Related Topics: Bioidentical Hormones, Features, Hormones

Why Hormones Can Sometimes Initially Make Symptoms Worse

Dr Tony Coope answers a question that some women ask after starting bio-identical progesterone treatment.

Dr Tony Coope
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The women that this phenomenon usually affects are those with a degree of estrogen dominance, which may have manifested as PMS, bloating, breast tenderness or cysts, lethargy, a tendency to gain weight, headaches/migraines, infertility, polycystic ovaries, insomnia, depression and altered mood – symptoms of excess estrogen in relation to progesterone.

In these cases the progesterone has been prescribed to ‘oppose’ the excess estrogen. In a balanced system the two hormones work together to regulate a woman’s menstrual cycle and fertility, and to encourage the normal growth of the foetus in the womb after fertilisation. There are no direct side effects from progesterone in standard doses, and theoretically its use should rectify the imbalance and resolve many of the symptoms. And so it usually does.

Women With Estrogen Dominance

However in women with previous ‘estrogen dominance’ the body’s estrogen receptors may have become less responsive (desensitized) to this hormone. The receptors are the ‘ears’ of the cells, listening out for and receiving instructions from the various hormones such as estrogen and progesterone. If the messages are ‘too loud for too long’, the receptors go ‘deaf’ and no longer respond, not unlike husbands when persistently nagged by their wives! In this case the message from estrogen is too strong and the receptors ‘down-regulate’ in an attempt to lower the volume and maintain balance.

In some women, the introduction of progesterone results in a re-sensitisation or awakening of these estrogen receptors, which now respond anew to the estrogen that is already present. For a short while this produces more of the same symptoms which then gradually subside as progesterone levels increase. During this transition stage it is easy for a woman to become discouraged and even discontinue the cream. The dosage can be reduced for a while to alleviate some of the symptoms, but it is vital to continue with the progesterone and return to a normal dose as the ‘flare up’ resolves.

Regular Users of Bio-Identical Hormones

Paradoxically, women who have been on progesterone for a while (often 9-18 months) may also suffer an exacerbation of similar symptoms. Here the mechanism is different, and appears to be due to the progesterone receptors becoming less sensitive over time – a sort of ‘progesterone resistance’. Estrogen is no longer fully opposed and therefore balanced by progesterone, the receptors for which are no longer responding to its message.

This seems likely to be due to an initial extra sensitivity to the hormone, so that the standard dose is more than is needed for full effect. This can occur in women who have suffered severe or long-term stress, so that their systems become exhausted and over-reactive at the same time.

The temptation in this case is to increase the dose of progesterone, which may work for a while, but usually only creates more resistance. The answer is in fact to stop the cream for a cycle or two until symptoms have abated, to allow the receptors to regain their sensitivity, and then to re-introduce it carefully at a lower dose, gradually increasing until you feel in balance, and stopping at the lowest dose that is effective.

Lastly, in both situations, supplements such as DIM, indole-3-carbinyl, milk thistle and also cruciferous vegetables, such as broccoli and cauliflower, may improve the metabolism of estrogen in the liver. This speeds up the process, as does the use of high quality probiotics, which discourage the reabsorption of estrogen by the gut.

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Please feel free to discuss this article in the comments section below, but note that the author cannot respond to queries made there.
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Comments 80
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Gemma johnson | 1:20 am, October 7th, 2011

At 58 I would love to pluck up the courage and try this cream but when I had started my menopause at 32 and blood tests confirmed finished at 42 I was put on hrt and many but they all drove me almost insane and my acne severe.
I came away from all hrt as I felt so shamed and have not had any help since.
Am 58 and would like to try this but will I have all the problems as I did with ?

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Dr Tony Coope | 5:25 am, October 7th, 2011

Gemma: I don’t think you really need to find courage, just trust, – there is absolutely nothing to fear. It is likely that you had a low progesterone level for some time before your menopause. The estrogen in the HRT would then have not been ‘opposed’, giving rise to estrogen excess and further hormonal imbalance, and the symptoms you describe. In addition, any synthetic progestin in the HRT has the potential to exacerbate symptoms both of depression and those similar to PMS.
Bio-identical progesterone in action is a very different compound to the synthetic progestins, is very safe, and has opposite effects, so I really recommend that you try it. If you need any help with this, please let me know.

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Gemma johnson | 10:08 pm, October 8th, 2011

Dr Coope

Thank you for your reply , I have purchased a pot of natural progesterone
From wellsprings who also sent me an email saying that for the first month I should double the dose for the first month is this necessary would it not be too much considering the awful side effects from the hrt which were suppose to help when infact made the symptoms worse and this is what am worrying me.

Kind regards

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Dr Tony Coope | 9:08 am, October 9th, 2011

Gemma: the symptoms you experienced previously were side-effects from the HRT itself, excess estrogen and synthetic progestin, and would have likely continued as long as you were on it. Any symptoms you may experience when first using the progesterone cream will be nothing to do with the progesterone itself, but short-lived and temporary due to a re-sensitisation of estrogen receptors, as I have explained in the article. On standard doses, If this were to happen at all for you (it’s not necessarily to be expected), it should only last a week or two, disappearing once your progesterone levels have been restored to normal.
This is why it is sometimes recommended to double the dose initially, – it builds up the progesterone levels more quickly, and shortens the duration of any temporary symptoms if they occur. I usually start with a standard dose, and change it if these do occur.
The important thing to remember is that you will continue to have problems until your progesterone levels are restored, and this can’t happen until you actually use it. I repeat, it’s not the same as the HRT you had before.

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Gemma johnson | 4:24 pm, October 13th, 2011

Dr Coope

Can you tell me where I can get natural Progesterone ,pro-juven cream or Progrest 1.5 Emeritas 1.5 as am told the body does not need to convert it and maybe better for me

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Dr Tony Coope | 10:05 am, October 14th, 2011

Gemma: I’m not sure what you mean by ‘the body does not need to convert it’, as progesterone has its own very important effects, but can also converted as needed into the stress hormone cortisol, estrogen, aldosterone which controls fluid balance in the body, and testosterone.
I think we need to have a conversation about all this, so I’ll e-mail you direct and if you like we can discuss it and I’ll hope to answer your questions.

