Progesterone Deficiency, Yes; Estrogen, Maybe...

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Most women don't want to run to their doctors for every ache or minor illness that comes their way. They'd rather just wait it out and let the body heal itself. Or maybe, like me, they're simply afraid to go -- anxious about being misdiagnosed or having to bring home yet another package of potent prescription drugs, with their usual side effects. Or concerned about having to endure a deluge of tests, perhaps to be told that there is nothing wrong and to be presented with a huge bill.

As we age, our bodies can come to seem less friendly, putting us through many tests and challenges. I've seen this particularly in my older relatives and friends as they've begun to suffer from joint pain and arthritis in their fragile bodies. And it's hard to forget my own mother and elderly aunts, maneuvering cautiously and living as best they could with their pain. Nor are they alone among the countless women who have become dependent on family, friends, or nursing homes. Because most have never been exposed to natural hormone replacement therapy (NHRT), they are especially prone to increasing osteoporotic symptoms and heart problems, which force upon them sedentary lifestyles.

The great news is that we can avoid or lessen the severity of these conditions. Our challenge is to overcome our lack of education about what happens in a woman's body at puberty, during the menstrual cycle, and finally just before, during, and after menopause. The average woman is in the dark about the underlying causes of many of the problems she'll encounter at these times. As a result, she may accept treatment or therapy that is not really in her best interest. Unless we all take charge of our own bodies, we will continue to experience the same traumatic consequences.

In the pages to come, we'll discuss all this in detail. But first I would like to review some relevant basics about a woman's hormonal system, define some terms we'll be using, and look at some standard medical therapies.

THE RIGHT BALANCE OF HORMONES

Both progesterone and estrogen are vital to the life and well-being of every woman. These hormones are produced primarily in the ovaries, beginning at puberty and continuing, in the case of estrogen, for the rest of her life. The two hormones exist in a delicate balance, and variations in that balance can have a dramatic effect on one's health. Additionally, the amount of these hormones that the body produces from month to month and year to year can vary, depending on a whole host of factors such as stress, nutrition, and exercise.

Finally, at the onset of menopause there is a radical change: the production of estrogen decreases significantly and the production of progesterone virtually stops. This causes a major shift in the fine balance between the two hormones that the body has attempted to maintain to that point. This imbalance leads, inevitably, to the unpleasant menopausal symptoms many women experience.

This might be a good place to point out that the chemical building block for many of the body's hormones is cholesterol. Not enough emphasis is placed on the importance of our good cholesterol. Cholesterol is the first step in a complex process. It is converted into pregnenolone, which is the precursor of both progesterone and dehydroepiandrosterone (DHEA). From one or the other of these hormones, in turn, come androstenedione, testosterone, and the estrogens. So progesterone, estrogen, testosterone, and DHEA are all made from cholesterol.(2)

Estrogen is thought of as the female sex hormone. It is responsible for triggering all of the changes that take place in a girl's body at puberty and for sustaining them in later life, and it plays a vital role in the menstrual cycle. Unlike progesterone, which is a single hormone, estrogen is actually the general name for a group of perhaps twenty different female hormones of very similar structure and function. The most important of these are estrone, estradiol, and estriol.

In this book we will generally follow the layperson's convention of speaking of estrogen as if it were a single hormone. But bear in mind when we do so that we are really speaking of the actions of one or more of the particular estrogens. We will identify specific estrogens only when such identification is important to the discussion.

Both progesterone and estrogen have many functions in the mature woman's body, but the most important for our initial consideration is probably their role in the control of the menstrual cycle. Here the two opposing hormones work in careful balance to control the woman's reproductive functions, time the cycle, and sustain any eventual pregnancy. On cue from follicle-stimulating hormone (FSH), which triggers an egg to mature, estrogen starts the endometrial buildup and controls the first part of the cycle. Without an adequate level of estrogen, the cycle will not start. Estrogen production gradually builds to a peak just before ovulation, then levels off for the remainder of the cycle, dropping again at the end.

On the other hand, the ovaries dramatically increase their output of progesterone at the time of ovulation, about twelve or thirteen days into the cycle. They are prompted to do so by luteinizing hormone (LH) from the pituitary gland -- the same hormone that stimulates the release of the egg. The level of progesterone rises rapidly to a peak in three or four days, surpassing the level of estrogen, and remains elevated in order to develop and maintain the endometrium (uterine lining) in the event of conception. Progesterone dominates and controls the cycle during this latter half.

Progesterone is essential to the survival of the fetus and its continuing development until birth. Its name, in fact, is derived from this principal function: "pro-gestation." It has many other roles in a woman's body, though, and exerts a much broader impact on her health and vitality than might be supposed.

If conception does not occur within ten or twelve days, the levels of both progesterone and estrogen drop quickly, menses takes place, and the cycle starts over again. The dramatic drop of progesterone is the trigger that causes the body to shed the endometrium. In addition, it has been discovered that the presence of sufficient progesterone prior to ovulation (that is, prior to its normal surge) prevents the release of an egg by either ovary. Knowledge of this phenomenon led to the development of birth control pills, which employ synthetic progesterone-like compounds that simulate some of the functions of progesterone.

At menopause the body reduces the production of estrogen and halts the production of progesterone. The amount of estrogen in the body drops below what is necessary to start another menstrual cycle -- so no cycle can start. However, low levels of estrogen are still present. The level of progesterone, on the other hand, drops to near zero. For all practical purposes, the female body ceases to produce progesterone. This, then, is the condition of a woman's body after menopause -- the presence of reduced amounts of estrogen accompanied by a virtual absence of progesterone.

In optimal circumstances before menopause, any negative physiological effects of estrogen are suppressed by the opposing effects of progesterone. In the menopausal woman, though, the imbalance of these hormones causes the deleterious effects of estrogen to surface. They include tendencies to increased body fat, salt and fluid retention, depression and headaches, and increased blood dotting -- root causes of the well-known complaints of many menopausal women. As we shall see later, this same imbalance between progesterone and estrogen is frequently a cause of PMS in premenopausal women.

It's obvious, then, that a large number of women could benefit from the use of supplemental progesterone. It is very effective in treating or preventing the above conditions as well as menstrual irregularity, cramping, miscarriages, infertility incontinence, endometriosis, hot flashes, night sweats, vaginal dryness, cardiovascular disorders, and more -- because it restores the balance between estrogen and progesterone.(3-5)

Until recently the market was waiting for an abundant and inexpensive source of supply. A source was actually identified more than fifty years ago when scientists found progesterone-like substances occurring naturally in numerous plants. One of these in particular was a substance found in the wild yam, called diosgenin.(*) More important, researchers soon discovered that this natural substance could be easily converted to a compound that is very similar to the body's own progesterone. More recently this has been formulated into a reliable, inexpensive, natural cream.(6) So the supply is now at hand.

