PMS

7 Period Problems You Shouldn’t Ignore

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Read this if your red tide wipes you out.
woman-lying-on-bed-period

There are some period problems that are unfortunately par for the course, like cramps, irritability, and bleeding more than you would like to be bleeding from your vagina.

But there are also some period problems that you should bring up to your doctor—just in case—because they’re a bit outside of what’s normally expected during menstruation. Here are some things to keep an eye out for.

1. You soak through a pad or tampon in an hour or less, your period lasts longer than seven days, or both.

The clinical term for an exceedingly heavy or long period is menorrhagia. These are basically horror movie-style periods, but some people don’t even realize this kind of bleeding is abnormal. “One of the biggest problems is someone being so used to heavy bleeding that she underplays the amount,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. “She’ll come in and say her periods aren’t too bad, then say she has to change her tampon every hour.” Passing clots larger than a quarter is also a sign your bleeding is too heavy, according to the Centers for Disease Control and Prevention (CDC).

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It’s not just that bleeding way too much or for too long is messy and inconvenient. Losing more than the typical two to three tablespoons of blood during your period or bleeding for longer than seven days can lead to anemia, the CDC says. If you have anemia, you lack enough healthy red blood cells to get oxygen to all your tissues, so you may feel tired and weak, according to the Mayo Clinic.

Bleeding too much can also be a sign of various health issues, like uterine fibroids, which are benign growths in and on the uterus that can sometimes come along with problems like pelvic pain and frequent urination. Uterine polyps, which are growths on the inner lining of the uterus, can also cause heavy bleeding, as can cervical polyps, which are lumps that emerge from the cervix. Both types of polyps are typically non-cancerous but, in rare cases, may contain cancer cells.

The hormonal issue polycystic ovary syndrome (PCOS) can also cause heavy bleeding. Worse, this bleeding can strike after months of an MIA period. This gives your uterine lining a chance to build up over time, leading to an abnormally heavy period when it finally comes, Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School, tells SELF. PCOS can also cause symptoms like excess face and body hair or severe acne, thanks to high levels of male hormones.

Heavy menstrual bleeding could even be a sign of a disorder that causes you to lose too much blood, like idiopathic thrombocytopenic purpura (ITP). ITP usually comes along with other symptoms like easy and excessive bruising or a rash of reddish-purple dots on a person’s lower legs.

Clearly, figuring out what’s causing your heavy bleeding won’t be easy on your own, so you should see your doctor. They’ll typically ask about your other symptoms and perform exams to determine what exactly is going on, and treatment will depend on what you’re dealing with.

2. Your period brings days of pain that make it practically impossible to leave your bed.

Dr. Streicher’s rule is essentially that if you’re experiencing even an iota of period pain beyond what you’re fine with, it’s too much. The first step is typically to take nonsteroidal anti-inflammatory drugs, since they block hormone-like chemicals known as prostaglandins that cause uterine cramping. If that knocks out your cramps, you’re good to go. If you’re still curled up in the fetal position after a few hours, that’s a sign that you need evaluation, Dr. Streicher says. You’re dealing with dysmenorrhea (severe menstrual cramps), and doctors can help.

There are many different causes of overboard menstrual cramps. Fibroids are a common culprit. So is endometriosis, a condition many experts think happens when tissue lining the uterus travels outside of it and begins growing on other organs. (Other experts believe that tissue is actually different in that it can make its own estrogen, which can create painful inflammation in people with endometriosis.) In addition to causing extremely painful periods, endometriosis can lead to painful intercourse, occasional heavy periods, and infertility, according to the Mayo Clinic.

Adenomyosis, which happens when the endometrial tissue lining the uterus grows into the muscular walls of the organ, can also cause terrible menstrual pain, along with expelling big clots during your period and pain during intercourse.

3. You never know when your period is going to show up.

Pour one out for all the times you thought you’d have a period-free vacation, only for it to show up right as you hit the beach. Fun! Irregular periods could be due to a number of different things that are (at least somewhat) in your control, like stress and travel, Dr. Streicher says. But they can also happen because of various health conditions.

Take thyroid issues, for instance. Hypothyroidism, which is when your thyroid gland in your neck doesn’t produce enough hormones, can lead to an irregular period, according to the Mayo Clinic. It can also cause myriad other symptoms, like heavier than usual periods, fatigue, constipation, dry skin, weight gain, impaired memory, and more. Treatment typically involves taking medication that mimics the thyroid hormone.

On the flip side, hyperthyroidism, which is when your thyroid gland is overactive, can cause light or infrequent menstruation, along with issues like sudden weight loss, rapid heart rate, increased appetite, and more frequent bowel movements, according to the Mayo Clinic.

