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Major questions and clarification needed

by Jo
(Denver)

First, I really appreciate all the information on this site. It’s certainly information that cannot be found elsewhere, and sadly the OB/GYNs seem to know little to nothing about any of this and/or are ready to “slice ‘n dice” as the answer to everything.

However, finding answers to one’s question can be the proverbial needle in a haystack, especially as the advice is sprinkled throughout posts that take hours and hours to wade through.

I have been scouring this website for the last 8-10 years since I entered menopause. I’ve spent countless hours poring over posts in hopes of finding answers. Yet I find it difficult if not impossible to find the answers I desperately need, especially as many of the situations do not reflect my own. For example, someone experiencing spotting – but the advice is in response to someone in peri-menopause, or perhaps still ovulating in their fertile years. That is a very different situation than someone post-menopausal who is experiencing spotting, which should not occur.

Further complicating the situation is the fact that some of the information is conflicting. Here are some examples:

<...
It oestrogen dominance can also occur when first using progesterone, when increasing it, when decreasing it or stopping it. ...
Many blame progesterone and reduce the amount they're using, ironically this does help. It's now no longer stimulating oestrogen, but defeats the purpose. Which is to suppress the excess oestrogen causing the adverse symptoms in the first place.
To prevent it oestrogen dominance happening progesterone should be increased. Ideally, high amounts should be used initially to prevent it oestrogen dominance occurring.>>

First it says: “Oestrogen dominance can occur when increasing progesterone”
Then it says: “To prevent it oestrogen dominance happening progesterone should be increased.”

Increase progesterone → Estrogen dominance symptoms → Increase progesterone to alleviate symptoms, but the increased progesterone can lead to estrogen dominance….

This creates an endless loop. Where does the loop end?

DOSAGE
The “Oestrogen Dominance” page also says:
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Yet everywhere else on the site it says “400-500mg, more if symptoms are severe.”

• How do we know whether to take 400, 425, 450, 475, or 500mg? What determines the amount?
• How long do we remain at a given dosage – say, 400mg – before increasing the dosage again if symptoms have not abated?
• Repeatedly the advice on this site is to stay at the higher dosage “until stable.” What does that mean? “Stable” for how long – a day, a week, a month?


HEAVY BLEEDING/SPOTTING PROTOCOL

• Do we follow the protocol only while having bleeding/spotting symptoms or daily from now on?
• How long before the Protocol kicks in?

The Protocol says to take 2000mg NAC.
However, Joy’s response (Jun 11, 2024) to “NAC by Denise (Arizona)” says:
“How much NAC did you start with? Sometimes one needs to start on a low amount and work up.”

So do we take the 2000mg according to the protocol, or start on a low amount and work up?


Obviously some things depend on the individual and his/her unique situation. But how much more helpful it would be if, as an example, the Estrogen Dominance advice said something like: “Start with 400mg for 7 days; if symptoms have not improved, increase to 450mg for another 7 days. Follow this pattern of increasing until symptoms subside; then reduce the dosage gradually by 50mg/week until ….”

This brings up another question: How do we know when to stop reducing the amount? Recurrence of symptoms? Then we’re back on the rollercoaster again.

In one response, Wray said: “ If stressed I rub it on top to toe! And do this until the stress passes.” Okay, great – but once the stress passes, do we now have to follow the gradual decrease? What if the stress is only a day or two? How does this work?

Sorry for so many questions, but in the countless hours and days I’ve spent reading through endless posts here on this site, I’m still very confused and I’m sure there are others like me. I ask not only for myself, but for all those who come here seeking answers they have not found elsewhere.

Comments for Major questions and clarification needed

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Aug 10, 2025
 Major questions and clarification needed
by: Joy

Hi Jo

Thank you for your kind words about the website. Progesterone therapy is not easy, I wish it were. It can also get very confusing, especially if one searches different websites.

It has been mentioned many times on this website that if the usual suggested amount of 100-200mg doesn't work, then increase to a level that suits you and your symptoms. One fix doesn't fix all. You have to experiment to see what suits you best. Once you find a level that suits you and your symptoms, stay on that amount for 7-10 days, then you can start to slowly reduce the amount of cream. If symptoms return then you have reduced too soon. Increase again and start again. There is no time frame as to when this will improve which is why we always state that it can take 2-6 months before the body adjust, possibly longer as it is dependent of symptoms.

It is always helpful when one states their age. Spotting/continual bleeding and heavy bleeding usually indicate Peri-Menopause. If younger, then one would need to address possible issues as mentioned on the Menstrual Cycle page.

The same would apply to Hot Flushes. 400-500mg progesterone is required until the hot flushes clear. Then you start to slowly reduce the amount of cream to a level that suits you.

When first using progesterone, it can aggravate estrogen receptors and one may experience Estrogen Dominance symptoms. The key is to continue use until these symptoms clear and progesterone has become the dominant hormone, which is what is needed.

Increasing or decreasing the amount of cream will affect progesterone levels. The body needs to adjust to the change. The same would apply if you change brands of progesterone.

Stress can cause progesterone and vitamin D3 levels to drop. Both need to be increased during stressful times. Again, reduce as mentioned above once you feel stable enough. How long this would take is entirely up to the individual.

Best wishes.

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