with Teresa Sievers, MD, MSMS, FAARM and Karen Callan BA, CHHC, AADP
Dear Dr. Sievers,
I am 42 years old and although I have always experienced the usual symptoms of PMS, lately they’ve gotten worse. I find myself anxious, irritable and have difficulty sleeping. My cravings for sugar and salt are out of control and it’s sabotaging my weight loss efforts. A friend recommended over the counter progesterone cream. What do you think? Annie
Almost 75% of women in the US suffer from PMS. In addition to your symptoms, bloating, headaches and depression are also common. The constellation of symptoms occurring prior to your menses appears to be indicative of low progesterone. But there could be other deficiencies and hormonal imbalances in your body affecting your progesterone unrelated to your monthly cycle that would need to be identified first. If low progesterone is the cause, treatments should be done under the supervision of a doctor experienced in bio-identical hormone replacement therapy.
Looking at your diet and lifestyle would be a good place to start. An imbalance of zinc and copper, low omega 3 fatty acid levels, B6 and magnesium deficiencies can cause progesterone deficiency. Zinc and copper imbalances in particular can affect the delicate balance between estrogen and progesterone. And zinc is also needed for essential fatty acid balance of good and bad fats. Omega 3 fatty acid deficiencies, high sugar and processed foods affect inflammation on the body, which could exacerbate your PMS. And like everything else, stress plays a roll as well.
Low estrogen can also cause PMS. But it’s rare for a women to experience PMS with both low estrogen and low (or even normal) progesterone at the same time. For these women, using progesterone alone will not help.
Other symptoms of progesterone deficiency include heavy bleeding, irregular periods, mood swings, osteoporosis, weight gain, food cravings and low HDL (good cholesterol) levels. While some women use birth control pills as hormone replacement therapy to alleviate those symptoms, the synthetic progesterone in the birth control pill (progestins) actually blocks natural progesterone production and its protective effects related to balancing estrogen, which can increase the risk of heart attacks. Progestins may also increase risk for blood clots and stroke. Often women stop using progestins because of the side effects of increased appetite, weight gain, fluid retention, irritability, depression, decreased libido, headaches, bloating, breast tenderness and acne.
On the other hand, natural progesterone therapy used in bio-identical hormone replacement therapy (BHRT) does not have the risks associated with synthetic hormone replacement therapy. And while many women fear progesterone therapy because of the risks of breast cancer, low levels of progesterone in pre-menopausal women have actually been associated with increased risk of breast cancer. (Micheli et all Int J Cancer 112, 312-318, 2004). Using natural progesterone therapy after ovulation has significant health benefits. Most importantly, the progesterone balances estrogen levels, decreasing estrogen’s stimulating-effect on the growth of breast and uterine tissue, which can cause cancer. And along with minimizing PMS, replacing progesterone deficiency enhances thyroid hormone action, improves sleep, increases metabolism, stimulates bone growth and lowers cholesterol and blood pressure. It’s also a natural anti-depressant and diuretic.
While progesterone can help many women, it is not a “cure-all.” Environmental, dietary and emotional issues, as well as other hormone levels such as thyroid can also be part of the problem. If you take natural progesterone but have excess stress in your life, coupled with a diet that consists of excess caffeine, sugar, alcohol and processed foods, you will likely not derive benefits. In fact you may feel worse, as these toxins overload the liver, blocking its ability to properly process the progesterone. BHRT combined with working with Coach Karen can help you maintain a healthy diet and decrease your sugar cravings, helping to improve liver function and continue your weight loss goals.
Self treatment of progesterone can further complicate your situation. Individual progesterone needs vary, while over the counter treatments only offer a one dose fits all solution. An excess of progesterone can cause the same PMS you had prior to taking it or worse. As a result you will note insulin resistance, increased carbohydrate craving and weight gain. And if you haven’t had nutritional deficiencies identified in Zinc, magnesium, and B vitamins, you could end up with other health problems.
Replacing progesterone should only be done under the supervision of a doctor. I have had a lot of success treating acute PMS with BHRT, but only after low progesterone is confirmed and other deficiencies ruled out. Hormones work as a symphony, therefore it’s important to evaluate all hormones, as imbalances in estrogen, testosterone, adrenal and thyroid can mimic progesterone deficiency. A proper saliva test reflects true tissue levels of progesterone; blood work will not. If a deficiency is found and replacement initiated, I use a compounding pharmacy to prescribe dosages based on individual needs. And to be sure adequate hormone levels are maintained, it’s important to have regular follow-up testing.
Teresa A. Sievers,
MD, MSMS, FAARM
Restorative Health & Healing Center
10201 Arcos Av., Suite 201, Estero
Learn more about Dr. Sievers at:
Karen R. Callan, CHC, AADP
Certified Health Coach
10201 Arcos Ave., Suite 201 Estero
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