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Progesterone Cream round 2 - Breakthrough bleeding... is this normal or is my dose too high?

by Kara
(Vermont, USA)

Since my mid teens or so, I can remember having a troublesome reproductive system. Irregular cycles, heavy bleeding, large clots, painful cramps and GI episodes that made me pass out. I've also always struggled with moderate but chronic acne, as well as abnormal hair growth and hirsutism.

Things got worse in my early 20s, when I went on birth control (Junel FE) in an attempt to help my acne. Not only did this not work, I started to get GI problems including constipation and GERD, as well as other problems like weight gain and migraine auras. My GYN said this wasn't due to the pill, but my GI specialist told me to stop taking the pill. This helped a lot, but the GI issues persisted and still exist to some extent today. In my mid 20s I discovered improvement with the use of Diinolylmethane supplementation, it started to regulate my periods. I attempted Emirita Progesterone cream once, but had terrible side effects and discontinued use only after a few days.

Around the same time, changing my diet to low carb helped even more, my acne became less severe as well. I ended up in the hospital with what was assumed to be appendicitis. My surgeon who performed the appendectomy also happened to be a womens health surgeon, and asked if I had any history with PCOS, endometriosis or fibroids. He said my CT scans indicated I could have these, and that a ruptured cyst could have actually infected/inflamed my appendix. I did an ultrasound which came back inconclusive, but have always suspected reproductive disorders of some kind despite GYNs telling me I was fine all of my reproductive life.

In my mid 30s I noticed I started to get night sweats with the use of the Diindolylmethane, especially right before and during my period. I decided that the use of DIM couldn't continue. I discontinued the DIM and replaced it with Inositol. In the past I had tried Ovasitol, but noticed it made my hirsutism much worse and gave me terrible anxiety. I had read that D-Chiro inositol can sometimes cause worse symptoms in women who have high DHEA and so I switched to Myo-Inositol only, and this seemed to help retain my cycle regularity along with my continued low-carb diet. Despite my period being regular, I was still struggling with acne and hirsutism.

So finally coming up to present day, I'm almost 37 years old and looking to give Progesterone another shot. A friend recommended that this time I take a much higher dose, as last time my side effects were likely the "awakening" of estrogen receptors, and what I was experiencing was actually side effects to excess estrogen.

I am about a week+ into using Ona's Natural Luna Pro 20 cream, which is 200 mg of progesterone per pump and 20% Natural Progesterone. I do one pump in the morning and one at night (12 hours apart). At first I didn't think it was doing much, especially after reading the article Jen Gunter had written about progesterone cream being a "scam." However, after just one day, I noticed that I had more energy and just felt so much better. My mood felt more stable, and the anxiety I assumed was from a stressful era at work just lifted off of me. Then, about 3 days in I noticed the dark hairs on my chin that I have to pluck every day weren't growing back. I still have acne, but I'm noticing the locations on my face are changing a bit, and the newer acne I'm getting seems to heal a lot faster. The general texture of my face and hair seem much softer.

Yesterday however, I noticed that I started a "second" period of sorts. I have occasionally had spotting between periods, but not regularly and generally during ovulation, where I'll have a tiny bit of old blood mixed with the cervical mucus, but overall I do not get mid cycle bleeding. I'm now on the second day of what I'd consider a light period. It's not nearly as heavy as the period I just had, but it's definitely not spotting. Is this normal with the initial use of Progesterone Cream? Should I push through it with my current dose, or back off to a lower one? I have read it can take several cycles to get back to normal, and I'm certainly willing to stick with it this time around.

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Oct 09, 2023
 Progesterone Cream round 2 - Breakthrough bleeding... is this normal or is my dose too high?
by: Kara

Just to be clear, there is a difference between a 20% cream and a 3% cream.  Information given on this website is based on a 3% cream.  One needs to adjust so that it equates to that of Natpro Progesterone Cream which is a 3% cream. You certainly have had a torrid time and at such an early age.  The correct use of progesterone would have certainly helped, this would apply to anyone using progesterone.  Please read the How to use Progesterone Cream and Estrogen Dominance pages.

Let's break this down.  On reading your story I immediately thought of PCOS.  PCOS, Endometriosis, and Fibroids - both painful are all caused by oxidative stress and unless your Inflammation is dealt with you may always battle with symptoms. Could also explain your GI issues.  A Vitamin D3 deficiency also causes GI issues in some people see here. Consider eating lots of fermented foods.  If the gut is not healthy, neither will you be.  Acne and abnormal hair growth indicates a testosterone problem and probably too much sugar in the diet regarding acne. So I would agree with the surgeon who performed your appendectomy.

Hirsutism, acne, alopecia, and oligo-amenorrhea are signs of hyperandrogenism, one of the most frequent endocrine disorders in women of reproductive age.  Ironically androgen excess in women causes both hirsutism, including facial hair, and hair loss from the head. By reducing 5 alpha-reductase activity in the skin, progesterone assists in reversing this trend.  

Most people are led to believe DIM reduces estrogen levels, it doesn't. It changes the ratio of bad estrone to better. Estrogen is broken down into 2 principal metabolites, 2-hydroxyestrone (2-OHE1) and 16-alpha hydroxyestrone (16alpha-OHE1). 16alpha-OHE1 is regarded as a potent oestrogen, whereas 2-OHE1 is a weak oestrogen. DIM increases levels of 2-OHE1, by doing so it also increases the ratio of 2-OHE1:16alpha-OHE1. This increased ratio is associated with a lower risk for breast cancer, see here. Other studies have found a protective role too. You could try taking Calcium D-glucarate, this does reduce estrogen.  

Do bear in mind that you are also in Peri-Menopause (PM) which starts at around 37 in most women.  Some experience it early, others later, but generally around 37.  PM would certainly cause irregular periods etc.  So too would the use of progesterone when first using it if used correctly.  This settles down once the body has adjusted, but PM would be a main cause.  It can take 2-6 months before the body adjusts to progesterone, longer if symptoms are severe.

Just a little on testosterone which I do not believe that any women should take see here. Side effects of testosterone treatment in women include hirsutism, scalp hair loss, acne/spots, oily skin and hair, deepened voice, enlargement of the clitoris, insulin resistance, metabolic syndrome and cardiovascular disease as mentioned in the paper given, an increase in visceral fat (visceral adipose tissue or VAT), cancer, an increase in advanced glycation end-products (AGE's). Have you been tested for insulin resistance as so many of your adverse symptoms indicate this?

Vitamin D3 is vital, a deficiency reduces the benefits of progesterone and is connected to every single functioning cell in our bodies.  Cofactors are equally important.  One should never take D3 without them. 

Have you considered contacting the makers of Ona's to discuss this with them?  As you are using their cream, it might be a good idea. 

Best of luck.

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