Adding Progesterone Into the HRT Mix

For years the old dictum in gynecology had been: If you are on estrogen replacement … and… you don’t have a uterus… you don’t need to add progesterone. To the hormonal mix.

How short-sighted!

Why would Mother Nature have a hormone produced all over the body if not for amazing physiologic reasons?

Yesterday at the Great Estrogen Debate, some experts said, “Why give progesterone all month long to a menopausal woman when it is only made during the second half of the younger woman’s period?”

But progesterone is made all over the body. Constantly. Throughout all our best years. In both genders.

Progesterone is NOT just made the last two weeks of the female menstrual cycle.

Progesterone producing enzymes are ubiquitous in human physiology. In many tissues, from brain to heart to lung to more.

Progesterone producing enzymes are located throughout many body tissues.

This means that progesterone is produced locally in all these tissues.

So throughout the body, male or female, progesterone is produced, by nature, locally.

Locally it is made. Used. Degraded.

Nature never does anything without an exact purpose.

All these progesterone producing enzymes throughout so many tissues “screams” out loud that progesterone is needed for all these tissues.

Hormones are a relatively “young” science.

Elwood Jensen PhD just discovered the 1st estrogen receptor in 1985.

The second receptor was discovered in 1996.

More and more receptors are being discovered, both genomic and non-genomic.

We don’t yet know what all of them do.

But hormones signal most all our tissues. And membranes.

So does progesterone.

Progesterone is not just a pregnancy hormone.

Please appreciate these main points.

Progesterone is constantly produced in middle-aged humans in lots of places, such as:

• Six places in the brain.

• In the coronary artery.

• In the gut wall.

• In the lining of the lungs.

• To protect multiple tissues.

• In both genders.

I could go on and on.

Progesterone is made globally (meaning all over our bodies) because progesterone has so many uses. Progesterone’s signals have so many protective actions.

We are just beginning to appreciate the tip of the ice-berg of what hormones do in general, and progesterone in particular.

Progesterone signals our calming nervous system, our parasympathetic nervous system.

Do we really need new equipment to signal our parasympathetic nervous system when we have progesterone? And it’s best friend oxytocin?

We also need progesterone to protect not just the lining of the uterus, what it’s most known and appreciated for, but also to protect our ovaries.

Progesterone, it turns out, protects against multiple cancer cells lines.

Including ovarian cancer.

Many Endocrine Disrupting Chemicals (EDCs) are anti-progestins.

• So we need lots of progesterone.

• Yet at the same time, progesterone is under attack.

• By today’s “dirty planet”.

Moral of this story: Do not take estrogen replacement without adequate progesterone replacement. Even if you do not have a uterus.

When blood testing, if you have adequate progesterone in your hormone replacement, your blood levels of progesterone should be approximately 4 to 15 ng/mL in the blood. Depending on your body size. Your health issues. Etc.

If your doc suggests you do NOT need progesterone as you do not have a uterus, run, do not walk, pass GO. Do not collect $200! This doc is not up on what they should be up on.

Emergent Progesterone Research Hot Off The Press

According to a 2024 re-analysis of Women's Health Initiative (WHI), women on estrogen-only hormone replacement therapy (because they were told they didn’t need progesterone as they didn’t have a uterus) went on to have “double” the long-term risk of ovarian cancer and “double” the risk of “dying” from this disease!

The risk increases over time, with a 60% greater risk for women who have ever used estrogen-only therapy compared to those who have never used HRT. Without progesterone that is.

The risk increases by 7% with each year of use, nearly doubles after a decade, and triples after two decades. When P is not added to E!

Dr. Cheblowski (One of my fav researchers who dug deep and found the methodology errors with the first Women’s Health Initiative - WHI) and his colleagues could determine that ovarian cancer incidence doubled among women who had taken estrogen alone, without replacing the progesterone.

This difference reached statistical significance at 12 years' follow up.

But if you give progesterone along with estrogen, this did NOT increase ovarian cancer risk.

INFACT, PROGESTERONE REPLACEMENT SIGNIFICANTLY “REDUCED” THE RISK OF OVARIAN CANCER.

Progesterone is a cancer protector.

I remember when Dr. Tori Hudson, who I regard as a close friend, great human and who headed the GYN department at the National School of Naturopathic Medicine and taught this and believed this: that progesterone is only to be given to women on estrogen therapy they have a uterus.

If they didn’t have a uterus, they didn’t need progesterone.

Dr. Tori was an ardent student of the North American Menopause Society. This is what they said. So she said. And she taught.

I sent her Safe Hormones, Smart Women, requesting her to read the book. And hopefully write a testimonial.

She declined writing one.

Mainly as I recommended progesterone to ladies that didn’t have a uterus. As I said progesterone is needed for many tissues, not only the uterus

She said no. But kindly explained why.

We are luckily still great friends. We just disagree.

It’s great to be able to have such good friends that even though you disagree, you are still colleagues and still kind to each other. In touch with each other.

It’s just divergent opinions.

Not divergent sisters-of-the-hearts.

I was just sent a book coming out in September to write a testimonial for it.

