Women seeking relief from symptoms associated with peri-menopause and menopause often reach for the progesterone cream. If you’re going through it, no pun intended, you know the symptoms. In case you’re unfamiliar, here are some of them: hot flashes, vaginal dryness, decreased libido, night sweats, mood swings, fatigue, difficulty concentrating, weight gain, increased pain, digestive disturbances, depression, memory lapses and more. Although bio-identical hormone replacement therapy might be appropriate for some people, the use of transdermal (through the skin) creams should be avoided.The purpose of using a cream is for seamless delivery of the hormone into the bloodstream. This delivery method prevents the complications associated with oral hormone replacement which gets processed through the gastrointestinal (GI) tract and liver. The GI tract and liver will break down the hormone into metabolites that differ from the original hormone and thus not produce the desired results. Avoiding this unwanted effect via the use of a cream won’t cut it however.
When a hormone cream is administered through the skin, not only does some of it go straight into the bloodstream, but the hormone also builds up in the sub-cutaneous (under the skin) fat. With consistent, prolonged application, the level of that hormone becomes elevated past normal physiological levels. And this can easily be seen on saliva testing of someone using a cream. When this happens, down-regulation of that hormone’s receptors is the result. Essentially, down-regulation means that there is a decrease in the number and sensitivity of the target cell’s receptors for that hormone. This prevents the hormone from working on the cells and producing the desired outcome that was originally intended. Down-regulation can be seen as a defense mechanism to prevent over-stimulation, but unfortunately it can lead to symptoms of deficiency because the hormone’s message(s) aren’t received.
Down-regulation of receptors isn’t the only complication. When the hormone builds in the subcutaneous fat, it can get released at random intervals and in random amounts unrelated to when or how much of the cream is applied. This is certainly a problem when the intention is to provide a specific dose during specific times of the day or month. Also, liver function becomes hampered because it now has the burden of having to metabolize and detoxify the excessive amount of that hormone. And when dealing with progesterone specifically, other hormones can become imbalanced as well. Progesterone is a precursor (meaning it eventually can get converted into another hormone) to many other hormones. These include the likes of estrogen, testosterone, androstenedione, DHEA, aldosterone, and cortisol. An artificial rise in any of these hormones due to the conversion of excess progesterone results in its own complications.
So now what? What are the best alternatives? Personally, I prefer sublingual liquids. These are absorbed through the mucosa of the mouth and go straight into the bloodstream avoiding immediate metabolism by the GI tract and liver. Additionally, people have success with creams or gels that are only applied through the vaginal or rectal mucous membranes, not the skin.
If you, or someone you know has been or is currently taking progesterone cream transdermally, (or other hormones transdermally), you should encourage them to have their levels checked via saliva to see how it’s affecting them. Chances are, their levels will be “off the charts”.
Dr. Rob D’Aquila – NYC Chiropractor – Diplomate of the International Board of Applied Kinesiology
Dr. Rob, does this also apply to progesterone cream that is not bio-identical? What do you really think about using them? Thank you, sherry
Hi Sherry,
Is there a synthetic prescription “progestin” cream? Is that what you’re using? If you’re using “progestin” then you can’t be sure because it won’t show up on a saliva test.
If you’re on a progesterone cream that is applied transdermally you should have your levels checked.
I don’t like the creams, as mentioned – I prefer liquid sublinguals. I see the creams cause more harm than good and always result in an overdose of progesterone. The only (and best) way to know is to get your levels measured.
Take care,
Dr. Rob D’Aquila
Hi Dr. Rob,
Can you get an accurate reading of hormone levels with a blood test for estradiol, progesterone, total & free testosterone, shbg, fsh, am cortisol, dheas, dhea, vit d 25oh, homocysteine, candida antibody, anti-tpo microsomal disorders, T3 total, T4 Free and TSH.
Insurance doesn’t cover the expensive saliva test and I was told this was just as good as the saliva test. I would love to become a patient of yours via telephone, unless you’re coming to Hawaii for a visit!
I’m no longer on bioidentical hormone cream but now have very dry skin and continued hair loss which includes severe bald spots. I feel that could be an autoimune issue. When I eliiminate sugar and consume a large amount of protein it makes a difference in my hair loss.