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Karine | 9:09 pm, November 29th, 2011

I am not sure if in my case things are getting worse before getting better: it’s hard for me to tell with my history and symptoms. After an operation following a severe case of PID after a doctor pierced my uterine membrane while installing an IUD, I started suffering from nightsweats until I discovered natural progesterone at age 33 (am now 35). I did have cysts removed during operation but doctors tell me even today that I don’t have PCOS, yet cysts remain in my abdomen and occasionally burst at ovulation. Before starting a little dose of 1 dab/day, I had monthly headaches, bloating, extreme depression during pms, insomnia and nightsweats. I also took many vitamins/supplements recommended in Dr Lee’s book which really helped. Everything went away very quickly and my cycle became very regular, and I stopped natural progesterone for a few months after and all was fine. After a stressful move back to the UK it appears my symptoms came back about 5 months ago (especially PMS and its 3 days of extreme depression – I am not normally depressed!) and so I have doubled the dose of natural progesterone as recommended in Dr Lee’s book and taking supplements again for 2 months now. I have been feeling wonderful and the extreme depression has magically vanished as soon as I started again. However, the nightsweats and insomnia seem worse, libido is non-existent, and although my periods are always fairly regular, the last one was rather weak and dragging on for 10 days. I have not had children yet, am rather thin and my mother started menopause early at 34 (although after an emotional shock), but doctors seem to ignore my concern as they say I still have a fairly regular period. My gyne here in the UK took blood tests and said my hormones were fine, and offered antidepressants and the pill, which I both refuse to take as I feel fine except those 3 days of monthly depression and the nightsweats… and surely that would not help my libido! Could these symptoms be a temporary effect – things getting worse before getting better? Could these be symptoms of estrogen deficiency as well, as Dr Bond mentions in another article where she mentions “groups” of symptoms? Or am I just clearly heading towards an early menopause? I’m just afraid of stopping the progesterone cream yet as it only just got rid of my extreme depression but at the same time… perhaps stopping a while would help? Any help is appreciated, I must have missed information somewhere…! Kind regards, Karine.

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Karine | 9:17 pm, November 29th, 2011

Oops I now realise how long my previous post was! Apologies! I guess I only want to know if I’m going in the right direction – of course I am considering seeking help from a doctor more inclined to use bio identical hormones for saliva testing, but before doing so thought perhaps I should give this new regimen a bit more time? Thank you and sorry again! Karine

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wellsprings | 10:01 am, November 30th, 2011

Karine – your symptoms have been present for quite some time and two months may not be enough to completely rebalance your hormones. So your instinct is right and if you keep on with the regime and monitor your progress you should see results. However, seeing a doctor experienced in natural hormone usage would also be helpful for more individual advice.

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Karine | 10:08 am, November 30th, 2011

Thank you for your quick reply. I’ve actually ordered more progesterone from your company last night (and some for my mum!) and will keep at it another few months. I have confidence it works, I just want to make sure I do it properly. Thanks again!

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Dr Tony Coope | 10:18 pm, November 30th, 2011

Karine: just to say I agree with the advice given above to continue with your present regime, and to give it time. What stands out for me in your story is the link between significantly stressful events and the subsequent appearance of symptoms, – firstly the PID and uterine perforation, then your move back to the UK. If you have the same sensitivity that your mother had as regards stress or shock impacting the reproductive system, this could also be important. A possibility here is of borderline low levels of progesterone being further reduced by the knock-on physiological effects of stress, – most of your symptoms are suggestive of a ‘dominance’ of estrogen in relation to progesterone. This is why it is important to continue the progesterone, and I’m glad you are doing that.
It’s less clear what your estrogen levels might be, – it is possible to be estrogen dominant even with reduced estrogen, if your progesterone is lower still. If your blood tests were ‘fine’ this should mean that your FSH and LH were normal, ruling out premature ovarian failure and early menopause. I think you are very wise to turn down antidepressants and the pill, and I would hope that you will now gradually come back into balance.
If progress proves disappointing, then it would be important to have a saliva hormone screen, and also consider the possible role here of your adrenals, taking into consideration the stress you have experienced more recently, and also back in the past.

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Karine | 3:39 pm, December 1st, 2011

Dr Coope, thank you so much for your very detailed answer. Strangely enough, although I realised stress played a role in my situation lately, I had not even thought of my operation as a source of stress in the first place (but it was definitely stressful – I am just used to operations as I’ve had a few in my childhood). My stress is now at manageable levels, so I will continue with natural progesterone and hope to see an improvement shortly, and if not I will act as you suggested. I truly believe natural progesterone works, I just need to get the dosage right and… not stress about it in the meantime! Thank you once again for your time.

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Neeta | 2:35 pm, January 31st, 2012

I have been on a low dose combination patch HRT (bio-identical estrogen, but synthetic progesterone , Climara Pro) for 6 weeks to address severe hot flashes lack of sleep crashing fatigue, severe vaginal dryness, hair loss and terrible joint pains and aches. it has helped tremendously but I find now the aches/pains and fatigue are coming back. and I feel like I am in slow motion, and have gained 4 inches around my waist, although only 5 lbs bodyweight overall, this is very disconcerning, as I have lost over 100 lbs 2 years ago and now I’m struggling to keep it off, when I had no problems until menopause hit! . all my blood tests were normal. I am age 51 and no periods for 2 years. my biggest fear is that I will feel like this forever and I will not be able to gain my energy back. a few months ago I was running 3 x a week, doing high intensity interval training, walking daily, weight training, felt like a million bucks and looked slim and much younger than my age. . It seems suddently I now look old, I feel tired and weak and have to push myself to do anything. it takes me 3 hours to get myself in gear in the mornings. please tell me there is hope and that bio-identical hormones will help me.

