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Confusion regarding ovulation and progesterone use

Hi Wray,

Thank you for the wealth of information you have put together on this site. I have a somewhat long question about using natural progesterone cream for a pre-menopausal woman.

First a brief(ish) history: I'm 29 years old, and have endometriosis, the symptoms of which seem to be returning after a hiatus from symptoms during and after two closely-spaced pregnancies. I was on the pill from the age of 16 to 23, having first started to take it for pms cramping. During each of my pregnancies, I had extreme nausea, moderate depression, and with my first pregnancy I had pre-eclampsia. Accordingly, I've 'self-diagnosed" progesterone deficiency. :)

Here is my question--I'm confused regarding how to use the cream, as there are a couple of contradictory statements on the site (or perhaps not contradictory, but something I need clarification on). On the "how to use progesterone" page, you write it's important to not start the cream before ovulation, as this can suppress ovulation and your body's natural progesterone production. But, on the "progesterone misconceptions" page, it is stated that using progesterone cream before ovulation can actually enhance ovulation.

I would like to use progesterone cream to relieve the emotional lows of pms, as well as endometriosis-type pain, menstrual weight gain, and general brain fog during pms. All of these symptoms have noticeably increased within the last year. Preventing pregnancy would be an added bonus, but not essential as a vasectomy is on the horizon for my husband.

Can you advise as to how I should be using this cream? I thought I had it worked out, but I've managed to get myself thoroughly turned around with all the information.

Thank you again for this wonderful resource!

Comments for Confusion regarding ovulation and progesterone use

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May 16, 2012
 Ovulation and progesterone therapy
by: Anonymous

I agree the info on when to take it is somewhat confusing. Wray, I think we need you personal comments on this! I started taking it and I have had two periods in one month! I need some feedback as to why! It's a great resource and wonderfully informative site so please keep up the good work!
May 16, 2012
 also confused
by: Andrea

Hi, me too I am confused about the use of progesterone regarding ovolution. I understood from one of your posts Wray, that you used progesterone without interruption when you were in perimenopause and when having regular periods. But that would hinder ovolution, or more important the production of progesterone in the body, wouldn't it? Thank you for clarification. xoxo Andrea
May 17, 2012
 Confusion regarding ovulation and progesterone use
by: Wray

Hi there Ah yes! I wrote that page on 'How to use' some years ago, and I need to update it. At that point, I, like everyone else including it seems the medical profession, thought progesterone was only secreted after ovulation and the formation of the corpus luteum. But not so, I found some fascinating papers that show we have a pre-ovulatory surge from the brain. It begins about 50 hours before ovulation, rising exponentially about 24 hrs beforehand. The first paper I found was published in 2011, I then discovered their work had previously been published in 1983! Then in a 2008 paper I found reference to a study done in 1930! And all this time everyone thought, and still does, that progesterone is only produced after ovulation. The 2008 paper says…"Because sexual behavior is expressed before ovulation and, hence, before formation of the corpus luteum, and progesterone was believed to come only from the corpus luteum, how could progesterone be involved? That is, how could progesterone do something before it was secreted? Because the field was certain that there was no progesterone released before ovulation, this may have been the origin of the second-class status of progesterone contrasted with estradiol. However, with the development of the first progesterone assays in the late 1960s…. Young’s group was proved correct; there was apparently another source of progesterone besides the corpus luteum, and in fact, there was a quite sizable preovulatory surge of progesterone. This progesterone surge was later learned to be essential for the facilitation of feminine sexual behavior." Finding these papers, which are all on the Progesterone Misconceptions page, was not only a revelation for me, but suddenly all the puzzles I'd had about severe symptoms occurring just prior to ovulation, fell into place. Many women write in saying they have very severe symptoms round about ovulation, I had no explanation for them, now I do. If we don't have that pre-ovulatory surge of progesterone to counter the surge in oestrogen, symptoms will be as bad as those we experience during progesterone withdrawal the few days before we bleed. It also means the essential rapid rise of progesterone in the early luteal phase will not occur. Essential for implantation, which many women trying to fall pregnant have problems with. So thank you for pointing out the discrepancy! The problem with writing all these pages, I have to remember do I have that info on another page in which case I need to alter it, it drives me dotty trying to remember! I think I've added it to the pregnancy page. Continued below.
May 17, 2012
 Confusion regarding ovulation and progesterone use Part 2
by: Wray

