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NatPro

 

Progesterone Therapy

Progesterone therapy has been practiced for over 50 years in the treatment of a wide variety of symptoms and diseases that are hormonally related. During this time no adverse side affects have been reported. Some people have benefited from it continuously for over 30 years.

There is no evidence to suggest it is possible to overdose using progesterone therapy.

Hormones are chemical messengers and can only work once inside the nucleus of a cell. To get into the nucleus the hormone needs a carrier which is called a receptor. Receptors are very specific, they will only transport the hormone for which they are made. Progesterone receptors will not transport the synthetic progestogens into the cell nor will they transport progesterone itself if there is adrenalin in the blood.

The level of progesterone varies in women from approximately 5mg per day in the first half of the monthly cycle up to 50 mg per day in the second half. During pregnancy the placenta produces up to 40 times the highest amount made when not pregnant. Men make from 5 to 15mg per day on a continuous basis.

Here's an important word of caution...

Tests to find the level of progesterone in the blood of women are generally of little value for a number of reasons...

  • The ovary secretes progesterone in small spurts and the amount can vary within half an hour
  • Low levels have been found in women who are not ovulating
  • If adrenalin is present or the blood sugar is too low even high levels of progesterone cannot be used
  • After a large meal the level of progesterone drops
  • The level drops during the long nights experienced in northern latitudes
  • Progestogens contained in the Pill or HRT lower the level of progesterone

Progesterone therapy is usually administered in a cream or oil base, which means that it will be carried in the blood on a red blood cell membrane. Often tests only check the plasma which would show up little or no progesterone.

So what can you do for reliable results?

Saliva tests are generally more reliable. However, if you are a woman and if a blood test is your only option then make sure this is done during the 5 to 10 days before your next period. This is to check whether ovulation has occurred, as the level should then be at its highest point.

A blood test is not a necessity. Simply trying progesterone therapy and seeing its effectiveness in dealing with your health problems is the easiest course of action as it is inexpensive and risk free.
Progesterone therapy can be administered in many forms...

  • Transdermal creams varying from under 1% to 10% in strength, which are an effective, slow release form
  • Sublingual oil or tablets, giving a quick release so not suitable for long term use
  • Injections, very effective at treating emergencies such as epileptic, migraine or asthmatic attacks, but not for long term use
  • Suppositories, again a fast release form so not suitable for long term use
  • Orally administered capsules, which are ineffective, as up to 90% is destroyed by the digestive system and the liver before reaching the receptor sites

Transdermal creams are the most commonly used form of progesterone therapy for a number of reasons, some of which are...

  • Ease of use
  • Cost effectiveness
  • Can be used over a long term
  • Direct benefit to the skin, making the use of other moisturizers unnecessary

When using progesterone therapy it is essential to start on a high dose. Some practitioners give 2500mg/day for very severe cases of post natal and manic depression, PMS, panic attacks, temporary psychosis etc.

After the initial high dose, which should bring relief in anywhere from three days to three months, it may gradually be reduced until the reappearance of symptoms.

This indicates the level of progesterone needed. As it is the precursor to the stress hormones any extra stress will require increased levels of progesterone therapy.

Once started on progesterone therapy you will become sensitive to the level needed on a daily basis.

How Much Progesterone Cream to Use

The cream can be used at any time of the day and, if preferred, on more than one occasion, but no less than twice a day, as progesterone levels drop after about 13 hours.

It can be applied to any part of the body and does not have to be used only on the thin skinned areas as is sometimes recommended. The skin comprises 95% kerotinocytes, which have a plentiful supply of progesterone receptors, even the hair follicles absorb it well.

Please note the amount suggested is a guide only as each individual is different. It's only by trial and error that the correct amount is found. Another point to remember is that stress drops progesterone levels sharply so apply more to prevent the return of symptoms.

Progesterone should always be used dependant on symptoms and not on 'dose'. If symptoms are severe more will be needed, if mild then less.

Generally between 100-200mg/day of progesterone (that is 3ml to 6ml of cream) is needed.

Rub the required amount of cream thoroughly into the skin on any part of the body.

Important note for women... If you have been on HRT (hormone replacement therapy) or have a naturally high level of estrogen, progesterone will make you more sensitive to the estrogen in your body. Because of this, for the first two or three months the symptoms caused by excessive estrogen may affect you. If this is the case it is advisable to increase the daily application of progesterone cream, with the advice of your health specialist, until these symptoms have gone.

The main symptoms of excessive estrogen are...

  • Breast tenderness
  • Bloating/weight gain from water retention
  • Spotting or a temporary reappearance of your periods
  • Headaches/migraines/dizziness
  • Heart palpitations
  • Hypoglycemia
  • Aches and pains or bruising
  • Depression
  • Tiredness/chronic fatigue
  • Hot flushes
  • Mood swings
  • Anger
  • Skin problems
  • Nausea

Simple Progesterone Test

An elevated progesterone level induces an increase in body temperature. Women can measure their temperature by using a thermometer. A rise in progesterone is indicated by about a 0.4 degree Fahrenheit increase and a fall of progesterone, triggering menstruation, indicated by a decrease in temperature.

A thermometer can also help in determining if you are progesterone deficient during pre-menopause years. (Post menopause women are not ovulating and menstruating and have constantly low progesterone levels so progesterone level changes will not occur.) Your temperature should rise at ovulation and remain high until a day or two so before the end of the cycle and the start of menstruation. Fluctuations may occur due to a "double ovulation". Although this is rare it is possible within three days of initial ovulation or due to sickness.

If your temperature never rises (indicating no ovulation) or consistently drops several days after ovulation and stays low for days thereafter it is very probable that your progesterone levels are not being adequately maintained. Low progesterone levels can contribute to miscarriages and osteoporosis and numerous other symptoms of estrogen dominance. To verify your findings the only reliable method is saliva hormone testing.

A General Observation about drugs

Some drugs may be dispensed with once progesterone therapy has been started, most notably the anti-depressants. Always taper off slowly and with the advice of your health specialist.

Any additional stress, good or bad, can cause your symptoms to recur. If this should happen then increase the daily application until they have gone.

Menopause

Progesterone and menopause are inextricably linked at many levels. Strictly speaking menopause only occurs when periods have finally stopped. It is generally recommended to allow a year to pass before drawing this conclusion. The symptoms which can be experienced in the years before its onset (sometimes referred to as peri-menopause) are generally far worse than those following after. In some women symptoms can start ten years before, sometimes they can persist from 5 to 10 years after.

Natural causes

Menopause normally occurs at an average age of fifty-one. Some women can reach their early sixties, whilst the youngest on record is nineteen. Smoking can reduce the age it begins by two years. An early puberty usually means a late menopause, but many factors can influence it's start.

Women are born with a finite number of eggs, all fully developed whilst she is still a foetus, peaking at several million. The current theory as to what causes menopause is that as a woman ages, the number of eggs declines and the ovaries shrink. At menopause, there are only about 1,000 left. But it is still only a theory, no one knows for sure.

At puberty the child starts developing into a woman. This is controlled by the affect of the two sex hormones estrogen and testosterone. Estrogen causes the breasts to grow and fat to be deposited, especially on the hips and thighs. Too much can cause a child to have very large breasts and fats deposits, causing the well known 'puppy fat'. One of the main reasons for puppy fat is a lack of progesterone, which opposes the action of estrogen, but not until ovulation occurs is this produced. Once ovulation starts the puppy fat generally goes. Testosterone increases libido, deepens the voice and causes body hair to grow. But too much can cause aggression, acne, large quantities of body hair and contribute to poly-cystic ovaries. Women produce about 80% less testosterone than men.

