Many women feel crap when put on a contraceptive or HRT that contains progesterone. Why is that? I was asked about the issue of progesterone intolerance the other day and thought it might be useful to share what I said to them.
Essentially, you need to have oestrogen and progesterone in hormone treatments but many women don’t do well on the synthetic progesterones they contain – unlike testosterone therapy, which contains bio-identical types – gender bias or what, don’t get me started?!
I essentially told this person to start by trying a non-synthetic type and see if she had the same problems. Most are much better.
Anyway, I’m not a hormone expert (although I am writing a darn-good Hormone Plan, though I say so myself!), so I looked at what those who are had to say. Dr Louise Newson first:
If you suffer from bloating, acne, mood changes or other PMS-like symptoms while taking HRT, you may have a progesterone intolerance (or sensitivity) – here’s how to handle it
Dr Louise Newson
Progesterone intolerance is thought to affect 10-20% of women.
Symptoms include anxiety, low mood, greasy skin, cramping, bloating, breast tenderness and headaches
Natural, body identical progesterone is less likely to cause these symptoms compared to synthetic progestogens
Progesterone is commonly thought of as the “relaxing hormone” as, for most women, it has calming, anti-anxiety (anxiolytic) properties. But some women can be particularly sensitive to progesterone or, most likely, its synthetic form, progestogen. This is known as progesterone intolerance (or sensitivity) – your body reacts to the progesterone or progestogen, causing symptoms that can be similar to some symptoms of premenstrual syndrome.
You can read her whole factsheet on it here. She essentially suggests the same as me – try a non-synthetic type, but also recommends trying taking it locally rather than by mouth – vaginal and pessary types are metabolised differently in the body and may suit you better. She also suggests the coil as it delivers a lower dose of (still synthetic, grr) progesterone, but I’m not a lover of those because often they are made of copper and throw the agonist mineral zinc out, which brings a whole other set of problems. The Mirena coil is actually not copper, but plastic, but even so..
In case you need info on coils, here is Louise’s Coil FAQ.
Ok, next up, I looked at what functional medicine hormone expert Dr Carrie Jones had to say. I like her stuff on hormones – she taught me a lot about the DUTCH testing etc. She essentially says similar things about dose, different delivery mechanisms, but she also points, quite rightly in my view, to sensitivity to excipients in the meds, peanut or soy issues, the health of your liver and other stuff. I found this great video where she goes through several progesterone therapy options, so that might be worth a view if you’re having problems:
If you’re wanting to check your hormones, you can see hormone tests here. Do read the info there as I’ve given lots of tips on how best to test various things. For progesterone levels, I prefer blood. DUTCH (dried urine) does give you a lot of metabolising info, though, and they use a serum equivalent to determine progesterone levels, which I find does correlate quite well with blood
BONUS TIP: if your progesterone is low, think why that might be. Instead of just taking some progesterone (synthetic or bio-identical), consider if your DHEA pre-cursor that you make progesterone out of is low OR might it be that you are making too much oestrogen or testosterone from that DHEA and it’s not going down the progesterone pathway? We can test these using the DUTCH test.
ANOTHER BONUS TIP: If on serum testing, your progesterone turns out to be 20% or less lower than the reference range, then I usually suggest trying something like Progestaid 1-2 caps with meals.
Progesterone Problems: Summary
If you’re struggling with progesterone therapy:
Are you actually low enough to need progesterone therapy (more than 20% out of reference range) or might a natural supplement help enough?
If you are low, consider why you might be low in progesterone in the first place. Use the DUTCH to identify any metabolising or DHEA problems. And to see what the balance is between the hormones – could your symptoms actually be oestrogen dominance, for example, or adrenal/pituitary low production?
If you do need meds, check the type and switch to a bio-identical one if you can.
Change the delivery mechanism.
OK, hope that all makes sense and helps.
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