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I warned you about this hormone for nearly 30 years--now I can recommend it.

One of the most important subjects women over 50 are talking about these days is hormone replacement therapy. Suzanne Somers' books have made bioidentical hormones the latest fad. Bioidentical hormones are those that exactly match the structure and functions of hormones produced in our bodies. Synthetic hormones are manmade hormones that are more like a drug than a real hormone.

We've seen the problems synthetic HRT causes, including higher risks for heart disease and cancer. But are bioidentical hormones as safe as you're hearing? I've repeatedly said, "We don't know." Why? Because we don't have the studies necessary to prove their safety. In eases where we do have studies, I've recommended the hormones. But in many eases, we don't have enough information. One hormone in particular caught my attention again recently when we finally saw the results of a study on its safety.

When I became a nutritionist nearly 30 years ago, bioidentical progesterone was all the rage. It was said to be effective in eradicating many PMS and menopausal symptoms. And it was available without a prescription in an over-the-counter cream. What could be better than a do-it-yourself solution to menopause for women who want to feel empowered?

I first heard about bioidentical progesterone when I attended a seminar given by a representative from the company that made a topical hormone cream. I asked to see the studies proving its safety and efficacy, but there were none. "Studies are too expensive for us to fund," she answered. That stopped me in my tracks. Her information sounded impressive, but it was only based on anecdotes and testimonials. I just couldn't recommend a hormone without good scientific studies.

John R. Lee, MD, was the doctor who put bioidentical progesterone on the map. He used a topical progesterone cream on his patients for decades and insisted that there were no side effects. It turned out he was wrong.

Years later, I moved to northern California and I found myself living two miles away from Dr. Lee. I met local doctors of integrative medicine who told me that some of their patients who had been patients of Dr. Lee did, in fact, experience side effects from bloating, to headaches, mood swings, and weight gain.

Although his information was based on observations, no one I talked with had seen any statistics or studies to back up Dr. Lee's claims. He became an expert on natural progesterone based on notes in his patients' charts. This was a time when women wanted to take charge of their bodies. Dr. Lee's timing was perfect. And so an industry was born.

Companies sprung up touting the benefits of bioidentical progesterone based on quotes from Dr. Lee. And although some of these companies became wealthy, they didn't fund scientific studies.

When I heard knowledgeable medical doctors talk about side effects from natural progesterone, I warned my readers to wait for studies that showed it was safe and effective. I've always been opposed to using progestins--synthetic progesterone with known side effects. Until recently, I couldn't endorse the use of natural progesterone at all. Now there are a few good studies that let me give them my okay--but only under certain circumstances.

Some benefits of progesterone

I changed my mind about progesterone when I read a comparison of bioidentical and synthetic hormones that appeared in Postgraduate Medicine (January 2009). This article, with nearly 200 references, had enough science behind it to put me more at ease.

So who should use it and when? For starters, if you're at risk for breast cancer and heart disease, even after making lifestyle and dietary changes, progesterone may be helpful.

Progesterone creams can help prevent breast cancer in women with estrogen dominance (high levels of estrogen). In these cases, there are studies that support the careful use of low dose bioidentical progesterone. Some found it protects against breast cancer. While synthetic progestins increase your risk for breast cancer by increasing estrogen-stimulated breast cells, progesterone inhibits them.

In a 1995 study on women scheduled for breast-reduction surgery, some of the women applied topical progesterone to their breasts for two weeks before surgery. After surgery, their breast tissues were examined. Those who used progesterone had less breast-cell division. The researchers suggested that progesterone cream applied to the breast may, indeed, be protective.

The International Journal of Cancer published another impressive study in 2005. In this study, researchers analyzed 50,000 postmenopausal women. They found that they had a significantly higher risk for getting breast cancer if they used progestins, and a reduced risk if they used natural progesterone--either alone or with estrogens.

But be careful. Hormones are tricky and interrelated. If you're at risk for breast cancer, discuss the benefits versus the risks of hormone therapy with a knowledgeable health practitioner.

What about heart disease and stroke?

We know that estrogen protects against heart disease. But synthetic progestins cancel out these cardioprotective effects. Progestins reduce HDL (healthy) cholesterol, while progesterone, when given with estrogen, either maintains or increases HDL levels. So if you're at a high risk for heart disease and have done everything else, small amounts of progesterone given with estrogen, could be appropriate.

And while progestins put you at an increased risk for blood clots, progesterone doesn't when you use it topically. Although there are few good studies on bioidentical hormones and stroke, the ones that do exist indicate that they're safer and more effective than their synthetic counterparts.

When progesterone may not be appropriate

Progesterone is a hormone. And with all hormones, you can have too much of a good thing. Here are a few times when progesterone can cause problems:

When doses are too high: There's no data to suggest that high doses of natural hormones are safe. Research gynecologist and endocrinologist, Guy E. Abraham, MD, believes it's not just progestins that can cause problems. He told me that taking large doses of either progestins or progesterone can lower immunity. Always use the smallest effective amount of any hormone.

When a non-hormonal solution can work: Before recommending a hormone, I usually suggest that postmenopausal women take a product containing Maca, a Peruvian adaptogenic herb. This herb helps regulate hormones. In an article I wrote on Maca (September 2008), studies using a patented, standardized Maca extract known as Maca-GO or Femenessence reduced hot flashes without any of the mood swings or depression that can accompany hormone therapy. In fact, this Maca product reduced all menopausal symptoms by 84%!

If you can't find it in your local health food store, call Natural Health International (888-668-3661). Need more information? The best book I've found on natural solutions to menopausal symptoms is Menopausal Years: The Wise Woman Way, by Susun S. Weed (Ash Tree Publishing, 2002).

Don't be your own doctor

When it comes to hormones, playing doctor can be dangerous. While natural progesterone has been used to reverse vaginal atrophy--common in postmenopausal women--when you take progesterone without having sufficient estrogen, it can actually contribute to vaginal atrophy.

Plus, the best quality progesterone is not one of the popular unregulated creams available with no prescription. Even though bioidentical progesterone is made from wild yams and soy, many of these wild yam creams don't even contain this hormone. The best quality progesterone comes in a transdermal gel or cream you can obtain from compounding pharmacies like Women's International Pharmacy (800-279-5708). These pharmacies can make a progesterone product with precisely the amounts you need--often in smaller amounts of this hormone than you can find in health food store products. You will need a prescription to get these products.

Get your progesterone level tested by a knowledgeable doctor of integrative medicine or nurse practitioner. There's a delicate balance between sex hormones. Look for nonhormonal answers to your symptoms first. When bioidentical progesterone is appropriate, small amounts for short periods of time may be worth trying.

Does Progesterone Cause Heart Disease, Cancer, and Stroke?

Progestins are synthetic drugs and are not like the hormone produced in your body. Progesterone is bioidentical. Still, the medical community persists in calling synthetic progestins "progesterone." This is confusing. It's why you see studies that indicate progesterone contributes to heart disease, cancers, and stroke. Progesterone does not. Progestins do.

Fugh-Berman, A., and J. Bythrow. "Bioidentical hormones for menopausal hormone therapy: variation (m a theme," J Gen Intern Med, July 2007.

Holtorf, K., MD. "The bioidentical hormone debate: Are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?" Postgraduate Medicine, January 2009

Hudson, T., ND. Women's Encyclopedia of Natural Medicine, Keats Publishing, 1999.

Moskowitz, D. "A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks," Alt Med Rev, September 2006.
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Publication:Women's Health Letter
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Geographic Code:1USA
Date:Jul 1, 2009
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