About two years after the onset of puberty menstruation begins. The cycle is governed by four hormones. Initially follicle stimulating hormone (FSH) stimulates the egg, and the follicle surrounding it, to grow and the ovary to make estrogen. Estrogen is the dominant hormone in the first half of the cycle, stimulating the buildup of tissue and blood in the uterus.

At mid cycle the pituitary gland produces luteinising hormone which stimulates the follicle to rupture, releasing the egg, which slowly makes it's way down the fallopian tube. The ruptured follicle, now called the corpus luteum, starts producing progesterone, the dominant hormone in the second half. Progesterone readies the endometrium (the uterine lining) for pregnancy. If the egg is fertilized it embeds itself in the lining and pregnancy ensues. If not, then the levels of both estrogen and progesterone drop sharply causing the lining to be shed.

This cycle continues until about ten years before menopause, when anovulatory (no ovulation) cycles begin. This is when the significance of the relationship between progesterone and menopause becomes apparent. When the anovulatory cycle happens no progesterone is produced during that month, but estrogen is still being made, leading to symptoms of estrogen dominance. Please refer to the above list for possible symptoms. As menopause approaches, anovulatory cycles increase, which in turn increases the amount and severity of the symptoms. By menopause the progesterone level can be as low as those in a man, but estrogen levels only drop when it finally arrives. Despite this women are often told the adverse symptoms which they've been experiencing are due to a drop in the estrogen level!

The link with progesterone is highlighted by the fact that women in industrialized countries have a hard time compared to women in rural societies. Dr. P. Ellison of Harvard University has studied estrogen levels in various ecological and cultural populations and has found that estrogen levels in western women are abnormally high. This can be due to a number of factors:

  • The food we consume (particularly animals fed estrogen to fatten them)
  • The crops sprayed with pesticides (most of which are estrogenic)
  • The Pill and HRT
  • Drinking recycled water which has not had the estrogen removed
  • Using cosmetics which are made with liquid paraffin and estrogenic antioxidants

Many women are under great stress during peri-menopause having to juggle work and home, often a teenage daughter is going through puberty at the same time, children leaving home, a bad marriage, job difficulties and maybe elderly parents now need looking after.

An understanding of the effects of a lack of progesterone is key to undestanding that progesterone can play an enormously beneficial role in helping to go through menopause without too many adverse affects. By naturally opposing the action of estrogen, the symptoms of estrogen dominance are lessened and in some cases eliminated. The easiest method to apply progesterone is in a cream form.

New research conducted by Wallace and Kelsey and published in "Human Reproduction", indicates that it might be possible, using ultrascan on the ovaries, to show the approach of menopause. Currently blood hormone levels are used to try to determine this, but these are notoriously inaccurate as it is common practice to only check estrogen levels, not progesterone. The patient generally needs to specifcally request this despite the fact that progesterone and menopause are inextricably connected. As the symptoms of menopause are caused by a lack of progesterone and too much estrogen, the standard "estrogen only" test is of little help.

Menopausal women are actively encouraged to have Pap smears, mammograms or have a doctors examination on a regular basis. These have not been shown to reduce deaths from cancer, but merely enable earlier detection and treatment. (Please see page on cancer). Dr. P. Ellison suggests that the abnormal levels of estrogen in western women may be related to the current epidemic of breast and ovarian cancers.
Chemical causes

Menopause can be precipitated at any time in a woman's life by chemotherapy used in cancer treatments. The symptoms are the same as in natural menopause. Tamoxifen, the chemical used to control breast cancer, can cause severe hot flushes. Progesterone can be safely used to combat them.
Hysterectomy

By removal of the uterus and possibly the ovaries, a woman is in instant menopause. If the ovaries are not removed at the same time as the uterus, they will generally atrophy within two to three years. In the recent past, following a hysterectomy, women were usually given HRT. However, with the publication of studies finalized in 2004, which proved beyond doubt that HRT can cause an increase in cancer (particularly breast cancer), stroke and heart disease, this practice has declined. Unfortunately few medical practitioners recommend progesterone regardless of the clear connection between progesterone and menopause.
Causes of Premature menopause

For reasons not too clear some women can go into premature menopause. One possible theory is the affect xeno-estrogens (xeno means foreign) have on the developing foetus. Xeno-estrogens mimic natural estrogen, but are extremely potent and highly toxic. Early exposure to estrogen or the xeno-estrogens can cause the follicles to mature rapidly and die off leaving few eggs in the ovary to reach puberty. This in turn leads to early menopause. Please visit the recommended web sites below for more on xeno-estrogens.
Turners' syndrome (TS)

Mention must be made of the 1:2000 girl babies born with TS. Again for reasons unclear, these children are born with an X chromosome either missing entirely or partially missing. Apart from many potential problems, they have non-functioning ovaries, which means no estrogen will ever be produced. So as the child approaches puberty, the lack of secondary sexual characteristics becomes apparent, no breast, thighs etc. develop. She is then given supplemental estrogen to correct this, but no progesterone to balance the estrogen. Unfortunately, under the misguided belief that estrogen prevents osteoporosis, (please refer to the page on osteoporosis), she is often put onto HRT. As TS was first reported as recently as the 1930's, it is possible that environmental poisons are to blame.

Can progesterone help recovery from Polycystic Ovarian Syndrome (PCOS)?

PCOS is a condition that is rising alarmingly all over the world.

It is the most prevalent reproductive problem in young girls and women, affecting up to 10% in the 15 to 50 age group. Although reaching almost 25% if women with mild cystic ovaries and ovaries damaged by the contraceptive pill are included.

PCOS is generally considered a syndrome rather than a disease, because it manifests through a group of signs and symptoms that can occur in any combination, rather than having one known cause.

Other names for Polycystic Ovary Syndrome are Stein-Leventhal Syndrome, hyperandrogenic chronic anovulation, functional ovarian hyperandrogenism, and Polycystic Ovary Disease.

Symptoms vary and include some or all of the following...

