Related Topics: Bioidentical Hormones, Menopause

Which Hormone To Supplement? Progesterone, Oestrogen Or Both?

Hormone balance is critical for our health and wellbeing, but which hormone or hormones do you need, and how do you decide?

AnnA Rushton

Women are ruled principally by two hormones: oestrogen and progesterone and the reality is we need both of them. Historically at menopause women’s levels of both hormones drop but whereas in the past the balance could be more easily maintained as women continued to produce oestrogen from their fat cells and progesterone in the adrenals, the balance has shifted.

Oestrogen is not a villain, though you may think so based on its bad press in relation to being a risk factor for breast cancer and heart disease.  The ‘villain’ is actually the excess oestrogen women have been exposed to over the last 50 years since the advent of synthetic hormones in the Pill/Coil and HRT and the xenoestrogens in our environment and food chain.

This was the situation that led the late Dr Lee to describe what he saw in his female patients as oestrogen dominance.  A situation that occurs where progesterone levels are lower than oestrogen and so not able to balance out the effects of their excess. What is less commonly realised is that women can have low oestrogen levels and still be oestrogen dominant if their progesterone levels are even lower.

Who needs progesterone?

Women need both hormones from puberty to post menopause and there are many conditions identified where progesterone may need to be supplemented. Again what is not often realised is that a woman can be menstruating regularly but not ovulating, in which case she is not producing progesterone to balance her oestrogen. These are the most commonly seen conditions where progesterone supplementation is helpful:

*   PMS                                      *     PCOS

*   Infertility/Miscarriage    *     Baby Blues/Post natal depression

*   Heavy bleeding                 *     Endometriosis/Fibroids

*   Menopause;  hot flushes, sweats, anxiety, mood swings, weight gain

Who needs oestrogen?

Women with vaginal dryness and discomfort and vaginal atrophy all benefit from additional oestrogen as do women who have found that progesterone alone does not fully control severe menopausal symptoms. Dr Jeffrey Dach in the USA has also found that menopausal women with depression and anxiety benefit from additional oestrogen, but balanced by progesterone.

How to decide what you need

The key role of progesterone is to protect from the excess oestrogen that can lead to breast cancer, heart disease and more. Essentially its role is to balance out oestrogen so that it:

  • Protects the breast and endometrium
  • Helps break down fat, stabilises blood sugar and is a natural diuretic
  • Anti-depressant and increases libido
  • Helps fertility and women with history of miscarriage
  • Facilitates thyroid function
  • Builds up bone

Women from puberty to pre or peri menopause generally only need progesterone to deal with their symptoms as they relate to excess oestrogen and oestrogen dominance.

Menopausal women, and those who have had a hysterectomy (which is a surgical early menopause), also need progesterone but may also need a small amount of oestrogen in a balanced formula so they get the protection from oestrogen excess. They are usually women who show signs of low oestrogen as above and and those on long term HRT usually do better on a combined cream when they switch to bioidentical hormones.

Post menopausal women still may have hot flushes and generally need progesterone to protect their bones from osteoporosis.

As a general rule, most women find that progesterone alone is sufficient to control their symptoms and only switch to a combined cream if they have a specific need for oestrogen related symptoms or their symptoms are severe and not sufficiently controlled by progesterone alone.

Further reading:

  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -
  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -  -

Please feel free to discuss this article in the comments section below, but note that the author cannot respond to queries made there.
Comments 35
Sorted by:  Date | Recommended
AnnA Rushton | 11:37 am, September 19th, 2016

Fibroids and a bloated stomach are signs of oestrogen dominance Elvira and beset helped by supplementing with progesterone only, with a cream such as Serenity.

Elvira | 11:24 pm, September 18th, 2016

Hi just found this site, I had fibroids one at 13cm and 5 other ones smaller which I then had to have a hysterectomy at age 47 in May this year (2016). A shock and not happy but its done but I have the bulging stomach still and cannot lose the weight I am 5′ 3″ and now 12 stone – I was always 8 stone the most 9. I do not eat much at all but still cannot lose the weight. People say its my thyroid but blood tests keep coming back normal, even cholesterol and diabetes were normal. Regarding thyroid a specialist said I will have to get used to a fat neck. I am at my wits end as to why I cannot lose weight and I feel tired even after sleeping all night. Does anyone have any advice please

AnnA Rushton | 10:03 am, January 31st, 2016

Kath please email with your history and hormone usage so they can advise you.

Kath Collins | 10:45 am, January 29th, 2016

Hysterectomy 15yrs ago (left ovaries), Pcos, under active thyroid, fibromyalgia & osteoarthritis all large joints/back! Still flushing I’m 53 & started all at 28yrs! I’ve got the 20-1 cream as previously had senerity cream before this! Any advice??