Okay, enough – I could go on for hours on my hair situation. I just want it to improve.
Thank you for your time and much appreciated help.
Aloha,
Roberta
Hi Roberta,
For total and free testosterone, SHBG, FSH, Vit. D, homocysteine, and all thyroid markers, I prefer blood.
For the rest I would use saliva.
For candida, I prefer a stool test, which can also pick up other things.
I’m available for telephone consults. I don’t know what you consider expensive, but it may be worth the expense.
By the way, I met an intuitive who said I’d be asked to go to Hawaii professionally. Although she said it would be 2014. We shall see!
Your issue may be autoimmune, which is another whole issue, so to speak. Blood work should be able to confirm that best. Although, keep in mind that one test which doesn’t show antibodies doesn’t rule out autoimmune issues. The antibody levels fluctuate, so several tests, especially while symptomatic will be best.
Sounds like sugar needs to go! Of you’ve read a fair amount of my site, you know how I feel about sugar.
Aloha,
Dr. Rob D’Aquila
Thank you for this highly interesting information. I will be bringing it to my upcoming hormone panel follow-up appointment
Thanks for the article. It’s amazing how many doctors don’t know about hormone imbalances and how to fix them. I have been trying going from one doctor to the next for 2 years, without any success. 2 years ago, I developed painful pelvic symptoms and my menstruation became extensive and non-stop. Fast forward months later of the same, and one doctor suggested my TSH of 3.85 might be the cause of the irregularity. I was put on Synthroid and within 2 months, my meds were increased by 2 .25 increments. By the 2nd increase (75 mg), my hair began falling out. I’ve never had hair loss issues before – ever. Speaking to my doc about this, I was instructed to “hang in there’. I hung in there for 6 months and lost 50% of my hair. AND, it didn’t help my menstrual cycle. What did help was a laparoscopy surgery. I haven’t been on Synthroid for 2 years but the excessive hair loss that began with that med has never ceased since. No doctor can explain why this is, but now they are saying perhaps my hair loss had nothing to do with Synthroid but is a progesterone, or estrogen, or testasterone, or androgen…issue. They can’t figure out quite which one, because my levels are normal on paper. One wants to put me on androgen blockers; another wants me on progesterone (bio-identical); another wants me back on thyroid meds (my TSH varies from 2-3.58, depending on the time of month). But no one really knows what to do. And I sure don’t, either. I’ve considered progesterone, but why mess with more of my hormones when my levels look normal? I have only had blood tests, no saliva. Is that what you recommend? And have you ever heard of this situation that I’m experiencing…and have thoughts on it? I don’t want to be a guinea pig for doctors’ supplements and suggestions, but have no idea what else to do.
Thank you.
Hi Holli,
I’m sorry to hear about all of this. You’ve certainly been going through it.
The hair loss could be thyroid resistance, although it doesn’t sound like you were on the Synthroid that long. However, I’d also have looked a lot deeper than just a TSH test. And 3.85 is not lab high in my area of the country.
The hair loss could be an androgen issue, yes, and it could also be an estrogen issue, because estrogen is necessary for proliferation of tissues.
I definitely prefer saliva over blood. And it sounds like you can use more of a work-up with tests even though it must feel like you’ve been evaluated from head-to-toe.
Good luck,
Dr. Rob D’Aquila
Hi Dr Rob,
Firstly I want to say how wonderful I think you are, spending your time listening and trying to help all the people out there that are struggling with their health.
It can be overwhelming, and you obviously are very intelligent, well educated, understanding, and interested….. so THANK YOU!
I am 43 years old and have been on bioidentical progesterone oil for over seven years! I have had many health problems over the years,with too many sypmtoms to list, some are non specific and very frustrating. I have been diagnosed with Hashimotos and I have hypertension too. I also think I have been suffering from adrenal fatigue.
After recent investigation into my hormone therapy, I think I need to try something else? Have you heard of ‘Amberen’? Do you think this could be good for me?
Warm Regards
Steph, from New Zealand
Hi Steph,
Thanks for your kind comments, I appreciate them.
If I were you, I’d first look to get the Hashimoto’s under control. I’d have a complete thyroid panel done (via blood), including: TSH, Free T3 and T4, Total T3 and T4, TBG, T3 uptake, and reverse T3.