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Dr Tony Coope | 10:58 pm, January 31st, 2012

Neeta: it’s not easy to work out exactly what is going on here without knowing something of your past history. Your initial symptoms are characteristic of classical menopause, usually attributed to the decline in estrogen levels, but often the picture is more complicated than this, and the previous (and present) levels of progesterone can play a significant part in how you feel.
Your initial improvement is almost certainly due to the estrogen you are using, but the dose may not be high enough. The synthetic progestogen is limited in its ability to fully ‘balance’ the negative effects of estrogen, and in your case may well be part of the problem.
If possible, I like to know progesterone and estrogen levels before starting any form of HRT, and usually find saliva testing is much more helpful, but it would take at least two months off HRT for your hormones to return to their original levels, which with your symptoms would not be either practical or sustainable.
But I think you may well have a much better result using an estrogen-only patch or another form of estrogen, plus (separately) bioidentical progesterone, the dosage of each being adjustable according to your symptoms.
Do let me know if you need further help with this.

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Helen | 12:14 pm, March 13th, 2012

I have a long history of natural pregnancies, IVF (due to husband’s low sperm counts), miscarriages etc. Hence my hormonal balance has been through the mill.
I am now going through early menopause at age 42. Periods are irregular or absent and often very long. My doctor prescribed HRT which I only took for 10 days before putting on 5 lb in weight and suffering severe nausea.
Then 5 months ago I tried Wellsprings Serenity cream and after about 5 or 6 weeks the hot flushes disappeared. After another month I started on 20-1 cream in a bid to alleviate vaginal dryness. I was getting on absolutely fine until a few weeks ago and the hot flushes have come back with a vengeance. I am reluctant to go back to my highly sceptical GP but can’t live like this.
What do you suggest?

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Catz | 3:07 pm, May 11th, 2012

I have fibroids, simple hyper-plasia, hormonal migraine and had an ovarian cyst (which led to an oopherectomy). All symptomatic of estrogen dominance. My Gyne wants to do a full hysterectomy and put me on hrt. I am following a more conservative route for the moment and will shortly start a bolus of progesterone tablets to hopefully kick start my ovary into producing progesterone again.

My gyn dismissed my using a natural progesterone as the dose would be too low and imprecise.

Would it be worth using progesterone cream after this? I’m not yet menopausal (46yrs).

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wellsprings | 3:19 pm, May 11th, 2012

Catz – certainly worth trying bioidentical progesterone cream as your fibroids are linked to oestrogen dominance and this may not be resolved just by removing the fibroid.

Progesterone will protect you from breast cancer, heart disease and osteoporosis so certainly worth considering. It would also be worth reading Dr Shirley Bond’s article on oestrogen dominance at this link and also

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Dr Tony Coope | 5:58 pm, May 11th, 2012

Catz: as an addendum to the above, the standard dose of the progesterone cream is calibrated to supply the body’s average premenopausal needs, which theoretically should be enough to slow or stop further growth of your fibroids. In practice it can be more complicated than this, but as progesterone is so safe, there is no problem in increasing the dose in the hope of shrinking them. Any concern about an ‘imprecise’ dosage doesn’t really stand up, partly because of the safety aspect and also because progesterone is an ‘intermediate’ substance and can be converted in the body to other vital hormones as well as the stress hormone cortisol.
So I am also sure that progesterone can be of benefit to you in this situation, and could also help reduce your tendency to migraines.

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Louise | 5:28 pm, August 28th, 2012

I am 58 and post menopausal. I have had a terrible transition due to chronic stress, low thyroid and adrenal fatigue over the past 8 years. I have been using bio-identical Progesterone cream for 2 years ( 15-20mg a day ) and have recently been advised to up the dose to 50mg. I have had these symptoms all through the menopause, but now they are now much worse – terrible aching muscles/joints, lot of weight gain around abdomen ( I am of small build), craving for carbs ,headache daily, dry/constricted vagina,lethargy, cloudy thinking, poor/slow memory, depression/crying. Am I sensitive to the cream and should I stop it or persevere? I have read so many conflicting reports about the cream. Some say that these are side effects and that it is not safe to use the cream, some say it is due to oestrogen dominance. I literally cannot function and just want to go to bed and rest all the time. What to do?

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Ruth | 6:32 pm, September 22nd, 2012

Hi, I a m 53 and recently was started on Prometrium for excessive bleeding with huge clots that lasted over a month.
I took 200 mg for 7 days and then 100mg daily after that. I am now getting some breakthrough bleeding. Can I take 200 mg again for a few days to get things under control. I am going on vacation in a few days and really don’t want to be dealing with this.

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Vikki | 1:38 pm, September 23rd, 2012

I had breast cancer 8 years ago and using tomixifen for 5 years has given me abnormal cells in my womb. I have now had a hysterectomy (six weeks ago) my surgeon has recommended HRT. I really do not want to take it as my breast cancer was estrogen based. A friend recommended your cream. I am confused as the cream is progesterone? Can you help before I see my GP and start HRT? Thanks.

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georgina glover | 4:26 pm, September 24th, 2012

Dr Bond prescibed me pro -juven natural progesterone cream for osteoporis, I started taking it late July this year and by mid August I was having difficulty sleaping, this has now got servere and makes me quite stress due to being so tired. Dr Bond says stop taking the cream but has given no advise as to how long these side effects may last. Can you advise also what to take to help me sleap. many thanks Gina

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monica roller | 6:04 pm, October 1st, 2012

I applied it on my acne.. is that harmfull or not. Tired of the acne and blemishes.. tears.. i am 41 years old keeps oily skin. I began eating brocclli and coliflower.. please tell me what shall i do or eat to balance this hormone problem.

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Diane | 10:28 pm, October 13th, 2012

Dr Coope,

I am 55 years old and have bee on Bio-Indentical Progesterone 20% (200MG/GM) for years. It has helped me to keep calm. My problem is that I have gained so much weight. Can Progesterone cause weight gain? I just had my Lab done and my Estradiol is 19 is this normal? Cortisol – 9.6, TSH 2.45, T4, Free 1.0, T3, Total 125, DHEA, 236, Progesterone 1.5 and Testosterone, Total 204. And no Libido.

What do you suggest?