AnnA Rushton | 3:13 pm, January 26th, 2016

Flushes post menopause are increasingly common due to stress and hormone imbalance Georgia but you need to speak to your doctor about the spotting to have it investigated.

Georgia Bailey | 1:50 pm, January 26th, 2016

I had my tubes tied at the age of 22 now i am 64 years old having hot flashes and don’t know what to do ..started back having spotting period my age help

AnnA Rushton | 4:33 pm, December 13th, 2015

Angela it is safe to switch at any time between the two creams and women can use them for as long as they wish to as there are no side effects or withdrawal symptoms. Not all symptoms respond at the same rate, some take longer so please make sure you are following the correct application as in the article below:

Angela | 6:52 pm, December 12th, 2015

Please tell me when it is ok to switch from 20-1 to natural progesterone creams. How long can I safely be taking the product. I have been taking 20-1 for over two months I have seen a great improvement to the hot flushes, but no improvement to my labido, mood and weight gain. Please let me know if I am doing something wrong.

AnnA Rushton | 10:23 am, October 25th, 2015

Julie please send these questions to so they can give you a specific answer for your concerns.

Julie Maloney | 1:21 pm, October 24th, 2015

Hi I’ve just started using the 20-1 cream and hoping it will relieve my symptoms which are the usual frequent hot sweats and vaginal dryness so my question is firstly I assume I am starting with the right cream for me and secondly if you use it by insertion into the vagina can I use this method all the time or alternate on different parts of my body and lastly how far into the vagina does it need to go to work can I use an applicator. Also I’ve never tried and don’t want to try using HRT.

AnnA Rushton | 6:57 pm, July 28th, 2015

Maggie SErenity will certainly help with the low libido and you can use it vaginally to help with the dry vagina. However, when you say ‘delicate’ if it is vaginal atrophy then normally requires additional oestrogen from your doctor. We suggest using Serenity alongside this additional oestrogen until it is more under control at which point you could switch to 20-1.

Dr Tony Coope has written this article which you may find very helpful:

Maggie Smith | 6:09 pm, July 28th, 2015

Hi x I already have the Natural Progesterone cream.
Is it the right one for me?
I am 66yrs old.
Libido non existent.
Dry and very delicate Vagina.
I appreciate your advice.
Sincerely, Maggie Smith

AnnA Rushton | 9:22 am, April 25th, 2015

Kathy for weight gain concerns any additional oestrogen is not usually helpful so you may find once your flushes are under control you would be better with a progesterone only cream. The reason for using morning and night application is to give you maximum 24 hour coverage and absorption but of course life does not always work out that way so just try to keep 12 hours between applications where you can.

Kathy Anderson | 7:22 pm, April 23rd, 2015

Hi I have only recently started using 20-1 I have found that the little pot of gold has decreased the intensity and frequency of the hot flushes which I am soooo grateful for, however the bloating hasn’t subsided i will probably have to put up with these inconveniencesin my life but for how long. My question though is i am a nurse, work nights unfortunately I do not always apply my cream at a set time before i go to bed in the morning after work or before work at night can or does this effect its efficiency

AnnA Rushton | 11:25 am, March 26th, 2015

Flushes can be related to medications, stress as well as hormone balance. Bioidentical hormones are used by women post hysterectomy and post menopause as progesterone provides protection from breast cancer, heart disease and osteoporosis. Many of your symptoms relate to oestrogen dominance (usually connected to HRT) so rebalancing with progesterone would help. HOwever it is not good to stop HRT suddenly as it can bring on severe withdrawal symptoms, so see this article by Dr Tony Coope on how to change over if that is what you want to do.

Emah | 4:42 pm, March 25th, 2015

I had TAH +bso 4 yrs ago and has been on HRt premarin, estrogel and livial at different times. My gynaecologist says I don’t need progesterone. I still have severe heat and hot flashes ,night sweats, weight gain, insomnia and malaise. Why are my still having these issues 4years after the total hysterectomy even with HRt . Can progesterone help?

AnnA Rushton | 12:59 pm, February 1st, 2015

Claire your symptoms relate to oestrogen dominance and migraines and swollen breasts are both associated with this. You could rebalance with progesterone which also supports thyroid function so there is no contraindication with your condition. This article by Dr Shirley Bond may be of interest:

Claire mcdonagh | 11:10 am, February 1st, 2015

Please help. When I had my daughter 17 years ago my thyroid stopped working and I now take thyroxine even when my thyroid was regulated I continued to suffer badly from migraines lethargy weight gain etc. was told I had hormone imbalance and had a total hysterectomy at 36 I felt better immediately but have periods of total exhaustion severe crippling migraines I stopped the HRT for four years and have been coping (just). Since December I have been struck down with lethargy and severe migrains daily. Went to doctor who put me back on HRT patches but has now told me to stop as had more migraines swollen and painful breasts and shooting pains in chest. He has just taken all my bloods and am waiting for results. No one seems to be able to tell me what is wrong

colette maguire | 3:32 pm, January 29th, 2015

After reading that I think I just need the cream for night sweats and wieght gain. Im early into my menopause.