  • Oligomenorrhoea (absent or infrequent periods) or amenorrhea (no menstrual period). The normal cycle length is between 21 to 35 days. But in women with PCO the cycle length can vary from every 6 weeks, to only 1 to 8 periods a year, to none at all. Other symptoms include include lengthy bleeding episodes, scant or heavy periods, or frequent spotting. Ovulation would be infrequent or not at all, leading to a drop in progesterone levels
  • Enlarged ovaries (usually 1.5 to 3 times larger than normal) with a few to many follicles arrested in growth, commonly called...
  • Cysts (fluid-filled sacs), giving the classic "string of pearls" appearance to ovaries with many cysts. PCOS is difficult to diagnose without the presence of some cysts or ovarian enlargement. Often the underlying cause is inflammation, which would not be picked by the radiographer. Cystic ovaries can lead to...
  • Chronic pelvic pain - although the exact cause of this pain isn't known, inflammation is the most likely cause. It is considered chronic when it has been noted for greater than six months. But follicles arrested in growth cannot ovulate, which leads to...
  • Anovulation (lack of ovulation), which is relatively common as the follicles mature only occasionally, this leads to...
  • Low progesterone levels, as it's only after ovulation that the follicle, now called the corpus luteum, produces progesterone. But low progesterone levels lead to...
  • High levels of luteinising hormone (LH) as the pituitary is trying to stimulate ovulation. High LH suppresses follicle stimulating hormone (FSH) so this leads to arrested follicle growth in the next cycle. But LH also stimulates the thecal cells in the ovary to produce androgens which leads to...
  • High androgens (hyperandrogenism), particularly high testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS), leading to excess facial and body hair, male pattern baldness, deepening of the voice, weight problems including obesity and a smaller hip to waist ratio, acne, oily skin, dandruff, suppression of ovarian function, leading to anovulation which leads to...
  • Infertility (the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age) and low progesterone levels
  • High blood glucose level is occasionally found, leading to...
  • High insulin, this leads to...
  • High androgens, anovulation and low progesterone
  • A prolonged high insulin level leads to...
  • Insulin resistance, a condition where the body's use of insulin is inefficient, which in turn can lead to weight gain/obesity, blood glucose problems, acanthosis nigricans (a sign of insulin resistance, these are dark brown, 'velvety' patches found on the neck, armpits, groin, vulva and other areas), skin tags (acrochordons), high androgens, high triglycerides, elevated LDL and reduced HDL cholesterol levels. But this leads to a greater susceptibility to...
  • Heart disease, which is often associated with...
  • Hypertension (high blood pressure) and...
  • High homocysteine, which is caused by a lack of vitamins B2, 6, 12, folic acid and zinc. But a lack of zinc can lead to...
  • Acne and a suppressed progesterone level. But heart disease, insulin resistance and malfunctioning ovaries are caused by...
  • Oxidative stress, which in turn is caused by...
  • A lack of antioxidants, which includes zinc, selenium, arginine, N-acetyl cysteine, glutathione, and in particular Vitamin D. But oxidative stress is also caused by...
  • High sugar intake and foods which convert to sugar, these are the most oxidizing foods we can eat. It causes glycation, which releases free radicals, damaging cells in the process and leading to...
  • Inflammation

Natural treatment

Above all have a vitamin D test done, and take a minimum of 5000 IU's per day, bringing the level in the blood to 50ng/ml (125nmol/L) or above. A lack of vitamin D is found in PCO, with many authorities believing it could be the main contributing factor. A lack also leads to hyperparathyroidism which is often present in PCO. High levels of parathyroid hormone suppresses thyroid activity, leading to a higher than normal TSH level. The year round level of vitamin D should be 50ng/ml (125nmol/L) or higher
A lack of vitamin D reduces the benefits of progesterone
Use between 150-250mg/day progesterone, this helps stabilise blood sugar and suppresses androgen production. It also helps to correct ovarian malfunction
Take the B vitamin inositol, this aids in reversing insulin resistance and stabilizing glucose levels. Studies have shown this restores gonadal function
Take the antioxidant amino acids L-arginine and N-acetyl cysteine, studies have shown these restore gonadal function.
The amino acids L-glutamine and L-glycine are very helpful. The brain can use them in place of glucose for energy, so they stop all binging, tiredness, cravings for sugary foods and alcohol. Glutamine also heals the lining of the gut, it boosts the immune system and is the most abundant amino acid in the muscles, so helping with muscle weakness. These two amino acids are also two of the three precursors to glutathione, which apart from vitamin D, is the most important antioxidant the body makes. The third amino precursor is cysteine, which is essential to take
MCT oil (medium chain triglyceride) is another excellent source of energy which is not converted to fat, but can be used directly by the cells for energy, take 5-60ml/day. It's extracted from coconut oil and comprises 60% caprylic acid, which kills candida, and 40% capric acid.

Reduce androgen levels - use progesterone to suppress these and avoid all food which converts to glucose, to reduce insulin, which causes androgens to rise.

Reduce insulin levels - eat organic protein (with no growth hormones), avoid all starchy carbs such as the grains and legumes, sweet/starchy fruit and root vegetables, eating only the non-starchy leaves, shoots, sprouts, non sweet fruits and fruit vegetables etc.

Check homocysteine levels. As this can be a contributing factor, a blood test should be done. If higher than 6 then it is essential to take the following nutrients to bring it down...

  • 150mg B2 - riboflavin
  • 75mg B6 - pyrodoxine
  • 1000mg B12 - cyanocobalamin
  • 1200mcg folic acid
  • 3000mg TMG-tri-methyl glycine (anhydrous)
  • 100mg zinc for 3 months, then reduce slowly to the normal daily dose of 15mg. This will also help the acne if present.

It could take a while for things to sort themselves out, so have patience. Researchers have found it takes from four to six months for the ovaries to start functioning correctly.

If inflammation is found, (a CRP test can be done to find this, see below under 'Tests'), it should be reversed. This will prevent the suppression of ovarian function, allowing the ovaries to start functioning normally.

Insulin resistance is not always found in PCO, but if it is, it must be reversed. This will lower insulin levels, which in turn lowers androgen levels.

Insulin resistance can be present from birth. If a diet with an excess of folic acid and a deficiency of vitamin B12 and the amino acid taurine is eaten by the mother while pregnant, the child will be affected. Neither B12 nor taurine is found in plants. A lack of vitamin D while pregnant can lead to insulin resistance in the child too.

Insufficient vitamin D is now thought to be the principal cause of oxidative stress and insulin resistance.

Additional information
Progesterone

Apply 150-250mg of progesterone per day. The higher dose might be needed.

It should only be used at ovulation, for the last 14 days of the cycle, taking day 1 as the first day of bleeding.

Cycles can be very erratic or non-existent in PCO, if this is the case use a 28 day cycle to begin with, until the natural cycle exerts itself. This would mean using the cream from day 15 to 28. For more information please see this web page on how to use progesterone.

If symptoms are severe, please consider using the progesterone daily, through any bleeding that might occur. Do this for at least 3 months, before following the cycle once again. A scan will confirm if the cysts are being absorbed back into the body.

If after the 3 months the scan confirms the cysts are going, a cycle can be started using the progesterone following a 28 day cycle. This should prevent any further cysts developing and hopefully initiate ovulation. It's essential to take the necessary antioxidants too. Progesterone alone won't be sufficient.

If there is a cycle, but with spotting before a full period, between 200-250mg of progesterone will be needed during the last 14 days to prevent the spotting. The spotting is a sign that the progesterone level is dropping too low, too soon, to support the endometrium.

Stress drops progesterone levels sharply so symptoms come back. Increase the amount used if stress should occur.

Before using progesterone it's essential to first read the page on Oestrogen Dominance.

Medical treatment

The medications used to treat PCO's include...

  • Birth control pills
  • Spironolactone
  • Flutamide
  • Clomiphene citrate

Treatment with clomiphene induces the pituitary gland to produce more FSH, which in turn stimulates maturity and release of the eggs. Although one study found a high level of bioactive FSH in PCO granulosa cells which failed to effect maturity of an egg.

The birth control pill contains progestins (synthetic progesterone) and oestrogen, which not only stops ovulation, but reduces the level of natural progesterone in a woman, plus the many adverse side affects it has. For more on this please see the web page on Contraceptives.

Contraceptives also increase insulin resistance.

If insulin resistance is present glycophage (Metformin) or one of the thiazolidinedione medications is given. Glycophage reduces vitamin B12 levels, which could cause homocysteine to rise. Standard tests for PCO include...