Irregular periods are also a sign of premature ovarian failure, which is when a person younger than 40 starts losing their normal ovarian function, according to the Mayo Clinic. It can also cause menopausal symptoms like hot flashes, night sweats, vaginal dryness, and difficulty conceiving. Doctors can offer estrogen therapy to relieve symptoms like hot flashes (typically in conjunction with progesterone to avoid the precancerous cells that may take hold if you take estrogen alone). They can also counsel you about the possibility of in vitro fertilization if you’d like to physically conceive and carry children in the future.

PCOS and uterine polyps be behind irregular bleeding, too.

4. Your period decides not to show up for a while.

While it’s true that you can sometimes randomly miss a period for reasons like stress, you shouldn’t just ignore a long-term missing period. Suddenly being period-free may feel blissful, but you’ll want to make sure there’s not a health issue going on, like PCOS, an eating disorder or excessive exercise affecting your menstruation…or, yes, pregnancy.

“If you’re menstruating normally then suddenly go months without a period, that’s not something to ignore,” Dr. Streicher says. If your period vanishes for three months or longer (this is known as amenorrhea), see your doctor for evaluation.

It’s worth noting that the use of some hormonal birth control methods—especially the hormonal IUD—can make your period basically disappear. Still, check with your doctor, just in case, when this happens.

5. You’re dealing with a lot of unexpected spotting between periods.

There are times when this is normal, like if you’ve just started a new type of birth control, or even if you’re pregnant (spotting can be totally fine during pregnancy), Dr. Minkin says. But if nothing in your life has changed and you start spotting between periods, call your doctor for an appointment.

It could be something that’s ultimately pretty harmless, like a benign uterine or cervical polyp that’s causing bleeding between periods. But spotting is also a hallmark of pelvic inflammatory disease (PID), which is the result of sexually transmitted bacteria from infections like chlamydia and gonorrhea spreading to reproductive organs like your uterus, fallopian tubes, and ovaries. In addition, pelvic inflammatory disease can cause issues like fever, strange vaginal discharge that smells bad, and burning when you pee.

If you have PID, your doctor will first address the STI in question with antibiotics, says the CDC, then treat your partner for an STI if necessary. Pelvic inflammatory disease is a leading cause of chronic pelvic pain and infertility in women, so if you suspect you have it, treatment is of the essence.

More rarely, spotting in between periods can be a sign of cervical cancer, according to the Mayo Clinic. Cervical cancer can come along with watery, bloody discharge that might have a bad odor and pelvic pain, including during intercourse. Even though this likely isn’t your issue, you’ll want to get checked out, just in case. Treatment for cervical cancer may involve a hysterectomy, radiation, or chemotherapy.

6. You experience debilitating mood issues before your period.

When your estrogen and progesterone drop before your period, you may experience the typical mood swings that mark premenstrual syndrome (PMS). (Bear in mind that this may not be as drastic if you’re on hormonal birth control, which stabilizes your hormones throughout your cycle.)

But if you deal with severe mood swings, irritability, anger, a lack of enjoyment in things you usually enjoy, and other symptoms that affect your life, you may have premenstrual dysphoric disorder (PMDD). PMDD happens when you experience these symptoms in the week before your period, then they start getting better in the first few days of bleeding, and disappear in the weeks after your period. It’s listed in the DSM-5, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, for good reason: This psychological issue can completely turn your life upside down.

“If you suspect you have PMDD, the one thing I would encourage is keeping a daily record of the severity of your symptoms,” Dr. Minkin says. If these symptoms only rear their head the week before your period, PMDD might be your issue. If you realize you’re constantly dealing with them and your period just makes them worse, it might be premenstrual exacerbation, which is another way of saying you have a mental illness like depression that gets worse during your period.

Either way, a doctor can help. If you have PMDD, your doctor may have you take antidepressants in the timeframe when you usually experience symptoms, then stop once your period starts, Dr. Minkin says. (If you have premenstrual exacerbation, they may recommend staying on the antidepressants through the month and potentially upping your dosage in the week before your period.)

Or your doctor may suggest you go on birth control using a synthetic version of progesterone called drospirenone, Dr. Minin says, like Yaz and Beyaz. These are FDA-approved to treat PMDD. Though experts aren’t sure why they can be so successful in this arena, it may be because drospirenone reduces a person’s response to hormonal fluctuations. It’s also a diuretic, meaning it can flush out liquids that could otherwise cause fluid retention and contribute to annoying issues like bloating.

7. You have excruciating migraines before or during your period.

If migraines had any home training, they’d at least leave you alone when you’re about to get your period. Unfortunately, period migraines are indeed a thing.

