How long do I remain on the progesterone cream?

by Mari
(Phoenix, AZ)

I am 33 years old and have been using the NatPro progesterone cream since end of May 2013. For the past 3 months, I've been using 332mg/day. I apply 1tsp in the morning and 1tsp before bed. Upon the advice of my naturopathic doctor, I've been taking the progesterone cream every day, including days of my cycle, in order to restore adrenal health, letting my cycle do as it pretty much pleases :)

I do have some PCOS symptoms like hair loss, facial hair, and irregular periods. I've had some improvements in my mood and my hair since using the cream. However, my last three periods have been a little strange. Before using the cream, I would have a cycle every 35-36 days which would last 6 days.

But now, since using the cream, my first cycle came after 36 days with 1 day of brown discharge. My second cycle came in after 42 days with 2-3 days of brown discharge. And this last cycle I had came after 27 days with 3-4 days of brown discharge. My PMS symptoms include the following: Unstable mood, felt more hot and sweaty, hair was falling out a bit more, I was getting some painful acne on my face, and I was retaining A LOT of water.

However, in addition to the above symptoms, in this most recent cycle (of 27 days), I had sore nipples, a problem I've NEVER had before. While the sore nipples reduced as the days went by, I would still experience some on and off spasms of pain in my left breast, and only occasionally in my right breast.

I would like to know the following:
1. How long do I remain on this elevated dose of progesterone? Is it when I see that my cycles are consistently regular or 28 days in length?

2. This brown discharge that I am now having before my cycle worries me. I didn't used to have it before at all. Before the cream, I used to have cycles that started red and ended red. But now they start off with really scanty brown discharge and then proceed to dark red, then red. What does the brown discharge mean? And will it eventually go away to where my period starts red right away?

3. I'm assuming that because of my more prominent PMS symptoms this last cycle, that my progesterone was going down too fast. Should I adjust my dosage to accommodate this by reducing it the first two weeks of my cycle and increasing it the last two weeks? Or should I stop the cream the first two weeks and then start it again last two weeks, and if so, what would be the dosage in these cases?

4. I've been retaining a lot of water and I feel like I'm weighing a lot more. What can I do to address this problem?

5. What does the main in the breasts signify? What should I be doing differently?

I would really appreciate answers to these questions as I don't know who else to ask and look forward to any insight and advice on this matter.

Btw, I get plenty of Vitamin D supplementation: I take 20,000IU/day.

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Sep 09, 2013
How long do I remain on the progesterone cream?
by: Wray

Hi Mari I agree with your naturopath, it is essential to use the progesterone daily to suppress any excess testosterone or oestrogen. Once things have stabilised you can begin following your cycle again. How long this will take is impossible to say. You say you have PCOS like symptoms, has anyone checked to see if you do have it? Progesterone alone won't be enough, PCOS is caused by oxidative stress and large doses of antioxidants are needed to reverse it. A list of these is given on the link above. Whether you have it or not, I would suggest taking them, as they do help the reproductive system to stabilise. We also have a page on Hair Loss you could look through. Many of the nutrients which help PCOS also help hair loss. We do have a page on Acne too. Each month we loose blood, but some of it is also absorbed back into the body. The brown discharge is old blood which has not been shed in previous cycles. Progesterone does help 'clean' the uterus out which is a good thing. It does take time for the progesterone to settle down, there will be times when you experience adverse symptoms. This is usually when oestrogen is highest in the cycle, i.e. just prior to ovulation, mid-luteal phase and just prior to bleeding when progesterone levels drop. If at any time you experience this, I suggest you apply more progesterone. High testosterone initiates acne, see here. If bound to SHBG (sex hormone binding globulin) testosterone becomes inactive, progesterone raises levels of SHBG, see here, so preventing the rise of free testosterone and severe PMS. Evidently the cycle where the acne and PMS flared, plus the water retention and sore nipples, your oestrogen and testosterone were higher than previous cycles. Why this should be so, I don't know. Possibly the ovaries produced more, maybe you had slightly more stress. Or you had large meals or food/drinks containing sugar, all these contribute to dropping progesterone levels, see here. Plus insulin drops levels too, see here. Fructose, sucrose and glucose, reduce SHBG by 80, 50 and 40% respectively, see here. Thereby allowing testosterone to rise, which not only suppresses progesterone, but causes the acne and PMS. Continued below

