PCOS & Natural Progesterone Dosage?

by Denise

Hello Wray, I have been diagnosed with PCOS and my doctor who specializes in BHRT, placed me on natural progesterone troches (taken under the tongue) at the following STARTING dosage:

Day 6-12 (14 mg every evening)
Day 13-28 (14 mg TWICE daily, stopping when bleeding begins)

I have been taking this dosage for 9 weeks now and have had VERY LIGHT periods (practically spotting) for 5 days and periods starting early (bleeding starting on Day 20). This has happened for the last three 20-day cycles.

Is this the right dosage considering that the periods are starting earlier and are so light? I asked my doctor about this via phone message and she said to continue with this dosage until I see her in 2 months where we can make adjustments. Could you offer your opinion about this dosing for PCOS? Thank you and thank you for this site!

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Apr 30, 2010
PCOS & Natural Progesterone Dosage?
by: Wray

Hi Denise. Thanks for the kind words! Well two things, first I don't believe troches are the best delivery system for progesterone, and secondly the dose of 14mg is less than the amount we make in a monthly cycle. I'm also puzzled why you are taking it from day 6, as we make very little progesterone during the follicular phase, none from the ovaries. This only occurs after ovulation. For more information on troches please see here. Troches are a relatively new method of administering bio-identical hormones. The reasoning behind them is the hormone bypasses the stomach and first pass metabolism of the liver as it?s absorbed by the buccal mucosa, so entering circulation. However according to one report, more than 50%, occasionally up to 70%, of the total dose of hormone is swallowed. Once swallowed stomach acids and the liver will destroy up to 90% of the hormone. Although this does not affect oestrogen, both testosterone and progesterone are not suited to this route. The best delivery systems are injections, vaginal suppositories or gels and transdermal creams. Absorption of progesterone via a transdermal cream has been found to be as affective as injections and to enter circulation rapidly. It has an advantage over all the other systems as it can be used where needed. On painful areas, in the vagina for dryness and inflammation, excellent for burns, on the face where it helps with wrinkles and more. See here. And here. And here.

We do have a web page on PCO, please have a look here. PCO is caused by oxidative stress, this leads to inflammation and malfunctioning ovaries. You need a high dose antioxidant complex to reverse the inflammation. Please have a vitamin D test done too, a lack of vitamin D can lead to PCO. Interestingly a lack of vitamin D reduces the benefits of progesterone. Take care, Wray

Apr 30, 2010
Dry Eyes, Too
by: Denise

Just wanted to add that I also have severe dry eyes that became MUCH worse after stopping birth control after 16 years of use (to regulate periods). Wray, have you found a connection between PCOS and dry eyes? Have you found that progesterone therapy and diet helps the dry eye issue? Thank you again!

May 02, 2010
Dry Eyes, Too
by: Wray

Hi Denise. Oh yes there is a connection between PCO and dry eyes. Please see this. Interestingly there is an autoimmune disease called Sjogren's Syndrome, where the most common clinical presentation is the combination of dry eyes and dry mouth. The following study found oestrogen elevated, please see here.

The BC pill stops all ovarian function, so lowers oestrogen levels. Stopping the pill the oestrogen level would increase. Progesterone does suppress oestrogen, but I don't believe the troches you are using would help much. PCO is caused by inflammation, it's essential to reverse this. The diet must be changed to avoid all starchy carbs and sugars, these are the most inflammatory substances we can eat. Progesterone and supplements are needed too. Progesterone, although an excellent anti inflammatory, is not sufficient. I have recently formulated a complex for PCO, I would love you to try it. It's already helped 4 women I've been corresponding with. If you're interested, please contact me here. Take care, Wray

May 03, 2010
PCOS and Dry Eyes
by: Anonymous

Hello Wray, this is really helpful! I would be interested in hearing about the "complex" you developed for PCOS. If it is the treatment plan listed on this site, I have read it and have ordered d-chiro-inositol and it should be arriving this week. I think I am going to give the troches a chance for now, as they seem to be doing something (at least starting a light and early period). As of yesterday, I am also starting a low glycemic index diet. Even though I am a thin person (128 lbs), I'm hoping this will help with the suggested insulin-resistance issue that occurs with PCOS. I was tested for Sjogren's (came back negative) and my other blood tests were the following, just to mention:

- High DHEA and testosterone
- ANA antibodies (positive) - dr. suggests some sort of auto-immune issue, but they don't know what.
- I believe progesterone and estradiol was tested as well, but I'm not sure of the results.
- Negative for Sjogren's syndrome and Lupus (dry eye issue)
- Normal thyroid levels (Free T3, Free T4, TSH, Thyroid anti-bodies)

Thank you again - I would be interested in hearing about the complex you mentioned... I will send you a note. Thanks again!

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