THE STANDARD TREATMENT

Unfortunately, natural substances themselves are not patentable and don't yield the large profit margins of proprietary drugs. So the pharmaceutical industry immediately went to work inventing synthetic (and profitable) prescriptive progesterone-like products derived from this very same source of natural progesterone. Soon a whole new class of substances, called progestins, was created by the industry. These progestins are widely used today in birth control pills and are the drugs of choice of the medical establishment to treat PMS and menopausal symptoms. One of them, Provera, was the drug originally prescribed for my own use. Very little attention was given to the possible use of the natural progesterone itself.

Just a note about names at this point, because there is a fair amount of confusion about what to call these synthetic substances. Some of the literature, and perhaps some doctors, may refer to progestins by the name "progestogens," "progestations," "progestens," or, in Europe, "gestagens." For the sake of clarity we will use the name "progestin" in this book. Just be aware if you see any of the other names that they are referring to exactly the same group of substances.

Many doctors persist in referring to these substances as "progesterone," but that is a serious error. There is only one progesterone -- the natural substance. The progestins so widely prescribed are synthetic substances derived from minute amounts of botanical source materials. They mimic some of progesterone's functions, and they have some advantages for particular applications, but all of them are chemically different from progesterone. This chemical difference causes all of the progestins to have significant side effects, whereas progesterone has no known side effects. That's important enough to repeat: the progestins all have possible serious side effects; natural progesterone produces no known adverse reactions. We'll talk more about this later.

Progestins have some limited advantages. They are administered orally, which makes them convenient to take. Further, the oral tablets facilitate specific and consistent dosage, making them convenient to prescribe. Last, their synthetic nature makes them much more difficult for the body to metabolize (compared with natural progesterone), so they stay in the body longer and have a longer-lasting effect. That's both good news and bad news. The good effects persist, but so do the unwanted ones.

This question of side effects is not to be taken lightly. In his book Natural Progesterone, Dr. Lee reprints just an abbreviated list of the side effects of Provera, the most common progestin used in menopausal treatment. He lists five specific warnings (including sudden or partial loss of vision and pulmonary embolism), eight contraindications (existing conditions you may have that preclude use of the drug), ten possible adverse reactions (such as breast tenderness, acne, and weight changes), and five other consequences (such as headache, loss of hair, change in appetite) that have been observed when Provera is taken with estrogens. In contrast, natural progesterone has -- I repeat -- no known side effects.

THE PERILS OF BEING A PATIENT

Many of us have strong concerns about taking artificial substances anyway. Deep down we know that most of the synthetic hormones and drugs we use won't correct the actual cause of our symptoms but will only temporarily relieve them and camouflage the problem. Yet, we often don't know where to turn. We listen to the doctor as he firmly advises us to continue with the prescribed medication. He gives us a fleeting sense of hope that we are going to put an end to this misery by saying, "You haven't given the medicine enough time," or, "Give it three to six weeks (or months) more."

You may have already experienced some side effects or felt worse since beginning the drug. You wonder, "What do I do now? How can I cope?" In my own case, I tried to find a way to deal with this dilemma and my resentment of a system that was not getting to the cause of my problems. To use the words of author Peter S. Rhodes, I tried "internal considering."(7)

Putting myself in the shoes of the medical doctors who were doing their best to treat me at the time, I said to myself: "Doctors are busy people with full waiting rooms and many interruptions for emergencies. When they go home, they're tired, and it's all they can do to try to keep up with all the latest findings." They must continually deal with new information and the stream of articles in scientific journals. Of course, that heavy schedule also includes business seminars given by drug companies and conferences with their representatives.

Soon, my "internal considering" began to fade. I had tried to give my doctors the benefit of the doubt, but I was well aware of what is certainly no secret: that doctors are heavily influenced by the pharmaceutical companies' sales force and by promotions for various drugs. I realized that the advice they would be giving me could be prejudiced.

Then and there, I decided to substitute action for consideration. The frustration I'd encountered forced me to face my own ambivalence. If I wanted unbiased answers to my questions, the time had come for me to do my own trail-blazing and to take responsibility for my own health. It was time to go to work. The following is what I found.

A VERY PROFITABLE BUSINESS

The puberty-to-postmenopause population provides the drag companies a booming business. This multibillion-dollar bonanza for the U.S. pharmaceutical industry, however, is taking its toll on more than half a million women, especially those going through the midlife crisis. It's no wonder more and more books are being written about the medical establishment's exploitation of women and our need to protect ourselves from becoming "hormonal guinea pigs."(8)

The commercially adulterated substances that are used today to create estrogen and progestin products, notwithstanding their poor utilization by the body, are misrepresented to the consumer as the "fountain of youth." At the same time, the plant-based phytohormones that the body is able to utilize go virtually ignored, having little place in the profit-driven world of drug promotion. What is sad is that misinformation about estrogen is being given to vulnerable women who are most desperately looking for relief.

No matter what "the authorities" say, "Estrogen is a potentially dangerous drug with significant side effects," warns Dr. Lawrence Riggs of the Mayo Clinic.(9) Nevertheless, the pharmaceutical industry has cultivated a great market among menopausal women by publicizing estrogen as "essential to a woman's good health and her womanhood."(10) However, as sales have been increasing, so have breast and endometrial cancer.

PROMOTING ESTROGEN: A POWER STRUGGLE

Estrogen is considered one of our most potent prescription drugs. In The Menopause Industry: How the Medical Establishment Exploits Women, Sandra Coney recounts this sordid tale: "Warnings about the dangers of estrogen had been made sporadically for nearly 30 years. In particular, it was known that estrone, the form of estrogen in Premarin, could be associated with the development of endometrial cancer. As early as 1947," she discloses, Dr. Saul Gusberg of Columbia University"called the ready use of estrogen `promiscuous' and warned that what was going on was a human experiment." He had observed too many estrogen users coming in for dilation and curettage (D&C) for abnormal bleeding caused by endometrial overstimulation, as well as documented cancerous and precancerous changes of the uterus.(11)

With time and with more investigation of the serious problems that were occurring, the FDA finally insisted that all prescriptions be accompanied by warnings about the risk of cancer, blood clots, gallbladder disease, and other complications. When this estrogen scare reached the public, sales began to decline. Without a moment to lose, however, the American Pharmaceutical Manufacturers' Association and the public relations firm for Ayerst Pharmaceutical, Hill and Knowlton, wasted no time in producing sales strategies and an intense promotional campaign. This included articles sent out to magazines (Reader's Digest, McCall's, Ladies' Home Journal, Redbook) and 4,500 suburban newspapers in order to "preserve the identity of estrogen replacement therapy as effective, safe treatment for symptoms of the menopause."(12)

Those with monied interests were so opposed to the FDA's plan for packaging the warning inserts that they took legal action, for "patient information would reduce sales of estrogen drugs and, therefore, reduce profits." Other organizations that joined in opposition were the American College of Obstetrics and Gynecology, the American College of Internal Medicine, and the American Cancer Society. They claimed that "giving patients information violated the physician's right to control how much information to disclose to patients and threatened medicine's professional autonomy." Eventually the U.S. National Women's Health Network introduced a brief to the court in favor of the FDA,(13) and the FDA won out.

