Menopause

Progesterone and menopause are inextricably linked at many levels. Strictly speaking menopause only occurs when periods have finally stopped. It is generally recommended to allow a year to pass before drawing this conclusion. The symptoms which can be experienced in the years before its onset (sometimes referred to as peri-menopause) are generally far worse than those following after. In some women symptoms can start ten years before, sometimes they can persist from 5 to 10 years after.

For a comprehensive list of menopause symptoms please click here.

The causes of menopause...

Natural causes

Menopause normally occurs at an average age of fifty-one. Some women can reach their early sixties, whilst the youngest on record is nineteen. Smoking can reduce the age it begins by two years. An early puberty usually means a late menopause, but many factors can influence it's start.

Women are born with a finite number of eggs, all fully developed whilst she is still a foetus, peaking at several million. The current theory as to what causes menopause is that as a woman ages, the number of eggs declines and the ovaries shrink. At menopause, there are only about 1,000 left. But it is still only a theory, no one knows for sure.

At puberty the child starts developing into a woman. This is controlled by the affect of the two sex hormones estrogen and testosterone. Estrogen causes the breasts to grow and fat to be deposited, especially on the hips and thighs. Too much can cause a child to have very large breasts and fats deposits, causing the well known 'puppy fat'. One of the main reasons for puppy fat is a lack of progesterone, which opposes the action of estrogen, but not until ovulation occurs is this produced. Once ovulation starts the puppy fat generally goes. Testosterone increases libido, deepens the voice and causes body hair to grow. But too much can cause aggression, acne, large quantities of body hair and contribute to poly-cystic ovaries. Women produce about 80% less testosterone than men.

About two years after the onset of puberty menstruation begins. The cycle is governed by four hormones. Initially follicle stimulating hormone (FSH) stimulates the egg, and the follicle surrounding it, to grow and the ovary to make estrogen. Estrogen is the dominant hormone in the first half of the cycle, stimulating the buildup of tissue and blood in the uterus.

At mid cycle the pituitary gland produces luteinising hormone which stimulates the follicle to rupture, releasing the egg, which slowly makes it's way down the fallopian tube. The ruptured follicle, now called the corpus luteum, starts producing progesterone, the dominant hormone in the second half. Progesterone readies the endometrium (the uterine lining) for pregnancy. If the egg is fertilized it embeds itself in the lining and pregnancy ensues. If not, then the levels of both estrogen and progesterone drop sharply causing the lining to be shed.

This cycle continues until about ten years before menopause, when anovulatory (no ovulation) cycles begin. This is when the significance of the relationship between progesterone and menopause becomes apparent. When the anovulatory cycle happens no progesterone is produced during that month, but estrogen is still being made, leading to symptoms of estrogen dominance. Please refer to the above list for possible symptoms. As menopause approaches, anovulatory cycles increase, which in turn increases the amount and severity of the symptoms. By menopause the progesterone level can be as low as those in a man, but estrogen levels only drop when it finally arrives. Despite this women are often told the adverse symptoms which they've been experiencing are due to a drop in the estrogen level!

The link with progesterone is highlighted by the fact that women in industrialized countries have a hard time compared to women in rural societies. Dr. P. Ellison of Harvard University has studied estrogen levels in various ecological and cultural populations and has found that estrogen levels in western women are abnormally high. This can be due to a number of factors:

• the food we consume (particularly animals fed estrogen to fatten them)
• the crops sprayed with pesticides (most of which are estrogenic)
• the Pill and HRT
• drinking recycled water which has not had the estrogen removed
• using cosmetics which are made with liquid paraffin and estrogenic antioxidants

Many women are under great stress during peri-menopause having to juggle work and home, often a teenage daughter is going through puberty at the same time, children leaving home, a bad marriage, job difficulties and maybe elderly parents now need looking after.

An understanding of the effects of a lack of progesterone is key to undestanding that progesterone can play an enormously beneficial role in helping to go through menopause without too many adverse affects. By naturally opposing the action of estrogen, the symptoms of estrogen dominance are lessened and in some cases eliminated. The easiest method to apply progesterone is in a cream form.

New research conducted by Wallace and Kelsey and published in "Human Reproduction", indicates that it might be possible, using ultrascan on the ovaries, to show the approach of menopause. Currently blood hormone levels are used to try to determine this, but these are notoriously inaccurate as it is common practice to only check estrogen levels, not progesterone. The patient generally needs to specifcally request this despite the fact that progesterone and menopause are inextricably connected. As the symptoms of menopause are caused by a lack of progesterone and too much estrogen, the standard "estrogen only" test is of little help.

Menopausal women are actively encouraged to have Pap smears, mammograms or have a doctors examination on a regular basis. These have not been shown to reduce deaths from cancer, but merely enable earlier detection and treatment. (Please see page on cancer). Dr. P. Ellison suggests that the abnormal levels of estrogen in western women may be related to the current epidemic of breast and ovarian cancers.

