Re: Q: Progesterone dosing

[Guest guest]

I have really good luck with products by Bezweken either progon-B or phyto-b , all plant based but work really well without dipping into bioidentical hormone replacement. I did bioidenticals for 7 years and find similar effects with the above two products and a lot less tinkering and adjusting doses. Just my clinical experience. On another note, I frequently dosed progesterone around 750125mg in post-menopausal women when I did prescribe bioidentical hormones. ODell Q: Progesterone dosing

Hi everyone-

I have a post-menopausal woman who showed highly estrogen dominant on saliva testing. She is overweight and had been having significant difficulty losing weight despite great diet, exercise, blood sugar suport, and stress managament. As part of her plan, we started a natural progesterone cream at 20 mg/d. She found a website about a progesterone dosing of 100-200 mg/d to "overcome the initial stimulation progesterone has on the estrogen receptors at low doses". The website said that the low dose (20-40 mg/d) will continue to stimulate the estrogen receptors, keeping a woman in estrogen dominance and never overcome this stage. I don't do a lot of hormone treatments but I'd never heard of this effect or dosing that high. The site said that the dose could easily be decreased if symptoms of too much progesterone were starting. I realyl don't want to create more problems by dosing too high- I'm generally cautious when prescribing hormones and use as little as possible for the shortest time needed. So I don't know if this is accurate info or someone just trying to sell more product. Anyone have any ideas on this?

Thanks-

Hindman, ND, LAc

Portland, OR

family practice

[Guest guest]

The higher dosing of progesterone (100-200mg) is most likely an oral troche or capsule. Transdermal P requires much less doses, around 20-40mg because it bypasses the first pass of liver. I've never heard of P stimulating estrogen receptors so it appears that source was unreliable. That's one of the reasons why progesterone gets used... to offset a dominant estrogen state.

Progesterone also acts as a 5-alpha reductase inhibitor, which affects insulin resistance and weight. Progesterone use may facilitate weight loss in your patient.

All the Best,

Lemley, ND, NCMP

NAMS Certified Menopause Practitioner

Bozeman, MT

[Guest guest]

I would respectfully disagree on the statement it is allopathic... and argue that we augment nature by way of natural, bio-identical hormones. Supporting the body's ability to heal by way of mimicking the natural state with the body's own hormone to treat and preventing dis-ease... to me that is naturopathy at it's core essence. ;-)

All the Best,

Dr. Lemley

Bozeman, MT

[Guest guest]

100-200 mg sounds like an oral dose to me, which you have to dose that high due

to first pass in the liver. I can't imagine dosing that high in a cream, but

maybe others have?

Karon-, ND

Bambu Clinic

Portland, OR

[Guest guest]

Have you already tried dealing with the estrogen dominance via drainage etc.? I find that my post menopausal women can do very well with liver undas, and appropriate gemmos especially Rosmarinus. Once the liver is properly conjugating estrogen then the "dominant" situation may resolve without having to add in hormones from the outside. I also find that using the Evening Primrose Oil during the second half of the cycle from full moon back to new helps the body gently produce progesterone on its own. Also, her stuck weight may be a need for thyroid drainage even though she may not actually need thyroid hormone. Just cleaning up the terrain with unda gemmo phytogen and hormonal EFA's often does the trick and weight just slowly gradually comes off. A recent patient of mine is post menopausal and just lost 14 pounds over the course of 6 months without much effort other than the above approach. Hope this is helpful.... Sincerely, Sobyl Bunis Chiropractor Santa barbara/San Obispo Calif. To: unda_cases From: kjhindman@...Date: Mon, 6 Jun 2011 16:44:00 -0700Subject: Q: Progesterone dosing

Hi everyone-

I have a post-menopausal woman who showed highly estrogen dominant on saliva testing. She is overweight and had been having significant difficulty losing weight despite great diet, exercise, blood sugar suport, and stress managament. As part of her plan, we started a natural progesterone cream at 20 mg/d. She found a website about a progesterone dosing of 100-200 mg/d to "overcome the initial stimulation progesterone has on the estrogen receptors at low doses". The website said that the low dose (20-40 mg/d) will continue to stimulate the estrogen receptors, keeping a woman in estrogen dominance and never overcome this stage. I don't do a lot of hormone treatments but I'd never heard of this effect or dosing that high. The site said that the dose could easily be decreased if symptoms of too much progesterone were starting. I realyl don't want to create more problems by dosing too high- I'm generally cautious when prescribing hormones and use as little as possible for the shortest time needed. So I don't know if this is accurate info or someone just trying to sell more product. Anyone have any ideas on this?

