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Estrogen and Progesterone Facts

Estrogen and progesterone must be in the proper ratio for optimal biological function?

During the luteal phase progesterone must be 20-40 times higher than estrogen in order to avoid symptoms of elevated estrogen. It is the ratio of free estrogen to free progesterone that is must be in the normal range in order to alleviate symptoms.

Elevations in estrogen and decreased progesterone affect the estrogen /progesterone ratio equally. Estrogen and progesterone were designed to function in balance. When estrogen is elevated or progesterone is diminished you will note the following symptoms:

Instability of Mood- Progesterone metabolites bind GABA receptors and exert an antidepressant and anti-anxiety effect. Also, progesterone is a precursor of cortisol. Metabolites of cortisol also bind GABA receptors. GABA receptors are the targets of barbiturates and SSRI's.

Tension Depression

Anxiety Confusion

Mood Swings Crying

Nervousness Forgetfulness

Inability to handle stress

          Poor sleep


Alterations in sodium and fluid balance - Progesterone blocks aldosterone receptors, decreasing sodium and water retention. Women with progesterone deficiency or estrogen excess during the luteal phase will complain of water retention and weight gain.

Weight gain


Breast tenderness

Swelling of extremities

Alterations in carbohydrate metabolism- Elevated estrogen levels alter glucose metabolism through alterations in cortisol and corticosteroids. Also estrogen decrease the function of thyroid hormone.

Hypoglycemic episodes

Increased appetite




Estrogen is known to be the stimulating hormone in these conditions.


Fibrocystic breast


Endometrial polyps and heavy vaginal bleeding

Breast Cancer

Endometrial Cancer

Progestins (i.e. Provera, norethindrone etc.) Bind the progesterone receptor and exacerbate the symptoms associated with decreased progesterone. Progestins provide contraception and stimulate secretory endometrium. Progestins do not provide the other functions of progesterone.

Indications for Bio-identical Progesterone

Puberty- Anovulatory cycles create excess estrogen and decreased progesterone. This can produce PMS symptoms. Progesterone is effective in relieving these symptoms24

Breast pain- Estrogen increases breast cell proliferation and swelling. Studies show progesterone relieves 96% of mastalgia and 85% of mild to moderate fibrocystic breast.24, 40

PMS- Studies show PMS symptoms are increased in women with elevated luteal phase estradiol levels. Also, women with low levels of a progesterone metabolite have increased symptoms.1-23

Fibroids- Progesterone can be used to decrease the rate of growth of small (<5cm) fibroids. Very effective for dysmennorrhea associated with fibroids.

Endometriosis- Progesterone is effective in relieving the pain and bleeding associated with endometriosis. Most effective when used from day 7-26 of the menstrual cycle.

Dysmenorrhea- Progesterone is a smooth muscle relaxant and decreases prostaglandin production. Progesterone cream applied to the abdomen will relieve cramping in less than 20 minutes.

Perimenopause - Anovulatory cycles produce a hyperestrogenic state. This produces symptoms of PMS, increases risk of breast cancer, promotes growth of fibroids, and causes heavy vaginal bleeding. The addition of natural progesterone cream will effectively treat all of these symptoms by supplementing the body with the progesterone that is usually produced by the corpus luteum.

Menopausal Symptoms- hot flashes were relieved in 83% of women using transdermal progesterone without any estrogen supplementation. Progesterone is safe in women with a history of breast cancer. Progesterone can be converted into estriol, estrone, and estradiol. Progesterone levels decrease to approximately zero after menopause. Progesterone has many beneficial effects independent of estrogen.

Osteoporosis- Progesterone stimulates osteoblasts, which are involved in bone formation. The addition of progesterone can help in prevention and possibly reversing osteoporosis.

Patient instructions

How to use bio-identical progesterone cream

A progesterone cream must have about 1000 mg of US pharmaceutical grade progesterone in a 2-ounce container. Most commercial creams are sold in 2 oz. containers.

Progesterone levels are maintained for approximately 8 hours when salivary levels are tested. Progesterone levels are not maintained as long or as consistently with oral progesterone.

All women are different. These are guidelines. Encourage women to adjust dose to alleviate symptom

In this concentration:

1/8 tsp 10mg

1/4 tsp 20mg

1/2 tsp 40mg

Perimenopausal women and women with PMS -

20mg-40mg twice a day during the luteal phase days 12-26 of the menstrual cycle. Transdermal progesterone maintains stable saliva levels for 8 hours. If symptoms are more severe the week prior to menses the patient may add a third dose.


Usually the patient can taper her dose to 10mg-20mg twice a day after 2-3 months.

Women with anovulatory bleeding, fibroids, endometriosis

Start the progesterone as early as day 7 or 10 in order to decrease the amount of estrogen only exposure. All of these conditions are stimulated by estrogen.

Menopausal Women not on estrogen

10mg-20mg twice a day for 3 weeks a month.

The 4th week the patient should not use the cream or if her symptoms return during the week off use half of her usual dose. The body needs to see fluctuating progesterone levels in order to respond appropriately.

Progesterone is safe for women treated for breast cancer with menopausal symptoms.

Menopausal women on estrogen

Patients must taper off their estrogen to avoid the recurrence of symptoms that takes place with sudden discontinuation of estrogen.


Take estrogen every other day for one month

Take estrogen every 3rd day the next month

Take estrogen every 4th day the next month

If the patient becomes symptomatic taper the dose over 6 months instead of 3 months


If the patient needs estrogen to help with symptom relief or for added prevention for osteoporosis, you may suggest soy or a natural estrogen if the patient wants natural hormone replacement.


The patient may apply 10 mg. directly to the abdomen to relieve menstrual cramps within 10-20 minutes

Apply 1/4 to 1/2 tsp. twice a day starting day 12 of menstrual cycle. Continue until day 26. Day 1 is the 1st day of bleeding 

Apply to hands, feet, inner arms, neck, chest, breasts, or abdomen. Rotate the sites.

You may increase the dose to 3 times a day the week prior to your menstrual cycle if symptoms increase during this time.

You may apply as needed to abdomen to relieve menstrual cramps.

If you are menopausal, you may use progesterone for three weeks and either half your dose for one week or stop progesterone for one week.

It is important to discontinue progesterone at least one week a month to achieve the best results





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