Sep 09, 2013
How long do I remain on the progesterone cream? Part 2
by: Wray

Hi Mari We do have a page on Breast Tenderness. Progesterone is an excellent diuretic, now given to Traumatic Brain Injury victims to prevent any oedema. I'm delighted you're taking so much vitamin D, please have a test done to check the level soon. Take care Wray

Sep 13, 2013
Update
by: Mari

Thanks for your reply. I had an appointment with my Natropath a few days after posting the above, and I got my recent blood test results back! Amazingly enough, she said my hormones looked fantastic.

Here were my results (taken on Day 27 of my cycle):
Testosterone: 15
LH: 3.4
FSH: 3.0
Progesterone: 2.9
DHEA: 125.5
Estradiol: 53.4
Vitamin D: 65.9

Now, given my last cycle (see above, 3rd cycle, when I had some more prominent PMS symptoms), my Natropath recommended that I start the first two weeks of my cycle, Days 1-14 with 100mg of Progesterone per day, and then for the last two weeks of my cycle, 14-28, I would increase it to 200mg of Progesterone per day. This was because my liver function was also in slight overdrive according to my blood test, and given my PMS symptoms, it seemed like more estrogen was running through my system, my liver then working extra to detox from it. She felt it was because I was taking 300mg of Progesterone, and that may have been too much, and it was being converted into estrogen and causing my symptoms.

Now I'm confused, because according to your website, I should actually increase the amount of progesterone to counter the harmful effects of estrogen dominance. Is it true that progesterone converts to estrogen when in excess?

I'm confused a great deal now because I don't know if I should reduce how much progesterone I'm taking and see whether or not that will make me feel better, or I should increase it. I'm a bit worried because I don't know for sure, and I'm just afraid of having those adverse symptoms again. Any clarification would help! Thanks.

Sep 16, 2013
Update
by: Wray

Hi Mari Your testosterone is fine. But your LH is slightly higher than your FSH which does indicate PCOS. It should be lower than or equal to FSH. Your ratio of P:E2 is only 54:1 which is very low. We've found from Saliva Tests we run that it goes to 600:1 and over. So I would say you are still very oestrogen dominant. If your naturopath knows you have a 35 to 36 day cycle, why on earth did she tell you to use the progesterone following a 28 day cycle?! It's best to use it daily until stable, before attempting to follow your cycle. High progesterone suppresses both oestrogen and testosterone, it does not get converted into those hormones. I gave you that info on SHBG, and the paper which shows progesterone raises levels. This means more testosterone will be bound. It's the active testosterone which gets converted into oestrogen, so less active means less oestrogen. Your vitamin D is higher than most, but to my mind could be higher still. But you are taking a good dose so that should raise it further. I feel this will begin helping you, and maybe you don't need to increase the progesterone. You could try calcium D-glucarate or DIM, both these help detox oestrogen. Possibly the Ca D-glucarate is the better. Oestrogen is metabolised in the liver by glucuronic acid, the process is known as glucuronidation. Glucuronidation is one of the major detoxification pathways of the liver. It removes carcinogens, toxins, tumour promoters, the sex hormones ie, the androgens and oestrogens, mineralocorticoids and glucocorticoids, aromatic and heterocyclic amines, polycyclic aromatic hydrocarbons, various nitrosamines, drugs, fungi etc. It's then excreted in the bile, but an enzyme in the intestine called beta-glucuronidase reverses the glucuronidation process. It breaks the glucoronide bond between a toxin and glucuronic acid, and releases carcinogens, toxins and excess steroid hormones back into circulation. There's evidence beta-glucuronidase activity is increased in breast and prostate cancer. Calcium D-glucarate inhibits beta-glucuronidase, see here, here, here and here. Incidentally this enzyme is produced by undesirable gut bacteria, supplementing with probiotics suppresses the bacteria, and subsequently the beta-glucuronidase. Silymarin from milk thistle also inhibits beta-glucuronidase, plus it helps the liver detox. Take care Wray

Sep 16, 2013
Should I go back to 300mg/day?
by: Mari

Thank you, I appreciate your clarification. It does make more sense to be on an increased progesterone dose at this point, and not reduce. But do you suggest I go back to 300mg/day?