Thanks-

Hindman, ND, LAc

Portland, OR

family practice

[Guest guest]

I agreePlus with doing extensive liver drainage, and using herbs to help the liver with estrogen metabolism, like Cell Guardian from Natura health products in Ashland oregonI also like the Biotone EFA in these type of peopleR Zieve MD

Have you already tried dealing with the estrogen dominance via drainage etc.? I find that my post menopausal women can do very well with liver undas, and appropriate gemmos especially Rosmarinus. Once the liver is properly conjugating estrogen then the "dominant" situation may resolve without having to add in hormones from the outside. I also find that using the Evening Primrose Oil during the second half of the cycle from full moon back to new helps the body gently produce progesterone on its own. Also, her stuck weight may be a need for thyroid drainage even though she may not actually need thyroid hormone. Just cleaning up the terrain with unda gemmo phytogen and hormonal EFA's often does the trick and weight just slowly gradually comes off. A recent patient of mine is post menopausal and just lost 14 pounds over the course of 6 months without much effort other than the above approach. Hope this is helpful.... Sincerely, Sobyl Bunis Chiropractor Santa barbara/San Obispo Calif. To: unda_cases From: kjhindman@...Date: Mon, 6 Jun 2011 16:44:00 -0700Subject: Q: Progesterone dosing

Hi everyone-

I have a post-menopausal woman who showed highly estrogen dominant on saliva testing. She is overweight and had been having significant difficulty losing weight despite great diet, exercise, blood sugar suport, and stress managament. As part of her plan, we started a natural progesterone cream at 20 mg/d. She found a website about a progesterone dosing of 100-200 mg/d to "overcome the initial stimulation progesterone has on the estrogen receptors at low doses". The website said that the low dose (20-40 mg/d) will continue to stimulate the estrogen receptors, keeping a woman in estrogen dominance and never overcome this stage. I don't do a lot of hormone treatments but I'd never heard of this effect or dosing that high. The site said that the dose could easily be decreased if symptoms of too much progesterone were starting. I realyl don't want to create more problems by dosing too high- I'm generally cautious when prescribing hormones and use as little as possible for the shortest time needed. So I don't know if this is accurate info or someone just trying to sell more product. Anyone have any ideas on this?

Thanks-

Hindman, ND, LAc

Portland, OR

family practice

[Guest guest]

In the type 1 diabetic, one can use all the herbs, supplements, and detox as much as they want but that patient will die unless that patient gets what the body needs for it to survive... insulin. Therefore, is insulin allopathic or naturopathic?

Similar circumstance for the peri-menopausal/menopausal woman as described in this case. It's not stressed out, overweight, garbage eating 20 year with an irregular cycle and acne we're talking about here. When ovarian production of progesterone and estrogen stops, try all you want, but no herb, supplement or detox program is going to restore ovarian function, ever. Now by virtue of menopause, there becomes an increased risk of developing all those wonderful age-related illnesses by result of losing those specific hormones. The use of progesterone and estrogen, depending on the patient, will prevent and treat ailments like osteoporosis, colon cancer, breast ovarian and uterine problems, dementia, heart disease, stroke and blood clots, insulin resistance, remove atrophic changes, etc. The list goes on an on. A natural substance that happens to be a hormone does all that. It's called estrogen. Find me an herb, supplement, or detox program that does all that. The non-bioidenticals, such as Premarin/Provera, do not hold up to this and they tend to cause problems, as excemplified by the Womans Health Initiative. The use of bioidentical, dare I say a natural substance, to manage symptoms and treat/prevent illness in the menopausal woman is hardly allopathic. Using nature to restore nature is completely within our philosophy. But that's my opinion, and as naturopaths, we are full of opinion.

Good dialogue. Keep it coming ;-)

Respecfully,

Lemley ND, NCMP

NAMS Certified Menopause Practitioner

Bozeman, MT

[Guest guest]

For me, using progesterone is green allopathy.We too quickly go to hormones because people want quick resultsR Zieve MD

The higher dosing of progesterone (100-200mg) is most likely an oral troche or capsule. Transdermal P requires much less doses, around 20-40mg because it bypasses the first pass of liver. I've never heard of P stimulating estrogen receptors so it appears that source was unreliable. That's one of the reasons why progesterone gets used... to offset a dominant estrogen state.

Progesterone also acts as a 5-alpha reductase inhibitor, which affects insulin resistance and weight. Progesterone use may facilitate weight loss in your patient.

