| Progesterone Saturation: Too Much of a Good Thing? |
02.08.12 01:36:30 |
Video Transcript:
Hi. I’m Dr. Christopher Mote, and today is another ARK Clinical Pearl.
A common question that I get when I’m talking with other doctors on our clinical support calls is the use of progesterone creams. In general, progesterone creams are a good idea. It’s a way to get delivery of a hormone when it’s deficient. But there are problems with progesterone creams, and I don’t advocate their use universally.
The first problem I see with progesterone creams is that you’re really only gonna see the levels of progesterone that are attained in the body when you are using salivary hormone testing. Because you’re using a transdermal delivery system, because that progesterone tends to stay in those tissues and not get back to the bloodstream, you frequently will not see elevated levels of progesterone in serum testing, and if that’s your mechanism of testing, you’re not gonna be able to see when a patient gets super-saturated.
What happens is chronic use of progesterone creams leads to a buildup in those tissues, and because progesterone is a key facilitator to open the GABA chloride channel and allow for relaxation in a patient, toxic levels of progesterone would leave those GABA channels chronically open so that the patients are chronically sedated, depressed, fatigued. The progesterone, when it builds up in the tissues and becomes toxic to the body, then causes the body to hold more fat, hold more fluid, to buffer or dilute those toxins in the tissues so patients gain weight, and it will contribute to osteoporosis because you get peripheral conversion of that progesterone to cortisol and cortisone, which is catabolic.
So I don’t think that this is the ideal delivery system in every patient, and I certainly don’t recommend it in a premenopausal patient, because we are still seeing the fluctuations of the progesterone from the follicular to the luteal phase. But in a postmenopausal patient, the dosing can be titrated such that it could be a very effective delivery mechanism, but I will make two suggestions.
One is that if you’re gonna use the creams, have that patient monitor their salivary progesterone at least twice a year, and secondly, before you even start that, I urge you to consider maximizing that patient’s endogenous progesterone by looking at the HPA axis function and maximizing that first. A postmenopausal woman can get up to 50 percent of her progesterone needs met from the adrenal cortex but not if they’re locked in a chronic stress response.
So starting with the adrenals, adding just a little icing on the cake with the progesterone cream, can be an effective way to deal with the symptoms related to low progesterone.