It’s not that menstruation will just randomly cause migraines in unsuspecting people who have never had one, but women with a history of migraines may experience them before or during their periods, according to the Mayo Clinic, which adds that this may be due to estrogen fluctuations. “They tend to get the headache right as they go into their periods, and it seems to get better after they have had their menses for a day or two,” Dr. Minkin says.

If you’re dealing with this, your typical migraine medication may work for you. As you probably know if you’ve grappled with migraines, the treatment options are legion. They include pain-relieving medications to relieve symptoms ASAP and preventive drugs to ward off migraines altogether, according to the Mayo Clinic. In the former camp, you have choices like anti-nausea meds and triptans, which constrict swollen blood vessels and block pain pathways in the brain. In the latter, you’ve got meds like tricylic antidepressants, which affect brain chemicals like serotonin that may be implicated in migraines.

No matter what your period problem may be, you don’t have to suffer in silence.

You have no reason to feel embarrassed about your period—or the myriad problems that can come with it. After all, celebrities are out here talking about menstruation! Some pad commercials even—gasp—use red “blood,” these days! What a time to be alive.

If you’re having period problems, see your doctor for help. If they aren’t committed to relieving your symptoms, that’s a sign you should try to find a more sympathetic medical professional who can help you find the best treatment.

MAGNESIUM: THE SAFE FIRST LINE OF DEFENSE FOR CLINICAL DEPRESSION

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The science supporting the efficacy of magnesium for major depression and other psychiatric disorders, testing for magnesium deficiency, and which forms and dosages are most effective.

Depression, a life-threatening psychiatric disorder, lies at the confluence of biochemical, hormonal, immunological, and neurodegenerative variables, which intersect to generate the pro-inflammatory state with which depression is associated. A major public health issue, depression is estimated to become one of the top three contributors to the global burden of diseases within a few years. Not only does depression consume a sizable portion of health care expenditures, but it is considered to be an independent risk factor for metabolic, cardiovascular, and neuropsychiatric disorders (1).

Current treatments are predicated upon a misguided serotonin theory of depression, and are accompanied by a laundry list of deleterious side effects ranging from sexual dysfunction to homicidality (2, 3, 4). Antidepressant medications likewise significantly increase the risk of all-cause mortality, or death from any cause, as well as heart disease, leading researchers to deem this class of pharmaceuticals as harmful to the general population (5). This, in combination with data indicating that antidepressants are clinically equivalent to placebo, render them an unfavorable option (6), especially considering that they offer little in the way of resolving the root cause.

Magnesium: The Miracle Mineral

Rather than resorting to psychotropic drugs, it would be prudent to explore whether magnesium (Mg) supplementation improves depression, since this essential mineral is implicated in the pathophysiology of this disorder. Magnesium may be indeed branded as miraculous given its essentiality as a cofactor to over three hundred enzymatic reactions (7). It is second only to potassium in terms of the predominant intracellular cations, or ions residing in cells that harbor a positive charge (7).

 Magnesium is fundamentally involved in protein production, synthesis of nucleic acids, cell growth and division, and maintenance of the delicate electrolyte composition of our cells (7). It also imparts stability to the membranes of the energy factories of our cells called mitochondria (7). As articulated by researchers, “The physiological consequences of these biochemical activities include Mg’s central roles in the control of neuronal activity, cardiac excitability, neuromuscular transmission, muscular contraction, vasomotor tone, and blood pressure” (7).

The biological effects of magnesium are widespread. When deficient, magnesium is correlated with systemic inflammation. Not only does magnesium sufficiency promote cardiovascular health, relaxing the smooth muscles that comprise blood vessels and preventing high levels of vascular resistance that cause hypertension, but it also plays a role in musculoskeletal health and prevents sarcopenia, osteoporosis, and fractures (8). Magnesium is essential to regulation of sleep (9) and vitamin D metabolism (10) as well as neural plasticity and cognitive function.

However, food processing and industrial agriculture, including monoculture crop practices and the use of magnesium-devoid fertilizers, have led to soil erosion and depletion of magnesium content in our food (7). Magnesium is likewise removed from most drinking water supplies, rendering magnesium deficiency an inevitability (11). As such, our daily intake of magnesium has steadily declined from 500 milligrams (mg) per day to 175 mg per day (7). The nutrient-poor, energy-dense dietary patterns which have come to dominate the industrialized landscape are also insufficient in the fiber-rich fruits and vegetables which contain magnesium.

Animal Studies Propose a Role for Magnesium in Depression

Preliminary animal studies pointed to a role of magnesium in depression, as depletion of magnesium in the diet of mice lead to enhanced depression- and anxiety-related behavior such as increased immobility time in the forced swim test (12). In the forced swim test, a common assay for examining depression-like behavior in rodents, the animal is confined to a container filled with water and observed as it attempts to escape. The time in which the animal exhibits immobility is used as a barometer of despair, indicating that the animal has succumbed to a fate of drowning (1).

