The Captains Lady

What's the Talk About Progesterone Instead?

A sure sign of progesterone deficiency (and estrogen dominance) is weight-gain. Ask any woman who is on ERT (Estrogen Replacement Therapy) and she will tell you she has gained weight since beginning treatment from using Estrogen alone. 

Many women do not realize that they may need progesterone replacement as well as estrogen. Some may even need additional testosterone. These three hormones perform numerous functions in the body, in each and every cell. It is thought that while estrogen can help with hot-flashes and vaginal dryness, Progesterone is the precursor to estrogen and by taking it alone estrogen levels often return to satisfactory levels. This is not completely agreed upon. It is agreed that Estrogen and Progesterone used together in a cyclic manner have the best results in alieving menopausal symptoms. If they are natural and not synthetic, so much the better. Synthetic hormones treat only the symptoms of menopause and not the cause. I will say it again.

"Synthetic hormones treat only the symptoms of menopause and not the cause."

Natural, or bio-identical hormones, replace the hormones you have lost. Your doctor should know the difference and if she does not, either share the findings below with her or find someone who does.

See Your Doctor For Blood Tests!

Progesterone, Estrogen and Testosterone hormone levels can be checked by your doctor. This can be done with a simple blood test. Hormone levels may be more accurately revealed through saliva testing.  Hormone levels should probably be tested every 3-6 months and your doses changed accordingly.

While you are at it, ask your doctor to check for Adrenal Burnout, which can mimic menpause and even cause hormone imbalance. Have your cortisol levels checked. For more information on Adrenal Burnout, visit my 'Stress Syndrome Management' page. I also provide a link at the bottom of this page for even further information concerning Adrenal Burnout.

As already stated, it is important that your doctor prescribe bio-identical hormones rather than synthetic hormones, produced by drug companies, which only treat symptoms of menopause rather than replace the hormones you have lost. 

It is important to have your hormones prescribed according to your blood test findings, or at least approved of by your doctor, rather than experimenting with over-the-counter hormones. Even natural hormones can be powerful and have their side effects.

Synthetic vs. Bio-identical Hormones

Synthetic Estrogen: Premarin and other conjugated estrogens.

Synthetic Progesterone: Provera, Amen, Prempro (a combination of Premarin and Provera), Norethindrone, Norgestimate and Nordestrel.

Synthetic Testosterone: Methyltestosterone. Estratest (estradiol and synthetic testosterone), and Premarin plus synthetic testosterone.

Bio-identical Estrogen: Estradiol, Estrone, Estriol. Synthesized in a lab from plant extracts (soybeans and yams) and are designed to be molecularly the same as the hormones in our bodies.

Bio-identical Progesterone: USP progesterone (Pro-Gest, Prometrium, Crinone) made from Wild Yam designed to be molecularly the same as the hormones in our bodies.

Bio-identical Testosterone: Dehydroepiandrosterone, or DHEA, an adrenal precursor to testosterone.

Progesterone Cream

If you insist on going your own way, Progesterone cream is available over-the-counter and is available for purchase online. It is derived from Wild Yam or Soy, or both. Not all brands offer you the dose of at least 400 mg per 1-ounce (and most creams come in 2 oz jars) that is necessary for any benefit, so read your labels. You will also want to make it states 'USP Progesterone' on the label. USP means that it has been made in a lab with the guarantee of the correct dosage per ounce. 

It would be better for you to determine through blood testing whether you need Progesterone (and how much depending on your levels) before just purchasing a jar and using it. A prescription would be even better. Progesterone may not be what you need most, or at all. Everyone is different.

Do not use a cream that contains Mineral Oil. It blocks progesterone absorption and is a sure clue of an unworthy product.

How To Use Progesterone Cream

Instructions always come with your product, but here is a bit more advice. If you are peri-menopausal (in the beginning stages of) or menopausal, and most women are, well before they seek help, you will want to use the full monthly dose for three months or so to overcome deficiencies. Most 2 oz jars of cream contain 800-1200 mg of progesterone. Of this, you will use 1/8-1/2 teaspoon per day (approximately 14-20 mg). 

