9 Essential micronized progesterone concerns to grasp:
I think you will agree with me when I tell you that accurate information about micronized progesterone can be hard to sift through.
Relying on incorrect advice concerning your personal well-being could have disastrous consequences.
The problem is that there is quite a lot of confusion surrounding what exactly micronized progesterone is. Is it synthetic, natural or bioidentical? Does micronized mean it is more finely ground and therefore easier for the body to absorb and utilize?
In the past there have been quite a lot of controversy surrounding hormone therapies which may have led many women to forego treatments all together, but their hot flashes and other symptoms started up again.
I have helped many women work through menopausal symptoms to find relief. In our clinic we have helped hundreds of women work through hormonal balance issues, perimenopause, menopause, and hysterectomies, etc.
We have helped turn once desperate and frustrated women into happy, loving, productive, sexually active, stress-free women and more.
In this post I am going to teach you all about micronized progesterone, what it is, how to get relief from menopausal symptoms, how to use it and what to look out for.
#1: Micronized Progesterone
Micronized progesterone is progesterone that has been finely ground in a lab so that it can absorb easily into the blood stream. It is commonly used in transdermals (topical) creams, lotions and gels.
When someone says natural micronized progesterone, they are referring to micronized progesterone that is extracted from plants that closely matches progesterone made in the human body.
This is not like synthetic progesterone that you might find in birth control pills and other forms of HRT (hormone therapy treatments) used for menopause. They are usually found in prescriptions like Provera.
The micronized part of the equation is the description of how it is made. For instance, oils, creams and lotions encourage absorption thru the digestive tract when taken by mouth, or the skin when taking or using micronized progesterone cream.
Many women have said they felt calm and could sleep after taking micronized progesterone and it compliments their estrogen therapy.
Compared to synthetics, is has less, if any side effects, compared to synthetic progestins like Provera [Medroxyprogesterone acetate].
#2: Natural Progesterone
Natural micronized progesterone has been shown to promote GABA a calming chemical in the brain that can have a powerful sedative effect when taken in capsule form.
Similar effects have been reported when taking progesterone creams as well, so it’s best to use at night.
Natural micronized progesterone also protects the uterus from exposure to estrogen therapy.
Prometrium is the common brand prescription capsule of Natural Micronized Progesterone which comes in 100mg or 200mg capsules. Prometrium is made in a peanut oil base and is typically taken by mouth at night for 10-14 days by mouth.
Compounding pharmacies can also make alternative forms in different types of oil capsules, by special order from your health care practitioner.
Lower dose Progesterone creams can also be found in health food stores, but they are not strong enough to protect a uterus from exposure to estrogen therapy.
#3: Hormone therapy trials controversy
There is a constant struggle concerning the negative attitudes towards hormone therapy since the ‘women’s health initiative trial’ (WHI) was released. This trial concerned the combining of estrogen and progestin (as prempro) for preventing menopausal symptoms.
The concern is due to the controversial synthetic Prempro created in a lab by pharmecautical companies that is not pure progesterone. It was modified so that they could get a patient on it and profit from. Prempro is not bioidentical and the body does not fully recognize it as such.
The trial was stopped in 2002, because hormone users had a higher risk of breast cancer, heart disease, stroke, and blood clots.
— Amy Alkon (@amyalkon) July 31, 2017
Some considered the added risk too small, but many women and their physicians decided that they should stop using hormone therapy as a means of treatment. This resulted in many women having recurring hot flashes, sleeplessness, and other menopausal symptoms.
Hormone therapy is still the most effective treatment to combat menopausal symptoms, however many women are still weary. One problem is that woman began using alternatives they thought were safe – but may not be at all.
Before the WHI results came in, others were searching themselves for different ways to combat hot flashes, night sweats and vaginal dryness.
This is mostly due to the fact that there were side effects associated with (synthetic) HRT hormone therapies of the past, such as breast tenderness or bleeding. There was also an alarming link concerning estrogen with breast cancer.
Also taking drugs has become unpopular to many for symptoms because it implies that menopause is a disease rather than normal life right-of-passage.