After receiving those results, it should point to what my causing thyroid hormone imbalances, assuming there are any.
Next, the immune system needs to be under control, so as to prevent it from continuing to destroy thyroid tissue. And also be aware that it’s very possible that you have antibodies to other tissues in your body and not just the thyroid. Your immune system can be destroying other vital organs or tissues.
I’d order this book to start – http://www.thyroidbook.com/ – and find a physician competent in the using the material.
I haven’t heard of Amberen – if you were my patient, I’d muscle test it to see how your body reacted. Everything is marketed to sound great to increase sales. I’ve never seen one specific product be the “Holy Grail” for everyone. And in fact, I’ve never seen any supplements or combinations be the answer without a patient’s lifestyle being in order as well.
I’m not going to analyze the entire product, but the site says (for one ingredient): “The principal signaling action involves the activation of the sympathetic function of central and peripheral nervous systems…”
If “you” had overactive sympathetic nervous system function driving your symptoms and issues, it would seem to me that this would simply make it worse. And very often, hypertension can be a result of an overactive sympathetic nervous system (as can adrenal disorders).
I hope this helps.
Good luck,
Dr. Rob D’Aquila
Hi again,
Thanks very much. I have been trying to get the book, but unfortunately it is out of print. I will keep trying. It sounds very hopeful and am excited to be learning more about my health and possible ways to better it.
I am wondering if you could give me some more advice about the progesterone oil I am using? It sounds like I need to stop using it and I am not sure how? I am assuming by decreasing it slowly? I admit I am scared of the thought that I have made things worse all these years, and the symptoms that it has helped will return with vengeance.
Warm Regards,
Steph
Hi Steph,
The book should come back in print, unless a 2nd edition comes out. I’m 99% sure it will be available again – keep checking.
As far as the oil, it’s tough to say. You should have your progesterone levels measured via saliva.
When a person is totally overdosed on progesterone, bc of use of creams, I don’t wean them off – at that point they are already saturated and I see no need to wean them. It could be a very tumultuous return to normal functioning while the person is clearing out the excess progesterone, but that’s just that. And again, there’s no sense in weaning an overdosed person in my opinion, because you’re just prolonging the process.
Hope this helps,
Dr. Rob D’Aquila
Hello again,
I have been on quite a mission to try to find some improvement in my health. I have had extensive food intolerance testing done, and I am now on a very restrictive diet that has been difficult Much less sugar and carbs.. I am taking many supplements and no longer taking the prog. oil.
The good news is a have lost weight and my blood pressure is down, and I dont have as many palpitations any more. My hair loss has slowed.
The bad news I am still miserable! My depression is severe! Many times I don’t want to go on. I am even more tired and the anxiety (in the form of OCD) is terrible.
It is so difficult to find a doctor that can help. I have found one that has recommended I have my amalgam fillings (14 of them) removed. I have made a start on this. While I think he probably has a point, his interest seems to be mainly mecury toxicity and I am not sure he will be able to help with the rest of my problems (although he believes nothing will get better until the fillings are gone).
All the tests, supplements, dental work, doctors visits, and very expensive health foods are putting us in debt, and I do not see an end to it all. I am struggling in every way.
Sorry to put this all down here in such a way, I thought it put help to get some of it out, and with the hope you might have some more insight into something more I could do?
Steph
Hi Steph,
It’s impossible for me to say whether or not your amalgam fillings are the main problem. I don’t know how this doctor concluded that you won’t get better without removing them. He/she may or may not be right. And if the amalgams aren’t removed by a very competent dentist, you can surely make things even worse. Usually balancing out the system as a whole through blood sugar, GI function, diet, liver detox, adrenal function, etc. is enough. It is possible that metal toxicity is the key, but I’d make sure everything else was in order first. Very often “fixing” everything else causes the immune system to “relax” and not react to the metals, therefore not causing symptoms. The reality is that EVERYONE has metals in them if they live in an industrialized nation. You can’t escape it. Some may have more than others of course. But regardless, why is it that some react poorly to the metals in their system, and some not at all? It comes down to immune system function which can be regulated (in general) through what I mentioned above.
Additionally, you may want to get checked for Hashimoto’s thyroid disease.