The Method

Menstruating (Ovulating) Women:
Apply once or twice a day as needed (you can divide doses), starting on the 12th day after the first day of menstrual flow thru the 27th day.

Peri-menopausal Women:
Apply once or twice a day as needed (you can divide doses), starting on the 7th day after the first day of menstrual flow thru the 27th day.

Menopausal or Non-menstruating Women:
Apply once or twice a day (you can divide doses) for 21 - 25 (maximum) consecutive days. Resume after a five – seven day break.

The Method can, and should,  to be used in conjunction with daily Estrogen replacement.

How To Apply Your Cream

You will want to rotate applications of the cream between your face, neck, chest, inner thighs, backs of knees, palms, bottoms of your feet or the underside of your upper arms. You are looking for the softest and thinnest areas of skin for best absorption. Do not use it where you use other creams. They may block absorption.

How Long Do I Continue To Use it?

This is where a doctor would be beneficial. She could have your blood tested for deficiencies. However, when you begin to feel balanced (after the 3 months or so), you may reduce the dosage and continue the same schedule, at the reduced dose, for as long as you feel you need it. For more information on the method of using Progesterone Cream and for purchasing Progesterone Cream, please use the references at the bottom of this page.

Tip! Bio-identical hormones are not to be used indefinitely, but only for as long as you are going through menopause, or your blood tests reveal the need for them. At some point, your body should stabilize although in today's world, with today's ever increasing stresses, it can be hard to say when that might be.

Tip! If you wake up feeling 'blah', unmotivated and generally like you could say 'whatever' to the world, you might need to increase your estrogen a bit. If, on the other hand, you wake up feeling anxious, uptight and have tender breasts, you might need a little less estrogen. 

Side Effects

There are no known negative effects of using progesterone creams. However, I get a little wary when someone tells me there are no side effects. There can be side effects to anything and everything. For example, there are precautions on some brand labels concerning manufacturers ingredients. And, many labels will tell you to stop taking it if you develop a skin rash, acne or begin to vaginally spot or bleed.

One thing to be aware of is that HRTs (Hormone Replacements Therapies) cause deficiencies in Folic Acid and B Vitamins, especially B6.

For information regarding stress syndromes related to menopause, please visit 'Stress Syndrome Management'.

Studies show that ERT (Estrogen Replacement Therapy) and HRT (Hormone Replacement Therapy using Estrogen and Progesterone combined), with all of the good and the bad that go along with them (with synthetic hormones and sometimes the misuse of bio-identical hormones, the threat of cancer, stroke, heart attack, blood clots, fluid retention, weight gain, etc.), even though they may mask or actually help with menopausal symptoms, work no better for you than stress management, alternative therapies, lifestyle modification, a healthy diet and exercise! So what does this mean?

It means that if you are terrified of HRTs, and you are freaking out from your symptoms, there is still a way to be in control of your hormones and your body!

Add Phyto-Estrogens To Your Diet 

& Watch Your Eating Habits!

For more information on foods containing phyto-estrogens, refer to 'Eating, Naturally!' 

Phyto-estrogens may also be taken in supplemental form. Check your local health food store. Most combinations include varying amounts of Soy, Black Cohosh, Dong Quai and, perhaps, Wild Yam. If you have cancer, or a risk for cancer, please speak to your care provider before consuming foods rich in physto-estrogens.

Eat Calcium rich foods. See below under 'Arthritis & Chronic Pain'.

And there are other certain diet and supplement recommendations. See below!

What about Chasteberry?

Chasteberry findings are mixed. It is usually called 'Vitex', and used for PMS and tender breasts, but it can either raise or lower your libido (sex drive) depending on your personal chemistry. 

You cannot use it with dopamine antagonists or antagonists because it raises the level of dopamine in the brain.  It affects pitutitary function and is supposed to be good at regulating hot flashes and dizziness, but it lacks phytosterols, which makes it a slow acting tonic and, for this reason, it requires at least a year's commitment even though some positive results may be felt within 3 months time.