All the Best,

Lemley, ND, NCMP

NAMS Certified Menopause Practitioner

Bozeman, MT

[Guest guest]

I tend to agree with Dr. Zieve.  If someone has imablanced hormones, is giving them even more exogenous hormones (bio identical or not) for the rest of their life really getting to the core cause?   On ocassion yes, such as if an organ is removed or damaged beyond function.  I think most times however, doing things such as drainage, detox, removing toxic burden, changing diet and lifestyle habits, tonifying organs, etc will being the body back to a state where it balances its own hormones properly.

 

Is there a place for homone therapy?  Yes, but like antibiotics, they are often overused when they aren't needed.

 

ND

Islip NY

 

I would respectfully disagree on the statement it is allopathic... and argue that we augment nature by way of natural, bio-identical hormones.  Supporting the body's ability to heal by way of mimicking the natural state with the body's own hormone to treat and preventing dis-ease... to me that is naturopathy at it's core essence.  ;-)

All the Best,Dr. LemleyBozeman, MT

[Guest guest]

Like I said, if the organ is destroyed (as in type 1 DM) thats a case that needs hormones.

 

Should menopause be seen just as diabetes is?  Is it a good idea to give 50, 60, or 70+ year old organs the hormonal status of a 30 y/o organ?  I think with all we have to offer as NDs, we can give great support to women going through, and ones that have gone through, menopause without having to use hormones.  Now if someone is 25 and had her ovaries destroyed somehow, hormones would be a good idea for that person, but its hard for me to see menopause as a disease like diabetes, etc.

 

I wonder if any study has been done for the post-menopause risks on women who live the type of healthy lifestyle, support, etc that we provide our patients.  I would bet that the risks are much lower than the 'average' american post-menopausal woman. 

 

I could very well be wrong, and I dont use hormones in my practice, but this is how it seems to me right now.

 

Jim 'liking the discussion' Prego ND

Islip NY

 

In the type 1 diabetic, one can use all the herbs, supplements, and detox as much as they want but that patient will die unless that patient gets what the body needs for it to survive... insulin.  Therefore, is insulin allopathic or naturopathic? 

Similar circumstance for the peri-menopausal/menopausal woman as described in this case.  It's not stressed out, overweight, garbage eating 20 year with an irregular cycle and acne we're talking about here.  When ovarian production of progesterone and estrogen stops, try all you want, but no herb, supplement or detox program is going to restore ovarian function, ever.  Now by virtue of menopause, there becomes an increased risk of developing all those wonderful age-related illnesses by result of losing those specific hormones.  The use of progesterone and estrogen, depending on the patient, will prevent and treat ailments like osteoporosis, colon cancer, breast ovarian and uterine problems, dementia, heart disease, stroke and blood clots, insulin resistance, remove atrophic changes, etc.  The list goes on an on.  A natural substance that happens to be a hormone does all that.  It's called estrogen.  Find me an herb, supplement, or detox program that does all that.  The non-bioidenticals, such as Premarin/Provera, do not hold up to this and they tend to cause problems, as excemplified by the Womans Health Initiative.  The use of bioidentical, dare I say a natural substance, to manage symptoms and treat/prevent illness in the menopausal woman is hardly allopathic.  Using nature to restore nature is completely within our philosophy.  But that's my opinion, and as naturopaths, we are full of opinion.

Good dialogue.  Keep it coming  ;-)Respecfully, Lemley ND, NCMPNAMS Certified Menopause Practitioner

[Guest guest]

HII have battled my own resistance to using hormones in my practice, and for the most part have not needed to use them. Is it balancing the body or overriding the body natural rhythm to balance itself out? It makes sense to me about 's comment that when the body has exhausted the production then no amount of stimulation will replace the progesterone. For the average woman pre-menopausal or peri-menopausal I have had good success like most of us have had with drainage, liver detox, EFA and herbs and homeopathics. Below is case of using progesterone and a question in another case for using progesterone.Case 1: I am treating a young woman in her thirties for minimum of 3 years doing all the above listed things to

balance her hormones and symptoms. She was oligomenorrhic and had severe headaches and migraines up to 15-20/month. We did a lot of work and fine tuned her diet. We got some good results but still not at the level where her body could/should be. After three years we discussed using natural progesterone cream, we started out at 25mg and she seemed to get a little worse. Through muscle testing and case analysis we upped her dosing to 50mg and she is doing very well, but not 100%. Her periods have gone from average 40 days to close to 32- 28days for the the past three months. She no longer has migraines before her menses and overall less frequently but will get one at ovulation (usually day before progesterone was due to start) and some into her cycle after progesterone has been stopped. So we are working on starting early and her dose was increased to 75mg prior to this.It has been challenging to balance her cycles but most marked improvement