Synthetic HRT remains a booming business. But because of the risks involved with the drugs, a variety of profitable tests, procedures, and drugs is called for along the way -- from blood tests, biopsies, and mammograms to hysterectomies, D&Cs, pain relievers, blood pressure medication, diuretics, and frequent doctor visits. And there are as many as 175 different possible treatment combinations to experiment with when bad reactions occur!(14)

Many of us don't recognize when we may have been given the wrong type of hormone. We are completely dependent upon what our medical doctors advise with respect to trying new formulations that have just come on the market. Yet, year after year, as we fail to get results from medicines developed through costly technology; we can't help but perceive the undercurrents of greed associated with products that are promoted at the sacrifice of public health. Slowly but surely, we are beginning to think twice about what's in store for us and are asking more questions that challenge the physician's monopoly of information.

What the medical establishment calls breakthroughs are often justified in the name of "consumer protection." However, we need to be mindful and learn as much as we can about what is best for our welfare. I think we should seriously consider the words of John Lee, M.D., over a decade ago concerning this frustrating situation:

The emerging realization that estrogen should never be given unopposed, i.e., without progesterone, due to its risk of developing endometrial carcinoma makes natural progesterone a valuable addition in those cases where menopausal symptoms require treatment...It is amazing to me that, given the extensive supporting medical references presently existing, estrogen without concomitant progesterone is still commonly prescribed.(15)

Previously I have discussed the different forms of estrogen. In this section I must reemphasize that two forms of synthetic estrogen, estradiol and estrone, are often prescribed in spite of being potentially tumor-forming. "It is believed but not proven that estrone is even more carcinogenic than estradiol,"(16) says Dr. Lita Lee. This is not good news, because orally administered estradiol is mainly converted to estrone in the small bowel.(17)

The next time your doctor prescribes these chemical compounds, you might want to ask this question: Why is Premarin, which consists of estrone and estradiol,(18) being prescribed when these hormones have been implicated as potential causes of cancer?

A study reported by Graham A. Colditz, M.D., in Cancer Causes and Control showed a 59 percent increase in breast cancer risk for women who had used synthetic HRT for over five years, and an additional 35 percent risk for those fifty-five years of age and older.(19) In conjunction with Harvard Medical School, Dr. Colditz extended his study of 121,700 nurses for a total of sixteen years. A later report published in the New England Journal of Medicine (June 15, 1995) concluded with similar figures and noted "a clear, significant increase in risk" associated with standard, long-term synthetic hormone replacement therapy.(20)

I have personally witnessed more than one of my friends and colleagues, after twenty or thirty years on various estrogenic substances, undergoing a mastectomy of one breast and another mastectomy two years later, and within about four more years they had died. They were denied a decent quality of life in what should have been their golden years.

We must all become more informed so as to avoid a possibly tragic outcome. If you need estrogen for any reason, ask for what may prove to be a safer form, estriol, which we'll elaborate on later in this chapter and in chapter 5. Even then, try it only after you have investigated other avenues.

REAL PROGESTERONE -- IT'S A NATURAL

The need for natural progesterone is confirmed and reiterated in numerous research papers. Progesterone has been prescribed for more than thirty years with no reported increase in cancer incidence.(21) In fact, a "Women's Health Report" in McCall's tells of research indicating that "progesterone deficiency -- which women with PMS have -- actually increases the risk of developing breast cancer."(22) This article records an astute observation by Phil Alberts, M.D., who heads a PMS treatment center in Portland, Oregon, that the stress that occurs during PMS often triggers ailments that do not seem at all related to one's hormones.

Who would guess that colds, flu, asthma, allergies, epilepsy, migraine headaches, and various endocrine disorders might be connected with a severe progesterone deficiency? Dr. Alberts explains that problems such as these, seemingly unrelated to PMS or menopause, tend to manifest themselves at times when a woman's immune system is depressed.(23) Progesterone is the real missing ingredient for increasing vitality, enhancing sexual libido, and reducing sleep disturbances.(24)

Upon finishing my personal research, I was overcome with strong feelings about the injustices inflicted upon the thousands of women who need this information and desperately deserve to be helped. However, turning my thoughts to a more positive sort of reflection, I began to think of all the medical doctors who are looking for better and more natural ways to help women avoid PMS and menopausal symptoms.

The physicians mentioned throughout this book are among the many who are now making available information on the benefits of natural HRT. More and more, you may come across published accounts by such individuals. For example, Niels H. Lauersen, M.D., says, "In my practice, hundreds of women who were severely handicapped by PMS have been completely symptom-free with progesterone."(25) We can place further reliance on the reinforcement of progesterone when we read in Dr. John Lee's book that progesterone also seems to assume a preventive role in PMS and other conditions.(26)

No wonder we feel gratitude for those who have introduced us to this natural treatment. We need to hear about the new findings over and over again. Otherwise, over and over again we will be enticed into trying synthetic hormones that only steer us further from homeostasis, the hormonal and metabolic balance we want to achieve.

THE PROTECTION AND POTENTIAL OF PROGESTERONE

One of the first things women ask is whether there are any adverse side effects with natural progesterone. All of my investigation says there have been no negative results -- only positive. In fact, Dr. Niels Lauersen tells us: "Progesterone is not believed to be cancer causing. No human cancer has been reported during progesterone treatment; quite the reverse, progesterone has been used in treating specific uterine cancers."(27)

Dr. John Lee mentions that when the proper progesterone dose is determined, "because of the great safety of natural progesterone, considerable latitude is allowed.(28) Occasionally, a slight feeling of drowsiness may indicate that you're using more than your body needs.