Hi there Now to your other queries. I have found if pain is experienced in Endometriosis about 500mg/day is needed to prevent it. Reducing slowly over some weeks once the pain has gone. Endo is caused by oxidative stress, as are most of our problems, and exacerbated by oestrogen. Large amounts of antioxidants are needed, besides progesterone, in particular vitamin D and NAC (N-acetyl cysteine). That quote I gave above is so accurate about 'the second-class status of progesterone'. It's still ascribed it, and yet it was what you needed for the nausea, about 400-800mg/day, for the depression and for the pre-eclampsia, 800mg/day or more for this. Dr Dalton would cure her patients of all these problems with amounts such as these. Pre-eclampsia is also caused by a lack of vitamin D, see here, here, here, here and here. In fact the two hormones go hand in hand. I'm so fascinated by this, that I've just done another page on this very thing, see Progesterone and Vitamin D. So using progesterone within that 50 hour surge will benefit ovulation, fertilisation and implantation. Using it about 8 days before, it can act as a contraceptive. Dr Dalton would suggest this to her patients who couldn't tolerate the pill, see here. You'll have to scroll down to find the reference. I see Andrea has made a comment too, if it's the same Andrea, she found 400mg/day to be of benefit for her symptoms. So I have to leave it to you to decide how much you'll use, but please use enough. Too little only exacerbates symptoms, and leads to Oestrogen Dominance. I do suggest to women with severe symptoms to use it daily for 2-3 months, ignoring the cycle. This ensures progesterone becomes dominant. Once stable the cycle can be resumed again. Continued below.
May 17, 2012
 Confusion regarding ovulation and progesterone use Part 3
by: Wray

Hi there About vasectomies, I'm sure you've done research for yourselves, but these are a few papers here, here, here, here and here. One has a list of other papers on the subject, about 100 if you feel like reading them all! Please have a vitamin D test done, it's such a vital nutrient. For more info on vitamin D levels, test kits etc see the Vitamin D Council, GrassrootsHealth, Birmingham Hospital and Vitamin D Links websites. Blood levels should be 70-100ng/ml or 175-250nmol/L and not the 30ng/ml or 75nmol/L most labs and doctors regard as adequate. The minimum daily dose should be 5000iu's per day, although the latest research indicates it should be 10,000iu's per day, see here. Bless you for the kind words! Take care Wray
May 17, 2012
 Ovulation and progesterone therapy
by: Wray

Hi there Thanks for the kind words! I take it you've only just started progesterone? I don't know what brand you're using but they should have warned you that initially it can make periods come either earlier or later. If it's ours I apologise, as I said to the first anon comment on this page, I write a page and then find months, years later I've left something out, or forgot to amend it! It's impossible to tell which way they'll go, as I've just had a query from one woman who says her period has been delayed by a week, and still no sign of it. There are a couple of approaches. Each time you bleed you can stop the progesterone and start again at ovulation, this in itself will be disrupted, which will make it difficult to know when to start! Or you can use it daily for 2-3 months, or until stable, ignoring any bleeding. And then resume following your cycle. Or irrespective of your normal cycle length, you can use the cream on a 14 day on, 14 day off cycle, and then once stable, allow your own cycle to slowly emerge. I would be tempted to use it daily myself, this does ensure progesterone becomes the dominant hormone too. We do have info on our page How to use progesterone cream, but I do need to amend it! Take care Wray
May 17, 2012
 also confused
by: Wray

Hi Andrea Glad to see you're still around! It is confusing, but I hope my explanation to the anon comment above helps. I really do need to change that How to page! Which I will do as soon as I've answered all the queries. I used it daily at the end of peri-menopause only because all my symptoms came back when I took a break. I also had no need of a cycle for reproductive purposes. Then of course my cycles became impossible to follow in the last year so found it far easier to use daily. But if a woman still has a regular cycle, I always feel it's a pity to disrupt this. So it's best to use from ovulation, or during that 50 hour pre-ovulatory surge if pregnancy is the aim. Or of course about 8 days prior to ovulation in case of contraception. Although this is very effective, all protection goes if stressed. As you know stress drops progesterone levels, so more would be needed to prevent conception, or a temporary alternative contraception used. It's far safer than the standard drug Contraceptives which all have the potential to harm. And of course stop ovarian function so no progesterone is made anyway! xox Take care Wray
May 17, 2012
 thanks!
by: Rebecca

Hi Wray,

I wrote the initial question---thank you so much for your thorough response. I have begun the vitamin D in addition to the natural progesterone (which I only started a couple weeks ago). I first bought Pro-gest, but ordered Natpro as soon as I learned of it. It arrived yesterday and I already prefer its consistency and texture (and its value per tube!)
I've started off with 200mg per day, and so far the only estrogen symptom I'm experiencing is noticeably swollen breasts, like when I began taking the pill years ago. I will bump up the progesterone and hope that any other symptoms will be suppressed.
So, just to be clear, I should try the following:

400-500mg of Natpro daily for 2-3 months.
Following the three months and suppression of endo symptoms, gradually drop down to around 200mg of Natpro if symptoms allow.
And, at that time, start taking it 8 days prior to ovulation for contraception, allowing a break when my period starts and then resuming?

Thanks so much for the clarity, it is much appreciated.
May 19, 2012
 thanks!
by: Wray

Hi Rebecca Thanks for the name! I makes it more 'human' for me addressing a name than an anon. Besides when there are so many anons on a page I can get confused which one I'm addressing! Particularly if they change the subject line, that has me foxed. Thank you for trying the Natpro, I'm delighted you prefer it, and we do try to make it as affordable as possible. And yes to all your points. But please experiment, you might find the 200mg/day is enough, unless symptoms become worse. I feel there's little point in using more than needed, but again do find the high amounts resolve the problem quicker. Endo is a difficult one to resolve, but it can be done. I'm so pleased you're taking the vitamin D, but please consider taking the other antioxidants too, these do have a tremendous effect. Take care Wray

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