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sally | 9:31 am, October 25th, 2012

Hi, i am only 23years old ive had PCOS since i was 16 had terrible hair loss and acne since then. Now at this age ive developed Hashimotos. im only on Armour 1.5 grain and gaining weight, still with hair loss (noticeable) and i find it hard to focus on studies. Can this cream help? i see most of the reviews are from women 40years and above with menopause.

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mary bryson | 3:08 pm, November 13th, 2012

i have started using the serenity cream today do i stop taking my hrt and prozac right away thanks

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Cally | 7:09 pm, November 29th, 2012

I started taking Emerita pro-gest progesterone cream days 12-26, 1/4 tsp day and night. I stopped taking it yesterday after I confirmed that I was not pregnant, for menses to start. Now I am very bloated, constipated, tired, and moody. I have endometriosis, cysts, and celiac disease. I was very consistent with the symptoms of estrogen dominance. I stopped eating gluten and dairy, started taking probiotics, and started eating more cauliflower and broccoli on a daily basis. I’d like to get pregnant, but I’d also like to just not feel so horrible during this time of the month. It almost feels like bipolar some months. Will it get better on progesterone and soon I hope?

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Kate | 12:18 am, December 3rd, 2012

I have been given everol conti patches. You will probably know that the absorption rate of each patch is around 50mcg of estradiol and 170mcg of norethisterone acetate in 24 hours. Is this not a lot of progesterone in relation to estrogen. I was going to half the patches. Also can i get bio progersterone cream on the NHS.

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lerrin | 3:51 pm, January 11th, 2013

Hi,I am 39 years old,I’ve been for a few laparoscopys for endrometriosis and I’ve been suffering with pcos and type 2 diabetes since I was about 29 and have had several large cysts removed from my ovaries my doctor prescribed birth controll pill and metformin but they both make me feel awful,I’ve recently had a spell of very bad health and have ended up in the er and seen at least 3 doctors all of whom have said its panic attacks and I’ve had to go on a hypoglycemic diet as my sugar has been hiting lows of 2 on the glucometer…I do not have health insurance and I have been unable to see a gynae but after doing some research of my own I’m not sure why my doctors haven’t prescribed naural progesterone cream for me in the past as I fit all the symptoms of estrogen dominance I’m 25kgs overweight,have hair loss,thick black facial hair,brain fog,memory loss etc..I’m not sure if I’ve done the right thing as I bought some and have been using it for 2 days but this afternoon I have a bad headache and am a bit dizzy..should I continue? Sorry for the long post

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Kim | 2:56 am, March 6th, 2013

I gained lbs7 over course of a month and my hair loss and hair thining has been getting worse. My Dr. Diagnosed me with hypothyroid and low progestron 5 months ago. I am on T3 and 50mg bio identical progestron pill and my symptoms didn’t improve much. Only slight mood lift and less brain fog. However no matter what I do the weight doesn’t move and my hair texture is getting worse. Recently my period is getting closer and heavier so my Dr. increased my compound progestron to 100 mg. is that change can help with my estrogen dominance symptoms?

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dr coope | 11:32 am, March 7th, 2013

Capsules are processed by the liver so you may find you get better absorption from a progesterone cream like Serenity. may well be that the cream would absorb better,

You do need a full thyroid screen and therefore the diagnosis is incomplete, such as you may have an auto-immune thyroiditis going on. Or there may also be an underlying adrenal exhaustion or insulin resistance which is sabotaging everything. Very tricky to give a specific opinion, so we suggest you put these possibilities to your doctor rather than try anyone new.

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Pam | 11:48 am, March 15th, 2013

Im 53 and have been battling hormones for the last 3 years. I’ve taken progesterone 8% on and off for these 3 years. Tried numerous supplements. The end result I gain 5 to 6 in and pounds in the middle, legs get horribly swollen….ending in stopping everything. I know for a fact I’m estrogen dominent, very low progesterone and low testosterone. I’ve tried DIM, I3C but then my body really goes crazy. Did probiotics for awhile too, NOTHING seems to work. I have vaginal dryness they gave me a estrogen cream to apply to vagina, after a time this makes me feel like I have a constent bladder infection, please help me!!

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dr coope | 12:51 pm, March 15th, 2013

Pam please send your query to and we will do our best to help you. If you feel you need more specialised advice on this, then Dr Coope is available for personal or telephone consultations.  If you wish to explore that further, you will find details here: 

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Rebeca | 5:21 pm, March 19th, 2013

Hi Dr. I am 42 years old and I started natural hormonal replacement about 4 months ago due to low progesterone. First month I was doing great but by the sencond and third months I started bleeding heavily in the middle of my cycles. I am working with an anti aging doctor who believed that I needed more progesterone until a blood work came back with way too high progesterone and estrogen. We decided to lower my progesterone pills and cream. My question is, should I quit the pills and cream to reset my body and for how long?
Thanks, Rebeca

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AnnA Rushton | 11:09 am, March 20th, 2013

Rebeca we have asked Dr Coope about this and it is not clear if you are on progesterone cream as well as the ‘pills’, (Utrogestan?), or is it an estrogen cream or gel? His belief is that blood results are much more fluctuating and unreliable than saliva readings, and your symptoms after the first month could be due to estrogen receptors waking up under the influence of progesterone. If you are on two forms of progesterone, oral and cream, this is likely too much, and could be causing the problem.

We think your doctor is actually doing the right thing, by reducing your dosage, but to be clearer would need more specific information but doubt if stopping everything is the right answer. If you wish to have a second opinion or need more specialised advice on this please contact Dr Coope for a consultation, and you will find information on how to do that at this link 

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Rebeca | 12:31 pm, March 20th, 2013

I take both pills and cream, both natural compound for me. But I will contact to Doctor for a consultation. Thanks. Rebeca

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Kiki | 11:38 pm, March 26th, 2013

Hi. I have been on T3 thyroid medication and bio identical progestron pill for last 5 months. My fatigue brain fog and depression was lifted immediately but weight gain and hair loss has not resolved maybe even worsen. My doctor increased my progestron to 100 mg from 50 mg. it’s been 3 weeks but no change in my thinning hair and weight gain. What is going on? I am on some natural supplements for Adrenal support as well and my last blood work showed normal thyroid levels. How long does it take to have symptoms resolves completely?