Not only does natural progesterone have no serious side effects, but it is a precursor of other hormones including adrenal corticosteroids, estrogen, and testosterone. Dr. Lee informs us that it participates in the ultimate formation of all the other steroids and hormones.(29) Progesterone is beneficial in treating or preventing

- irregular menstrual flow; cramping

- bloating; depression; irritability

- migraine headaches; insomnia; epilepsy

- miscarriages; infertility; incontinence; endometriosis

- hot flashes; night sweats; vaginal dryness

- hypoglycemia; chronic fatigue syndrome; yeast infections

- heart palpitations and other cardiovascular disorders

- osteoporosis (reversible by increasing bone mass)(30-33)

With progesterone, blood pressure often returns to normal,(34) body fat is burned up for energy, and cell membrane function is safeguarded.(35) Progesterone not only has an anti-inflammatory effect but also helps balance the cellular fluid, which protects against hypertension.(36)

However, be especially careful if you are taking estrogen for the purpose of preventing heart disease. Epidemiologic investigations and many other studies show that estrogen has no coronary benefit and that its use increases not only the risk of cardiovascular disease but also the risk of stroke or even bleeding from a brain artery. Doctors have been giving estrogen on the basis of a study"limited to postmenopausal women free of any history of cardiovascular disease or cancer." Statistics can be easily manipulated, with mainstream medicine's focus on estrogen and its eagerness to prescribe estrogen hormone replacement therapy. As Dr. Lee says, the media have perpetuated the estrogen myth, even though the hype was built on flimsy evidence.(37)

It should be noted that the seventy of endocrine or reproductive system disorders can be affected not only by hormonal imbalance but also by poor diet(38,39) or by nerve interference within the neuromusculoskeletal system.(40) Many doctors do not adequately address these factors or the probable underlying progesterone deficiency, which is often accompanied by an overabundance of estrogen. Instead, they rely on treatment with antidepressant drugs, aspirin, ibuprofen, other analgesics, or sleeping pills. Fortunately, a much more effective remedy is available in the form of natural progesterone cream, which offers these further benefits:

- protects against fibrocyst formation, especially in the breast

- keeps the uterine lining healthy, helping to prevent fibroids, etc.

- assists thyroid hormone action

- normalizes the blood-clotting mechanism

- restores libido (sex drive)

- acts as a natural antidepressant(41-43)

Adverse symptoms can begin when a woman is in her thirties or even at the onset of menses in her teen or preteen years. So it is important to be thinking about natural alternatives in the years prior to menopause. Prevention is essential for any health condition, and the sooner we look into natural sources, the sooner we can start to think, look, and feel as young as we are. After studying what natural progesterone does for the bones, the heart, and the body as a whole, we can better understand the need for it as part of a natural HRT program.

Now You Don't Have to Refuse Hormone Supplements

I so often hear women repeating the same thoughts I once had: "I won't take hormones. I don't believe in taking pills." That's because many people don't make the distinction between natural ingredients and most of the drugs that are continually portrayed on TV. Yes, NHRT is in a different class, as it represents a natural replacement that the body needs; and yes, we do need to continue to resist commercial inducements to take pills, and to try to ignore the medical hype.

Concerning the need for NHRT, Dr. Betty Kamen states in her book Hormone Replacement Therapy: Yes or No? that even if you don't have menopausal symptoms and have a good diet and exercise regularly, the use of natural progesterone is still recommended to fortify one's body for today's steady diet of stress. And to be realistic, she points out, no diet is perfect anyway; and we all cheat on top of that.(44) No matter how diligent we are in maintaining a proper diet, there are always days when we want to escape from the stresses of life, saying, "Everything will be OK. Here, have a treat -- something sweet. It will make you feel better!"

Cravings for ice cream, doughnuts, or other simple carbohydrates can be pretty powerful. When stress takes over your senses, no one has perfect control, and if you do, you are the exception. It's easy to forget in that moment that the sugar will only stress one's system more. But, while using natural progesterone does not justify such lapses, we can take some comfort in the knowledge that it helps support the adrenals and our stress glands and helps protect against hypoglycemia.

Dr. Kamen confirms my own experience as to the need for natural progesterone when she says, "Perfect lifestyles/diet may be impossible for perfectly good reasons. Don't feel guilty. Feel better! Natural progesterone could make the difference."(45)

Natural HRT has made me feel like myself again. And I truly believe it will begin to reverse whatever damage the synthetic HRT may have done to my body. Fortunately, I did take antioxidants back then (and still do) to fight any free radical damage, and I added other vitamin and mineral supplements to my daily diet to help counter what might have been toxic to my system.

It is interesting to note that progesterone, a precursor of other hormones, is so nearly perfect for our body chemistry that even its promoters can't exaggerate its importance. Without it I can testify that I felt stressed, run-down, and dependent on medical help; with it, I feel energetic, calm and, most important, free. Menopause does not have to be treated as an illness. It can be better viewed as a challenge! Once a woman establishes proper hormone balance through natural methods, she'll find she's taken a great step towards increased vitality.

It's Safe, It's Sound, It's Easy

For some practical guidance, let's look now at two principal means by which to supply natural progesterone most efficiently to the body: either oral capsules (taken by mouth) or transdermal cream (applied directly to the skin). Some other methods that may be useful will be covered in appendix A.

The most popular way to apply natural progesterone is with the cream. Dr. John Lee reports that he has been using transdermal natural progesterone in postmenopausal women since 1982 and has seen remarkable success.(46) "Progesterone," he says, "like all gonadal steroids, is a relatively small and fat-soluble compound which is efficiently and safely absorbed transdermally. Not to use it in cases of progesterone deficiency is imprudent, to say the least."(47) He cautions, however, that any product containing mineral oil may "prevent the progesterone from being absorbed into the skin."(48) Furthermore, according to Dr. Raymond F. Peat, certain components of mineral oil (which is in many cosmetics) are toxic, and any that does get into the system does not metabolize.(49)

The cream is now available in many brands and formulations and at varying strengths. Researchers have measured the levels of hormone in women who were using various wild yam creams that do not contain USP (U.S. Pharmacopeia) progesterone. While many of these creams worked well, some were found not to have much effect. However, according to Aeron LifeCycles Clinical Laboratory in San Leandro, California [(800) 631-7900], most of the creams that contained USP progesterone did produce hormonal changes in most women.(50) (See chapter 4.)

Christiane Northrup, M.D., in her book Women's Bodies, Women's Wisdom, also recommends natural progesterone over synthetic because it is compatible with the body and does not have the side effects (bloating, depression, etc.) produced by progestins.(51) Dr. Peat agrees that transdermally applied progesterone is effective for most symptoms as well as for long-range maintenance.(52) Dr. Lee points out that in the beginning stages of treatment some of the application may be retained in the subcutaneous fat layer sometimes delaying the initial physical response. However, the longer a woman uses the cream, the greater the benefits.(53)

Alleviation of symptoms as a clinical response provides a good yardstick for comparison. As with many forms of health care, starting with the least invasive product (in this case the mildest) gives you a baseline for evaluating your response. You can always switch to a stronger product or add to your initial treatment program.

During the years of menopause, I personally found the use of the transdermal progesterone cream to be adequate for my needs. As I proceeded into postmenopause, however, I felt that the micronized natural progesterone, taken orally in combination with estriol, was more effective in meeting my body's demands. During periods of excessive stress, I add the cream to my program as well, since the progesterone is a precursor of the adrenal hormones.(54) This, in combination with daily nutritional supplements, seems to take care of all my postmenopausal problems.