As far as menopause is concerned, unless you have painful periods or strong PMS symptoms, including a tendency for heavy or prolonged bleeding, there is no good reason to rush and add it to your list of things to take. I would imagine all mothers would think this is a magic potion for teenage daughters, unless of course it raises her libido! Still, it may be helpful if you have the conditions mentioned.

Soy Supplements

Soy has 'estrogen' like properties (isoflavones). It is reportedly safer than Black Cohosh, as long as you are not allergic to it. Soy may cause 'fuzzy thinking' in some who have food sensitivities to it. Limit your combined sources to no less than 10-15 mg and no more than 40 mg divided throughout the day if you choose to use it. You may also get soy from adding plain, firm tofu to shakes and salads. I do not advise taking isoflavones in supplement form. Studies show that Soy does not have much affect, if any, on flushing and sweats, but it does help with balancing hormones in general.

Do not use Soy or Black Cohosh if you have a risk for cancer.

Also, there are studies out there that show Soy is not good for the human body at all! In fact, it is said it is quite harmful. Do some research on your own before indulging too much.

For more information visit 'All Natural Products Links' .

Exercise to Relax!

I mention exercise below, under Arthritis, but it is worth mentioning here as well. Exercise decreases hotflashes by decreasing the amount of circulating LH and FSH hormones. It raises your level of endorphins (feel good chemicals in the brain), which drop signifcantly when hot flashing. Work up to walking 3 x per week for 20 minutes. Start with five minutes if you have to. Studies show this can reduce hotflashes. The important thing to remember here is to exercise to relax, not to build muscle or lose weight. These things will be added benefits, but focus on exercise as a relaxation tool rather than something you have to work at. For  more information, visit 'Exercise for HSPs'.

Some women are trying DHEA...

...which is a steroid hormone that is produced by the adrenal glands and is derived from pregnenolone. DHEA levels decrease in menopause. If your adrenals are not working properly (functioning at too low a level) you will also loose DHEA. Supplementing with DHEA can cause measurable increases in estrogen (estrone and estradiol) and testosterone. However, effects of supplementing with DHEA (usually 25 mg) have not been thoroughly studied, so it may be risky. 

Vaginal Infection, Dryness, Discharge or Pain?

Even before menopause actually takes place, a vaginal difference can be noticed, but afterwards it can be a nightmare for some. Up to 40% of all post-menopausal women have problems with vaginal infections (yeast, Gardnerella, etc.) during pre-menopause only to have it worsen during menopause when hormone levels dip and dive.

During the middle years of a woman's life, she often goes through hysterectomy, either full or partial. Post operative infections, such as Gardnerella (a bacterial infection) often follow hysterectomy, with or without symptoms. Gardnerella is often the cause of infection even without hysterectomy. Basically this means that there is an absence of normal lactobacilli that has 'caused problems'.

After surgeries and/or during menopause, these 'problems' can cause 'Atrophic Vaginitis' and under medical examination, 'Atrophic Vaginitis' often goes hand in hand with an overgrowth of the bacteria called 'Garnerella', which can mimic 'Atrophic Vaginitis (more common with low estrogen levels). Gardnerella is usually not a serious health threat, but tough cases should be supervised by your doctor. 

Both, however, are still symptoms and not causes. I often think of these two, Gardnerella and Atrophic Vaginitis as being 'married'. I figure if you can divorce one, you can divorce the other, as Garnerella irritates already thin and sensitive vaginal tissues!

Did you know that sleep disturbances can be related to bacterial infections? It might interest you to know that some people say that they begin to lose weight and to sleep better once they heal their problem with Gardnerella, although it is not completely understood as to why.

Signs and Symptoms of Atrophic Vaginitis and/or Gardnerella

Vaginal dryness, pain or slight bleeding during intercourse.

Irritation (can be what looks like raw or red areas inside the vaginal entrance).

Discharge (can be thin, mucus colored, sticks and dries in the pubic hair, with fishy odor or no odor).

A feeling of 'fullness' or 'sensitivity' when washing or sitting.  

Having to urinate more often, especially at night, due to the wall between the vagina and the bladder thinning.

Lumps or bumps under the skin of the labia (vaginal lips) that itch, stick around for a bit and then disappear.

* These may be signs of other conditions as well. Please see your doctor for a diagnosis.