Chemical causes

Menopause can be precipitated at any time in a woman's life by chemotherapy used in cancer treatments. The symptoms are the same as in natural menopause. Tamoxifen, the chemical used to control breast cancer, can cause severe hot flushes. Progesterone can be safely used to combat them.

Hysterectomy

By removal of the uterus and possibly the ovaries, a woman is in instant menopause. If the ovaries are not removed at the same time as the uterus, they will generally atrophy within two to three years. In the recent past, following a hysterectomy, women were usually given HRT. However, with the publication of studies finalized in 2004, which proved beyond doubt that HRT can cause an increase in cancer (particularly breast cancer), stroke and heart disease, this practice has declined. Unfortunately few medical practitioners recommend progesterone regardless of the clear connection between progesterone and menopause.

Causes of Premature menopause

For reasons not too clear some women can go into premature menopause. One possible theory is the affect xeno-estrogens (xeno means foreign) have on the developing foetus. Xeno-estrogens mimic natural estrogen, but are extremely potent and highly toxic. Early exposure to estrogen or the xeno-estrogens can cause the follicles to mature rapidly and die off leaving few eggs in the ovary to reach puberty. This in turn leads to early menopause. Please visit the recommended web sites below for more on xeno-estrogens.

Turners' syndrome (TS)

Mention must be made of the 1:2000 girl babies born with TS. Again for reasons unclear, these children are born with an X chromosome either missing entirely or partially missing. Apart from many potential problems, they have non-functioning ovaries, which means no estrogen will ever be produced. So as the child approaches puberty, the lack of secondary sexual characteristics becomes apparent, no breast, thighs etc. develop. She is then given supplemental estrogen to correct this, but no progesterone to balance the estrogen. Unfortunately, under the misguided belief that estrogen prevents osteoporosis, (please refer to the page on osteoporosis), she is often put onto HRT. As TS was first reported as recently as the 1930's, it is possible that environmental poisons are to blame.

Now the all important question...

How to alleviate the symptoms of menopause?

There are two principal lines of approach...

1. Nutrition and Diet (click link for full details)
2. Progesterone

Depending on the severity of the symptoms, women should use between 100-200mg/day of progesterone. For more information please see...

Before using progesterone it's essential to first read about...

For information on...

Menopause references

Medscape May 8, 2007
Menopause Linked to Elevated Fasting Plasma Glucose Levels in Nondiabetic Women

Menopause. 12(2):232-237, March/April 2005
Percutaneous administration of progesterone: blood levels and endometrial protection

Br J Dermatol. 2005 Sep;153(3):626-34
Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study

Gynecological Endocrinology , Volume 18 , Issue 5 May 2004 , pages 240 - 243
High local endometrial effect of vaginal progesterone gel

BMJ 2004;328:E301-E302 (12 June), doi:10.1136/bmj.328.7453.E301, Editorial
Balancing mammography's benefits and harms

BMJ 2003;327:12 (5 July)
Women with dense breast tissue need both mammography and ultrasonography to detect tumours

BMJ 2003;327:101-103 (12 July)
Women need better information about routine mammography

American Journal of Obstetrics & Gynecology September 2002, 187:3
Twice-weekly transdermal estradiol and vaginal progesterone as continuous combined hormone replacement therapy in postmenopausal women: A 1-year prospective study.

Journal of the National Cancer Institute, Vol. 92, No. 20, 1657-1666, October 18, 2000
Predicting the Cumulative Risk of False-Positive Mammograms

Obstetrics & Gynecology 1999;94:225-228
Transdermal Progesterone Cream for Vasomotor Symptoms and Postmenopausal Bone Loss

J Natl Cancer Inst 1998;90: 906-910
Variation in mammographic breast density by time in menstrual cycle among women aged 40-49 years.

American Journal of Obstetrics & Gynecology October 1997, 177-4 1
Randomized, double-blind, dose-ranging study of the endometrial effects of a vaginal progesterone gel in estrogen-treated postmenopausal women.

Human Reproduction, Vol. 8, No. 12, pp. 2248-2258, 1993
The ecological context of human ovarian function

Dr Mercola October 2011
Still Getting Mammograms? Check Out This Surprising NEW Data

J Clin Endocrinol Metab. 2011 Aug 10
Cigarette Smoking and Endogenous Sex Hormones in Postmenopausal Women

The Endocrine Society 92nd Annual Meeting and Expo; June 19- 22, 2010
Progesterone effective for hot flushes, night sweats up to 10 years after final menstruation

Obesity 18, 604-610 (March 2010)
Testosterone and Visceral Fat in Midlife Women: The Study of Women's Health Across the Nation (SWAN) Fat Patterning Study

CANCERactive 2010
DO SCREENING MAMMOGRAMS INCREASE THE RISK OF BREAST CANCER?