Micronization Enhances Effectiveness

In the past, progesterone taken orally was considered ineffective because of its poor absorption rate(55) and its premature removal by the liver. Recent advances, however, have changed the picture. Breaking the progesterone down through the process known as micronization has been shown to enhance the rate of absorption and hence the effective level in the body.(56) And according to Rabbi Eric Braverman, M.D., "When compounded in an oil base, the progesterone is so firmly held by the oil base that it is actually absorbed through the lymphatic system first, thereby allowing a couple of passes through the body before being cleared via the liver."(57)

Several pharmacists I have talked to said essentially the same thing. Dr. Peat explains how this works: "If progesterone is perfectly dissolved in oil, it...is not immediately exposed to enzymes in the wall of the intestine or in the liver. People often speak of `avoiding the liver on the first pass,' but in fact chylomicrons [microscopic fat droplets] pass through the liver many times before they are destroyed."(58)

One knowledgeable pharmacist at Women's International Pharmacy, however, told me that if a person's liver is not functioning fully because of compromise by alcohol or disease (such as hepatitis), the cream form may be more effective. He described the transdermal progesterone as "productively potent" because it acts systemically before it acts locally. This process can be quite beneficial, as it cuts down on some of the work the liver has to do.

Progesterone is not the only hormone that can be micronized. We have referred previously to the estradiol form of estrogen as being harmful. However, for those readers who are reluctant to give it up, please note that studies in which estradiol has been broken down, through micronization, for utilization by the body have ascertained that when natural progesterone is prescribed along with minute doses of the micronized estradiol, both hormones together are at least safer than the standard synthetic HRT. (Nevertheless, if estrogen is deemed absolutely necessary for long-term use, estriol should be considered, and will be discussed in the next section.)

First, let's look at one trial involving a"combination of micronized estradiol (E2) (0.7-1.05 mg) and natural progesterone (200-300mg) given to ten menopausal women with vasomotor problems and/or vaginal atrophy. Five other women," the report says, "were placed on a daily course of conjugated estrogens (0.625 mg) with medroxyprogesterone acetate (10 mg)."(59,60) All women in the first group (on E2 and nonsynthetic progesterone) had a decrease in total cholesterol and an increase in high-density lipoprotein cholesterol. Those on conjugated estrogens and medroxyprogesterone acetate (Provera), on the other hand, had no meaningful changes in their total cholesterol but some increase in their HDL. In this study they found: "Most significantly, the adverse effects of synthetic progestins on lipoproteins and cholesterol were eliminated by using natural progesterone."(61)

The experiment showed that "administration of micronized E2 and progesterone results in symptomatic improvement, minimal side effects...improved lipid profit [fat balance], and amenorrhea [no menstrual periods] without endometrial proliferation or hyperplasia [precancerous uterine abnormalities] in menopausal women."(62) Obstetrics & Gynecology says in its evaluation, however, that women who still have a uterus and have been on estrogen therapy for a prolonged period of time, without the addition of some form of progesterone, are at increased risk of endometrial hyperplasia and adenocarcinoma:

The problem of endometrial hyperstimulation induced by estrogen therapy is obviated by the addition of cyclic progestin to the hormone replacement....A number of synthetic estrogens and progestins have been used for postmenopausal replacement hormonal therapy, both cyclically and as a daily combination.(63)

The review goes on to say that there are disadvantages to the synthetic compounds.(64) Indeed, study after study confirms our need to choose hormones in their natural form over the synthetic versions. And for women concerned about possible side effects of the estrogens, using progesterone alone would be the most sensible course to follow.

In one set of trials, various preparations of progesterone were used: (1) plain-milled, (2) micronized (more finely ground), (3) plain-milled in oil, (4) micronized in oil, and (5) micronized in enteric-coated capsules. All of these preparations were administered orally to six postmenopausal women in order to establish which combination would achieve the best absorption rate. These were the findings:

Micronized progesterone in oil showed the highest average progesterone concentration....[A] decrease in the particle size of progesterone through micronization increased aqueous dissolution in the intestine and further enhanced absorption....Progesterone taken orally is physiologically active, producing a significant increase in tissue progesterone concentrations in breast, endometrium, and myometrium.

On the basis of the results of this study, the optimal preparation for the administration of natural progesterone should include micronization of the progesterone particles and dissolution in oils consisting of principally long-chain fatty acids.(65)

Other important research exists, however, showing much greater effectiveness and less toxicity to the tissues with a base of natural vitamin E (tocopherol -- not the cheaper tocopherol acetate some manufacturers use).(66) In the same journal it is stated that "oral progesterone has not shown any adverse effect on the beneficial changes in serum lipoproteins induced by the administration of estrogens."(67) In fact, a major medical journal consultant has commented that the concept of dissolving progesterone in vitamin E for absorption into the lymphatic system "is so simple it is amazing that the pharmaceutical companies have not jumped on it."(68)

The aforementioned study, along with thirty-three others in the report, demonstrates that a micronized natural progesterone preparation given orally raises blood levels of the hormone with no observable adverse side effects (such as bloating, breast tenderness, weight gain, and depression), all of which are induced by synthetic hormones.

The American Journal of Obstetrics and Gynecology, while still advocating estrogen therapy, concedes: "Oral natural E2 and progesterone would seem preferable for long-term replacement therapy."(69,70)

THE OVERLOOKED ESTROGEN

You've probably heard a lot of discussion these days about estrogen. It seems that most women of a certain age are either on it, pondering whether to start it, or contemplating getting off it. Some have been made to believe that it is the cure-all for PMS and menopausal discomfort, heralded to end all our female problems. In chapter 3 we will find that this type of promotion has led to widespread suffering and disease. Here we will review another estrogen now attracting interest: estriol, which is not normally prescribed by your doctor.

In its pure tablet form, estriol has been administered in thirty different countries for more than thirty years.(71) One of the advantages it has over other estrogens is its use for urinary or vaginal symptoms, with little or no contraindication to the uterus. Estradiol (brand names: Estrace, Estraderm) and estrone (brand names: Premarin, Ogen) cause the lining of the uterus to thicken, thus increasing a woman's risk of endometrial cancer. Estriol, on the other hand, has a weaker stimulatory effect on the uterus.(72)

In any form, unopposed estrogen supplementation as usually prescribed may put you at risk unless botanical progesterone is used to counter any excess of estrogen. So if and when you contemplate estrogen therapy, consider the possibility of combining progesterone with estriol or estrogenic herbs (see chapter 6). Some companies, recognizing the danger of using estrogen alone, are now marketing an estrogen/progestin combination pill -- but as we know, a synthetic version is not the same.