Upon doctor's advice, I had actually reduced it to about 200mg/day (as explained above) and it seems my symptoms have calmed down a bit, but then I'm only on Day 21 of my cycle so far.

On Day 20, I had some slight brown discharge. I have been feeling the heat these days---and they are sudden, so I think they are hot flushes.

So I just wanted to confirm, I should remain on Xmg of progesterone until my cycle regulates itself? What should I be looking for exactly? That my cycle follows a 28 day cycle or that each cycle starts consistently around the same time?

To be honest with you, I'm not actually sure if my cycle is 35-36 days... that's just how it has been for the past 1.5 years. Before that, for a short while, I had cycles at 28 days in length (this lasted probably a few months). Before that, I always had irregular periods. I don't really have any way to tell when my cycles are regular: according to 28 days or consistently x number of days each time?

Sep 20, 2013
A couple of other things I'm confused about
by: Mari

Actually, I'm confused about the following:

I'm not sure now to distinguish between PCOS and Estrogen Dominance. The progesterone therapy seems to be a little different for each.

Based on my symptoms, I seem to have both PCOS symptoms (facial hair, acne, hair loss, irregular periods) and estrogen dominance symptoms (hot flushes, fat accumulating around the middle, mood swings, irregularities in menstrual flow, water retention). A lot of these symptoms probably overlap, right?

So what I'm confused about is... should I follow the PCOS protocol or the estrogen dominance one? Should I take 300mg of progesterone everyday, regardless of my cycle, or should I take 100mg for the first 2 weeks of my cycle and then 200mg for the last two weeks as my doctor suggested?

I have never taken HRT (just the NatPro progesterone) or any kind of birth control, just to give you an idea of my history. I also do not consume alcohol, smoke, or have a poor diet. Everything I have is either organic, grass fed or wild. I'm 5'3" and gained quite a bit of weight, weighing about 164lbs. I believe this is mostly water weight.

I recently had cycle, this time it started even earlier than my last one (read the first post in this thread). My cycle started after Day 24, and I had 4 days of scanty brown discharge prior to that (starting from Day 20). Yesterday, I finally started to see some red blood and assumed my period finally started. But the flow has been extremely scanty, almost like the 4 days of just brown discharge.

My PMS symptoms this time were very minimal. I have been taking 100mg/day for the first two weeks and then increased it to 200mg for the last two weeks (I never ended up completing two weeks because my period, as I said, showed up so early). The only symptoms I had were some mild depression and a bit of hair falling out. I had some acne on my chin and other places, but they never came to surface---i.e. they went away very quickly, they were unnoticeable and were mildly painful.

I'm really confused about what I should be doing... mainly, I don't now if I should go according to estrogen dominance symptoms and just take 300mg like I was since May, everyday, or I should go according to PCOS symptoms and take 100mg first two weeks, and then 200mg the last two weeks of my cycle...

If I go according to PCOS, how do I determine the length of my cycle or do I ignore it and go according to 28 days?

I'm sorry for all of the questions. I really, really appreciate your diligence in answering everyone's doubts and inquiries. I hope you can help!