  • Abdominal ultrasound
  • Abdominal MRI
  • Biopsy of the ovary
  • Estrogen levels
  • Fasting glucose and insulin levels
  • FSH levels
  • Laparoscopy
  • LH levels
  • Male hormone (testosterone) levels
  • Urine 17-ketosteroids
  • Vaginal ultrasound

(Medline)
The following ranges are for normal levels... FSH levels (generally low in PCO)

    During puberty: 0.3-10.0 IU/L
    Women who are menstruating: 3.5-3.0 IU/L or 5-20 mIU/ml
 

(Medline FSH)
LH levels (often high in PCO)   

Adult female: 5 to 25 IU/L (levels peak around the middle of the menstrual cycle)

(Medline LH)
Progesterone (generally low in PCO)   

    Serum 10 ng/ml
    Saliva 0.2 ng/ml

(Medline Progesterone)

Oestradiol (normal, high or low in PCO)   

    Serum 30 to 400 pg/mL
    Saliva 2 pg/ml

(Medline Oestradiol)

Testosterone (often high in PCO)

    Serum 3 - 9.5 ng/ml
    Saliva 0.1 ng/ml(Medline Testosterone)

Vitamin D (low) (essential test). The test should be done for 25-hydroxyvitamin D, also called calcidiol. The following list gives an indication of levels of vitamin D found in the blood (Vitamin D Council):

  • Sufficient 50-100ng/ml or 124.80-249.60nmol/L
  • Hypovitaminosis less than 30ng/ml or 75 nmol/L
  • Deficiency less than 25ng/ml or 62.4nmol/L

CRP (increased levels) (essential test). The level of CRP rises when there is inflammation throughout the body, normally none should be found. Levels if found, vary from <1.0mg/L to >3.0mg/L

Parathyroid hormone (often increased). Normal values are 10-55 pg/mL

Homocysteine (increased levels) 0.54-2.3 mg/L (4-17 micromoles per liter (mcmol/L)

DHEA-sulfate (increased levels) (normal values for serum can differ with age) (Medline DHEA-S)

  • Ages 18 - 19: 145 - 395 ug/dL
  • Ages 20 - 29: 65 - 380 ug/dL
  • Ages 30 - 39: 45 - 270 ug/dL
  • Ages 40 - 49: 32 - 240 ug/dL

TSH (levels sometimes increased). Normal values are 0.4 - 4.0 mIU/L

Glucose test (levels sometimes increased) (Medline Glucose)
        Normal levels are up to 100 milligrams per deciliter (mg/dL)
        Persons with levels between 100 and 126 mg/dL may have impaired fasting glucose or insulin resistance
        Diabetes is diagnosed when fasting blood glucose levels are 126 mg/dL or higher

Insulin resistance (sometimes observed). (Medline Insulin resistance) (Lab Tests Online - Understanding insulin resistance) There is no single test for IR, but the following are often tested...

  • Blood pressure equal to or higher than 130/85 mmHg
  • Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
  • Elevated insulin levels
  • Elevated CRP - a marker for inflammation
  • Large waist circumference - 35 inches (87.5cm) or more
  • Low HDL cholesterol - Under 50 mg/dL
  • Triglycerides equal to or higher than 150 mg/dL

Can progesterone help with Conception and Pregnancy problems?

Progesterone is vital to pregnancy. In fact it's name means pro-gestation, an unfortunate name as it's other roles in the body tend to be forgotten. It was first extracted from the corpus luteum, so came be be regarded as a female hormone involved solely in reproduction.

Progesterone is not a sex hormone, it plays no part in the secondary sexual characteristics which develop at puberty. It is secreted primarily by the ovaries in females and the testes in men. Smaller amounts are produced by the adrenal glands, the brain and glial cells. There are no great quantitative differences between men and women (at least outside the luteal phase). It is the precursor to the sex hormones oestrogen and testosterone, and to cortisol and aldosterone.

Progesterone regulates gene expression, has a positive fundamental effect on cell differentiation and growth, with anti-oxidative and autoimmune anti-inflammatory mechanisms. It positively effects the nervous system by stimulating neurotrophic factors, quenching oxidative hyperactivity and regulating autoimmune responses.
Menstrual Cycle

Normal monthly cycles can vary from as little as twenty one days to as long as thirty five, the average being twenty eight. Cycles outside this range are generally regarded as abnormal. For more information on this see the pages on Menstruation and PCOS.

The first half of the monthly cycle is known as the follicular or proliferative phase, and can last from 7 to 59 days, although the norm is 12-21 days. A long follicular phase is defined as lasting 24 days or longer. Oestrogen is the dominant hormone.

The second half of the menstrual cycle is called the luteal or secretory phase. All women, irrespective of the length of their cycle, should start ovulating 12 to 14 fourteen days before the next menstruation. Progesterone is the dominant hormone.

Oestrogen is a mitogen, it stimulates cells to proliferate i.e. to divide and multiply. Progesterone stops mitosis and causes differentiation.

At the beginning of the follicular phase, in response to FSH made by the pituitary gland, a few to several hundred eggs start developing. Each egg is contained in a cyst called a Graafian follicle, which starts making oestrogen, this in turn causes the egg to grow and mature. Oestrogen also stimulates the endometrium (lining of the uterus) to grow and thicken. When one or possibly two eggs are fully developed they rise to the surface of the ovary and appear as small 'blisters'.

At the beginning of the cycle, ie day 1 of bleeding, oestradiol production either drops slightly or is flat for the first 2-4 days. It then rises slowly for the next 6-10 days, and then sharply for 2-5 days. This is the preovulatory peak, after which it drops.

During the fifty hours prior to the mid-cycle surge, oestradiol, progesterone and another pituitary hormone secreted by the anterior pituitary gland called LH (luteinising hormone) begin rising, while FSH declines.

The cells forming the outer layer of the Graafian follicle are called thecal cells. LH is required for both the growth of preovulatory follicles and ovulation of the dominant follicle. Under the influence of LH they secrete testosterone. LH causes proliferation, differentiation, and secretion of androgens by the theca cells which surround the ovum, giving rise to androgen levels.

The androgens, notably androstendione, migrate from the theca cells to the granulosa cells where they are converted by the enzyme aromatase into oestrogen, particularly oestradiol. The theca cells also produce oestradiol without the need for conversion.

This rise in the androgens is responsible for the acne, oily skin, facial hair, loss of scalp hair etc., that some women experience.

12 hours prior to the mid-cycle surge, progesterone rises exponentially. This surge is produced by brain cells, and has nothing to do with the surge that occurs after ovulation. It's thought to initiate the LH surge which begins 12 hours after the progesterone surge. FSH rises again at the same time as LH.

This preovulatory surge in progesterone is now known to be essential for the facilitation of feminine sexual behaviour too.

The surge of the gonadotrophins causes oestradiol levels to rapidly fall, while progesterone continues to rise. The gonadotrophins plateau for about 14 hours after which they drop sharply.

Androstenedione (A) and testosterone (T) increase at a slow rate before the surge, rising faster when the mid-cycle surge begins. Then about fourteen hours after initiation of the surge, they decline, but at a slower rate than oestradiol. In spite of the significant increase in A and T, oestradiol still plummets. It's thought that the rapid rise in progesterone may inhibit aromatase activity.
Ovulation

Ovulation occurs approximately 10-12 hours after the LH peak and 24-36 hours after the oestrogen peak. The Graafian follicle ruptures, releasing the egg. The follicle is now called the corpus luteum due to its yellow colour.

For the next twelve to fourteen days the corpus luteum secretes progesterone, which rises steeply until 6-7 days after ovulation when it peaks. The peak lasts for about 3-4 days, when progesterone declines sharply, after which menstruation occurs. The corpus luteum is able to synthesise upwards of 40 mg of progesterone on a daily basis. Although the range is normally 5-20mg per day.

It's been found that progesterone is capable of stimulating it's own synthesis. The typical negative feedback system seen in other endocrine tissues does not operate in the corpus luteum, and at the end of the luteal phase, in spite of LH secretion, the corpus luteum regresses and progesterone secretion declines.