Estriol for Managing Infections and Restoring Tissue

A couple of studies have found that with the use of estriol, vaginal tissue is restored to a normal, healthy condition.(73) With as little as 3 mg daily of estriol, vaginal flora were renewed.(74) Furthermore, vaginal application of the unconjugated estriol cream (not synthetically compounded) was found to be more effective than estriol taken orally at the same dosage.(75)

Beneficial results were also found in a controlled study of postmenopausal women with a history of chronic urinary infections. The reduction in urinary infections was significantly greater with those on estriol than with those on a placebo.(76) In another study, normal pH was restored after 1 mg of oral estriol was administered daily for one week.(77)

The clinical studies found no contraindications when the proper doses of estriol were prescribed.(78) No water retention was observed in the clinical studies,(79) nor changes in blood pressure(80) or abnormalities in routine urinalysis or cholesterol levels.(81-83) By contrast, the forms of hormones that are usually prescribed, which are compounded with synthetic substances, have indeed been shown to result in the aforementioned conditions.

One downside to estriol is that there have been no studies concerning its effect on bone mineral density. It is often presumed to be the weaker estrogen (although some studies have found the contrary)(84) and thus is also weaker than estradiol and estrone in retarding bone resorption. During pregnancy, estriol levels are extra high at a time when the body may be drawing on calcium and other minerals from the mother's bones to supply the developing skeleton of the baby. Based on this reasoning, if a woman is not at high risk for cancer, Dr. Lee would prescribe progesterone as the primary hormone, but might also add some estriol in combination with estradiol and estrone, a ratio of 4:l:l or 1:1:1. The latest research finds that estradiol is transformed into estrone in the intestinal tract. Because of the strong implication of estrone in hormone-mediated cancers, some physicians prescribe bi-estrogens (80 percent estriol and 20 percent estradiol) along with the progesterone.(85)

Should I Use Estriol?

What might be completely effective for one woman may not be the complete cure-all for another. If you find that hot flashes and other discomforts are still bothering you even after using natural progesterone (as directed and for a minimum of three months), you might try a stronger source of yam extract cream, a USP progesterone, or a prescriptive product before considering supplemental estriol. Although I chose to do the latter, those who know they are at high risk for breast cancer should think twice about using any estrogen -- or an excess of phytoestrogens -- until we have more knowledge of their consequences. In clinical investigations, hot flashes were diminished when estriol was used in doses of 1 to 8 mg daily, depending on the patient's need.(86,87) In most patients, estriol resolved problems with not only vaginal atrophy, but also headaches, insomnia,(88) irritability,(89) nervousness,(90) tiredness, heart palpitations, and depression.(91)

It also helps with urinary incontinence, which often affects postmenopausal women because, according to a scientific abstract, "in the postmenopausal [woman], the urethra becomes narrower and more sensitive to the passing of urine."(92) Progesterone alone may help some women with incontinence, as a deficiency of this hormone, according to Dr. Ray Peat, makes the bladder more sensitive. Others have felt the need to try estriol. In one study, improvement was considerable when patients were treated with 3 mg of estriol daily.(93)

Dr. Alan Gaby contends that the use of estriol could reduce the need for D&Cs and even unnecessary hysterectomies, because it rarely produces endometrial bleeding. Estriol is also effective in lowering the risk of blood clots in the lungs and veins. Dr. Gaby comments in his book Preventing and Reversing Osteoporosis that to relieve menopausal symptoms, "a dose of 2 to 4 mg of estriol is considered equivalent to, and as effective as, 0.6 to 1.25 mg of conjugated estrogens or estrone."(94) Of the three estrogens that naturally occur within your body, some doctors believe that estriol should be dominant. Vitamin E supplements can increase the ratio of estriol to estradiol and estrone.(95)

During my study I read an article written in 1991 by Dr. Lira Lee, who reported that she was not able to obtain estriol and that it was not easily available in the United States. She was limited to using a homeopathic estrogen, of which she said, "It works....No more hot flashes!"(96) Today, however, estriol in its natural form is very much available in the United States.

Dr. Lee points out that except during pregnancy, less than 1 percent of the estrogen we normally make is estriol. However, because of certain preliminary studies regarding cancer and many women's positive experiences with this hormone, he agrees that more study is certainly warranted.

Dr. Marcus Laux prescribes "tri-estrogen" therapy to his patients. For some postmenopausal women he recommends a ratio of one part estrone, one part estradiol, and eight parts estriol, along with application of natural progesterone cream to the breasts.(97) Indeed, in Fertility and Sterility (April 1995) we find evidence that natural progesterone applied directly to the breast does offer protection against estrogen's stimulatory effect on breast cells.(98) Other ideal skin sites are the places where the capillaries are abundant and closer to the surface, such as the areas where we blush and the hands and inner arms. Since the skin of the lower abdomen, thigh, and back is thicker and less well supplied with superficial capillaries, absorption at these sites is less efficient.

Excess Estrogen Equals Excess Weight

Contrary to popular opinion, researchers make it clear that menopause does not mean an absolute end to estrogen production. Two other parts of the body besides the ovaries produce estrogen: the adrenal glands and the fat tissue. These, says author Sharon Gleason, "will maintain low levels of estrogens to minimize symptoms."(99)

Dr. John Lee states that a sign of estrogen dominance is weight gain caused by both water retention and fat deposition at hips and thighs. This is an interesting point, because I have found that many women wonder why they are gaining weight even though they are exercising and on a strict diet. One of my neighbors thought she had gained weight because she had given up smoking. At the same time, however, her doctor had put her on estrogen therapy for her menopausal problems, informing her (albeit incorrectly) that this hormone would be good for bone growth and make her feel a lot better. After talking to her I couldn't help but think that her accumulation of a middle-age spread could very well stem from the dual effect of her synthetic estrogen (prescribed alone) and the rapid drop in progesterone level that accompanies menopause.

Another case is highlighted in The Menopause Industry, by Sandra Coney. This woman, prescribed Premarin for her joint problems and pelvic inflammation, began to put on weight "at an alarming rate" and was then switched to different forms of estrogen, including Estraderm patches and implants. The unfortunate result was a thirty-five-pound weight gain, fluid retention, and breast discomfort.(100)

In contrast, botanical progesterone is a natural diuretic. It burns fat (often caused by high doses of synthetic estrogen already in the body) for energy and lowers cholesterol levels(101) -- once again helping to avoid another unwanted side effect of synthetic HRT.