This model is confirmed by studies showing that administering substances with antidepressant properties such as Hypericum perforatum, also known as St. John’s Wort, can significantly decrease the time the animal spends without locomotor activity (12). In addition, the time the animal spends immobilized is influenced by many of the factors that are changed as a consequence of depression in humans, such as drug-withdrawal-induced anhedonia, impaired sleep, and altered food consumption (1).

Human Studies Confirm the Role of Magnesium in Depression

There is a paucity of research on the influence of specific micronutrients in depression and results are inconsistent, but several studies have revealed low serum magnesium in this mood disorder. It is well-documented, for example, that dietary magnesium deficiency in conjunction with stress can lead to neuropathologies and symptoms of psychiatric disorders. Researchers echo this sentiment, stating that, “Dietary deficiencies of magnesium, coupled with excess calcium and stress may cause many cases of other related symptoms including agitation, anxiety, irritability, confusion, asthenia, sleeplessness, headache, delirium, hallucinations and hyperexcitability” (11, p. 362).

The Hordaland Health study in Western Norway illustrated an inverse association between standardized energy-adjusted magnesium intake and depression scores, meaning that people who consumed less magnesium had higher rates of depression (13). When the serum and cerebrospinal fluid of acutely depressed patients diagnosed with major depressive disorder or bipolar patients in a depressive episode were compared to healthy controls, the calcium to magnesium ratio was found to be elevated in the former (14). Calcium and magnesium are minerals which antagonize one another and compete for absorption, since each of these minerals is a divalent cation (a positive ion with a valence of two). Suicidality, one of the primary manifestations of severe depression, is accompanied by low cerebrospinal fluid levels of magnesium despite normal calcium levels, lending credence to the role of magnesium in positive emotionality (15).

Magnesium Effective in Bipolar Disorder, Fibromyalgia, PMS, and Chronic Fatigue Syndrome

A formulation of magnesium aspartate hydrochloride known as Magnesiocard has been shown to invoke mood-stabilizing effects in patients with severe rapid cycling bipolar disorder in one open study label (16). In half of the patients treated, this magnesium preparation had results equivalent to lithium, the standard of care for this patient population, such that the researchers suggested: “The possibility that Magnesiocard could replace or improve the efficacy of lithium as a preventive treatment of manic-depressive illness merits further clinical investigation” (16, p. 171). When used as an adjunctive therapy in severe, therapy-resistant mania, magnesium sulphate infusions significantly reduced the use of lithium, benzodiazepines and neuroleptics, so much so that the researchers concluded that it “may be a useful supplementary therapy for the clinical management of severe manic agitation” (17, p. 239).

In another randomized trial of elderly patients with type 2 diabetes and magnesium deficiency, elemental magnesium administered at 450 mg per day was found to have equivalent efficacy to 50 mg of the antidepressant drug Imipramine in treating depressive symptoms (18). Magnesium citrate taken at 300 mg per day has likewise been shown to decrease depression and other symptoms in patients with fibromyalgia as indicated by significant decreases in the fibromyalgia impact questionnaire (FIQ) and Beck depression scores (19).

Data also indicate that supplementation with 360 mg of magnesium administered to women with premenstrual syndrome (PMS) three times a day in the second half of the cycle is effective for so-called negative affect and other premenstrual-related mood symptoms (20). Lastly, intramuscular magnesium sulphate administered every week for six weeks has been proven to be effective in improving emotional state and other parameters in chronic fatigue syndrome (CFS) (21).

Mechanism of Action for Antidepressant Effects of Magnesium

According to researchers, “Biological systems discussed to be involved in the pathophysiology of affective disorders and the action of mood stabilizing drugs are affected by Mg, such as the activity of the hypothalamus–pituitary–adrenocortical (HPA) system, corticotropin releasing factor (CRF)-, GABA- and glutamatergic (via NMDA receptors) neurotransmission and several transduction pathways including protein kinase C” (12). Not only that, but magnesium elicits similar effects on nocturnal hormonal secretion and sleep brain waves to lithium salts, which are used as a treatment modality for bipolar disorder, supporting the role of magnesium as a mood stabilizer (22).