Furthermore, many women felt that taking pregnant mares’ urine as a source of oral estrogen, like synthetic Premarin, the only estrogen tested in the WHI trial, was downright disgusting.
#4: Natural Hormones
The concept of natural hormones can be misleading at best. Some women have assumed that because a product is labeled natural and that it is from plants that it is therefore safe or a safer choice. However, this is not necessarily the case.
Any product claiming the principal ingredient is from an animal, plant or mineral source can be labeled as natural. This means that, a product can claim its natural regardless if is ground up, put into a capsule and sold over the counter or made in a laboratory, manufactured by a pharmaceutical company or only available as a prescription.
For example, soy and yam are two of the ingredients listed in some supplements women take to alleviate menopausal symptoms, however the FDA approved drug Estace has yams listed as its natural source.
But unlike Estrace, soy supplements aren’t regulated and haven’t been tested on humans, so no clear evidence exists that its safe or effective.
There’s some evidence that certain soy components may actually stimulate breast tumor growth. Therefore ‘natural’ doesn’t necessarily equal “safe”.
#5: Bioidentical hormones
People are more and more interested in moving away from pharmaceutical towards more natural therapies, so the shift is toward bioidentical hormones.
Bioidentical hormones are those that are identical in molecular structure to hormones that women make in their bodies. Since they are not found like this in nature, they have to be made, therefore, synthesized from a plant extracted usually from wild yams and soy.
- Bioidentical Estrogen: Bioidentical estrogens are 17 beta-estradiol, estrone, and estriol. (Estradiol is the form of estrogen that decreases at menopause.)
- Bioidentical Progesterone: Bioidentical progesterone is simply progesterone that has been micronized (finely ground) in the laboratory for better absorption in the body.
- Bioidentical Hormone Therapy
Bioidentical hormone therapy is often called “natural hormone therapy” because bioidentical hormones act in the body just like the hormones we produce. But here again, that tricky word natural muddies the waters.
As was mentioned before, pregnant mares’ urine is natural, but the drug Premarin is not bioidentical, at least not to human estrogen. The same goes for Cenestin, which is made from plants but is not bioidentical.
Technically, the body can’t distinguish bioidentical hormones from the ones your ovaries produce.
On a blood test, your total estradiol reflects the bioidentical estradiol you’ve taken as well as the estradiol your body makes. On the other hand, Premarin is metabolized into various forms of estrogen that aren’t measured by standard laboratory tests, so the body doesn’t respond well to it.
Proponents of bioidentical hormones say that one advantage of bioidentical estrogen over Premarin is that estrogen levels can be monitored better and treatment can therefore be individualized.
Skeptics will tell you that since no one knows exactly what hormone levels to aim for that symptoms, not levels should be treated and monitored.
#6: How to find bioidentical hormones
There are many products that are considered bioidentical estrogens and micronized progesterone, many are FDA-approved and can be purchased at your local drug store.
Bioidentical estradiol can come in pill, capsules, patch, cream and various vaginal preparations and micronized progesterone comes in capsules or vaginal gels.
— MWIA (@MedWIA) May 2, 2015
When you take bioidentical estradiol in a pill or capsule it is converted by the liver to estrone, a weaker bioidentical estrogen, however when taken as a topical (estrogen patch, or creams, for instance) it enters the bloodstream easily as the exact bioidentical estradiol – therefore topicals are better.
Topicals such as creams, gels and lotions applied to the legs or arms can also deliver bioidentical estradiol directly to the bloodstream although it’s uncertain how much is absorbed.
What is certain is that many women find relief from using topical creams, such as bioidentical progesterone cream.
#7: Are bioidenticals a safer choice?
It’s not entirely clear if bioidenticals are safer what is clear is that many women are finding relief from hot flashes and vaginal dryness by taking bioidenticals such as micronized progesterone cream.
There have been few large studies regarding the differences from taking various forms of hormones and methods of administration and the risks and benefits.
In my opinion the reason for this is simply funding. Most large pharmaceutical corporations that manufacture synthetic progesterone have the money to conduct these tests however the outcome most likely would paint them in a negative light versus companies selling bioidentical or natural hormones.