Other Side Effects of Estrogen Dominance

Dr. John Lee proposes further reasons why estrogen should not be given without natural progesterone, and why we may begin to feel more and more uncomfortable if we take estrogen alone for any length of time. He says that estrogen "allows influx of water and sodium into [the] cells, thus affecting aldosterone production leading to water retention and hypertension. Estrogen," he continues, "[also] causes intracellular hypoxia [oxygen deficiency], opposes the action of [the] thyroid, promotes histamine release, promotes blood clotting thus increasing the risk of stroke and embolism, thickens bile...promotes gall bladder disease [and] causes copper retention and zinc loss."(102)

Is it any wonder that so many women feel miserable when using synthetic estrogens? And is it any wonder that Dr. Lee says, "Something is wrong with the estrogen theory"? Prescribed alone, estrogen can lead to breast or uterine cancer even five years prior to menopause.(103) Other consequences of estrogen dominance, he says, include "heightened activity of the hypothalamus [and] hyperactivity of adjacent limbic nuclei leading to mood swings, fatigue, feelings of being cold, and inappropriate responses to other stressors."(104)

Just before menstruation, as Dr. Lee says, too much estrogen in the body often causes edema, or swelling and bloating. Dr. Ray Peat agrees: "Under the influence of estrogen, your body retains extra water."(105) This, he says, is one reason we often crave extra salt.

Some authorities recommend cutting down on salt the week before one's period in an effort to reduce bloating and breast tenderness. However, Dr. Peat points out the often overlooked fact that sodium "is essential for [maintaining] adequate blood volume, and that it is almost always unphysiological and irrational to restrict sodium intake." He explains that "reduced blood volume tends to reduce the delivery of oxygen and nutrients to all tissues, leading to many problems."(106) (For more on the wise use of sodium, refer to Jacques de Langre's book Seasalt's Hidden Powers.)

FIBROCYSTIC BREASTS

Estrogen dominance in the body causes fibrocystic breasts. However, Dr. Lee assures us, "Restoring hormone balance with natural progesterone usually results in prompt clearing of the problem....When natural progesterone is used...during the two weeks before menses, fibrocystic breasts revert to normal within 2-3 months."(107) One patient, who came to him fearful of breast cancer, reported having undergone repeated needle drainage and biopsies. But as one might expect, after a course of progesterone and an improved diet, not only had her cysts disappeared, but many other symptoms were also relieved.(108)

Dr. Lee's instructions for use of the cream are quoted in the popular book Alternative Medicine. "Using this progesterone transdermally," he says, "from day fifteen of the monthly cycle to day twenty-five will usually cause breast cysts to disappear."(109)

Concerning fibrocystic breasts, Dr. Nina Sessler says:

Avoiding caffeine and other methyl xanthine derivatives such as black tea, most colas, and chocolate, as well as many nonprescription and prescription medicines which contain methyl xanthines, has been shown to help a great deal with the discomfort. Many physicians recommend vitamin E (400-800I.U.) and...vitamin C can also help reduce the inflammation that often accompanies FBC [fibrocystic breasts].(110)

On the other hand, noted breast surgeon and author Susan M. Love, M.D., states that most studies of caffeine and benign breast disease have been either inconclusive, unscientific, or contradictory and that the popular perception of a connection may or may not be a reality. She points out that individual physiological differences could account for caffeine's affecting one person but not another.(111)

Several years ago, Dr. Linda Force had surgery on her breast to remove a fibrocyst. Following the surgery her breast swelled to twice the normal size and was very painful. The surgeon had not removed all of the cyst because it would have created too much deformity. Dr. Force says, "As time went on, I controlled the problem by watching my diet and avoiding caffeinated beverages. But when I was thirty-five and developed PMS, the breast discomfort intensified. This is when I went to Dr. William Douglass, who dispenses rectal progesterone therapy over a three-month period. For those months only, I was fine. After that, my discomfort was not as bad as it had been previously, and I learned to tolerate it. But every month when my period would start, my breasts would swell and become very sore."

Fifteen years after the first surgery to remove her fibrocysts, Dr. Force was still suffering from the cysts, which were getting more and more painful as time went by. Her medical doctors were advising her to undergo surgery again if they didn't clear up. That's when I provided her with literature about the transdermal progesterone cream. It explained how the decline of progesterone can create estrogen dominance which in turn can cause any number of disorders such as fibrocysts, weight gain, endometriosis, depression, and more. Her first question was, "Is it natural?" I assured her that it is botanically derived and that she had nothing to lose.

As a doctor, she quickly understood the dangers and side effects of unopposed estrogen. The fact is that when estrogen is administered to women with fibrocystic breasts, their condition becomes worse. However, it is easily treated with progesterone therapy.(112)

Beginning her treatment immediately, she conscientiously applied the cream to the sites of the lumps in her breast and to her abdomen twice daily, once in the morning and once at night. As the weeks went by, she saw subtle improvements (more regularity and less clotting) during her periods. After three months, her fibrocysts had disappeared and she was free of the pressure and pain she'd previously had. Her relief at having avoided the prescribed surgery and drugs was evident. And as a true health provider, she soon made this important information about natural progesterone cream available to all her patients and staff.

UTERINE FIBROIDS AND OVARIAN CYSTS

Dr. John Lee refers to fibroids that develop in the uterus as

another example of estrogen dominance secondary to anovulatory cycles and consequent progesterone deficiency. They generally occur in the 8-10 years before menopause. If sufficient natural progesterone is supplemented from day 12 to day 26 of the menstrual cycle, further growth of fibroids is usually prevented (and often the fibroids regress).(113)

Ovarian cysts are also a problem in many women. Dr. Peat says these are usually associated with a low thyroid condition, and that administration of thyroid hormone can get rid of them by lowering estrogen levels and making the ovaries produce more progesterone.

Dr. Lee's approach, on the other hand, is to administer just the progesterone directly. He says that "natural progesterone, given from day 5 to day 26 of the menstrual month for two to three cycles, will almost routinely" cause disappearance of these cysts by suppressing normal FSH (follicle-stimulating hormone), LH (luteinizing hormone), and estrogen production and giving the ovary time to heal.(114) Furthermore, studies have been reported in the Journal of the National Cancer Institute as far back as 1951 in which progesterone even produced evidence of regression of cervical tumors.(115)

It's reassuring to know that progesterone can protect us in so many ways; but we must all be alert to the fact that the long-range harmful effects of "estrogen dominance" in the body are not widely recognized.

ENDOMETRIOSIS

Majid Ali, M.D., calls endometriosis, which he says afflicts five million American women, "a painful, often disabling disorder that can lead to infertility." It is sometimes treated, mistakenly, with synthetic birth control pills. He blames estrogen "overdrive" for the "growth outside the uterus of misplaced cells that normally line the uterine cavity."(116) Linda G. Rector-Page, N.D., Ph.D., adds that this tissue often attaches to other organs, and there is a backup of some of the heavy menstrual flow.(117)

Dr. Ali maintains that treatment with synthetic estrogens, so widespread among doctors, is a grave error. In fact, Women on Menopause, by Anne Dickson and Nikki Henriques, reveals that unopposed estrogen was first linked in 1970 to "abnormal cell growth in the endometrium," resulting also in the possibility of endometrial cancer.(118)

Today, women need to be aware of the many other serious side effects when estrogen is administered alone and their progesterone levels are down: nausea, anorexia, vomiting, headaches, and fluid retention leading to weight gain. It is important, say the authors of this book, for women who have other physical disorders to avoid supplementation with only estrogen, for it can exacerbate high blood pressure, diabetes, migraine, and epilepsy. A study in Sweden also showed that women using high doses of the synthetic estrogen known as ethinylestradiol (used in lower doses in the birth control pill in the United States) had an increased rate of breas t cancer.