Best,
Dr. Rob D’Aquila
Hello Dr D’aquila, I’m 53 and, im on. BIOIDENTICAL HORMONE RPLACEMENT THERAPY, for almost two years,wich is helping me a lot for my menopause symptoms, but recently I have been feeling a some kind muscle pain, and legs discomfort. Plus not sleeping well, and stop my exercise routine due to the muscle pain.
What do you think.
Thank you
GLORIA.
Hi Gloria,
These symptoms could be related to hormonal imbalances. However, I’d start with an extensive blood panel to look into other possibilities first.
Take care,
Dr. Rob D’Aquila
I just had my hormones tested after years of suffering with symptoms-hair growth, weight gain. After the saliva test I found my estrogen and testosterone were very high and progesterone low, She started me on a progesterone cream from a compounding pharmacy. to see if raising this will lower the others. She then took an insulin test and found it to be elevated so I am to start metformin. I am getting retested in 2 months. What are your thoughts and what does all this mean?
Hi Jody,
As a doctor, I wouldn’t let a patient leave the office without knowing the answers to these questions. And I certainly encourage my patients to ask me any questions that come up after an appointment as opposed to searching for answers online, as helpful as that may be.
It sounds like your doctor should have given you advice on changing your diet and lifestyle in order to help your blood sugar and insulin levels get into normal range, assuming they’re not already, which is what it sounds like.
Secondly, I don’t see how adding progesterone will “lower the others” (estrogen and testosterone). It may improve ratios, but I can’t see how it would actually lower the other hormone values.
It also sounds as if your thyroid may need evaluation based on your symptoms.
Starting with progesterone cream would probably not be my approach, but I don’t know your whole case and have never evaluated you obviously. Also, my license doesn’t allow me to tell anyone to or not to take any prescription medication such as metformin, therefore, I never do.
Good luck and thanks for the comment,
Dr. Rob D’Aquila
hi. i am 44, have lifted weights for 25 years but much less the past few years. simply because i dont have the energy i once have. i have a multitude of symptoms, mainly hair loss, widows peaks, like a man and now all over hair loss, if i touch my hair, it falls out. this is very depressing. i also have severe depression to the point of feeling suicidal daily, sever anxiety, just recently cannot get to nor stay asleep without a sleeping pill, then im drugged up the next day. i have zero energy. i pee a ton, and have been having horrible diarehea the past few weeks. seemed to have started after eating lettuce, i got food poisoning because i was immediately in the bathroom after eating a salad. i am already treating with t3 25 mcg, had been on hydrocortisone for a year but have been weaning and and take around 10 mg now, i took florinef for about 8 momths and weaned off it. it helped a little iwth the peeing but not really, i have celiac so i have been gluten free for a year and half, i quit coffee two years ago, i havent been eating sugar at all for months but do eat a few carbs like gf oatmeal, strawberries(sugar), use stevia, no bread but brown rice, chicken, veggies, lunch is lettuce, tomato and boars head turkey. i am hungryall of the time, like 10 minutes after i eat im hungry. i have taken chlorella and cannot tolerate it, diarehea, cannot tolerate magnesium, i took it for a year and for a year i had a headache, when i quit magnesium, the headache went away. i still get headaches bad though not as often. i recently did sex hormone saliva tests and all were low. i am due to start compounded bioindentical cream, probably progesterone and testosterone since i am still cycling. periods used to be regular but getting sooner and longer every month(coild that be the hydrocortisone?) i have a history of acne( took accutane for 3 years) so i dont want the testosterone to make me break out, the accutane was hell. reading what you wrote about bio identical creams now has me freaked out badly about taking them. i have been to all the naturopathic doctors here and they all have a different take on what to fix. i amVERY low income and quite honestly cannot afford to see another out of pocket doctor. it seems since i am taking thyroid, rested my adrenals for a year(idid not work out for A year and hated it), take massive suppluments( vit C, 150 iron, potassium-40 meq prescription kdur, two teas sea salt daily, krill oil, vit E, D, B100, b12 sublingual, probiotic- solaray), i am also having horrible heart pounding which makes me suspect i dont need thryoid at all. my original tsh was barely out of range and at the time i was eating a ton of gluten. obviously i have low sex hormones and need them. out of all the doctors ive seen, just one seems to get it but she costs like 300$ a pop and times me if i go over the alloted time. plus labs and suppluments she may suggest. with the peeeing, diarehea, working out, now only about 2-3 times a week, i sweat like a pig, i feel i am constantly dehydrated. also with all that stuff plus the magnesiumfor a year, i feel like i must have pulled some metals out, plus detoxed some estrogen from my liver. i MUST get some relief soon, i am miserable not sleeping with the heart pounding. i will start the bio identicals on tuesday, paying out of pocket for them yet you say EVERYONE? devolops an intolerance to them? is that true of everyone? i was told i could safely take themthe rest of my life. i feel like i get conflicted stories from everyone and am not sure what the truth is, what MY truth is? all i know is after two years of feeling miserable and basically being a skinny( yet with all those years of weights, have NEVEr been able to lost my hips and lower stomach whic points to estrogen?) single, female, being bed ridden for the past twoyears is no way to live. what do you suggest? plus when i do sleep, i wake with horrific hypoglycemia, starving and cant sleep cause im so hungry. i dont want to make things worse down the line with bio identicals.
