Progesterone for PMS

Over-the-counter natural progesterone creams can be used in a self-help fashion to relieve the type of PMS characterized especially by mood swings, food cravings ( especially sugar cravings), extreme irritability (or as some women say, homicidal feelings), “crying for no reason”, feeling cold, poor sleep two days before the period, hypoglycemic-type symptoms , cyclical headaches, breast swelling, fluid retention, fatigue, fibroids growing and short menstrual cycles. I say this based upon my own experience and the experience of other women I have met in my six years as an independent menopause consultant. These experiences correlate directly with the work of Dr. John Lee, who has given natural progesterone to women for over 20 years.³

Natural progesterone counteracts the imbalance Dr. Lee calls “estrogen dominance”, wherein estrogenic effects dominate over progesterone’s effects due to an insufficient amount of progesterone produced by the body. Many teenagers experience this during their early years of menstruating, because their bodies have not yet established a regular cycle. Women who have had one ovary removed, or who have one non-functioning ovary, may also experience estrogen dominance during non-ovulatory cycles. Women who are coming off of birth control pills or re-establishing their cycle after a pregnancy may experience this imbalance. For these younger women, I recommend a six month to one year course of the herb Vitex, which works on the pituitary gland to re-establish a normal menstrual cycle by increasing production of luteinizing hormone, resulting in an increase in progesterone made by the corpus luteum.

Vitex is a safe, mild-acting herb which has been used for many years in Europe for PMS, irregular menstruation, infertility, fibroids, hyperprolactinemia, poor lactation, and perimenopause.⁴ In various German studies, where women took Vitex in extract form for up to 16 years with no significant side effects, the directions were to take 25-40 drops in a little water, first thing in the morning, any time after 3 AM. Do not eat breakfast or drink juice or coffee for at least 1/2 hour after taking Vitex, to give it a chance to get into your system.

In premenopause, if the body is not able to make sufficient progesterone, which is made primarily by the corpus luteum during the second half of the menstrual cycle, then supplementary natural progesterone can be added in cream form, in addition to the Vitex. Progesterone should be added in a manner to imitate the menstrual cycle, during the second half of the cycle (see Guidelines below). Vitex doesn’t help as much with perimenopause or post-menopause; then you have to take natural progesterone supplementally. Vitex helps the corpus luteum to make more progesterone. If you are not ovulating, then you don’t have a corpus luteum.

Natural progesterone cream is rubbed¸ on the body in areas where there are lots of fat cells, such as thighs, buttocks, belly, and breasts. The cream can be measured in 1/8 or l/4 or 1/2 level teaspoons. Use a real measuring spoon, don’t just take a dab of cream. That way you get about the same amount of progesterone each dose. You’d be surprise how different an “estimated” 1/4 tsp. is from one person to the next!

It’s important to know that when beginning to add natural progesterone to your body, you may at first experience aggravated symptoms of estrogen dominance such as increased breast swelling, fluid retention, and headache. This means that your hormone receptors are out of balance, and it may take as long as three months to fully rebalance them.

If estrogen and progesterone have been out of balance for awhile, then their receptors are out of balance, too. Adding progesterone activates more estrogen receptors, and you experience more intense symptoms of estrogen dominance. Each month, the body resets itself, in the numbers of receptor sites. In order to rebalance your body without too much pain, you can add natural progesterone more slowly.

For example, I started out enthusiastically with 1/4 tsp. of cream twice a day for Days 7-14 of my menstrual cycle, and 1/2 tsp. twice a day for Days 14-28. I got my period on Day 26, so I stopped the progesterone and that became a new Day 1. Fine, but during the second month I had swollen, painful breasts that were so bad that I stopped taking progesterone on Day 17. I got my period early. After that, during the third month I was in no pain and continued on the pattern recommended with no trouble. It’s important not to give up in that second month!

If you experience breast swelling, fluid retention or headache when first commencing natural progesterone cream, lower the dose from 1/4 to 1/8 tsp. for the first month. Increase the dose to the full recommended dose over a couple of months.

Fibroids
For women with fibroids, this issue of a temporary increase in the symptoms is important. If your fibroids are already very large and you have been threatened with the need for a hysterectomy, you need to be very, very careful in starting with natural progesterone, because during the first month or two the fibroids may grow. If you want to try natural progesterone as a last hope before a hysterectomy, you need to begin very slowly and only add a little bit of progesterone the first month, for example, 1/8 tsp. twice a day for Days 21-28. Add a little more the second month, for example, 1/8 tsp. twice a day for Days 14-28. Self-help can only do so much at this point. It may not work. This underlines the importance for women to begin addressing the fibroid issue when fibroids are still small. By using Vitex as soon as fibroids have been found, you can prevent their growth.

Unfortunately, few gynecologists know about the benefits of Vitex and natural progesterone for reducing fibroids and heavy bleeding. Usually nothing is done about fibroids; one justs waits until menopause and hopes they go away. Unfortunately, many women experience months of estrogen dominance before menopause finally happens, and the fibroids grow. As a result, one of the main reasons that women have hysterectomies is because of large fibroids.