Sandy MacFarland, who was suffering from endometriosis, was only nineteen when her gynecologist suggested she have a hysterectomy. According to the Endometriosis Association, this condition, which affects girls and women from the ages of eleven to fifty, is "the leading cause of hysterectomy."(119) Fortunately, Sandy's father was a nutritionist, and he decided to try to correct what he thought might be a hormone imbalance with natural progesterone. This decision not only saved Sandy's uterus but also normalized her once irregular periods.

HYSTERECTOMIES: FORCED MENOPAUSE THROUGH SURGERY AND SYNTHETIC HORMONES

Hysterectomies are recommended for numerous reasons, often unwarranted. They are frequently suggested when women complain of adverse reactions to their prescribed estrogen or progestins. A doctor may recommend a hysterectomy instead of offering natural therapies that facilitate the body's own healing process. Gall Sheehy, in her book The Silent Passage, tells us that doctors will justify to their patients a more radical surgical approach by explaining that they won't have to take the hormones that have been causing such irritating side effects. The surgery will free them from the worry of having to protect their uterus with hormones.

Gail Sheehy asked one doctor if he took the ovaries out as a routine procedure. The doctor nonchalantly told her, "In a postmenopausal woman, the ovaries are of no use anyway." In dismayed retrospect, Sheehy asks, "Wasn't this extreme?" This doctor was disregarding the fact that the ovaries continue to manufacture testosterone, which, as Sheehy points out, "strongly influences a woman's sexual desire and energy."(120)

We might want to think several times before considering a hysterectomy. Every organ has an integral role to play throughout one's entire life. In her book Sheehy tells us that "between 33 and 46 percent of the women whose ovaries had also been removed complained of reduced sexual responsiveness."(121) Dr. Howard Judd of UCLA, an expert on the postmenopausal ovary, emphasizes that "the concept that the ovary bums out is not true."(122) The fact is that after menopause, even though the ovaries no longer produce estrogen, they do manufacture testosterone.

Sheehy relates that most women who have undergone hysterectomies are in the age group of twenty-five to forty-four. When the cervix and uterus are removed, some women feel the effects of menopause within two years of the surgery. However, an oophorectomy (where the ovaries are removed) will generally bring on the state of menopause immediately. So, coerced menopause often befalls women when they are quite young.(123)

Menopause usually begins around the ages of forty-five to fifty; and the last period is experienced in the early fifties.(124) However, ovarian defect can begin at thirty. Undue trauma, or more than normal physical or mental stress, can bring on menopause years sooner. If a woman smokes, has a poor diet, is on medication, or has undergone surgery, chemotherapy; or radiation, she will also experience a dramatic loss of progesterone, which accelerates the aging process. And the degree of menopausal symptoms can also vary enormously in accord with each individual's genetic differences.(125)

STROKES AND BLOOD CLOTS

My personal experience with blood clots began two months after the laboriously long and difficult delivery of my son. As I was adjusting to my newborn baby, who had colic throughout the night, the meaning of stress became dear beyond doubt. Dr. Lee has mentioned that when stress is heightened, a woman is predisposed to anovulatory cycles (menstrual periods with no ovulation). And conversely, he says, "Lack of progesterone interferes with adrenal corticosteroids by which one normally responds to stress."(126) Also during the immediate postpartum phase, progesterone levels are near zero until ovulation resumes.

I had no way of understanding then the underlying and multiple reasons for my stress and immense weakness, or why my body could not adapt to the demands of taking care of an infant during the night and a two-year-old during the day, while cooking for family and friends who had come to join us at this time of celebration.

As the days proceeded, I rapidly lost motor control on my left side. Within two months after the birth, my left side had become paralyzed as the result of a blood clot that had lodged in a blood vessel wall on the right side of my brain. This embolism left me helpless and traumatized for several months. The neurosurgeon, my OB/GYN, and other specialists were completely mystified as to the cause of my condition.

This postnatal paralysis all took place twenty-six years ago. Now, however, after sifting through much research, I can't help but speculate that progesterone deficiency was perhaps one of the causes for my stress and that natural progesterone might have rescued me from the trauma I had endured. I recall, too, that Dr. Peat writes that during stressful times in a woman's life, supplementation with the hormone progesterone is urgently needed to correct imbalances in the endocrine system.(127) Have these doctors and researchers solved the mystery that was so puzzling to my specialists over two decades ago? Progesterone may help many at-risk women to avoid strokes and other stress-related disorders.(128)

THE HORMONAL DUET

Needless to say, the above experience took place during my childbearing years. Comparing the premenopausal stages of life with the menopausal and even postmenopausal stages, we view hormone replacement in different ways. Our needs differ depending on many factors: our symptoms, age, diet, amount of exercise, level of stress, and other lifestyle habits.

We also need to remember that the menopausal or postmenopausal woman does have some estrogen -- it's the progesterone that is no longer produced anywhere in her body to any noticeable degree. It makes one wonder why medical doctors have been prescribing estrogen replacement for so many years -- often to the exclusion of progesterone, the disregarded hormone.

Estrogen and progesterone need each other, as each of them sensitizes receptor sites for the other. As Dr. John Lee says,"The presence of estrogen makes body target tissues more sensitive to progesterone and the presence of progesterone does the same for estrogen."(129) It appears that these two natural hormones in proper balance, and unadulterated, have a harmonious mutual affiliation.

Dr. Betty Kamen writes, "Estrogen regulates the neurotransmitters of the brain -- substances which control the function of our nervous system," including the thinking processes and motor activity. Since this process permits the brain cells to communicate with each other,130 it may be of value to have one's hormone levels checked when severe PMS or menopausal discomfort arises. Many women can attest to Dr. Kamen's observation that if either hormone level drops, "All hell breaks loose."(131)

On the other hand, according to Dr. Peat, estrogen in excess can act as an "excitotoxin" to the brain, causing an energy drain (cellular exhaustion) by stimulating the brain beyond the nervous sytem's capacity to respond. He says that even an average estrogen level can be a serious problem when there is insufficient progesterone to balance it and that "it is best to have five of ten times as much progesterone as estrogen."(132)

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This has been excerpted from a book published by Healing Arts Press.

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By Raquel Martin and Judi Gerstung

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