Magnesium operates as an agonist, or a stimulatory molecule, for γ-aminobutyric acid (GABA) receptors (22). GABA is the main inhibitory neurotransmitter in the central nervous system. By binding to the GABA receptor and replicating the effects of GABA, magnesium may alleviate anxiety. Magnesium may also elicit its antidepressant effects by acting as an inorganic antagonist of N-methyl-d-aspartic acid (NMDA) receptor function (Poleszak et al., 2007). Receptor antagonists are ligands, or substances, which bind to a receptor but inhibit its activity rather than activating it. NMDA receptors, which occur on the surface of nerve cells, are activated in part by glutamate, one of the excitatory amino acids in the brain.

Researchers state that, “Dysfunction of NMDA receptors seems to play a crucial role in the neurobiology of disorders such as Parkinson’s disease, Alzheimer’s disease, epilepsy, ischemic stroke, anxiety and depression,” such that, “ligands interacting with different sites of NMDA receptor complex are widely investigated as potential agents for the treatment of a variety of neuropsychiatric disorders” (22). In fact, drug inhibitors at the NMDA receptor complex, such as ketamine, demonstrate antidepressant effects (23, 24), but also induce such severe side effects that their clinical utility is limited (31). Magnesium, on the other hand, may have a similar mechanism of action by interfering with NMDA receptor activation without the adverse consequences of drug-induced NMDA receptor blockade (25).

Recent Study Proves Efficacy of Oral Magnesium for Depression

A recent open-label, randomized, cross-over trial was conducted in outpatient primary care clinics on 126 adults diagnosed with depression (26). During the intervention, 248 mg of elemental magnesium chloride per day, obtained from four 500 mg tablets, was administered for six weeks and compared to six weeks of no treatment, and subjects were evaluated for changes in depressive symptoms (26).

Magnesium administration results in clinically significant improvements in scores on both the Patient Health Questionnaire-9 (PHQ-9), a validated measure of the severity of depression and response to treatment, as well as the Generalized Anxiety Disorders-7 (GAD-7), a sensitive self-reported screening tool for severity of anxiety disorders (26). Impressively, results appeared in as little as two weeks, representing the dramatic improvement that nutrient restoration can facilitate (26). Impressively, however, magnesium exerted anti-depressant effects regardless of baseline magnesium level. It also exhibited efficacy independent of the gender, age, or baseline severity of depression of subjects, as well as their use of antidepressant medications (26). The authors of the study conclude, “Magnesium is effective for mild-to-moderate depression in adults. It works quickly and is well tolerated without the need for close monitoring for toxicity” (26).

Populations At Risk for Magnesium Deficiency

Half of the population of the United States was found to consume less than the recommended amount of magnesium when estimated a decade ago (27). Not only is magnesium lost with certain medical conditions, but this mineral is excreted as a consequence of biological activities such as sweating, urinating, and defecating as well as excess production of stress hormones (7, 11). In addition, because low magnesium has been correlated with various disease states, increasing magnesium status may mitigate risk of these diseases.

For instance, researchers note that, “Low magnesium intakes and blood levels have been associated with type 2 diabetes, metabolic syndrome, elevated C-reactive protein, hypertension, atherosclerotic vascular disease, sudden cardiac death, osteoporosis, migraine headache, asthma, and colon cancer” (27, p. 153). In addition, magnesium deficiency at a cellular level “elicits calcium-activated inflammatory cascades independent of injury or pathogens” (27, p. 153). Low magnesium is associated with systemic inflammation, and inflammation is at the root of most chronic and degenerative diseases.

Testing for Magnesium and Food Sources of Magnesium

While the first inclination of some physicians may be to test magnesium levels for an objective parameter of deficiency, the widely used serum or plasma magnesium does not accurately reflect magnesium levels stored in other tissues (28, 29). In addition, both this hematological index of magnesium status, referred to as total magnesium, and the erythrocyte magnesium level, indicative of the levels of magnesium inside red blood cells, are not negatively affected until severe magnesium deprivation has occurred (7). Therefore, these testing methodologies are not accurate enough to catch preliminary or subclinical magnesium deficiency.

Good food sources of magnesium include pumpkin and squash seed kernels, Brazil nuts, almonds, cashews, peanuts, pine nuts, quinoa, spinach, Swiss chard, beet greens, potatoes, artichoke hearts, dates, bananas, coconut milk, prickly pear, black beans, lima beans, soybeans, and seafood sources including halibut, abalone, anchovy, caviar, conch, crab, oyster, scallop, snail, and pollock. However, it is important to note that magnesium can be leeched from vegetables when food is boiled, and that fiber in excess can decrease magnesium absorption by increasing gastrointestinal motility (7).

Most Bioavailable Forms of Magnesium

As elucidated by the researchers, “Over-the-counter magnesium can be offered as an alternative therapy to those patients hesitant to begin antidepressant treatment and is easily accessible without a prescription” (26). Because the soil is no longer enriched in magnesium, supplementation may be warranted. Organic salts of magnesium, including the acetate, ascorbate, aspartate, bicitrate, gluconate, and lactate forms are more soluble and biologically active over the magnesium mineral salts such as magnesium oxide, magnesium carbonate, magnesium chloride, and magnesium sulfate (7).