Therefore using progesterone at ovulation will enhance the early rise in progesterone so vital for successful implantation. In fact using it within the 12 hours of the pre-ovulatory surge will enhance ovulation, and ensure there's an early rise.

If fertilisation has occurred, progesterone will continue rising. In order to do so, the corpus luteum needs stimulus from a fertilised egg, under the influence of hCG (human chorionic gonadotrophin). The corpus luteum also produces androgens, oestrogens, 20alpha-hydroxyprogesterone, and 5alpha-reduced progesterones.

Although the corpus luteum is influenced by LH, insulin is also required. It regulates luteal cell function and causes an increase in progesterone secretion. Insulin also stimulates a substantial increase in oestradiol in the presence of androstenedione. LDL cholesterol is known to be critical for progesterone production, whereas HDL is ineffective.

Under the influence of progesterone the lining of the uterus has stopped proliferating, instead becoming a spongy layer ready for the egg to embed itself.

After intercourse, when millions of sperm enter the vagina, and make their way through the cervix, through the uterus and into the Fallopian tubes, fertilisation takes place when a sperm embeds itself into an egg.

Low progesterone levels in the very early days of the luteal phase makes fertilisation less certain.

Progesterone is essential for sperm capacitation and the acrosome reaction.

The now fertilised egg continues on it's journey up the Fallopian tube until it reaches the uterus, where it becomes embedded in the endometrium (lining of the uterus). If fertilisation has taken place, the corpus luteum continues to make progesterone for about three months. This is dependant on stimulation by hCG, which is produced by the developing embryo, and later by the placenta.

During this time the placenta is developing and at about two months starts secreting progesterone, and continues to do so until birth.

Vitamin D is also vital for ovulation, a lack causing anovulatory cycles. Other nutrients vital for ovulation are N-acetylcysteine, arginine and inositol. If insufficient levels of these are present, anovulatory cycles can also occur.
A defective luteal phase

All women, irrespective of the length of their cycle, should start ovulating twelve to fourteen days before the next menstruation. If shorter, there is insufficient time for the endometrium to be readied for the embryo to implant, this is known as a defective luteal phase.

If the corpus luteum does not make sufficient progesterone during these twelve to fourteen days, it will also result in a defective luteal phase. Symptoms are spotting during the entire luteal phase, or for a few days before full bleeding occurs. It appears to be a problem found in many women now and could well be due to the Endocrine Disruptors in the environment.

Research has found that a steeper early luteal rise in progesterone and higher mid-luteal progesterone and oestrogen concentrations make for successful implantation.

Many so called 'infertile' women are not. Conception could be taking place each month, but unless there's a steep early luteal phase rise in progesterone, implantation will be unlikely.

Contraceptives can cause a severe disruption in the cycle after discontinuing them. It's essential to give enough time for the synthetic oestrogens and progestins to diminish, before attempting conception.

How to use progesterone to extend the luteal phase

A low dose of progesterone will not help. 100-200mg/day or more progesterone should be used, depending on symptoms. In some cases up to 400mg/day will be needed. It should be used from ovulation, or during the 50 hour pre-ovulatory surge.

If used too early i.e. 7 to 8 days before ovulation, which is when many women are told to start it, progesterone can act as a contraceptive, but usually 200mg/day or more are needed. So starting too early can prevent the chance of falling pregnant.

When to start using progesterone

It is advisable to start the progesterone well before pregnancy to allow the body to adjust. Many women are started on progesterone many days, often weeks after they fall pregnant and suffer oestrogen dominance symptoms. It's bad enough suffering from these when first pregnant, but twice?! For more info please see the page on Oestrogen Dominance.

How to check when ovulation has occurred

Taking temperature readings or using a mini microscope will help to check for ovulation, the mini microscope is more reliable, as temperature can vary from as little as 0.5 degrees to 5 degrees.

Saliva or vaginal mucus is used for the test, by dabbing a small amount on the end of the microscope. During the follicular phase, the pattern formed by the saliva/mucus is spotty, as ovulation draws near a fern like pattern starts emerging, becoming completely fern like when ovulation has occurred, returning to the spotty pattern almost immediately. For more information see Ovulation Microscope.

Normal oral body temperature in adult men and women ranges between 33.2-38.2°C (92-101°F). Typical average temperatures are 37.0°C (98.6°F).

In women it varies between the follicular and the luteal phase. During the follicular phase, i.e. from the first day of menstruation to ovulation, it ranges from 36.45 to 36.7°C (97.6 to 98.1°F).

During the 12-14 day luteal phase, i.e. after ovulation to menstruation, temperature increases by 0.15 - 0.45°C (0.2 - 0.9°F) due to the increased metabolic rate caused by rapidly rising levels of progesterone. Temperature ranges between 36.7 - 37.3°C (98.1 - 99.2°F) during the luteal phase, but drops down to follicular levels within a few days of bleeding.

Fertilisation

One of the most important things to remember about conception is the life span of the sperm and ovum. The average life of the sperm appears to be two to three days, sometimes longer, but the ovum only lives twelve hours and in rare cases twenty four hours.

All research points to a greater success in conception if intercourse takes place in the one to two days prior to ovulation, when the fern like pattern is almost complete. This is during the preovulatory progesterone surge.

This allows time for the sperm to travel through the uterus and up the Fallopian tubes to meet the egg before it becomes over mature or it dies. One of the problems with an over mature egg is it diminishes the chances of fertilisation, can result in a miscarriage or result in foetal abnormalities. The health of the future child is dependant on these factors.

The nearer intercourse takes place to ovulation, the greater the chances of conception.
Pregnancy

It must be remembered that twelve to fourteen days is necessary for the lining to mature enough to receive a fertilised egg. If bleeding does occur, it means the egg has not been fertilised or implantation has not taken place. The progesterone should then be stopped and only started again at the next ovulation. If bleeding does not start fourteen days later, it is possible that fertilisation and implantation have occurred.

On no account must the progesterone be stopped at this stage, otherwise it could cause a miscarriage.

If there is no menstruation and pregnancy is confirmed, the progesterone should be continued, using between 100-200mg/day or more until the fourth month. After the critical stage has passed the progesterone it can be tapered off slowly, or can be continued until birth.

The majority of women are advised to stop cold turkey, this is not advisable. Progesterone withdrawal can not only cause a miscarriage if the placenta is making insufficient at this point. But other adverse symptoms can occur. These are the same as those experienced due to progesterone withdrawal the few days prior to bleeding during the monthly cycle.

If tapering off, the amount should be reduced very slowly, taking about a month to do so. This is easy to do if using a progesterone cream, difficult if using injections or suppositories. Either switch to a cream, or in the case of injections withdraw slightly less progesterone from the vial for each reduction. In the case of suppositories, divide them into 25mg pieces, adjusting the tapering by using as many pieces as required.

It's advisable to continue using progesterone until birth if there's a likelihood of a pre-term birth or pre-eclampsia.

If nausea occurs 400-800mg/day is needed to stop it.

 It is the first three, possibly four months that are critical. 25% of miscarriages occur during the first six weeks when the child is still in the embryo stage. The risk drops to 8% after eight weeks, when the child is now termed a foetus.

During this time the placenta is developing and after about two months starts secreting progesterone, while ovarian production starts declining. If at this point placental production is insufficient to meet the demands of the growing foetus a miscarriage can occur. It is therefore advisable to continue with the supplemental progesterone until at least the third month. All being well the placenta continues to make progesterone in increasing amounts until birth, when levels drop abruptly with the expulsion of the placenta, or afterbirth as it's now generally termed.