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AnnA Rushton | 10:10 am, March 27th, 2013

Women take longer to rebalance their hormones depending on their previous conditions and level of oestrogen dominance and we cannot comment on your pill Kiki as oral progesterone (if it is progesterone and not a progestogen) is processed by the liver and absorbed differently by the body from the cream so you will not get the same results as you would from a cream. There will be no change in your thinning hair for some time as it takes around 6 months usually for hair growth to be apparent and you need to discuss this with your Doctor who prescribed it for you.

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Brenda | 5:26 pm, April 4th, 2013

Hello Dr. Coope,
I am 51 yrs old and have been in perimenopause for 8+ years. I saw a physician who specializes in HRT. After many blood and saliva tests he found that my estrogen was extremely high and my progesterone extremely low. He prescribed DHEA 5mg as well as bio identical progesterone at a compounding pharmacy. I recieved 6.25 mg progesterone caplets and was to start with one pill at HS and increase by one pill q3days until I felt significant relief. (better sleep, mood, increased energy and mood) I felt relief within a couple days @ 6.25mg(mainly improved sleep) but have increased to 18.75 mg @HS. I feel like a new person!!! However I am steadily gaining weight and I am not happy about it. I am not eating more I am actually eating less but better quality foods(whole foods). I also walk 4-6 times a week. He also prescribed 602mg vit b complex tid, vit c 250mg tid, vit d3 1000mg od,omega 3 oil 1000mg od, magnesium/calcium 167mg/333mg tid all which I have started. He also prescribed indole-3-carbinol 150mg bid and flora care(high quality acidophilus for my colitis(now under control with many medications including injectable immuno suppresive drug) but I havent started these 2 supplements yet. What can I do to decrease this weight gain (15lbs in a month with significant bloating and increase in my mid section)
Thanks for your words of wisdom!!

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Brenda | 5:47 pm, April 4th, 2013

Oops just to add, my adrenals are barely functioning after a severe flareup of colitis that took 3+ yrs to control.

My t3-4.9pmol/L, t4-11.7pmol/L, TSH-2.37 mU/L.

In addition, my previous physician had me on 50mg of progesterone cream @HS but it gave me migraines she reduced to 20 mg but migraines continued. My new physician says I am extremely sensitive to progesterone which is why he started at 6.25mg and gradually increased dosage. So what to do??

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Dr Tony Coope | 8:27 pm, April 4th, 2013

Brenda: I’m reminded of the old saying: ‘Too many cooks spoil the broth’. This is a very complex picture, and your doctor seems to be unravelling it admirably; but it takes time, with some ups and downs along the way, and it’s really a job for one person, not a committee, because it needs that person to work it through until everything is understood in its right place. At this stage of the process, it is not clear why you are putting on weight to this degree. Your story suggests repressed emotions and much stress, which of course affects the adrenals and your insulin sensitivity, so it may be helpful to ask your doctor about extra adrenal support (the DHEA is part of this), and for you to contemplate your past emotional history with the aim of resolving any major issues and unfinished business there. Good luck!

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seeking help | 6:37 am, April 7th, 2013

I have been on bio identical for 5yrs now and it hasn’t worked at all. The Dr gave it to me when i had to have a complete hysterectomy. I still get really bad hot flashes, weight gain, very tired and have memory loss. I’ve gone off and back on them for yrs. Hoping that they might work. I just don’t want to be tired anymore. They have tried different does but it hasn’t worked. Any ideas?

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dr coope | 11:04 am, April 7th, 2013

If you have had no positive results then clearly it needs a rethink although consistency is important when supplementing with hormones. Your symptoms indicate low levels of progesterone so if you on a combined product you may wish to discuss going on to progesterone only and ask your Doctor to do detailed blood tests to show you exactly what level of both oestrogen and progesterone you currently have. If you still have more oestrogen than progesterone that indicates oestrogen dominance.

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natalie | 6:34 pm, April 19th, 2013

Hi, i have been using a natural progesterone cream for 3 months, I have gained about 15 pounds…I was wondering if that is normal, i have read that , sometimes your symptoms get worse before they get better, but i am already over weight, so it is concerning me that i am gaining more weight. Thanks!

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AnnA Rushton | 8:53 am, April 20th, 2013

Progesterone normally helps reduce hormonal weight gain Natalie so this is not usual. If your other symptoms are responding well, then it is not likely the gain relates to our hormones. If they are not please email to with more details of your symptoms and the name of the cream you are using.

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ANGIE | 11:02 pm, May 5th, 2013

I am 51 and peri menopausal. I began taking 100 mg oral progesterone after labs revealed low P and T and normal Estrogen levels. The first several weeks I had horrible depression, irritability and anxiety like I have never experienced before so we increased to 200mg. My emotional symptoms improved greatly but I have been spotting daily, sometimes small amount of frank blood and sometimes old dark blood. It is quite annoying but I am reluctant to decrease my progesterone for fear my emotional symptoms will return. My HRT MD doesn’t seem to know what to do. I am also on Testosterone cream twice a day.

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Dr Tony Coope | 8:35 pm, May 6th, 2013

Angie: I think the likely explanation here is that the initial dose of available progesterone was too low for you (you lose a significant proportion of the original dose through breakdown in the liver after absorption when you take it orally). This was therefore not enough to raise your progesterone to effective levels, but enough to re-sensitise your estrogen receptors to the (normal) levels of estrogen in your body. Hence the ‘excess estrogen’ symptoms of depression, irritability and anxiety. Doubling the dose of progesterone then restored balance, and the emotional symptoms improved. Restoring your hormonal balance to a ‘younger’ version often seems to result in a functional spring-clean, and it is likely that the spotting, especially of the old dark blood, is a sign of this happening. It may take a month or two to settle to normal, but I doubt that you will have to do anything more that wait, as this is, in my opinion, all good.

