In my previous article I explained some important details of estrogen dosing and monitoring.  Let’s look now at how naturally-derived progesterone is safe and effective for short and long term, and how it is dosed and monitored.

Why progesterone supplementation A year ago, a new patient came to me taking Prempro. Prempro is conjugated estrogens + medroxyprogesterone acetate. It is used reduce menopausal symptoms such as hot flashes and vaginal dryness—but it is not recommended for long term, only for symptom improvement. Why? Because it contains both synthetic estrogen and synthetic progesterone, and large studies completed in 2002, collectively called the Women’s Health Initiative (WHI), revealed that synthetic oral conjugated estrogen plus progestogen (synthetic progesterone) put women at increased risk for breast cancer,   heart attack, stroke, and pulmonary embolism.

This adverse long-term effect is because medroxyprogesterone (but not natural progesterone) produces some non-progesterone-like effects and can potentiate the proliferative (cancer-producing) action of estrogen in your body.

Menopause management The most common menopausal symptoms are hot flashes and sweats, vaginal dryness, trouble sleeping, and mood swings. You want a natural compounded or micronized progesterone that is an exact chemical duplicate of your body’s home-made progesterone.

Here’s the good news: large clinical trials support natural (a.k.a. “bio-identical” or “bio-mimetic”) estradiol/estriol and progesterone as effective for curbing menopausal symptoms.  Not only do they curb symptoms, the also reduce diseases such as breast cancer, cardiovascular disease, osteoporosis, and even Alzheimer’s dementia. The following is an overview of the studies that support this.

Studies supporting natural progesterone supplementation after menopause Progesterone lowers breast cancer risk Well-designed studies show that the use of natural progesterone lowers the risk of breast cancer: In 1981 the Journal of Epidemiology reported that 1083 women treated for infertility were followed for 13-33 years for incidence of breast cancer; the premenopausal risk for breast cancer was 5.4 times higher and the risk for death from cancer was 10 times more in women with low progesterone levels compared to those with normal levels. A 2002 study reported in Cancer Epidemiology, Biomarkers & Prevention showed in a case-control study of third trimester progesterone levels and breast cancer risk that increasing levels of progesterone were associated with decreased risk of breast cancer; those in the highest quartile (1/4th) of progesterone levels had a 50 percent reduction in breast cancer compared with those in the lowest quartile of progesterone levels. In 2004 a prospective study reported in the International Journal of Cancer, progesterone levels were associated with lower breast cancer risk in 5963 women. In 2008 researchers had followed 80,000 postmenopausal women for over 8 years and found that those using natural progesterone along with estrogen significantly reduced breast cancer risk compared to the use of synthetic progestin.