Does progesterone therapy get rid of Endometriosis?

Research indicates that insufficient progesterone is made in someone with endometriosis and that the luteal phase is shorter than normal. In some cases the endometrium doesn’t respond to progesterone stimulus from the ovaries.

Giving supplemental progesterone can help to overcome this problem. The dose required is sometimes quite high to overcome this resistance. Normally a dose between 100-200mg/day of progesterone is needed, which equates to 3-6ml/day of Natpro. The higher dose should be used to start with, adjusting it to suit as the weeks go by.

The normal treatment for endo are the progestins, but they have serious side affects.

Endometriosis affects approximately 20% of women worldwide during the years from puberty to menopause, rarely after.

The endometrium is found growing in places other than the uterus. It is most often found in the pelvic area, on the ovaries, Fallopian tubes, the back and front of the uterus, the intestines and the bladder. But it has also been found in the eye, brain, lungs, diaphragm and skin. As the cells within the endometrium in the uterus swell and grow with the rise of oestrogen in the first part of the cycle, so do all the misplaced endometrial cells, giving rise to pain, from mild to extremely severe. Other symptoms are lower back pain, painful sex, bowel movements or upon urination, spotting between periods, fatigue and infertility.

Although no one knows the cause research has found the following markers...

• The interval between the LH peak and the onset of subsequent menstruation is shorter in patients with endometriosis
• In mild, moderate and severe endometriosis the plasma progesterone concentration does not rise on the first day following the LH peak
• Endometriosis has been associated with corpus luteum inadequacy and abnormalities of luteal phase progesterone secretion
• That oestrogen treatment of human endometrial tissue in organ culture maintains secretion of matrix metalloproteinases (MMP), and promotes establishment of ectopic peritoneal lesions. In contrast, suppressing metalloproteinase secretion in vitro with progesterone treatment, a natural inhibitor of metalloproteinases, inhibits the formation of ectopic lesions in experimental models
• It has been shown that 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD or dioxin) exposure promotes establishment of experimental endometriosis by interfering with the ability of progesterone to suppress endometrial MMP expression
• Estrogen-associated growth factors as well as inflammatory cytokines are potent stimulators of MMP expression and may contribute to the ability of endometrial fragments to invade the peritoneal surface and establish ectopic sites of growth. In contrast, paracrine factors associated with progesterone action during early pregnancy inhibit MMP expression and prevent ectopic endometrial growth
• Endometriosis, the presence of endometrial tissue outside the uterus, is a progressive, estrogen-dependent disease and occurs nearly exclusively in menstruating women of reproductive age
• Estrogen is an extremely potent mitogen for endometrium and endometriosis. Progesterone, on the other hand, inhibits the mitogenic action of estrogen on endometrium and enhances differentiation. These antiproliferative and differentiative effects of progesterone are less pronounced on endometriosis tissue compared with endometrium. Thus, endometriosis is, at least in part, resistant to progesterone action
• Aromatase P450 is the key enzyme for biosynthesis of estrogen, which is an essential hormone for the establishment and growth of endometriosis
• Progesterone must be considered a potential physiological inhibitor of glucocorticoid-dependent aromatase induction in adipose tissue. It is proposed that it is a suppressor of aromatase induction in adipose tissue in premenopausal women
• One study reported the successful treatment of severe endometriosis in premenopausal women with the aromatase inhibitor anastrozole combined with 200-mg oral progesterone, rofecoxib, and calcitriol. Treatment resulted in a rapid elimination of symptoms and was well tolerated in both cases

The enzyme aromatase converts androstenedione to estrone and testosterone to estradiol. It's found in the brain, endometrium, endometriosis tissue, fibroids, ovaries, placenta, testes, also in breast and endometrial cancer.

It's activity is increased by alcohol, age, cortisol, insulin and obesity amongst others, and decreased by progesterone.

Two theories have been proposed for the cause of endometriosis...

1. Endometrial cells migrate up the Fallopian tubes and embed in the pelvic area. Somewhat lacking in validity, as it cannot explain how migrating cells can be found in the brain, lungs, skin etc
2. Another line of research believes the problem starts as the foetus is forming in the uterus. Exposure to too much oestrogen, either endogenous or xeno-oestrogens, causes some endometrial cells to be deposited in other areas, instead of in the endometrium where they should be. When the child reaches puberty they of course develop too, with the resulting problems

Treatment usually takes the form of anti-inflammatories, aromatase inhibitors, continuous hormonal contraception to prevent the monthly bleed, surgical interventions, drugs which stimulate the production of gonadotropin releasing hormone, which causes a severe drop in both oestrogen and progesterone, resulting in possible menopausal symptoms and osteoporosis.

If a woman is nearing menopause they are usually advised to wait, as with the decline in oestrogen the endometrial tissue is no longer stimulated and the pain subsides too.

Additional information

Progesterone

Use 100-200mg/day of progesterone, this equates to 3-6ml/day of Natpro.

Nutrients

Take daily a high level of all the anti-oxidants...

• 10,000-25,000 IU vitamin A
• 1-10gm vitamin C
• 100-1000 IU vitamin E
• 15-50mg zinc
• 200-300mcg selenium
• 1000-3000 IU vitamin D3
• the probiotics Lactobacilus acidophilus and Bifidobacteria bifidum/lactis with at least ten billion bacteria per dose, these have a remarkable ability to activate the immune system
• 100-1000mcg vitamin B12
• 400-1000mcg folic acid
• 25-100mg vitamin B6
• 10-50mg vitamin B2
• 1 to 8gm L-glutamine
• 1000-6000mg N-acetylcysteine
• 1000mg glycine
• 500mg methionine
• 5-10ml fish oil with EPA and DHA or 15 to 60ml Omega 3 flax oil
• 100mg Co enzyme Q10
• 1-10gm MSM (methylsulfonyl-methane)
• 515mg milk thistle extract
• digestive enzymes (as directed on label)

The following herbs have anti-inflammatory properties and improve circulation and healing: arnica, gingko biloba and ginger.

Note: If pregnant or breastfeeding take no more than 10,000IU of vitamin A

References

Br J Obstet Gynaecol. 1978 Apr;85(4):246-50.
A study of plasma progesterone, oestradiol-17beta, prolactin and LH levels, and of the luteal phase appearance of the ovaries in patients with endometriosis and infertility

J. Clin. Invest. Volume 99, Number 12, June 1997, 2851-2857
Suppression of Matrix Metalloproteinases Inhibits Establishment of Ectopic Lesions by Human Endometrium in Nude Mice

Gynecologic and Obstetric Investigation 1999;48:45-56
The Potential Role of Environmental Toxins in the Pathophysiology of Endometriosis

Steroids Volume 64, Issue 9 , September 1999, Pages 648-653
Progesterone and transforming growth factor-&Mac178; coordinately regulate suppression of endometrial matrix metalloproteinases in a model of experimental endometriosis

Annals of the New York Academy of Sciences 955:139-146 (2002)
Paracrine Mediators of Endometrial Matrix Metalloproteinase Expression

Semin Reprod Med 2003; 21: 125-134
Endometriosis: The Ultimate Hormonal Disease

Fertility and Sterility Volume 81, Issue 5 , May 2004, Pages 1395-1398
Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor

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