Why Is This Happening?

As hormones fluctuate, normal bacteria in the vagina can overgrow causing infection and irritation leading to discharge, redness and pain.

Also, ladies, check your pH balance! You can do this yourself by going to your neighborhood pharmacy and purchasing over-the-counter pH test strips (about S8.95). for more information, visit 'The Importance of pH Balance!'. If your urine is too acidic, it can burn you!

Please see your care provider for a diagnosis. Then proceed from there. Medical doctors treat Gardnerella (and other forms of bacterial vaginosis), with antibiotics such as Clindamycin and Metronidazole pills or gel. However, 12-30% of all women end up with a yeast infection (candidiasis) as a result and have recurring problems with the vaginitis. This is why it is so important to rebalance the hormones in the body.

Atrophic Vaginitis, Gardnerella (and other bacterial overgrowths) and yeast infections are all a result of physical imbalances caused by high stress, especially unresolved relationship problems, allergies and hormonal changes. Therefore, you must do some soul searching and then turn to your diet, use alternative products and possible hormone replacement for healing and check your pH balance, as mentioned above. 

Gardnerella F.Y.I.

Garnerella does not cross barriers in the body like yeast and some other other bacteria. It will not infiltrate the rest of your system (like yeast can). This is good news, right? It is contained in the vagina and is more of a nuisance than anything else, unless it creates an infection. Having an overgrowth of Gardnerella does not necessarily mean you have an infection, or that you will get one.

What Can Be Done?

Typically, as far as natural approaches go, the following conditions might be treated the following ways.

Vaginal Candidiasis (yeast infection) - Acidophilus supplements, vaginal suppositiories, eating plain yogurt or applying it vaginally, Boric acid (vaginal suppository), Echinacea and/or Goldenseal (oral tinctures), Tea Tree oil (vaginal suppositories or douche). For more on candia (yeast infection) and how to treat it, click here.

Bacterial Vaginosis - Vaginal suppositories and douche.

Trichomoniasis - Echinacea and/or Goldenseal (oral tinctures) and Tea Tree oil vaginal suppositories or douche.

How To Use Home Treatments

Vitamin E - To ease some of your dryness and discomfort, you can prick the end of a Vitamin E capsule (200 IU - 400 IU maximum) and insert it into the vagina every night for up to two weeks, then only 2-3 times per week thereafter, for maintaining suppleness and reducing vaginal pain due to dryness and reduced flexibility of vaginal tissues. You may also apply it to irritated areas around the vaginal opening.

Oils - You may also soak a cotton makeup pad or a square of sterile gauze with olive oil, wheat germ oil or sesame oil, squeeze out excess and insert overnight once per week for vaginal dryness.

Garlic -You may do the same with a garlic clove (one clove, peeled but not cut), by wrapping it in gauze and changing it out for a new one every 12 hours. This helps to fight infection. I have only read this and not personally tried it. I would be interested in hearing how it works from any of you trying this method.

KY Lubricant - Use products such as KY-Jelly, a vaginal lubricant) during intercourse. The oils mentioned above can dry out to fast during intercourse causing friction to irritate the vaginal lining, which will cause more bacterial overgrowth.

Go easy on antihistamines. They dry out all mucous membranes, including those of the vagina. Cardiovascular, antidepressant, atropine prescriptions and diuretics can also have a drying effect on the vagina. To help restore mucous membranes, including vaginal, supplement with Vitamin E (200 - 400 mg. twice per day) and Vitamin A - 25,000 mg. per day (only if you are not pregnant).

Tea Tree Oil  - 'Old World' Captain Cook's Discovery! Captain Cook could not have known that when he discovered the aborigines using tea tree oil in the 1700's that the oil could be used for routine vaginal problems such as Candida albicans (yeast infection), trichomonas or Gardnerella. How to make it? First, buy a tea tree oil that has 20% concentration of the oil, such as Dessert Essence brand. Dilute the oil even further by adding 1 teaspoon of tea tree oil to 1 pint of warm water. Wash the outer vagina with the same solution and use for a douche. Do not use beyond two months and ask your doctor first.