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Kelly | 3:49 pm, May 9th, 2013

I am 45 and having night sweats and weight gain mostly. I have tried some things with no luck. My physicians assistant put me on a mid dose of just estrogen as I have no uterus. I feel worse than before. I still have horrible sweats and can’t sleep worse than before. I also dream every night all night. I am achy and weak which I did not have before. I am on no other medications and otherwise very healthy. Any suggestions?

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AnnA Rushton | 4:05 pm, May 9th, 2013

You are having unopposed oestrogen Kelly which leads to oestrogen dominance so rebalancing this with some additional bioidentical natural progesterone would help. You might also find this article helpful to read: 

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Kelly | 4:27 pm, May 9th, 2013

Thank you that was interesting. My physicians assistant wasn’t completely knowledgable about it all and just threw me on an estrogen pill. I’m looking at getting the wellsprings cream and trying. I feel like the estrogen is unbalancing me more than anything.

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Nancy | 6:53 pm, May 13th, 2013

Dr. Dr. Coupe,
Rencently I have had low grade burning and vaginal soreness. My Dr. increased my estrogen and I got worse for the last several weeks.
I am a 6 plus year user of HRT. Recently I started having severe uterine burning and swelling. This past Friday I choose not to use progesterone and on Saturday I was inflamed and had to lie down with an ice pack to get though the day. The progesterone seems to help. If I am opposite from most women and get burning and swelling from to much estrogen, how long would it take to see relief if I discontinue estrogen for a week or so. Thanks for your advice, my quality of life is terrible.

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Lucretia | 10:35 pm, May 14th, 2013

Great article, just what I was looking for.

Here is my web-site: heart disease is 1 killer of apes in captivity

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Dr Tony Coope | 6:13 pm, May 15th, 2013

Nancy: straightforward atrophic vaginitis almost always responds to local estrogen, – it definitely shouldn’t get worse. It sounds to me that you have an infection such as thrush (Candida), which is likely to be made worse by estrogen. Progesterone does have an anti-inflammatory effect, so may ease the swelling and discomfort (as in your case?), but it will not cure it. Your best plan is to see your Dr again, have a vaginal swab taken to identify the cause, and then treatment appropriate to what is cultured, whether it is fungal or bacterial.

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rachel | 7:53 pm, June 29th, 2013

Hi Dr. I had a question about progesterone cream. I am extremely obese and have Pcos and hypothyroidism. I do not ovulate . i have not been able to tolerate my thyroid medication as well. my age is 42. My saliva progesterone and estrogen results are that both hormones are extremely low. My saliva results for my cortisol are low across the board. What dose of progesterone cream do you recommend so I can build up my adrenals / cortisol and ovulate again? Whenever I use progesterone cream I quit the first week because the symptoms are so bad. The symptoms are migraines with aura and irritability. Thank you for your help.

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Dr Tony Coope | 8:18 pm, June 30th, 2013

Rachel: You are not having an easy time! Usually when you experience a response to progesterone like this it is because it has re-sensitised estrogen receptors which then respond more strongly to whatever estrogen is there, giving rise to symptoms of ‘oestrogen dominance’. Normally it would take a few weeks of perseverance for the progesterone levels to rise enough to balance this, and the symptoms should then subside. However there are other factors here, in that if your adrenals are flat, this will affect both your thyroid function, your hormone balance, and your sugar metabolism. To put this right, it has to be done in the right order, building up your metabolic balance from the foundation of restored adrenal function. I would also want to question your true thyroid state, as there is often a problem with interpretation of tests, or with their omissions (e.g. for autoimmune problems). I feel your situation is too complex to hope that any worthwhile change can occur with a simple approach, – you really need to develop an accurate overview as to what is actually going on here, and then build from there in stages to a state of better health. This will need guidance. If you cannot find this, I would be happy to talk with you in consultation to see if I can be of any help.

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tc22009 | 6:13 am, July 16th, 2013

I am 28 years old, and own and run 5 businesses, my stress levels peaked last year making my mood swings severe, psychotic and often. i had my hormones checked and it said i was at the level of a premenopausal woman. I then started taking heavy doses of progesterone cream. I gained 12lbs in 2 months (alot for me!) but i was happy again. i got off the heavy cream and switched to a regular dose, it seems like my hormones have leveled out, no more psycho but i cannot shake the weight. anytime i use the cream i bloat so bad i cant wear any of my clothes and its making me depressed.

i am a healthy and active person, workout regularly, but have a lot of stress. my hormone tests also showed high cortisol at night time and now i’m taking rhodiola for that. still no weight loss. do you have any advice for me? thank you so much!

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AnnA Rushton | 9:06 am, July 16th, 2013

Weight gain is common at perimenopause to compensate for the declining levels of oestrogen so it is then produced in the fat cells and adrenals. You seem to be doing all the right things but the stress will certainly impact your hormone levels so that would be the area to tackle plus strengthening your adrenal system. This article by Dr Andrew WEil explains it in more detail:

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Sarah | 1:25 pm, August 3rd, 2013

Hi there I have been on serenity since march and my flushes have now completely subsided .so I stopped the cream about a month ago .since then I have 2 shows .. The one last week was nothing more than brown discharge and it stopped quick , however I came on again 3 days ago and last night was admitted to A@ E with heavy vaginal Bleedin g … I am on tranxemic acid now but wondered what you think this bleeding may be caused by ? I am going for a ultrasound to check everything’s ok … But I was jolly scared. The blood was pouring out very fresh red colour with big dark clots .. My blood count amazingly is completely normal .. Any thoughts?

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Dr Tony Coope | 9:58 pm, August 4th, 2013

Sarah: I don’t have any past symptoms or history to clarify things here, – your menstrual history, where you are in relation to the menopause etc, but the most likely thing is that this is due in some way to your hormone balance, probably related to achieving that with the progesterone, but undermining it with the stopping of the cream. It suggests that you may have had a low progesterone for some time, culminating in a thickening of the endometrial lining of the womb, or fibroids, which increase its surface area; either of these could explain why you had such a dramatic bleed; but the ultrasound should clarify the diagnosis, which is important here. Once that is clear, you may wish to seek help to establish the next steps.