AnnA Rushton | 6:47 pm, December 9th, 2014

You use enough to control your symptoms Carol, some women need more and some less. You will find full dosage and application information in our online booklet for which there was a link in your confirmation of order email. You will find it here: 

Carol | 1:16 am, December 9th, 2014

hi, how much of the 20-1 cream should I be using, I’m never quite sure if I’m using enough or too much! Thanks

AnnA Rushton | 9:34 am, October 30th, 2014

Certainly oestrogen is needed for dryness so either continue with Serenity and a separate cream from your doctor if that is extreme, or switch to 20-1 which is a combined progesterone and oestrogen cream.

Kath | 6:10 pm, October 29th, 2014

Hello, I am 55 years old and had a partial hysterectomy 5 years ago. Started using the serenity cream which has been fine for a couple of years, now find my hot flushes and vaginal dryness are worse. Do I need some oestrogen?

AnnA Rushton | 3:44 pm, October 17th, 2014

Delighted you are back to enjoying life Margaret and 20-1 has been so helpful.

AnnA Rushton | 3:43 pm, October 17th, 2014

Suzanne it is not a good idea to stop HRT suddenly as you can get severe withdrawal symptoms, so cut down slowly and use Serenity to rebalance your hormones. YOu will find this article by Dr Coope helpful:

AnnA Rushton | 3:40 pm, October 17th, 2014

Delighted it has helped Margaret and that you are enjoying life again.

Suzanne Loades | 9:28 am, October 17th, 2014

I tried your progesterone cream about five years ago when my menapause started to be too difficult to live with. Since then I have been using HRT as I was having an extreme hot flush every 40mns throughout the night ! Now I still have occasional ones during the day and night but at the moment I am suffering from period pains, bloated tummy and loss of blood. I have stopped taking the treatment since a couple of days to give my body the chance to find a balance. I have also suffered with the thyroid for twenty years and rarely find the good balance there . I would like to try your product again. Should I try just the progesterone cream as I have put on a lot of weight this year and prefer to use more natural products ? I am almost 60 years old and started my menapause about 6 years ago.

Margaret carey | 3:18 pm, October 16th, 2014

I have been using your 20 to 1 cream for the past four month. I started with serenity for one month it was not strong enough but I am so very happy with this magic pot of cream, my hot flushes and mood swings are now a thing of the past. I have had gyne problems from the birth of my son who is now 25. I had a GYNE operation called “vetro suspension” had I of known then what I know now I would of never got the operation. Also back in those days I went to various GYNE consultants with the severe pain in my vulva area and difficulty walking and having intercourse. Unfortunately they all told me that nothing was wrong and everything was healthy, but I still had this pain for many years to come, it was not until the early 90’s that I was told that my condition was known as vulvaydania / unexplained vulva pain. I thought this was great finally I was given amitriptyline to help relax the muscles I have been on this tablet from the 1990 and will have to take for the rest of my life, also I now get Botox injections every 3 months and they are helping with my pain a little bit better. But since i have started using your product I must say that I have never felt so well and I am now a much happier person who is able to start enjoying life again. Thankyou for 20 to 1 cream it has been my life saver.

AnnA Rushton | 1:18 pm, September 30th, 2014

Christine we cannot answer this here please email

christine | 2:37 pm, September 29th, 2014

Thank you for your reply which cream would you recommend I have thyroid problem and high blood pressure. I have also had one ovary removed .

Alison | 1:13 pm, March 26th, 2014

I am 56 years old – I had a hysterectomy (but retained my ovaries) 9 years ago. I still have hot flushes but now experience vaginal dryness. I have developed middle age spread and low moods. Which cream would I benefit from using?

AnnA Rushton | 8:50 am, November 12th, 2013

Progesterone is helpful for both PCOS and thyroid and if you search both topics on our site you will find helpful articles for your friend.

wendy greensmith | 11:31 pm, October 30th, 2013

my friend has polycystic ovaries and a thyroid problem, could any of your remedies help her ? could you please advise
kind regards and many thanks to you all my awful symptoms are subsiding and only been using the cream for just over a week 🙂

AnnA Rushton | 10:57 am, May 9th, 2013

Delighted to help Frances, I always believe the more information we have the better able we are to make good health decisions.

frances | 9:26 am, May 9th, 2013

Your site has actually helped me to understand about bio identical hormones.

Leave a comment
(your email address will not be displayed)
About Us
Contact Us
The Team
Terms of Use  © 2018
Learn more about Serenity Natural Progesterone Cream Learn more about Serenity Natural Progesterone Cream