Sep 22, 2013
Should I go back to 300mg/day?
by: Wray

Hi Mari A 28 day cycle is only the average, it ranges in women from 21 days to 35 days. For instance my daughter, who's 31, has a 21 day cycle. Add these together, divide by 2 and you get 28 days. The drug companies that make Contraceptives are to blame. They couldn't make different day lengths to suit all women, so lumped them all into 28 days each. Even doctors seem to think we all have 28 day cycles, or should! We do have a page on Hot Flushes which might explain things. I have found 400mg/day is needed, although some women need more. You might find this helps them and the other symptoms too. Then when you feel stable you can begin reducing the amount, but please do this slowly. No more than 1ml or 33mg each time, even 1/2ml if you feel the 1ml is too much. Please consider taking some or all of the nutrients listed on the PCOS page, whether it's been confirmed or not, you do have some of the symptoms. I know the nutrients will help, progesterone alone will not be enough. And please don't forget to have your vitamin D levels checked. Take care Wray

Sep 24, 2013
A couple of other things I'm confused about
by: Wray

Hi Mari I can see where your confusion lies, apologies! I see I'll have to change the PCOS page, I wrote it some time ago. I've since found it's not as simple as following a cycle, or if cycles are erratic following the average 28 day cycle. Anyone with PCOS should use the progesterone daily for at least 2-3 months or until stable. I've found some have to use it daily for 6 months before coming right. This will ensure any excess oestrogen and testosterone are suppressed. It's rare for a woman with PCOS to have a regular cycle. But progesterone alone won't be enough, the nutrients do need to be taken too. There's an explanation on the PCOS page on what they all do, some initiate ovulation, some help stabilise blood glucose, some correct Insulin Resistance, and more. If you follow your cycle you will not be getting enough progesterone. And you don't have a cycle to follow, it could be yours is naturally long. By following a 28 day cycle you could upset things even more. Thanks to you, I really do need to change the PCOS page! When I first started this site I recommended 100-200mg/day, now I find myself asking women to use 200-400mg/day. It's only because I've had such good feedback from women who have tried the higher amounts. So please use it daily, ignoring any bleeding until stable. In fact this is best for any condition, not only PCOS. I would only suggest following a cycle if it's a known regular length and symptoms are only experienced the few days prior to bleeding, i.e. typical PMS. The women writing in here do not have typical PMS! Let me know how you get on. Take care Wray

Sep 25, 2013
How do we know when to reduce our dose, and can any dosage be considered too high?
by: Mari

Thank you, this last reply made so much more sense to me now! I called my ND and asked them about my situation also to see what they would recommend. Just to reiterate, this is what my last few cycles have looked like (33yrs old, started 300mg the last week of May 2013):

Cycle 1: After 35 days, 1 day of brown discharge, 6 days of flow (traveled for 3 weeks prior)
Cycle 2: After 40 days, 2 days of brown discharge, 7 days of flow (had been fasting for 20 days prior, from sunrise to sunset as per my faith)
Cycle 3: After 27 days, 4 days of brown discharge, 7 days of flow (experienced more prominent PMS symptoms: breast pain, moodiness, water retention,)

As per ND instructions, after this cycle, I had reduced my progesterone dose from 300mg/day, to 100mg/day for days 1-14 of my cycle, and then 200mg for days 15-28 (due to my last PMS symptoms). Following this protocol, on Day 21, I had brown discharge for 4 days, then 1 day of bleeding (which was very, very scanty) and then 4 more days of brown discharge. For the next 2-3 days after that, I started to experience more hair loss. I have been feeling more depressed, sad and can't seem to get my act together (brain fog?), I don't feel like doing anything productive. This may, in part, have to do with the fact that because of my confusion, I was unsure about how much progesterone to take, and thus wasn't very regular with the dosage or timing. My water retention has improved, as well as the night sweating.

I seem to feel better on 1tsp/day (166mg) and then increase it by whatever amount necessary to relieve symptoms when I start to feel some PMS or flushes.

As per your instructions, I should actually go back to 300mg/day and continue this every day until my symptoms normalize a bit, is this correct? If so, this is Question #1: what *exactly* should I be looking for as signs that I can now reduce my progesterone dose? If this can be clarified, then it will probably stop a lot of women from pre-maturely lowering their dose. This is because 2-3 months of continuous, daily use may not be enough for some women, who may go for longer than this.