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Sarah | 7:39 am, August 5th, 2013

Hi doctor . My history is I am 49 and my periods up until a year ago became very erratic and heavy and then nothing for a few months when heavy Iean flooding .. I have not had children either .this year from September they have oractically stopped .. But hot flashes started and got worse around march when I started serenity .within 2 months they had gone .

I am extremely healthy , run , surf 5.7 and 9.5 stone .. Eat a healthy diet take menopause natural vis and cod liver oil .. I have joint pain in hips and back quite regularly but mainly the back pain coincides with a period .. The last one being in April snd now again , coinciding with this current bleed .

I did have open heart surgery when 4 buy doubt that is anything to do with it . My mother passed away 2 years ago which was stressful and seemed to coincide with earlyish menopausal symptoms

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Dr Tony Coope | 10:00 am, August 5th, 2013

Sarah: thank you for that. As you come up to menopause, this makes it more likely that this is due to hormonal fluctuations, especially influenced by the stress you have experienced. It is still important to have the ultrasound to exclude endometrial thickening, fibroids, polyps etc, but my feeling is that you don’t have too much to worry about. If you can stay off the Serenity until this is done, and for at least 6 weeks in total, then it would be helpful to have a 1-day progesterone/estrogen saliva test done to establish your hormone balance at this critical moment. It would provide the information required to know what specific steps need to be taken to get you back in balance. If you need help in arranging this, please do not hesitate to contact me.

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megan | 10:41 pm, September 5th, 2013

I am a 29 yo with previous hx of endometriosis. I have been on yasmin for a number of years and came off of it in January (suffering migraines) I had ‘periods’ until May and since then, nothing- except acne, insomnia, and pain when i sneeze/cough on my R ovary side! My Dr completed a series of blood tests which showed everything was within normal limits except my progesterone, which was pretty much non existent. He has put me on 50mg progesterone tablets (from a compounding pharmacy) for 5 days, then increase to 100mg for 5, then 150mg for 5 days then break for a week. Will this return my periods and fix my acne? how long until i see results? Or would i be better on a cream? my dr didn’t go into much detail, just handed me a rx….
Thank you

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meg | 11:57 pm, September 5th, 2013

I am a 29 yo with previous hx of endometriosis. I have been on yasmin for a number of years and came off of it in January (suffering migraines) I had ‘periods’ until May and since then, nothing- except acne, insomnia, and pain when i sneeze/cough on my R ovary side! My Dr completed a series of blood tests which showed everything was within normal limits except my progesterone, which was pretty much non existent. He has put me on 50mg progesterone tablets (from a compounding pharmacy) for 5 days, then increase to 100mg for 5, then 150mg for 5 days then break for a week. Will this return my periods and fix my acne? how long until i see results? Or would i be better on a cream? my dr didn’t go into much detail, just handed me a rx….
Thank you

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Dr Tony Coope | 8:56 am, September 6th, 2013

Megan: there have been studies which show that there can be benefit from taking progesterone orally, but it is generally accepted that only up to 25% of the hormone is absorbed, the rest being broken down into metabolites by the liver. Some of these have an effect, but this is variable from person to person. My feeling is that absorption via skin is much more reliable as it goes straight into the bloodstream and fat stores, and so requires a much smaller dose.
Your progesterone levels may be low because the synthetic progestin part of Yasmin, drospirenone, is structurally close to progesterone, (although it lacks many of the beneficial effects of progesterone, as well as having potential side effects of its own). This means your metabolism may have removed much of your progesterone, seeing it as excess. Restoring your progesterone levels could help with the acne, discourage migraines, suppress some of the symptoms of endometriosis, and return you to a ‘younger’ hormonal balance, which may mean the reappearance of your periods. My preferred method would be the cream, which you can use for a 3 month trial period before taking stock, as results can be either startlingly quick, (2-3 weeks) or frustratingly slow (2-3 months). Let me know if you need any guidance.

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Aimee | 8:08 pm, November 25th, 2013

Hello, I am 43 and have been taking bio-identical compounded progesterone and testosterone cream since Aug. I have gained almost 7 pounds, and I have not weighed under 131 lbs since then, whereas for the last 6 years, I have only weighed that after a week of ‘binging on vacation”! I usually weigh between 124-127lbs. My doctor has tested my hormone levels twice, both times said I was too high in estrogen too low in progesterone and testosterone. I started with 20mgs of prog, then 40, now am at 80. Have been on that dose for a week. Testost. has increased from .25 to .5. I feel lethargic, I force myself to lift weights and go running, but I am anxious, stressed and tired. I had an adrenal saliva test done, my rhythm was backwards on cortisol.

I feel like the cream is keeping me from returning to my regular weight. I had a DEXA scan in April and I was 121lbs, 22% BF. In Aug, I scanned at 30% and weighed 133. I want to stop taking it, but am wondering if that’s the right thing to do. I had an ablation in 2008, so I do not have periods anymore. My sex drive is minimal, and I don’t know how they can tell where I’m at in my cycle for the hormone tests. I am worried the cream is the culprit, yet wondering if it’s too little a dose. They also started me on Metformin last week.

Can anyone help?

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A.A.S. | 4:16 am, January 7th, 2014

I’m using Emerita Progest cream. I’m not sure if this cream is making my main symptom is even worse – HAIR LOSS! That is the reason for me even wanting to try this cream.

I thought for sure I had low progesterone so I took a saliva test through ZRT labs, which I ordered through Dr. Lee’s website. I’m not 39 and have had hair shedding for exactly two years. Spotting before periods most times too. Thyroid normal. I just took a saliva test on day 20 of my cycle through ZRT labs. Here are my results:
Estradiol E2 is .7 (normal range is 1.3-3.3)
Progesterone is 127 (normal range is 75-270)
Ratio: PG/E2 is 181 (optimal range 100-500 when E2 1.3-3.3)

I was informed that even though my estradiol is LOW, I’m still estrogen DOMINANT since the ratio is 181:1 and optimal is like 600:1.