Hi Shana,
Sorry to hear about all you’re going through.
Regarding hormones, I wrote about basic physiology and my experience with patients. I don’t know how you will respond. There are so many variables that will affect the outcome.
Good luck,
Dr. Rob D’Aquila
Dear Dr. Rob
I am in my sixties I’ve been on BHRT for 4 years. I had some minor hair loss 4 months after beginning on bi-est, progesterone, testosterone and dhea. As time went on more hair loss. My gyn took me off of dhea and testosterone. He said that could be the cause of hair loss. My hair will shed some and then rest some but never returned as normal. I’ve seen derm who put me on 2 rx shampoos and aldactone 25mg. I ‘ve stopped the shampoo after two years and want to stop aldactone. I am planning on weaning off of bhrt…can these hormones and the fact that I’ve remained on the same dose be the cause of hair loss? My fear is when I start weaning off I’ll lose more hair. Doyou have a recommended time frame for being off of the hormones? I’m hoping after stopping my body will get back to whatever is normal for me. Thank you in advance for any suggestions or help.
Lucy
Hi Lucy,
It’s possible that your thyroid became a bit under-active, and that’s what contributed to the hair loss. Excess estrogen can increase thyroid binding globulin which is the protein that thyroid hormones are attached to during transport around the body. If the hormone doesn’t get released from this binding protein, it can’t properly work at the cellular level.
Unfortunately, there is no cookie-cutter approach that I know of to get off of bHRT. There are way too many factors involved.
Best of luck,
Dr. Rob D’Aquila
Hey Dr. Rob,
I have been on BHRT now for about a year and a half. I started doing it because I had a complete hysterectomy an the estrogen patch wasn’t agreeing with me. Also, I was having severe migraines which I think the patch was causing most of them. The first year of BHRT went good except I had acne real bad from the testosterone so they had to give me a prescription for it. When I started on my second year I started having all kind of side effects like weight gain, headaches, fatigue, and trouble wearing my contacts. Also, the first year I started sleeping good now I toss and turn. I feel yucky all the time. I don’t know what to do because I have signed a contract an have five more months left. I am wondering if it’s worth my health to finish my implants.
Alicia
Hi Alicia,
It sounds like your hormones are imbalanced… I’d get your levels checked, via a good saliva profile to see where they are, and then take it from there.
Best,
Dr. Rob D’Aquila
Thank you for your website!
I really appreciate the time taken by you to help many people on the comment site.
I have been on Pro-gest by Emerita for several years and have not
had any issues. After reading your article i am wondering if i may have
issues that i am not aware of. I guess i believed that the Pro-gest was
natural and a better alternative. Please give me your input and thank
you in advance.
Hi Caroline,
You’re welcome, I’m glad you enjoy the site!
There’s no doubt that natural progesterone is better… It’s really difficult to say what effect it’s having on you, without doing a test to measure your levels. The good thing is that it sounds like you don’t have any symptoms. That’s not necessarily the best barometer of health, but it certainly says something…
I have had one instance where a woman was on progsterone cream and her levels were within normal limits. However, she was the exception to the rule.
Best,
Dr. Rob D’Aquila