However, case studies have shown remarkably rapid recovery from major depression, in less than seven days, when magnesium glycinate and magnesium taurinate are administered at dosages of 125 to 300 mg with each meal and at bedtime (11). Magnesium threonate may also be explored as a therapeutic option, as it may have better penetrance of the blood brain barrier and restore neurological levels of magnesium. This form, which is delivered directly to the brain, may improve cerebral signaling pathways and synaptic connections between nerve cells as well as support learning and memory, although the studies have been conducted in animal models (30).

Researchers report that magnesium is usually effective for treating depression in general use, and that comorbid conditions occurring in these case studies, including “traumatic brain injury, headache, suicidal ideation, anxiety, irritability, insomnia, postpartum depression, cocaine, alcohol and tobacco abuse, hypersensitivity to calcium, short-term memory loss and IQ loss were also benefited” by magnesium supplementation (11, p. 362). Barring abnormal kidney function, the Institute of Medicine sets the upper tolerable limit for intake at 350 mg of elemental magnesium per day, but there are few adverse side effects documented unless consumed in inordinate doses (26).

Before changing your medication or nutraceutical regimen, always consult a functional or integrative medical doctor for contraindications. However, given the benign nature of magnesium supplementation and the ubiquity of magnesium insufficiency, depressedpatients should be offered this as a first line strategy alongside a holistic root-cause resolution approach to treating depression

Progesterone Cream: Stay Young and Sexy With This Ingredient that Reduces PMS.

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Story at-a-glance

  • Natural progesterone cream, made from naturally-occurring plant steroids found in wild yam, can be useful for premenopausal challenges such as PMS and painful cramps, and may help prevent miscarriages.
  • Be careful to avoid ALL synthetic progesterones, like Provera or medroxyprogesterone, as they can produce severe side effects including increased risk of stroke and cancer.
  • Oral hormones are ineffective, as only 10-15 percent eventually reach the target tissues.
  • Progesterone cream must be used cautiously when applied to skin as progesterone is highly fat soluble and will accumulate in fat tissue, thereby disrupting adrenal hormones such as DHEA, cortisol, and testosterone.
  • Ideally, progesterone cream should NOT be applied to your skin. Instead use mucous epithelial membranes of your labia or rectum. Absorption through these membranes is more complete than through skin, and hormones absorbed through vaginal membranes enter the same pelvic plexus of veins that your ovaries normally empty into.

progesterone-cream-complications918

Bioidentical hormone therapy has become widely adopted as a useful method of normalizing hormone levels. While it is far safer than synthetic or animal based hormones like Premarin, there are clearly some dangers associated with its use and the purpose of this article is to highlight some of the major ones.

This article is in no way meant to be a comprehensive review of the topic, but merely to point out some of the major concerns and approaches as I see them from having practiced medicine for nearly three decades.

If you have any interest. I would strongly recommend purchasing Dr. Wright’s new book Stay Young and Sexy. It is under $10 and simply the best book I have reviewed on the topic. If the book were $100 it would be worth the price. This book is a classic and should be in everyone’s natural medicine library. The publisher has also created a web site with a free hormone self assessment and sample chapters at www.stayyoungandsexy.com.

Natural Progesterone

I will focus much of this article on natural progesterone cream as it is one of the most popular and useful ones for women.Typically, women find rapid improvement in two of the most common premenopausal challenges which are PMS and painful cramps.  It can be also extraordinarily useful to prevent miscarriages but dosing would be continuous after conception.

Dr. John Lee was my original mentor in this area but he passed away a number of years ago and did not fully appreciate the challenges that are associated with using the creams on your skin.

Dr. Jonathon Wright, along with Dr. Lee, are considered the pioneers in introducing bioidentical hormone therapy in the United States. Dr. Wright is still alive and I believe has successfully resolved the challenge associated with using the creams. Before I discuss that though, let’s first do a brief review of why progesterone is important.

Natural progesterone is the identical hormone that is produced by a woman’s ovary. It is made from naturally occurring plant steroids found in the wild yam. It is NOT the synthetic version that is commonly purchased as tablets with a prescription such as Provera.

Synthetic progesterones, like Provera or medroxyprogesterone, can produce severe side effects including increased risk of cancer, abnormal menstrual flow, fluid retention, nausea, depression and can even increase risk of heart disease and stroke.

Side effects are extremely rare with natural progesterone. The only one of concern is that it can potentially alter the timing of your menstrual cycle.

