH)), Ovaries (Estrogen, Progesterone, Testosterone) or Testes (Testosterone), and Pineal (Melatonin). After about the age of 30, our body’s hormone levels start to decline. Many cite this decline with the “normal” aspect of aging and its familiar characteristics of fatigue and loss of energy, problems of memory and mood, lack of ambition, loss of libido, weight gain and muscle loss and much more that add up to a sense of poor health. This hormonal decline continues as we age, and usually becomes problematic in our 40’s and 50’s, although, it can create issues at an even younger age. An example are the statin drugs that can cause a dramatic decrease in testosterone even at a young age. With testosterone decline, we find incidence of erectile dysfunction.
Giving “pause” to thought We have all heard of and embraced the term menopause to describe a decline in the female sex hormones, but there are other “pauses” that are becoming more recognizable as house-hold names. Doctors have coined the terms “andro-pause” to describe the decline of male sex hormones in men, “somatopause” to describe the decrease in human growth hormone, “adrenalpause” to describe a decline in DHEA, and “pinealpause” to describe a decline in melatonin.
In the opinion of many doctors, maintaining optimal hormonal balance is our best opportunity to enhance vitality into “old age” and overcome these “pauses” in life. Some doctors however believe that aging is inevitable and that nothing can be done about it except to accept it gracefully. This is a stigma of modern medicine. On one hand, medicine is proud, and rightfully so, of enormous jumps in life expectancy ages, but on the other hand, they are skeptical about enhancements in quality of life. Therefore some doctors may be reluctant to treat hormonally deficient patients because they see this as a normal result of aging, and something they can’t do anything about.
In other words a 70 year-old man presents himself to the doctor’s office with complaints of loss of sex drive, fatigue, and inability to lose weight. It is likely that his doctor will say, “You are 70 years old, and this is normal for your age!”, rather than take blood tests of hormone levels. If the patient was insistent about getting his hormones checked the doctor may see “normal” results, that are the normal ranges for a man 70 years old and tell the patient that he is normal. But the patient isn’t “normal,” that is why he went to his doctor! He doesn’t want the hormones of a 70 year-old man, he wants the hormones necessary to have sex drive, muscle tone, strength, ambition, joy, and his vitality back. He also wants a good chance to be free of heart disease, diabetes mellitis, and other diseases of aging. Why not check his c-reactive protein, fasting insulin, and homocysteine levels, along with many other markers of hidden disease?
An indisputable fact in medicine is that we do age. Another fact that is indisputable, at least for the very foreseeable future, is that you will not live forever. However, there is a great likelihood that you can enjoy a quality of life of vitality well into your senior years because of research into the medical science of hormone replacement and supplementation.
Aging: Fight it or embrace it?
The average life span of an American continues to increase. The current life expectancy of 72 (male) and 79 (female) increases into the mid-eighties IF you can make it to age 65 and now, British researchers think that if you make it to 65 you can get a few more years and should make it to 90! It is also estimated by many gerontologists that by 2050, life expectancy will be well over 100 years old and that there will be millions of Americans at those ages. So if you are 50 now, in the year 2006, the odds will be pretty good that with a healthy lifestyle and regular physical examinations you will make it to vote in the 2056 Presidential Elections.
Is living longer any good if you are not “living?”
With any discussion about increased life expectancy comes the question posed by many: “Do I want to live longer if my mental and physical abilities are impaired?”
There are many who say that we should not seek to live longer if living longer means institutional care, living with chronic pain from disease, or living with impaired mental faculties. But is this the only lifestyle option there is with advanced age? Disability?
There are a growing number of doctors who say that old age does not inevitably bring disability. That the key to enjoying our later years, that is remaining active, mentally alert and independent may rest with hormone replacement therapy.
Can we really control the aging process?
Is it possible to roll back the hands of time and give ourselves a more youthful vigor even when we reach ages that doctors tell us we should consider vitality a thing of the past?
Hormone supplementation is a choice, one that needs to be made by a patient who understands the realistic goals of its benefits and a practitioner who understands the need of moderation—doing just enough and not more to enhance the delicate hormonal balance of our bodies.
What are hormones?
What is hormone supplementation?
How does it enhance vitality even as we age?
Hormones are chemicals within our bodies responsible for many things including the regulation of our metabolism, immune function, blood pressure, sugar levels, body temperature as well as a host of other