Progesterone sensitivity is a topic that's as complex as it is important.
For many, reproductive hormones cruise through the body without causing a fuss. But for others, they can trigger issues like premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and those pesky menstrual migraines.
The big question is: why do some women feel these hormonal fluctuations more acutely than others?
The truth is, we don't know. But that is not helpful when you are struggling.
This sensitivity can occur with or without HRT.
Progesterone 101: Why do I need progesterone?
If you have a uterus, progesterone (or progestin) is your friend, guarding against endometrial hyperplasia and cancer. But its goodness doesn't stop there:
- It makes your periods lighter.
- It's an anti-inflammatory and immune system regulator.
- It keeps your thyroid, brain, bones, and breasts tip-top.
Even if you've had a hysterectomy, where once it was thought you could skip progesterone, we now know better, although some doctors still have mixed opinions.
Progesterone receptors are everywhere in your body, impacting your brain, immune system, and even how your body detoxes.
The Benefits of Progesterone
1. It's like an energy drink for your thyroid, boosting metabolism.
2. It soothes your mood and can be a sleep saviour, interacting with brain chemicals to promote rest.
3. It's a beautician in hormone form, helping your hair grow and keeping your skin clear.
4. Lighter periods? Thank progesterone.
5. It's on your side in the battle against autoimmune diseases and inflammation.
6. It's a builder, promoting stronger bones and muscles.
7. It's on the front lines in the fight against cancer, especially countering oestrogen's effects on breast and uterine tissue.
How to Get Your Progesterone Fix
You can make it yourself (thank you, ovulation!), take it as an oral micronised capsule, or opt for a progestin.
Progesterone vs. Progestins: A Vital Distinction
It is essential to understand the difference between progesterone and progestins. Developing a form of natural progesterone was more difficult and too a lot longer to solve– hence the range of synthetic progestins.
Micronised progesterone is the real deal; it's the same as your body's.
The oral form sourced from plants like soy or yam and recognised in the UK under the name Utrogestan, or when it's merged with body-identical oestradiol known as Bijuve, mirrors the natural progesterone produced by your ovaries and adrenals. That's why these forms get the "bio-identical" and "body-identical" labels.
A heads-up for those with peanut allergies—while these supplements aren't made from peanut oil, they share enough properties to trigger a reaction in rare instances potentially.
You'll also find progesterone in pessary form, which can be incorporated into an HRT plan. However, it's important to note that this usage isn't officially sanctioned, and some doctors may hesitate to prescribe it in this way.
Progestins? They're the synthetic stand-ins. And while they might look similar, their effects can differ vastly. For example, while progestins might increase the risk of breast cancer, progesterone does the opposite.
Examples include levonorgesterol, norethisterone, dydrogesterone, and medroxyprogesterone acetate.
But, just because they are synthetic, it does not mean that they are bad – we are all different, and for many women, they work just fine.
Prescribing Options
When it comes to hormone replacement therapy (HRT), the general consensus leans towards starting with micronised progesterone, with dydrogesterone as a secondary option. This preference is due to their relatively lower risk profile for cardiovascular, thromboembolic, and breast cancer issues compared to other progestogens.
Progesterone typically takes the lead, mainly due to its ability to break down into components that can navigate through the blood-brain barrier. Once there, they cozy up to GABA receptors, which is excellent news for those seeking better sleep—something you don't get with other forms of HRT.
Of course, the one-size-fits-all approach takes a back seat here, as treatment should be tailored to the individual, with room for adjustment based on how one responds to different formulations.
The typical approach for many is to use Utrogestan at a dose of 100mg each day or, alternatively, 200mg for a span of 12 to 14 days each month. This regimen can vary, often based on whether you're still experiencing menstrual cycles. To ensure adequate endometrial protection, it's crucial to maintain this medication for at least 10 days.
Navigating Progesterone Sensitivity
It's tricky and not entirely understood. Sometimes, it's not the hormone but its metabolites that cause issues. If you're navigating this maze:
- Keep a diary to track your experiences.
- Be open to trying different forms of progesterone or progestins.
- Consider how you absorb it—through pills, patches, or pessaries.
If you haven't been able to take the oral contraceptive pill, bear in mind that this contains a progestin, so HRT may be different.
Exploring your options for hormone management can lead to a plan that's better aligned with your body's needs.
Here are some adjustments to consider:
1. If you're taking Utrogestan daily, consider changing to a cyclical regimen of 12-14 days instead.
2. You might want to try switching between oral progesterone and a progestin, or the other way around, as individual hormone metabolism can vary. Even different progestins can vary.
3. Consider using a hormonal IUD, which works locally and may have fewer side effects. It has the advantage that it stops periods.
4. Experiment with hormone patches like Femseven Conti, Evorel Conti, or Sequi, as absorption rates can affect how your body metabolises hormones.
5. Pessaries are an option to explore, as they may deliver higher progesterone levels directly to the uterus, potentially minimising side effects.
6. Using Utrogestan vaginally is another method; though it's off-label and without extensive safety data, it remains a potential alternative.
7. Adjusting your oestrogen dosage could also bring relief, as the right balance between estrogen and progesterone is crucial. In this instance, I recommend a DUTCH test to see what is happening to the hormones.
8. Some choose to take progesterone quarterly. While this isn't widely recommended and needs more extensive research, it might be suitable for some.
The Takeaway
Remember, HRT isn't a must—it's deeply personal and depends on your unique situation. Listen to your body, and partner with your healthcare provider to find what works for you.
The insights shared here aren't a replacement for medical advice from a healthcare professional. They're here to guide and inform you on your menopause journey.
Please schedule a complimentary call with me to discuss your experiences. This conversation is an opportunity to explore your symptoms and the possible ways to manage them with absolutely no obligation. Remember, understanding and then addressing your symptoms is vital to finding relief and improving your daily life.
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