Reasons Why Natural Progesterone Made by Your Body Is Good

Progesterone is a steroid hormone made by a woman’s ovaries when she ovulates and in smaller amounts by the adrenal gland. A menstruating woman will typically produce about 20 to 30 mg of progesterone a day during the luteal or last phase of her menstrual cycle.

While menopause doesn’t typically occur until age 50 or later, many women can start going out of balance in their 30s or even earlier. This decline in progesterone is not trivial for as women age into their fourth, fifth, and sixth decade, their progesterone levels continue to fall.  By the time they reach perimenopause as much as 75% or more of their youthful progesterone secretion may already be missing.

Natural progesterone is very useful to balance excess estrogen which can be a major risk for breast cancer. Natural progesterone is also different from estrogen in that your body can use it as a precursor or starting material to make other hormones such as adrenal hormones. It can even convert it into estrogen or testosterone if your body needs it.

Natural progesterone is made from a substance called diosgenin which is commonly extracted from wild yams or soybeans.  Even though it may be extracted from soy it is a highly purified hormone and there are absolutely no remnants of soy substances that would lead to any problem.

Estrogen Dominance

Many if not most women in our culture are estrogen dominant, so using the progesterone goes a long way towards balancing hormones which usually:

·         Decreases a woman’s risk for breast cancer,

·         Improves her PMS and breast tenderness and

The table below lists the properties of estrogen relative to progesterone. Some of the reasons that estrogen is frequently in excess in many women are:

·         Overproduction of estrogen. Ovarian cysts or tumors can lead to excess estrogen production. Stress also increases production, but probably the most common cause is obesity. All body fat has an enzyme which converts adrenal steroids to estrogen, so the more fat you have, the more estrogen is present.

·         Inability to breakdown estrogen. Excess estrogen is generally removed by the liver. Diseases of the liver like cirrhosis or decreased enzyme activity can lead to increased estrogen levels. Vitamin B6 and magnesium are necessary for the liver to neutralize estrogen. Increased sugar intake will also excrete magnesium and interfere with its ability to breakdown estrogen.

·         Exposure to pesticides in foods. Most of us eat foods that have pesticides on them. These and many other unnatural chemicals share a common structure with estrogen and serve as “false” estrogens which further stimulates the body’s estrogen receptors.

·         Estrogen supplementation. Clearly any additional estrogen given by prescription will increase the level unless it is properly balanced with natural progesterone.

·         Decreased production of progesterone. Progesterone is necessary to counterbalance estrogen. If women do not ovulate during their cycle they will not produce any progesterone that cycle. This happens commonly and worsens the already disturbed progesterone/estrogen balance. Decreased progesterone levels are one of the most common reasons for miscarriages.

To minimize your risk of cancer it is very important to understand that you should never take any supplemental estrogen without taking natural progesterone. Note that I use the term “natural’ progesterone, or the real hormone. Taking synthetic versions like Provera will actually increase your risk of cancers and heart disease.

Estrogen Effects

Progesterone Effects

Stimulates breasts cysts

Protects against breast cysts

Increases body fat storage

Helps use fat for energy and keep it off hips

Salt and fluid retention

Natural diuretic (water pill)

Depression and headaches

Natural anti-depressant

Interferes with thyroid hormone

Facilitates thyroid hormone action

Increases blood clotting and risk of stroke

Normalizes blood clotting

Decreases libido (sex drive)

Increases libido

Impairs blood sugar control

Normalizes blood sugar levels

Loss of zinc and retention of copper

Normalizes zinc and copper levels

Reduced oxygen level in all cells

Restores proper cell oxygen levels

Increased risk of endometrial cancer

Helps prevent endometrial cancer

Increased risk of breast cancer

Helps prevent breast cancer

Helps decrease bone loss slightly

Increases bone building

Why You Should AVOID All Oral Hormone Preparations

There are many ways to “naturally” address bioidentical hormone replacement but one of the most common mistakes is to use oral hormones.

If nature had intended to locate your ovaries in your stomach or somewhere else in your GI tract it might make sense for women to swallow progesterone. If your ovaries were in your GI tract, your body would certainly have been equipped with a way to process them safely and efficiently so that everything worked in perfect synchrony.

Of course your ovaries are not in your GI tract but in your pelvis outside your GI tract and connected to your uterus and vagina through your fallopian tubes. Your ovaries have direct access to your blood stream through a pelvic plexus of veins, which delivers their hormone secretions to your heart which in turn pumps them, unchanged to hormone sensitive cells throughout your entire body.

If you swallow steroid hormones you will seriously distort their natural metabolism  When you swallow them they will encounter potent stomach acids. The hormones that survive this assault then go to your liver where they will be further broken down. Your liver screens all molecules that enter your blood stream, passing some onward, modifying or detoxifying others, and rejecting a few. 