My second question deals with using too much progesterone. If I understood correctly from your website, there is no such thing as too much progesterone, is that right? From Cycle #3 above, I had more severe PMS symptoms even though I was on a higher 300mg daily dose, and I was already into my third month of continuous use. However, when I lowered it to 166mg/day, I felt better. Does this mean the 300mg/day dosage was now too high and I was ready to lower? Or can this be attributed to other factors that may have caused more prominent PMS symptoms (maybe I consumed more sugar or had more stress)? OR, should I have increased it even further?

This was actually the reason that my ND prescribed reducing my progesterone dosage as mentioned above, thinking that now perhaps the progesterone dosage was too high based on my PMS symptoms of Cycle #3.

Sep 25, 2013
Blood Test results in more detail...
by: Mari

Here are the results of my blood test, taken on Day 28 of Cycle #3:
TSH: 1.21 uIU/mL
Free T3: 2.7pg/mL
Free T4: 1.06ng/dL
Testosterone: 15ng/dL
LH: 3.4 mIU/mL
FSH: 3.0 mIU/mL
Progesterone: 2.9ng/mL
DHEA: 125.5ug/dL
Estrodiol: 53.4pg/mL
CRP: 2.19mg/L
Vitamin D: 65.9ng/mL
Cortisol - PM: 7.9ug/dL
Fasting Glucose: 77mg/dL
ALT: 37IU/L
Total Cholesterol: 179mg/dL
Triglycerides: 241mg/dL

My ND said that while my hormones looked much better, other things seemed to be worse like my triglycerides, kidney function was much lower, liver was working harder than usual, there was more inflammation. Could this explain my PMS symptoms for Cycle #3, that perhaps I had consumed more sugar/meat than usual or experienced more stress and this may have stimulated more estrogen dominance symptoms?

I've given you a lot of information here, so I'm sorry if it's a little overwhelming! I appreciate you insight :)

Sep 27, 2013
How do we know when to reduce our dose, and can any dosage be considered too high?
by: Wray

Hi Mari Well your cycles were 35 days, then 40, then 27. To tell you to use the progesterone as if you have a regular 28 day cycle makes no sense. Which is why I suggested using it daily. There is only one thing to look for, and that's are you feeling better, have your symptoms gone, nothing more, nothing less. I'm puzzled, you say you had a test done on day 28 of cycle 3, but that ended on day 27. So the test was done on day 1 of the next cycle. This is not the correct time for it as it should be done mid-peak luteal phase. Which of course you don't have at the moment with erratic cycles. But if I take those figures you've given me, your ratio is 52:1, very low. From Saliva Tests we run the ratios go up to 600:1 and over. In some women it doesn't have to be as high, but it gives you an idea of how low yours is. The low ratio explains the PMS, apart from which oestrogen is an inflammatory hormone. Meat isn't a problem, provided it's not full of hormones. But sugar in any form is poison. It causes glycation. This occurs when a sugar molecule binds to a protein or lipid molecule without the control of an enzyme. This impairs the function of the molecule, leading to advanced glycation endproducts or AGEs, see here. This results in oxidative stress, see here. Which in turn leads to inflammation, see here and here. Resulting in many of our inflammatory diseases, which are the end result of long term oxidative stress. Sugar is responsible for any increase in triglycerides, which would cause a strain on the liver. Yes there is such a thing as too much progesterone, no one needs to use more than required to get rid of symptoms. It's not harmful in any way, as the body just metabolises and excretes it, but it is costly. If you feel better on 166mg/day then stick to that. It's the yo-yo 100mg to 200mg you were told to use which I don't agree with. But I do suggest using it daily, through any bleeding until you feel stable enough to follow your cycle again. It could take 2 months, 3 months or 6 months. Continued below

Sep 27, 2013
How do we know when to reduce our dose, and can any dosage be considered too high? Part 2
by: Wray

Hi Mari Some women have used very high amounts for over a year, see here, here,here, here and here. If interested in reading about extremely high amounts of progesterone, take a look at this page here. Let me know how you get on. Take care Wray

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