Miscarriages and Pre-term births

Many factors cause miscarriages, far too many for here. But a few are chromosomal alterations, uterine anomalies, antiphospholipid antibodies, exposure to bisphenol A an endocrine disruptor, high alcohol intake, high levels of the inflammatory cytokines TNFa and IL-6, and natural killer cells, if activated by TNFa, may cause the death of the embryo. Progesterone suppresses TNFa and IL-6 activity, and excessive NK cell activity.

Of significance for this page are low levels of progesterone and Vitamin D, and high levels of oestrogen and free testosterone, often overlooked. A level of progesterone over 12.3 ng/ml in early pregnancy indicates a normal pregnancy.

A ratio of 1.05 or higher for free testosterone to total testosterone indicates a miscarriage is likely. But if the free testosterone ratio is lower than 0.84 a normal pregnancy occurs. The reasoning behind this is excess oestrogen causes foetal death. The enzyme 5-alpha reductase Type 1 mRNA is induced in the pregnant brain, this inactivates testosterone, which reduces the available substrate for oestrogen synthesis.

Progesterone also inhibits the enzyme aromatase, which effects the conversion of testosterone to oestrogen.

A short cervix increases the risk of pre-term births, progesterone reduces the risk.

It is also essential to bear in mind that stress can cause a miscarriage. The rise in cortisol in response to the stress, results in a drop in the progesterone level, this in turn can lead to spotting or a miscarriage. To prevent this, as soon as any stress is felt, increase the amount of progesterone till it has passed.

Many women are devastated by a miscarriage, understandably, but none are warned that as many as 20% of all pregnancies end in a miscarriage within two weeks of fertilisation. Another 15% occur within the first fourteen weeks (three and half months).

Studies have shown that low progesterone and vitamin D levels are found in preeclampsia. One study finding progesterone was 'pathologically and statistically' lower. Serum allopregnanolone (a potent metabolite of progesterone) was found to be significantly lower too. The Th1 (inflammatory cytokines) and Th2 (anti-inflammatory cytokines) play a role. The number of Th1 cells and the ratio of Th1:Th2 in preeclampsia is significantly higher than in a normal pregnancy. Progesterone and vitamin D both increase levels of Th2.

But a number of other factors have been found to play a role. Women with insulin resistance, high levels of malondialdehyde and homocysteine are at greater risk of developing preeclampsia. A lack of selenium and low levels of glutathione and other antioxidants increase the risk too.

If recurrent miscarriages, pre-term births or preeclampsia have occurred consider using 200-600mg/day progesterone. Many believe progesterone is not effective at preventing these, but the evidence points to far too little progesterone being used in the unsuccessful studies.

Depression

25% of women suffer some form of depression after child birth. From the 'baby blues', to post natal depression (PND), to post natal psychosis (PNP), which can result in infanticide and suicide. Luckily PNP only occurs in 0.05% of women. The depression is caused by the rapid drop in progesterone levels after the expulsion of the placenta. Serotonin levels drop too. Anti-depressants are not required, what is are large amounts of progesterone. From 800mg/day for PND up to 2400mg/day for post natal psychosis, the amounts Dr Dalton found effective.

To recap...

  • Progesterone must only be used at ovulation, or during the 50 hour preovulatory surge if pregnancy is the aim
  • Take temperature readings or use a mini microscope to help check for ovulation
  • On no account must the progesterone be stopped if conception is suspected, otherwise it could cause a miscarriage
  • It is essential to continue the progesterone over the first 2-3 month critical phase, particularly the first 2 months
  • It is also essential to bear in mind that stress can cause a miscarriage
  • The nearer intercourse takes place to ovulation, the greater the chances of conception
  • Use at least 100-200mg/day progesterone, possibly more
  • It should always be used a minimum of twice a day by dividing the amount
  • Make sure sufficient nutrients are taken to support the pregnancy, particularly vitamin D and taurine
  • Avoid all skin care, foods and drinks which contain endocrine disruptors and other toxins, these can cause epigenetic changes in the foetus

Drugs

Mention should be made of the drugs which are often given in place of progesterone to prevent miscarriages and pre-term births, in the mistaken belief they are one and the same. One is a synthetic progesterone called Duphaston which contains dydrogesterone. Another is 17-hydroxyprogesterone caproate (17-OHP-C), also a synthetic hormone.

But because they're progestins, they are not broken down into the normal progesterone metabolites, such as the all important allopregnanolone. These are as essential as progesterone itself, especially in pregnancy, when the foetus is particularly susceptible to toxins or a lack of necessary nutrients.

A metabolite of progesterone is sometimes used too, 17-Hydroxyprogesterone, this is natural, and increases during the third trimester. It's often called 17-OHP, or 17-OH, or 17-P.

No adverse side affects have been reported with the use of 17-OHP, which is produced primarily by the adrenal glands. But there are safety concerns about 17-OHP-C use. Progesterone is also more potent that 17-OHP-C.
OTC Drugs

Many women take over-the-counter mild analgesics during pregnancy. Drugs such as acetaminophen (paracetamol), and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and acetylsalicyclic acid (aspirin). These have been shown to increase the risk of congenital malformations, including cryptorchidism and hypospadia. Paracetamol in particular increased the risk of cryptorchidism as it's a potent inhibitor of androgen production.
hCG

hCG or human chorionic gonadotrophin is a hormone produced by the developing embryo after conception. Once the embryo has implanted a specialised part of the placenta takes over production. The role of hCG is to prevent the corpus luteum from disintegration. The corpus luteum is critical for the production of progesterone for the first 8 weeks, until the placenta begins to take over production. Please note that hCG starts dropping after 13 to 16 weeks GA as the corpus luteum is no longer needed.

GA: Gestational Age or LMP: Last Menstrual Period

It is standard practice to take the last menstrual period as the 'age' of the foetus. This is always regarded as occurring 14 days prior to ovulation. But foetal age can of course vary, as the menstrual cycle varies between 21 to 35 days. Ovulation occurring between days 7 to 21, and therefore conception occurring on or just after. If a woman has a longer or shorter cycle than 28 days, this should be taken into account.

Additional information

The growing foetus is an extra burden on the mother, so it is essential to make sure all nutrients the foetus needs are available.

Please consider taking the following each day...

  • 5 000iu's/day vitamin D3 (cholecalciferol) vital for a developing foetus, to prevent miscarriages, epigenetic changes, rickets, heart failure, epilepsy, Type 1 diabetes, and upper respiratory track infections in the newborn, to reduce the risk of preeclampsia in the mother
  • 1000-2000mg/day taurine to prevent epilepsy, insulin resistance, impaired glucose tolerance, diabetes, impaired neurological function, vascular dysfunction and growth retardation in the developing foetus and newborn. Taurine is not found in grains, legumes, vegetables, nuts, seeds or fruit, only animal protein.
  • 5ml Omega 3 fish oil, particularly DHA, needed by the developing brain
  • Vitamin B complex with extra folic acid bringing this up to 800mcg/day to prevent neural tube defects. If a vegetarian, please be cautious, as excess folic acid masks a B12 deficiency. A lack of B12 in utero increases the risk of insulin resistance in the child.

Do not take cod liver oil, or any fish liver oil. The excessive vitamin A it contains prevents vitamin D from being absorbed. Take beta-carotene if short of vitamin A.

