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.