Tapering the Estrogen Dose when using Progesterone Cream
by Eckhart, MD
Chronic Estrogen use makes you less sensitive to estrogen. As soon as you take progesterone cream, this makes you regain your original sensitivity to estrogen and it seems like you are getting more estrogen even though you are not.
As a result, using progesterone cream makes it seem like you are getting more estrogen (you regain your original sensitivity to estrogen).
So if you are taking estrogen supplements, and THEN take progesterone cream, you will require less estrogen. Most patients stop taking prescription brand name estrogen all together. So how do you stop the estrogen?
After taking progesterone cream, your estrogen sensitivity goes back up to normal. So immediately, cut the dose of estrogen to 1/2 of the original dose. Then taper off the estrogen VERY SLOWLY over a period of 6 months to 1 year. If you stop immediately, cold turkey, then the sudden drop in estrogen will cause hot flashes. To avoid hot flashes, SLOWLY TAPER off the dose of estrogen over a period of 6 months to one year.
If you still need to use estrogen, I like to give my patients Natural Estriol. Your body makes 3 kinds of Natural Estrogen, Estriol, Estradiol, and Estrone. Estradiol creates the feminine part of a woman. However, too much estradiol is associated with breast cancer and uterine cancer. Estrone and estriol are weak estrogens and go into the estrogen receptor and block estradiol and also xenoestrogens. Currently, health practitioners are backing away from estrone as some high levels / ratios were found in breast cancer patients.
John Lee, MD and I prefer to use Natural Estriol. Estriol is a natural hormone that goes up 100 times during pregancy. And what do we know about pregnant women? Women that have had many pregnancies have high levels of progesterone and estriol during their pregancy and have a smaller chance of breast cancer and uterus cancer.
One study done decades ago showed that natural estriol taken orally actually decreased the size of breast cancer tumors.
Thus, if you had to use an estrogen for vaginal atrophy or hot flashes, I would perfer that you use estriol. For vaginal atrophy and bleeding on intercourse the preferred estrogen to use is topical natural estriol applied directly to the vaginal tissue. You may use 0.5 mg - 2 mg every other day. Intitially, you may use topical estriol every day for 2 weeks and then use estriol 1 to 2 times per week as needed.
Where to Apply
Apply the progesterone cream to the skin anywhere where the circulation is good. Do not use where any lotion, perfume, or cosmetic is applied. You may apply it on the leg, the arm, the back, inner thigh and the chest. The topical progesterone cream is absorbed into the subcutaneous fat, and then slowly released into the blood stream where it is carried on the Red Blood Cell membranes and the chylomicrons (normal microscopic fat bubbles in the blood).
Rotate sites when applying Progestelle. If you just use one site, then the subcutaneous fat will saturate and you will not be able to absorb any more progesterone. For instance, if you keep doing right arm, right arm and right arm day after day, then you will not be able to absorb any more.
When you first try Progestelle, use only one drop at first so that if you have an allergy you will not get a big reaction. Usually, this is a reaction to the coconut oil, and NOT the progesterone. We do have other oils available.
Suggested Use
Use Progesterone Cream on days 12-26. Day 1 is the first day of your period. Use 20-40 mg/day of topical Natural Progesterone. Usually, you need 40 mg/day for the first 2-3 months, and then 20 mg/day for maintenance. However, there are some patients that are really good about their avoidance list and don't need to take progesterone after several months. Infrequently, some patients need to take progesterone for 6 months to 1 year to complete their menstrual period health.
If you are post menopausal you may take progesterone cream 3 weeks out of 4. Also you may use estriol the same 3 weeks out of 4.
If you have in increase in pain, bleeding, or discomfort, stop the progesterone cream immediately. Then, cut out all xenoestrogens and phytoestrogens according to the information that comes with the product. After cutting out all xenoestrogens and phytoestrogens for about 1-2 months, try the progesterone cream again.
The use of synthetic prescription birth control pills or synthetic prescription brand name hormones is not recommended. Synthetic prescription progestins will block Natural Progesterone. It is suggested that you use a condom without spermicide.
Increase in bloating, breast tenderness, and migraine headaches with the use of progesterone cream indicates the presence of some xenoestrogen (fake estrogen) or phytoestrogen.
Estrogen dominance will depress and decrease the activity of the thyroid receptor and will make you appear to be hypothyroid. Taking progesterone and cutting out xenoestrogens and phytoestrogens will revive the thyroid receptor back to normal and you will need less thyroid hormone. Make sure to work with your physician or health care professionally to decrease the thyroid dose. Hair should become fuller and fat less.
Every woman absorbs, metabolizes and reacts to progesterone differently. So you may titrate the dose to what your body likes. Your job is to find the least amount of Progesterone Cream that you need to get the desired effect.
A woman usually makes about 20-40 mg/day during the luteal phase of her menstrual cycle. During one day of third trimester pregnancy, her body makes 400 mg/day of progesterone. So you can see that progesterone is quite safe. And there is a wide therapeutic range of progesterone that is effective and safe.
Interactions
Birth Control Pills
Birth Control Pills may contain a synthetic progestin that blocks the Natural Progesterone. So Birth Control Pills cannot be used with Natural Progesterone. Progesterone is NOT recommended for birth control.
Thyroid
Estrogen Dominance (too much estrogen usually from xenoestrogens and phytoestrogens) causes thyroid receptor desensitivity. In other words, you become less sensitive to thyroid hormone. Thyroid tests are usually normal or below normal. However, the estrogen dominant patient looks hypothyroid. Hypothyroid patients have thinning hair, low temperature, and develop fat on the hips and belly. After 4-6 months of getting rid of xenoestrogens and phytoestrogens, and taking progesterone the thyroid receptor perks up usually and becomes normal. As a result, hypothyroid symptoms decrease and you become normal. Also IF you are taking thyroid supplements, these thyroid supplements should be slowly tapered off working with your doctor.
Before or After Ovulation
Progesterone taken before ovulation will fool the body into thinking it is pregnant, and the ovaries will not ovulate. In essence, the progesterone is saving your eggs for the future. However, progesterone taken after ovulation may encourage conception. Progesterone encourages a nice "nest" lining for the embryo to implant. You should work with your health care practitioner when using progesterone during pregnancy and lactation.
