PROS and CONS
Finally, answers about progesterone replacement therapy.
For years, women experiencing the uncomfortable side of menopause have searched for a definitive answer about hormone replacement therapy. This treatment, once thought to improve symptoms like hot flashes as well as decrease the patient's odds of heart disease and other chronic illnesses, is now barely considered safe. While physicans ponder their stance on the issue, women are left longing for a good night's sleep and a little relief.
Progesterone, found in both sexes, is just one of many hormones that, when used appropriately, can provide significant benefit for women. As the name suggests ("pro–gest", meaning "pro–gestation"), it is critical for the healthy development of a pregnancy. Some ladies with a history of miscarriages are treated with progesterone to combat a deficiency during the early stages of the pregnancy. Progesterone levels increase after estrogen levels rise during a regular menstrual cycle. This pattern works to balance the effects of estrogen in the body.
In females, progesterone levels naturally start to decline around age 30 [1]. The progesterone that the body makes is slightly different than the “progestins” found in standard medical hormone replacement regimens. This slight change is considered by many to be enough to demonstrate the problems discovered by the Women’s Health Initiative, such as increased heart disease and cancer [7]. Perhaps the most successful progesterone treatment comes from using bioidentical hormones, progesterone that is a better match to the body’s own hormone.
For relief from PMS or menopause-related headaches, a cream form of progesterone can be applied at the start of the pain. Progesterone has clinically been used 7-14 days prior to the onset of menses to lessen PMS symptoms of bloating, cramping and irritability. Progesterone used in capsule form, clinically, helped those patients who experienced difficulty sleeping. Progesterone has been effective in alleviating hot flashes for many women as well [6].
The safety of progesterone replacement came into question in 2002 after the Women’s Health Initiative published a study showing increased risk of heart disease and cancer from estrogen/progestin combinations (like Prempro), prompting many women and their physicians to stop treatment with synthetic progestins. Conversely, research using bioidentical progesterone combined with estrogen demonstrated improvements in the length of time before heart-related symptoms such as angina or chest pain appeared [2].
Other data has shown bioidentical progesterone has a protective effect against cell proliferation, or overgrowth, one of the first signs of cancer [3,4]. In fact, one study looking at the link between progesterone and fertility, showed that ladies with the lowest progesterone levels had a 5.4 higher risk of breast cancer than those with normal levels [5]. This study also documented an increased death rate in cancer patients with low progesterone compared to a control group with the same types of cancer but normal progesterone levels.
Conventional treatments do not include progesterone in hormone replacement if the patient has had a hysterectomy. The thinking behind this is that progesterone is needed to balance the stimulating effects of estrogen on the uterus, so once the uterus is gone, progesterone is no longer needed. Many doctors now believe that progesterone is still helpful for menopausal symptoms, whether the uterus is present or not.
The need for hormone replacement is dependent on the individual. Patients should ask their doctors about the risks and rewards of therapies, as well as how to improve the major facets of health, including diet, exercise and stress management.
References:
1. Hargrove, JT., (1995). Eisenberg E. Menopause. Med Clin North Am, 79:1337-1356.
2. Rosano, GM. (2000). Natural progesterone, but not medroxyprogesterone acetate, enhances the beneficial effect of estrogen on exercise-induced myocardial ischemia in postmenopausal women. J Am Coll Cardiol, 36(7):2154-9.
3. Chang, KJ., et al. (1995). Influences of percutaneous administration of estradiol and progesterone on human breast epithelial cell cycle in vivo. Fertil Steril, 63:785-791.
4. Foidart, JM, et al. (1998). Estradiol and progesterone regulate the proliferation of human breast epithelial cells. Fertil Steril, 69:963-969.
5. Cowan, LD., et al. (1981). Breast cancer incidence in women with a history of progesterone deficiency. Am J Epidemiology, 114:209-217.
6. Leonettie, HB., et al. (1997). Transdermal progesterone cream for vasomotor symptoms and postmenopausal women. NEJM, 336:683-690.
7. Rossouw, JE. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA, 288(3):321-33.
Other Trusted Sources:
Medline Plus
Mayo Clinic