To clear any confusion, 'fish oil' comes from the muscle of the fish and contains Omega 3. Fish 'liver' oil obviously comes from the liver, it contains large amounts of vitamin A and very small amounts of vitamin D. There is a world of difference between the two.

Blood levels should be 70-100ng/ml (175-250nmol/L) and not the 30ng/ml (75nmol/L) most labs and doctors regard as adequate. The minimum daily dose should be 5000iu's per day, although recent research indicates it should be 10,000iu's per day.

Read all labels on containers, especially those for food and cosmetics. Look for natural alternatives to body care products, many contain high levels of endocrine disruptors and carcinogens, particularly the sunscreens.

Miscarriage

Many factors affect fertility and therefore relate to miscarriage. Some of these are...

  • Venereal diseases causing scarring of the reproductive tract
  • Genetic abnormalities caused by environmental poisons
  • A diet deficient in the necessary vitamins and minerals
  • Stress
  • Hormonal imbalances

Evidence of the linkage between progesterone and miscarriage is the fact that one of the least known but commonest causes of infertility is a lack of progesterone during the second half of the monthly cycle. This is known as a "defective luteal phase". For pregnancy to be successful estrogen first builds the lining of the uterus, then after ovulation the role of progesterone is to thicken that lining ready for the fertilized egg.

Recent research has shown how often conception occurs in a fertile woman only to be followed by failure of the egg to embed itself in the lining. Progesterone is vital for pregnancy, hence it's name...'pro-gestation'. If the interval between ovulation and menstruation is too short (less than 12 days) it means there has not been enough progesterone produced which could result in a miscarriage as early as the next menstruation.

The only sign would possibly be a heavier period and/or pain. The reason for this is that the egg takes about 14 days to reach the uterus, and unless the ovaries maintain a high level of progesterone during this time menstruation will occur before the egg is embedded.

Another cause of infertility is the anovulatory cycle, in which a woman does not ovulate. This has always been common in women from their mid-thirties, but research has found that increasingly younger women are also suffering from these cycles. Too much estrogen during the luteal phase, particularly the xeno-oestrogens such as DDT, can cause miscarriages.

To avoid them and reduce infertility optimum health is essential. Follow these guides...

  • Avoid all environmental poisons, particularly if oestrogenic
  • Vitamin C increases sperm counts and mobility
  • A lack of Vit E, Omegas 3 and 6 damages the reproductive tract
  • Some vaginal secretions act as spermicides, this has been linked to a lack of Omega 3 and 6
  • Vitamin A is essential for the development of the male sex hormones
  • Omega 3 and zinc are vital to the development of the sperm
  • Zinc deficiency causes infertility
  • Avoid all soy products, unless fermented, as these reduce the sperm count
  • A lack of vitamin D leads to anovulation

 To overcome a defective luteal phase extra progesterone is needed. Progesterone can often stimulate ovulation or correct irregular cycles. Supplimental progesterone should be used from ovulation or, if time of ovulation is not known, from not more than 14 days before the next menstruation.

Progesterone therapy should be continued until pregnancy is assured and up until the fourth month, when the placenta will have taken over the manufacture of progesterone.

On no account must the progesterone be stopped suddenly as a miscarriage might occur. A normal cycle can be from 21 to 36 days, varying up to 4 days each month, with ovulation coming approximately 14 days before the start of menstruation in each case.

Signs of infertility

There are many factors that contribute to the signs of infertility. Some of them are...

  • a lack of progesterone
  • a lack of vitamin D
  • high oestrogen and/or testosterone
  • high FSH (follicle stimulating hormone)
  • high LH (luteinising hormone)
  • oxidative stress due to a lack of antioxidants
  • contraceptives which can cause the ovaries to malfunction after discontinuing
  • stress, emotional, mental or physical
  • endometriosis
  • environmental toxins, particularly oestrogen mimics
  • being overweight
  • being underweight, particularly caused by a lack of good fats and oils
  • a deficient diet leading to malnutrition
  • low sperm counts or abnormal sperm
  • poly cystic ovaries/cystic ovaries
  • diabetes
  • hyperprolactinemia
  • thyroid disorders

One of the least known but commonest signs of infertility is a lack of progesterone during the second half of the monthly cycle. This is known as a 'defective luteal phase'.

During the first half of the Menstruation Cycle, oestrogen stimulates the lining of the uterus to develop. This is known as the follicular or proliferative stage.

Once ovulation has taken place, and progesterone is being secreted by the corpus luteum, it causes the lining to thicken ready for the fertilised egg. The second half of the menstrual cycle is known as the luteal or differentiation phase, and should last 12 to 14 days.

Progesterone is vital for pregnancy, but if the interval between ovulation and menstruation is too short (less than 12 days) it means inadequate progesterone has been produced.

Research into the causes and signs of infertility has shown that often conception occurs in a fertile woman to be followed by failure of the egg to embed itself in the lining. This could result in a miscarriage as early as the next menstruation.

So fertility could be high, but with low progesterone it appears as if the woman is infertile.

The only sign of miscarriage might be a heavier period, clots and/or pain. The reason for this is that the egg takes about 12-14 days to reach the uterus, but unless the corpus luteum maintains a high level of progesterone during this time, menstruation will occur before the egg is embedded. In these cases the condition is easily corrected by supplementing with progesterone to extend the luteal phase.

Another of the signs of infertility is the anovulatory cycle, in which a woman does not ovulate. This is common in women from their mid-thirties, but research has found that increasingly younger women are also suffering from these cycles.

There are various causes for this. Excessive FSH which stimulates the ovaries to make too much oestrogen and testosterone, plus excessive LH. These four hormones if in excess prevent ovulation and therefore the production of progesterone. It could possibly be due to the excessive use of contraceptives or stress.

Contraceptives can result in temporary infertility after stopping them. They are designed to stop ovulation. But once the contraceptives have been stopped the ovaries can start up again.

Initially the ovaries make oestrogen and testosterone, but it can be many cycles later before the ovaries start ovulating. If too high a level of oestrogen and testosterone are produced, this causes a severe imbalance in the ovaries and anovulation results. Supplementing with progesterone suppresses the excess oestrogen and testosterone, and helps regulate the cycle.

Excess stress raises cortisol levels and drops progesterone levels (both potential signs of infertility). The adrenals produce progesterone before converting it into cortisol. If the adrenals are exhausted, they will rob other sources of progesterone, notably ovarian. This impacts on the reproductive cycle. Stress can cause anovulation and miscarriages.

Stress is also known to inhibit the release of FSH and LH, leading to impaired development of an egg/s. Because synthesis of progesterone is increased after ovulation, stress induced impairment of egg development could potentially alter progesterone synthesis and release.

Progesterone is excellent for stress, as it activates the GABA receptor sites. GABA is one of the most calming neurotransmitters.

Often the cause behind anovulation is oxidative stress.

A lack of vitamin D causes oxidative stress to the ovaries which results in them malfunctioning, it's essential to have a test done. Vitamin D is also essential for the developing foetus.

Oxidative stress can also be due to a lack of other antioxidants. This is particularly common if processed foods are eaten as these lack antioxidants.

Endometriosis is caused by oxidative stress and excess oestrogen, leading to severe inflammation (one of the clear signs of infertility). This poses major problems to any egg trying to embed in the endometrium. High levels of progesterone are needed to reverse it. Please see the page on Endometriosis.

Hormone imbalances induced by environmental toxins are another factor. There are now over 100 oestrogen mimics on the planet, please see the website Our Stolen Future. Unfortunately the problems can stem from in utero, when the developing foetus is subjected to the toxins. Males are particularly prone to the effects of oestrogen at this stage. Supplemental progesterone is essential as it suppresses this excess oestrogen.