Natural News Monday, January 11, 2010
The Data Behind the New Mammogram Recommendations - Explained

Medscape February 29, 2008
Hormone Therapy Compromises Mammograms and Breast Biopsies

ScienceDaily July 30, 2008
Testosterone Predominance Increases Prevalence Of Metabolic Syndrome During Menopause

ScienceDaily Apr. 29, 2008
Women's Biological Clock Revealed: Hormone May Predict Age At Menopause

Arch Intern Med. 2008;168(14):1568-1575
Menopause and the Metabolic Syndrome

Endocrine Reviews. April 12, 2007
Novel perspectives for progesterone in HRT, with special reference to the nervous system

Menopause. 2007;14:404-407
Menopause Linked to Elevated Fasting Plasma Glucose Levels in Nondiabetic Women

Headache. 2006;46(3):365-386
Ovarian Hormones and Migraine Headache: Perimenopause

Annals of the New York Academy of Sciences 2006 Volume 1052 Issue, Pages 152 - 169
The Case for Progesterone

AJPH July 2006, Vol 96, No. 7 1226-1235
Longitudinal Analysis of the Association Between Vasomotor Symptoms and Race/Ethnicity Across the Menopausal Transition: Study of Womens Health Across the Nation

Menopause: March/April 2005 - Volume 12 - Issue 2 - pp 232-237
Percutaneous administration of progesterone: blood levels and endometrial protection

Br J Dermatol. 2005 Sep;153(3):626-34
Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study

Endocrine Issue Volume 26, Number 3 / April, 2005 Pages 297-300
Ovarian aging and the perimenopausal transition: The paradox of endogenous ovarian hyperstimulation

The Lancet, Volume 365, Issue 9453, Pages 7 - 8, 1 January 2005
False-positive mammogramscan the USA learn from Europe?

Ann. N.Y. Acad. Sci. 1052: 145151 (2005)
Mechanisms of Progesterone-Induced Neuroprotection

Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:955
Prevention of Coronary Hyperreactivity in Preatherogenic Menopausal Rhesus Monkeys by Transdermal Progesterone

Ray Peat
Progesterone, not estrogen, is the coronary protection factor of women

Gynecol Endocrinol. 2004 May;18(5):240-3
High local endometrial effect of vaginal progesterone gel

BMJ 2004; 328 : E301
Balancing mammography's benefits and harms

BMJ 2003; 327 : 12
Women with dense breast tissue need both mammography and ultrasonography to detect tumours

BMJ 2003; 327 : 101
Women need better information about routine mammography

Climacteric, Volume 6, Issue 1 March 2003 , pages 53 - 57
Relationship between climacteric symptoms and serum serotonin levels in postmenopausal women

Menopause Int 2002;8:30-34
Hot flushes and serotonin

American Journal of Obstetrics & Gynecology. 187(3):556-560, September 2002
Twice-weekly transdermal estradiol and vaginal progesterone as continuous combined hormone replacement therapy in postmenopausal women: A 1-year prospective study

Zhonghua Fu Chan Ke Za Zhi. 2002 Dec;37(12):726-8
Changes of plasma serotonin precursor metabolite concentrations in postmenopausal women with hot flushes

American Journal of Epidemiology, 2000, Vol 152, Issue 5 463-473
Relation of demographic and lifestyle factors to symptoms in a multi- racial/ethnic population of women 40-55 years of age

JNCI J Natl Cancer Inst (2000) 92 (20): 1657-1666
Predicting the Cumulative Risk of False-Positive Mammograms

Journal of Women's Health & Gender-Based Medicine. 2000, 9(4): 381-387
Comparison of Regimens Containing Oral Micronized Progesterone or Medroxyprogesterone Acetate on Quality of Life in Postmenopausal Women: A Cross-Sectional Survey

American Journal of Obstetrics & Gynecology 180(6):1504-1511, June 1999
Percutaneous absorption of progesterone in postmenopausal women treated with transdermal estrogen

Obstet Gynecol. 1999 Aug;94(2):225-8
Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss

JNCI J Natl Cancer Inst (1998) 90 (12): 906-910
Variation in Mammographic Breast Density by Time in Menstrual Cycle Among Women Aged 4049 Years

American Journal of Obstetrics & Gynecology. 177(4):937-941, October 1997
Randomized, double-blind, dose-ranging study of the endometrial effects of a vaginal progesterone gel in estrogen-treated postmenopausal women

Hum. Reprod. (1993) 8 (12): 2248-2258
The ecological context of human ovarian function

Obstetrics & Gynecology 1989;73:606-612
Menopausal Hormone Replacement Therapy With Continuous Daily Oral Micronized Estradiol and Progesterone

Opinions differ as to the amount of progesterone needed, symptoms are the best measure. Please click here to learn more about progesterone therapy in general.

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