If a woman still has a uterus she should take a micronized progesterone or FDA-approved progestin to prevent endometrial cancer.
The issue is that natural, plant-derived progesterone creams sold over the counter may contain too little of the hormone to be effective.
To confuse the matter worse, wild yam creams such as wild yam progesterone cream, don’t help with symptoms because your body can’t convert them into progesterone in their current state. They need to become micronized in order to absorb properly and utilized by the body.
#8: Compounded hormones
There is quite a lot of confusion around compounded bioidential hormones. It is not true that they have to be custom mixed at a compounding pharmacy.
Custom compounding is only necessary when a prescriber wants to prescribe hormones in specific combinations, doses or preparations such as lozenges and suppositories not available elsewhere or to order hormones not approved for women such as testosterone and DHEA.
While it’s true that compound pharmacies use some of the same ingredients that are made into FDA-approved products their products are not FDA approved.
Compounded hormones are different for each individual. One person might need different strengths or a different combination.
If you are considering treatment here are some guidelines to consider.
- compounded drugs are made to order – they are not tested for safety, effectiveness and dosing might not be consistent.
- There is no proof that compounded hormones have fewer side effects or are more effective than FDA-approved hormone preparations.
- Some clinicians who prescribe compounded hormones order saliva tests to monitor hormone levels. Most experts say these tests are of little use because there’s no evidence that hormone levels in saliva correlate with response to treatment in postmenopausal women.
- There is no scientific evidence that the compounded preparations Biest and Triest, which are largely estriol, are safer or more effective than other bioidentical and FDA-approved formulations. Some proponents claim that estriol decreases breast cancer risk and doesn’t increase endometrial cancer risk. Both claims are unproven.
- Health insurers don’t always cover compounded drugs.
— IMS (@IntlMenopause) February 19, 2018
Still this doesn’t mean that you shouldn’t consider using compounded hormones. If you choose a commercially available bioidentical or micronized progesterone or ones that your medical prescriber has recommended you should be just fine. Some compounded products are very good and can provide some excellent benefits.
#9: Hormone preparations and delivery systems
Since the end of the WHI’s trial of Prempro, the FDA has recommended using hormone therapy only in low doses for a short time for severe menopausal symptoms. Yet experts don’t really know how the WHI results apply to other compounds.
This leaves women and their clinicians with a number of questions. In the combined hormone trial, the WHI tested only one estrogen (Premarin) and one progestin (Provera), in a single pill (Prempro), at a single dose (0.625 mg Premarin and 2.5 mg Provera).
Would a different estrogen or progesterone have fewer side effects? Would lower doses or a different mode of delivery, such as a transdermal (skin) patch or skin cream, be safer?
There are several ways in which a woman can take progesterone. The most common ways are by ingestation (swallowing a pill or capsule) and topicals (skin creams and gels) and vaginal suppositories.
There is one issue with taking a pill or capsule and that is a phenomenon called first pass. First pass is when a medicine is taken orally and has to pass through the digestive system and therefore must be processed through the liver. When this happens, it loses up to 90% of its potency.
In this case skin creams or topicals are better because they don’t have to pass through the liver, can be taken in much lower concentrations and therefore are safer.
Different forms of hormones are recognized differently by cells, so it makes sense that their effects might also be different. When an oral hormone passed through the liver it stimulates proteins associated with heart disease and stroke, such as C-reactive protein, activated protein C, and clotting factors.
Another example is a study found that among women taking estrogen-only therapy, those who took conjugated equine estrogens (Premarin) had a 78% higher risk for blood clots than users of esterified estrogen (Menest).
Also, the progestin medroxyprogesterone acetate (Provera) interferes more with estrogen’s good effects on cholesterol than micronized progesterone (Prometrium) does.
It’s important to work with your medical provider before beginning any hormone replacement therapy. The risk for customized compounded hormonal products depends on how it is made and delivered. If you have hormonal symptoms discuss them with your medical provider, physician or other hormonal specialist before starting any hormone replacement therapy.
Micronized progesterone is progesterone that has been finely ground in a lab, is extracted from wild Mexican yams and formulated to be bioidentical – closely matching the hormones produced naturally in the human body.