Overweight women have a lower chance of conceiving (excessive weight being one of the more common signs of infertility). The adrenal glands make (amongst many other hormones) androstenedione. This can be converted by fat cells into oestrone, one of the oestrogens. This increases oestrogen levels which causes an imbalance in hormone levels. Supplementing with progesterone will counteract this excess oestrone.

One of the commonest impending signs of infertility is low body-fat. It is vital for a woman to keep her body-fat above 20% of her total weight, otherwise she will stop menstruating. It is also essential to make sure sufficient good fats and oils are consumed.

A diet deficient in the good fats and oils, plus insufficient good quality protein, leads to malnutrition. This is turn leads to malfunctioning ovaries. Please see the page on Nutrition and Diet.

Prolactin, although originally known as the hormone of lactogenisis, has now been found to be an inflammatory hormone. A lack of protein can lead to hyperprolactinemia, due to insufficient tyrosine in the diet. This amino acid is the precursor to dopamine. Prolactin increases with high oestrogen levels and low dopamine levels. Like oestrogen, it also suppresses progesterone if in excess. Supplemental progesterone suppresses both oestrogen and prolactin. Supplemental tyrosine will increase dopamine levels.

Another of the signs of infertility, hypopituitarism, although a rare problem, can lead to low FSH and LH. This is turn will prevent follicles maturing and ovulating. The possible anovulation means no progesterone will be produced.

Low sperm counts or abnormal sperm in the man may also be a sign of infertility. Zinc deficiency can result in small sex organs and late sexual maturation in men. A high level of zinc is found in the male sex organs and the sperm itself.

Progesterone is needed for the acrosome reaction in sperm, low progesterone levels would stop this occurring. This would prevent the sperm entering the egg and fertilising it. There is strong evidence progesterone is involved in the sexual response in males. It also increases libido, and can correct erectile dysfunction.

A manganese deficient diet can lead to defective ovulation, testicular degeneration and infant mortality.

PCOS, or poly cystic ovaries is an increasing problem worldwide and one of the most common signs of infertility. Anovulation is a frequent occurrence, leading to potential problems in conceiving and carrying a child. Oxidative stress is behind PCOS, the antioxidants are essential, in particular vitamin D. This has successfully reversed PCOS in a number of women. In all likelihood, the avoidance of the sun or the use of sunscreens has contributed, if not the direct cause of the increase in cases.

Diabetes prior to falling pregnant can cause miscarriages and birth defects, due to high blood glucose. It also significantly reduces the relaxing affect progesterone has on placental blood vessels. This alteration may lead to a reduction of placental blood flow adversely affecting the foetus.

A healthy thyroid is essential. Both hyperthyroidism and hypothyroidism, can have a direct effect on ovarian function. Often a malfunctioning thyroid is a sign of vitamin D deficiency, and/or a lack of iodine. This is essential, as a mother lacking iodine leads to goitre formation and neuropsycho-intellectual impairment in the child.

Other problems which may be signs of infertility are adrenal disease, venereal diseases, age, genetic factors and tubal blockage.

Natural treatments for signs of infertility

Progesterone is essential if the infertility is caused by a defective luteal phase, or excess oestrogen, testosterone, FSH or LH is present.

100-200mg/day should be used, dependant on symptoms.

Please be aware Oestrogen Dominance can occur when first using progesterone.

Have a vitamin D test done. Blood levels should be 70-100ng/ml or 175-250nmol/L and not the 30ng/ml or 75nmol/L most labs and doctors regard as adequate. And the minimum daily dose should be 5000iu's per day, although a 2011 study indicates it should be 10,000iu's per day.

Eat sufficient protein, it's needed for the growth of the foetus. A malnourished mother will cause the child to be malnourished.

Zinc is vital for fertility, have a hair analysis done if a deficiency is suspected.

If prolactin is high consider taking the amino acid tyrosine.

Check for an iodine deficiency.

Progesterone for men

Why progesterone for men? Progesterone is commonly thought of as a 'female' sex hormone. This is misleading as it is vital to sustain not just health but life itself in all mammals of both sexes.

As a man gets older testosterone is converted into di-hydrotestosterone (DHT), which some believe is the cause of benign prostatic hyperplasia (BPH) and cancer, but some do not.

Oestrogen levels also increase as a man gets older. Oestrogen is known to stimulate cell growth. Reading between the lines, because as yet, there is no definitive study done on this, it appears to be the increased oestrogen level which is the problem and not the two testosterones. As progesterone is a powerful counter-balance for estrogen, progesterone for men is essential.

If in fact testosterone were the culprit, then men aged 22 would have the highest incidence of BPH and cancer, as testosterone levels are at their highest point in the early 20's, but of course they don't. From the early twenty's to the late twenty's testosterone makes it's greatest drop, thereafter it continues to decline, but at a slower rate.

BPH starts affecting a man in his fifties and interestingly oestradiol levels start climbing from the age of fifty and are at their highest point in men in their late 60's, but during the same period progesterone levels are declining. Progesterone for men becomes that much more important with age.

5-alpha reductase inhibitors such as finasteride are usually given to prevent the conversion of testosterone to DHT, but research has found that progesterone is a natural inhibitor of 5-alpha reductase.

Progesterone also down regulates the action of oestrogen if used in a sufficiently high dose. The endogenous oestrogen made by humans is now being supplemented by synthetic oestrogens found in the environment. They are now found in food, air, water, plastics, skin care products, no one can avoid them. Some authorities speculate this is the cause of the increase in problems such as hyperplasia or cancers of any hormonally sensitive tissues, such as the prostate, endometrium, cervix and breasts. So, despite often being, erroneously, thought of as a 'female' hormone progesterone for men is essential to preserve masculinity!

It's safety for men is without question. It's now given via IV transfusions for Traumatic Brain Injury, over 70% of TBI victims are men.

Below are the reference ranges for oestradiol, testosterone and progesterone for men...

  • Oestradiol 0.5 - 2.2 pg/ml
  • Progesterone 15 - 100 pg/ml
  • Testosterone 44 - 148 pg/ml

As a reference point, the same hormones below are for women...

Premenopausal
Oestradiol 1.3 - 3.3 pg/ml
Progesterone 75 - 270 pg/ml

Postmenopausal
Oestradiol 0.5 - 1.7 pg/ml
Progesterone 12 - 100 pg/ml

Range for all ages
Testosterone 16 - 55 pg/ml

Salivary hormone levels are often higher than serum (blood) levels when hormones are delivered topically (on the skin).

One of the most perplexing issues surrounding saliva testing is the odd phenomenon that topically delivered steroids cause a dramatic increase in salivary hormones without a concomitant increase in serum levels. For example, 30 mg topical progesterone supplementation results in an average rise in salivary levels from about 50 pg/ml (0.05 ng/ml) to 500 to 3000 pg/ml (0.5 to 3 ng/ml), a 10 to 60-fold increase.

This increase is proportionally even greater when progesterone is supplemented at 100 to 200 mg, a common topical dose used by many doctors, resulting in salivary progesterone levels rising to as high as 10,000 to 100,000 pg/ml (10-100 ng/ml). Under the same conditions, serum progesterone levels only increase about 4-fold, from about 0.5 to 2-3 ng/ml. The same disproportionate increase in salivary hormone levels is seen with topical delivery of all the other steroid hormones (eg. oestradiol, testosterone, DHEA. etc.).


Info from progesteronetherapy.com

 
 
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