Well I’ve been taking this cream for 1 week and my hair seems to be shedding even more so I’m beginning to freak out. Am I just awakening estrogen receptors? I don’t know but it’s still making me wonder if I should stop the cream.

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Lacey Rose | 6:26 am, January 21st, 2014

Dr. , your information is both helpful and reassuring! I recently started a regimen of 100 mcg of bio identical oral progesterone once a day. Over a period of a month and a half I’ve gained 7 pm lbs. My on gun swears it’s not the progesterone but water weight associated to the awakening of the estrogen receptors. So my question is what can I do to help this water retention and not aggravate my pre-existing hypothyroidism? Also this means I cannot take your advice of supplementing with indol 3-carbinyl. Cruciferous veggies are a big no no. So what then? Maybe just the milk thistle?

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AnnA Rushton | 10:58 am, January 21st, 2014

Oral progesterone is processed by the liver and so its action is different from that of a bioidentical cream. Certainly progesterone helps with water retention and weight loss but progesterone can awaken oestrogen receptors and the advice with cream use is to reduce the dosage to a small amount until the body adjusts. However as you are seeing a consultant you need to discuss this with them.

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Lacey Rose | 3:03 pm, January 21st, 2014

Thank you Anna. . Again great info! However I am a bit concerned as my obgyn prescribed a higher dose of progesterone. .. not lower.

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AnnA Rushton | 11:09 am, January 24th, 2014

It will depend on the form of progesterone Lacey oral forms are always much higher than transdermal creams but as you consulting an obgyn please discuss it with them.

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AnnA Rushton | 10:53 am, January 28th, 2014

Progesterone is associated with weight loss Lacey as it acts as a diuretic, see the book ‘From Belly Fat to Belly Flat’ by Dr C W Randolph. Certainly oestrogen is associated with weight gain but speak to your doctor re your progesterone dosage.

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Kim | 3:15 pm, March 16th, 2014

Hi. I have recently been suffering from hot flushes and weekness. I saw my Gyne who tested me to find my Oestradil <44. He put me on Esraphem very low dose but it made me Sick. I then heard of biodentical hormones and saw a doctor on this who tested me and told me all my levels were low and then prescribed cream which has allow dose of est, prog and test. I had a hysterectomy 10 years ago but kept an ovary which is slowly giving up. Why is it when I take this cream my hot flushes are worse and I feel more emotional than when I am not taking anything ?I feel better without hormones. Is it dangerous not to take hrt?

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AnnA Rushton | 4:59 pm, March 16th, 2014

We can’t comment on your cream Kim as we do not have any cream with testosterone it it. You need to speak to your gynaecologist about the reaction you have had and it is not dangerous not to take HRT but there are a number of health risks associated with it such as increased cancer, stroke and heart disease risk.

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Janice | 9:33 am, March 17th, 2014

Hi, my research tells me that Candida lives on progesterone, and lowers eostogen. This surely is important with all the sugar everywhere in food.

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Dr Tony Coope | 5:04 pm, March 17th, 2014

Janice: there is a lot of ‘info’ out there about progesterone that is very wide of the mark. Progesterone is a hormone made of proteins, but cannot be considered a food, even for candida, which in the body does do very well on sugar. The only connection between them that I can think of is that of Chronic Stress syndromes, where progesterone is often depleted due to the excess production of cortisol, which is made via a metabolic pathway which includes progesterone. At the same time, sugar levels are often raised through ‘comfort’ eating and the release into the blood of sugars stored as glycogen in the liver as a normal response to stress. Combine this with an inevitable reduction of immune system efficiency, and you have the ideal environment for candida overgrowth!

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Dr Tony Coope | 5:19 pm, March 17th, 2014

Kim: if your progesterone and oestrogen have been low for a long time, then exposure to those hormones may have ‘woken’ up cell receptors which are now responding more strongly, creating a variety of symptoms until your hormones come into better balance. Usually the thing to do is to cut down the dose but continue until the symptoms stabilise, which may take from 2-6 weeks. If they don’t do this, then you need to be re-assessed.

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Donna Green | 12:38 am, April 14th, 2014

I was on the wiley protocol for seven years with good success. (This is rhythmic dosing, two weeks on progesterone, estrogen all month and then an
induced period)
I went througha long period of stress with lots of anxiety and tremors cuz of a med a doc put me on. My adrenals were already low, btw

My ND decided to put me on
static dosing, because for the most part my anxiety
disappeared during progesterone weeks and came
back on estrogen only weeks.

So now I am on static dosing
(same amount of pro and estrogen everday)

It hasbeen one week and my anxiety has put me in bed with
chest pains.

Your article was written for me. It makes so much sense, esp the exhausted and over-reactive part….thats me. My Nd
cranked up my progesterone and made me worse.

This switch over from rhythmic
to static has put alot more progesterone into my
systemthan I ever had before. So I am thinking of loweringmy
pro, even tho my ND thinks the more progesterone the better.

Is this a reasonble conclusion
and how long do I wait if I should not get relief? A week? Then lower it again? I dont know the balance is.

Thank you so much for this insightful article.

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Dr Tony Coope | 2:41 pm, April 14th, 2014

Donna: our ideas of what is happening hormonally in a situation like yours is limited by our training, our insights, and what we have come to believe from our own experience. What is actually happening may be much more complex than we can easily conceive. The relative effects of progesterone and oestrogen can be thought out, but by the time we have added the variable influences of receptor sensitivity, adrenal depletion, continuing stress and emotional factors, the picture is much less clear. Protocols have their uses, but individual variation ensures they will not always be appropriate. It is often helpful to have saliva measurement of hormonal levels (serum values are much less reliable as these hormones tend to be fat-soluble), but in the end your own body is your best laboratory, and you can work out your own best balance by intelligent trial and error, changing dosages gradually, refining according to any improvement or deterioration in symptoms until you have found a satisfactory point. This may take a while; over time, change may happen spontaneously , and re-adjustment may be necessary. But for now, I think your conclusions are reasonable and worth exploring, – you may well notice a difference within a week or two of any changes you make.

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