But the book said that you don’t need progesterone if you don’t have a uterus.

And that estriol is not good. So Biest should be avoided.

And that best hormone replacement is achieved mainly if you take hormones to the point of “monthly bleeds”.

I sent back the manuscript and said it is amazingly elegantly written, but sorry… I can’t write a testimonial.

No one said thanks for taking the time to read this several hundred page manuscript. Or ask why I felt it was so beautifully written. But yet still could “not” write a testimonial for it.

I wanted to know when Tori declined to write one. If I write a book I want to hear criticism not just praise as everything, even book writing, is a huge learning experience.

I still thanked Dr. Tori for taking the time to read it. And even the time to say no.

We are still good friends that really appreciate each other’s elbow grease in this “space”.

But here is this new research on progesterone therapy being needed even if you do NOT have a uterus.

In this case, progesterone is being found to be “ovarian protective”.

(But now you have gleaning that progesterone is multi-tissue protective).

This new research was presented by Rowan T. Chlebowski, MD, PhD, (fromThe Lundquist Institute in Torrance, California) at the annual meeting of the American Society of Clinical Oncology in Chicago.

It’s latest WHI re-analysis findings

Dr. Chlebowski and his colleagues conducted an analysis from two randomized, placebo-controlled trials, which between 1993 and 1998 enrolled nearly 28,000 postmenopausal women aged 50-79 years without prior cancer from 40 centers across the United States. (The full WHI effort involved a total cohort of 161,000 patients, and included an observational study and two other non-drug trials.)

In one of the hormone therapy trials, 17,000 women with a uterus at baseline were randomized to combined equine estrogen plus medroxyprogesterone acetate, or placebo. In the other trial, about 11,000 women with prior hysterectomy were randomized to daily estrogen alone or placebo. Both trials were stopped early: the estrogen-only trial due to an increased stroke risk, and the combined therapy trial due to findings of increased breast cancer and cardiovascular risk.

Mean exposure to hormone therapy was 5.6 years for the combined therapy trial and 7.2 years for estrogen alone trial.

Main new finding at 20 years: If you don’t give progesterone along with replacing estrogen, then ovarian cancer incidence doubles.

At 20 years’ follow up, with mortality information available for nearly the full cohort, Dr. Chlebowski and his colleagues could determine that ovarian cancer incidence doubled among women who had taken estrogen alone (hazard ratio = 2.04; 95% CI 1.14-3.65; P = .01), a difference that reached statistical significance at 12 years’ follow up.

Ovarian cancer mortality was also significantly increased .

• You die more without progesterone.

• You die less prematurely if you have progesterone on board.

Care of Ovarian Cancer Survivors Should Change

The new findings should prompt practice and guideline changes regarding the use of estrogen alone in ovarian cancer survivors, Dr. Chlebowski said.

Twenty years ago the Women’s Health Initiative showed that hormone replacement therapy increases breast cancer risk, and everyone stopped taking HRT.

And now people pushing back on it and saying wait a second – it was the estrogen plus synthetic progestins that increased breast cancer, NOT estrogen alone.

Knowledge is power.

If Nature makes progesterone in six different areas in the brain, we need progesterone.

We often even replace lower dosages of progesterone in males.

For one example, progesterone helps protect lung tissue.

At the Department of Medicine, Cedars Sinai Medical Center, they gave progesterone + standard of care to males in the ICU with severe Covid. Compared to males treated with standard of care alone.

Results: Forty-two patients were enrolled from April 2020 to August 2020; 22 were randomized to the control group and 20 to the progesterone group.

Two patients from the progesterone group withdrew from the study before receiving progesterone.

There was a 1.5-point overall improvement in median clinical status score on a seven-point ordinal scale from baseline to day 7 in patients in the progesterone group as compared with control subjects (95% CI, 0.0-2.0; P = .024).

There were no serious adverse events attributable to progesterone.

Patients treated with progesterone required three fewer days of supplemental oxygen (median, 4.5 vs 7.5 days) and were hospitalized for 2.5 fewer days (median, 7.0 vs 9.5 days) as compared with control subjects.

Interpretation: Progesterone at a dose of 100 mg, twice daily by subcutaneous injection in addition to SOC, may represent a safe and effective approach for treatment in hypoxemic men with moderate to severe COVID-19.

Mother Nature never does anything without a purpose.

We make progesterone globally.

We need it.

Both genders.

Knowledge is power.

Dr. B.

Reference:

Ovarian Cancer Risk Doubled by Estrogen-Only HRT June 12, 2024Ovarian Cancer Risk Doubled by Estrogen-Only HRT Publish date: June 12, 2024 https://www.mdedge.com/authors/jennie-smith

Rowan T. Chlebowski, MD, PhD, of The Lundquist Institute in Torrance, California, presented these results from the latest WHI findings, at the annual meeting of the American Society of Clinical Oncology in Chicago.

Progesterone in Addition to Standard of Care vs Standard of Care Alone in the Treatment of Men Hospitalized With Moderate to Severe COVID-19: A Randomized, Controlled Pilot Trial. Chest. 2021 Jul;160(1):74-84