This routing of orally swallowed hormones is in sharp contrast to the way nature intended them to be distributed to your tissues.  If you swallow hormones only 10-15% will eventually reach the target tissues and you will need to take an oral dose that is 500% higher than you need. Over 30 different metabolites are created in your liver when you swallow the progesterone and any of these can then have unwanted side effects.

So if you or anyone you know currently use oral hormones like progesterone or DHEA or any hormone, I encourage you to strongly consider phasing them out. 

Like most good things in life if you use too much of the hormone cream, complications can develop and disrupt your hormone balance.

The Key to Safely and Effectively Using Progesterone Cream

If you want to copy nature and reproduce a hormonal environment that most closely resembles a normal premenopausal woman the first logical step would be to get the hormones directly into your blood stream, just the way your ovary does.

Hormones carefully measured and formulated in an appropriate cream or gel need only be rubbed once or twice a day into your mucous (epithelial) membranes. Since there are no destructive detours through your GI tract when administered this way, your tissues are exposed to the appropriate concentrations of the hormone without the side effects of 30 different liver metabolites.

I first started using these creams in the early 1990s be became gradually disenchanted with them after I noticed that they typically worked wonderfully initially but then invariably stopped working. This is now known as “dermal fatigue”. 

What happens, not only for progesterone cream, but for ANY hormone preparation you use by applying as a cream to your skin is that within a few weeks to a few months you will saturate the fat tissue with the hormones and they will actually stop working or can even make your symptoms worse.

The problem relates to the fact that progesterone is highly fat soluble and once applied to your skin will store itself in your fat tissue. When one initially uses the cream, there aren’t any problems as the fat stores are very low. But as time goes on, the cream accumulates and contributes to disruptions in your adrenal hormones such as DHEA, cortisol, and testosterone. I have learned that although progesterone cream is an enormously useful tool, it needs to be used very cautiously.

I found that many of the women who were on the cream have terribly elevated levels of this hormone. Progesterone is normally a cyclical hormone and the body really needs to see a change in the concentration to affect a proper physiological response. If the level is constantly above the concentration that it recognizes as “off” or low, this is not possible.

Fortunately, this is repairable. But it may involve going off the cream for as long as two years to wash the progesterone out of your system.

Best Way to Use Progesterone Cream

The key mistake that many well intentioned knowledgeable doctors, including myself made is to advise to use the cream on your skin. While this certainly provides better results than swallowing the hormones, it can still be improved.

There is a relatively minor tweak you can make with the creams which avoids nearly all of the side effects of applying the cream on your skin.

If you apply the cream to your mucous epithelial membranes that line your uterus and vagina you obtain a virtually ideal administration system. Not only is absorption through these membranes more complete than through your skin, but hormones absorbed through your vaginal membranes enter the very same pelvic plexus of veins that your ovaries normally empty into.

From here the hormones are carried to your heart and lungs and distributed to your tissues just as if your ovary had actually produced them.

Men also require hormones. Obviously men don’t have a vagina to use but we do have a rectum that has a similar mucosal epithelial surface and can be used to administer the hormones in a near ideal fashion without any of the complications previously described.

Timing and Dose of Progesterone Cream

For most premenopausal women the usual dose is 15-24 mg/day for 14 days before expected menses, stopping the day or so before menses.  So you would use the cream for twelve days and then stop. Typically this would mean you would start on day 12 of your cycle and stop on day 26.

The abrupt lowering of your progesterone level is the primary stimulus for your period to start.  Hopefully when it starts any PMS and painful periods will be dramatically reduced.

When a women is in menopause she may only need 15 mg but taken for the first 25 days of the month, then take 5 or 6 days off and restart on the first of the month.

For most women a single daily application will work. However, because the half-life is relatively short, some women find that they get a more satisfactory response by splitting the daily dose in two, half in the morning and half in the evening. If you are only taking the hormones in the morning and begin to feel symptoms later in the day, splitting the dose in two should solve this problem.

Testing of Your Natural Hormones

This is somewhat of a controversial area but basically involves three different types.

·         Blood

·         Saliva

·         Urine

I have never been a fan of blood testing as many of the hormones are secreted in a pulsatile fashion and it is difficult to get an accurate idea of the levels in this way.

Saliva testing is easier than urine but is not as accurate.

My current belief is that a 24 hour urine test is the preferred method and the one I use for myself and family. This is the one that Dr. Wright advocates in his own clinic. Dr. Wright has trained many hundreds of physicians in this system and if you are seeking further guidance in this area it would be wise to seek one of them to help you in this area.