If you have large fibroids and/or heavy bleeding (which can occur even without fibroids) due to progesterone deficiency, you need to work closely with a gynecologist to manage the fibroids and/or bleeding with either natural progesterone or synthetic progestins. Heavy bleeding is common in the premenopausal years from 35 to 50. DO NOT IGNORE HEAVY BLEEDING WITH YOUR PERIOD! This is one problem that calls for medical assistance. You can lose a lot of blood and become very weak.

Bad Moods
A woman who attended my classes told us that she had severe PMS, heavy bleeding and small fibroids. Her main complaint was her bad moods, however. That’s what she emphasized when she saw her doctor. Her doctor prescribed Zoloft, an antidepressant, which made her sick to her stomach. Finally she read about Vitex and started taking it. Her moods improved and after a year she went back to her doctor for another ultrasound. Her fibroids were gone. The doctor refused to admit they were gone. He said they were still there, they were just “invisible”!

Another woman who conferred with me because she was approaching menopause and had irregular periods and bleeding between periods was sent back to her doctor to check on the irregular bleeding. She was put on “low dose” birth control pills to control the bleeding, despite my recommendation of progesterone alone, but she continued to have irregular and even heavier bleeding ov?‘er the next several months. Finally it was found that her fibroids were growing under the stimulation of the estrogen in the birth control pills. Fortunately she was able to have her fibroids removed without a hysterectomy, and she found another doctor to work with her using natural progesterone only. “Low dose” birth control pills are only low dose compared to previous birth control pills; they still contain more (synthetic) estrogen than postmenopausal Hormone Replacement Therapy, and this is not going to help the “estrogen dominance” problem.

Information about natural progesterone and estrogen dominance has been passed around the country from woman to woman because the medical establishment has not been interested in how we feel, unless they can sell us Prozac, or in how much we bleed, unless they can sell us “low-dose” birth control pills, or in preventing fibroids, because hysterectomies have been profitable. These trends will only be reversed by women helping themselves, and demanding help from their doctors, insisting that PMS is not a psychological problem, but a hormonal imbalance, and insisting on natural progesterone.

I must mention here that a wrong turn was made on the road to the discovery of the benefits of natural progesterone for PMS in 1990, when the Journal of the American Medical Association published a study on the “Ineffectiveness of Progesterone Suppository Treatment for Premenstrual Syndrome”. This study is repeatedly cited as proof of the failure of natural progesterone to relieve PMS. Upon reading the report, however, there are several glaring problems with it.

First, the women in the study were given a very high dose of progesterone in suppository form, 400 mg the first month and 800 mg the second month. As mentioned above, women experiencing symptoms of estrogen dominance often find that the symptoms are exacerbated in the first two months, especially if the dose of progesterone is increased too rapidly. Second, the study was done for only two months, and again, as mentioned above, it takes at least three months to fully rebalance the hormone receptors. In my own case, if I had given up at two months as the study did, I would not have experienced the benefits of natural progesterone. Third, the dose given was not physiologic. Hormones work best when they are given in a physiologic dose. Fourth, there was no attempt to separate women who were likely to be having estrogen dominance symptoms (heavy bleeding would be definitive) from women who might be suffering from PMS for other reasons, such as hypothyroidism or low estrogen levels (blood tests could distinguish these, but of course there is the other problem of subclinical hypothyroidism, which is usually not recognized.)

Finally, the women chosen for the study had SEVERE PMS, which had led them to seek a doctor’s help. Seventy-three percent had a history of mental illness. Results for these women would not necessarily be representative of the results that might be achieved with otherwise healthy and stable persons. Nevertheless, as I said, this study is cited as the reason for dismissing natural progesterone as a remedy for PMS, and ignoring the clinical experience of Dr. John Lee, Dr. Katharina Dalton, Dr. Neils Lauerson, Dr. Ray Peat, Dr. Joel Hargrove, and others who have written books and articles on natural progesterone and the good results they have gotten from prescribing it. We owe a great debt of thanks to these clinicians who, along with other independent-minded physicians like Dr. Christiane Northrup, have taught us how to use natural progesterone.

But the biggest obstacle to good research on natural progesterone remains the drug industry. In April, 1998 I read in The Boston Globe that brain researchers have found that premenstrual mood changes are due to a drop in progesterone at the end of the menstrual cycle. Progesterone breaks down into allopregnanolone, a kind of natural sedative that soothes jangled nerves like alcohol and Valium do. After progesterone drops, allopregnanolone drops, and there can be a surge of anxiety. Neuropharmacologist George F. Koob concludes that this “points the way towards new drugs that might allay premenstrual anxiety” (italics mine). I would conclude, more elegantly, that this points the way towards the use of natural progesterone cream for PMS. I do realize, however, that what is sought is a patentable drug, not a natural remedy that can’t be patented.