with adding in the progesterone cream but finding the right dosing and timing has been tricky. Has she done better on the progesterone due to all the pre work, probably. But why cant she produce enough of her own progesterone. HOw can better balance be achieved? We have lightly touched on the lung system in the past and going back to that as there is some lung history of pathology and her endocrine system has been off since day 1. She more than likely has PCOS and that is being treated as part of the plan.Case 2: 50something year old post menopausal woman. Her main complaints are vaginal dryness and pain with sexual intercourse and lowered libido. She came to see me just after having uterine polpys removed that were presumed triggered from vaginal estriol cream that she had been using regularly over the last 2yrs or so. Even though the estriol low dose vaginal suppositories is suppossed to be "safe". She is definately

sycotic in miasm with tendency to form other cysts and toxins packaged up. We have not used any hormones and have done lots of drainage and hormone balancing in all the usual ways.She has some relief from vaginal pain with Comfort suppositories but not enough or long term. My question is has anyone used progesterone cream successfully on its own to treat vaginal dryness and libido issues and would it be contraindicated in the sycosis patient. Even if emunctories are open and doing well at this time.Thanks for your response NDSeattleFrom:

"doclemley@..." To: Sent: Tue, June 7, 2011 7:13:22 AMSubject: Re: Q: Progesterone dosing The higher dosing of progesterone (100-200mg) is most likely an oral troche or capsule. Transdermal P requires much less doses, around 20-40mg because it bypasses the first pass of liver. I've never heard of P stimulating estrogen receptors so it appears that source was unreliable. That's one

of the reasons why progesterone gets used... to offset a dominant estrogen state. Progesterone also acts as a 5-alpha reductase inhibitor, which affects insulin resistance and weight. Progesterone use may facilitate weight loss in your patient. All the Best, Lemley, ND, NCMP NAMS Certified Menopause Practitioner Bozeman, MT

[Guest guest]

In case 1, if PCOS is the situation, that explains her lack of progesterone so good workup is indicated. It's always nice to know what we are dealing with otherwise we are just guessing. PCOS is basically insulin resistance/pre-diabetes, so this is where all those other good things (diet/lifestyle/herbs/supps/detox) will/should restore normal and proper ovarian function over time. Adding P is a judgement call, but will likely bring about quicker results in the short-term, thus facilitating more rapid progress while working on everything else. P is a natural 5-alpha reductase inhibitor, thus inhibiting the conversion into a strong/potent form of testosterone, thus acne, irregular cycles (decreased P), hair growth, etc which are hallmarks of PCOS.

In case 2, the further a woman distances herself into menopause the greater the likelihood she will eventually experience atrophic changes. For some it happens sooner, for others it is years down the line. The area becomes more thin, dry, friable, irritated, prone to infection. They may note bladder symptoms as well. Those atrophic changes makes intimacy downright uncomfortable, frequently leading to having an aversion to becoming intimate due to pain. Vitamin E, other suppositories works only as a band-aid. Not to discredit this approach, but they have a moisturizing effect at best and provide only temporary relief. For some that is enough. However, those therapies will not alter at all the atrophic changes which is caused by lack of estrogen and as time goes on, the situation will get worse. Count on it. Having been in practice >12 years, never have I come across an estriol/polyp correlation. Estriol IS safe when used propertly. Just because she used the suppository for 2 years does not mean estriol caused the polyps. Many suppositories bases contain nasty substances like propylene glycol... you know, anti-freeze. Perhaps the solvents used in the cream to activate absorbtion of hormone could also have been irritating, as can be for some. The likelihood is high when she had adequate E3 levels from puberty on, she didn't have polyps. The polyps could be the result of nasty chemicals entirely apart from estriol, also they could be the result of something entirely unrelated to the suppository. Thinking it was E3 does not make it so. Would progesterone work? I've never used it for this. It might, but I doubt its efficacy because atrophic vaginitis is an estrogen thing, not a progesterone thing. Only the application of a local estrogen (E2 or E3) will easily restore the integrity of the area, providing immense comfort, thus enhancing intimacy. If comfort and intimacy is the concern, the moisturizers will help temporarily, but the situation will eventually get worse unless an estrogen is used. Talk to your local compounding pharmacist about using a hypoallergenic transdermal.

All the Best,

Lemley, ND, NCMP

NAMS Certified Menopause Practitoner

Bozeman, MT