Help with progesterone cream after several months of therapy

by Lisa
(Nashville, TN)

After a few years of suffering from a myriad of health problems, I found I was estrogen dominant. Six months ago, my Pg/E2 ratio was 1:23 (this test was done on cycle day 19). I started compounded progesterone cream about 5 months ago. I have found two medical providers who know about ED (a nurse practitioner and a PA) but I would like further clarification. My PCP is excellent and very open to anything I want to try but she admits this is not her area of expertise. The PA I see is actually specializes in hormone replacement and is very familiar with ED.

Here is what happened. On 40 mg of cream (daily) I wasn't getting any symptom relief. So my PCP had me double it to 80mg daily. But on 80 I had a super long cycle and didn't get my period until several days after I stopped the progesterone on cycle day 33. I’ve never had a cycle that long. The PA recommended I use the cream 1 week off and 3 weeks on, as it was very important to have a period (which I agree with). My next cycle was really short. Btw, I have always had regular cycles and when I do an OPK I always get an LH surge. I have three children, two with IVF and one naturally.

My last cycle (last month) I went back to 40 mg and had a 29 day cycle, so things seemed to be heading back to normal. My PA told me it would take a few months for my cycles to even out. I just did a saliva test last week and my ratio is still low (this was on cycle day 4). It was 1:41.
So, I am a bit stumped. My PA says that using it before ovulation can impeded the uterine lining from building up enough to support and implanted embryo. I am not really TTC but would be very open to another baby. I'd like to get my cycles on track first. Her recommendation now is to go back to the 1 week, 3 week scenario. Week 1: no cream (period), week 2 use 40 mg and weeks 3 and 4 use 60 mg. All of this is to raise my pg/e2 ratio.
Should I add in something else to help lower estrogen levels? I have considered going to 80 mg or higher but that seemed to prevent menstruation and mess up the cycle. I also hear people get advice to apply the cream either for 2 or 3 weeks of the cycle, so that’s confusing.
One other thing, even though my ratio is still off, many of my ED symptoms are gone (like anxiety) although a few remain (mild digestive problems and moderate fatigue).

Thanks for your help,

Comments for Help with progesterone cream after several months of therapy

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Jul 30, 2013
Help with progesterone cream after several months of therapy
by: Wray

Hi Lisa I'm a bit puzzled by your ratio. Do you mean your progesterone was 1 and your oestrogen 23? If so you must be a basket case! Or do you mean it to be the other way round, as progesterone is normally given first, i.e. 23:1? If you have a 28 to 29 day cycle, having the test on day 19 wasn't far off. The test should only be done ±7 days after ovulation or before bleeding. Doing a test on cycle day 4 would be meaningless, as progesterone is not secreted in the follicular phase. It must be done mid-luteal phase, this is always, in every woman, 12-14 days before bleeding. Progesterone peaks then, so does oestrogen. Incidentally it's not important to have a period every month. There's evolutionary evidence we should not be having the 400 plus periods in a lifetime we have now. But 100 as our ancestors did, and some rural women still do, see here. This is another worth reading, see here. Using progesterone before ovulation can and does prevent the lining from building, as it's inhibiting oestrogen. It's very effective for women who bleed continually. It can in fact stop ovulation too, it acts as a contraceptive. Although about 200mg/day is needed for this, the amount you are using is far too low to have much affect, as evidenced by your current ratio, 1:41. Progesterone initially upsets the cycle in many women, making it earlier or later than normal, it's nothing to be concerned about as it does settle in time. I'm pleased the low amount of progesterone has helped some of your symptoms. But you are still young it seems, women in Peri-menopause need to use far more to overcome theirs. If a cycle is still present, progesterone should always be started at ovulation, and continued for 14 days when bleeding should occur shortly after. If a woman has severe symptoms, I suggest using it daily for 2-3 months, through any bleeding until symptoms calm down, and then follow the cycle. This allows progesterone to become the dominant hormone. Continued below

Jul 30, 2013
Help with progesterone cream after several months of therapy Part 2
by: Wray

Hi Lisa Most labs give a huge range of 100:1 up to 500:1, which I feel is too large a range. From Saliva Tests we run the ratios were all over 600:1. You ask how you can reduce your oestrogen levels, the easiest is to use much more progesterone. I generally recommend 100-200mg/day, often more is needed if symptoms are severe. We do have a few pages you could look through with more info, How to use progesterone cream, Menstruation and Pregnancy, and another here on pregnancy. Take care Wray

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