Who Might Need a Lot More Progesterone Than You Think?

For many years it has been commonly thought, in functional circles, due to Dr. John Lee’s teachings (who I greatly admire and wrote a preface for my book Hormone Deception) that premenopausal women make 20 mg of progesterone a day.

So for a long time many docs thought that was all that women needed.

Over time, the dose range started to go higher.

With possible dose-ranges of 20 mg through 50 mg in perimenopausal women to 300 mg postmenopausal women.

Many functional doc replace, on the average, about 100 to 300 mg in most postmenopausal women. In diverse delivery modes. Depending on the individual hormonal foot-print or their personal health issues.

But wait…

We have now learned that we have progesterone producing enzymes globally all over the body. Six places in the brain, in the coronary artery, even some in the lungs.

We have progesterone receptors where progesterone delivers signals, all throughout the body. Not just in female reproductive tissues.

We know that much progesterone is commonly produced by the adrenal cortex as well as the gonads, which consist of the ovaries and the testes. In both genders.

Progesterone is also secreted by the ovarian corpus luteum mid cyle in women.

Progesterone is also produced during the first ten weeks of pregnancy, followed by the placenta in the later phase of pregnancy.

But we also produce progesterone throughout the body. In both genders.

By enzymes.

The enzymes P450 side chain cleavage (P450scc) and 3β-hydroxysteroid dehydrogenase (3β-HSD) promote biosynthesis of progesterone.

P450scc is located on the inner mitochondrial membrane. All over the body.

It converts cholesterol to pregnenolone, and 3β-HSD then converts pregnenolone to progesterone.

We think of pregnenolone as a brain hormone. But pregnenolone also makes progesterone. Which is very brain protective. That’s part of pregnenolone’s brain protective actions.

Progesterone is very HPA axis protective. Progesterone plays a crucial element in the hypothalamic-pituitary-adrenocortical axis.

Many patients with severe early life stress turn out to require higher dosages of progesterone replacement, even in adulthood, to reboot healthy HPA functioning.

Wherever there are progesterone receptors, progesterone delivers signals that cause genes to tell those local cells what to do.

Although progesterone is primarily associated with the reproductive system, it also plays more functional roles throughout the body, for example, the neuroendocrine axis.

Progesterone has neuroprotective factors in both the central as well as the peripheral nervous system.

Progesterone boosts Schwann cell production of myelin. So it is very helpful in MS patients. Both genders.

Progesterone regulates astroglial plasticity.

Progesterone protects neuron survival in neurodegenerative diseases, such as amyotrophic lateral sclerosis. And cogntive decline. Or post stroke and brain injuries.

Progesterone has application in neurological disorders, and osteoporosis.

Progesterone even helps some males with benign prostate hyperplasia.

Progesterone is not a “stand alone” therapy. But added to other interventions.

Progesterone especially protects lung function. In both genders.

Research has shown that 200 mg IM of progesterone in males in the ICU, got out of the hospital quicker, with less complications, when added to standard care, versus males who did not get progesterone intervention.

Because progesterone is so lung protective, it can be used in COPD patients.

Progesterone can have both a protective or a proliferative effect on ovarian cells.

In terms of ovarian cancer, the higher the level of progesterone, the lower the risk of developing ovarian cancer.

Instances such as pregnancy, the use of oral contraceptives, and breastfeeding are all linked to increased levels of progesterone and a decreased risk of ovarian cancer.

Conversely, advanced age, earlier onset of menstruation, and anovulatory cycles are associated with an increased risk of developing ovarian cancer due to their low levels of progesterone.

Progesterone can be used to treat secondary amenorrhea, anovulation, and endometrial hyperplasia.

Dysfunction vaginal bleeding, especially occurring in adolescents or postmenopausal women, can often be treated by progesterone administration.

Clinicians have used progesterone to treat hypertension.

There are citations of progesterone’s use to treat drug dependence, specifically cocaine and nicotine.

Carol Peterson is a pharmacist that worked with the premier Women’s International Pharmacy for many years.

She is a true expert on progesterone dosing.

She taught all about progesterone in Everything Hormones which is now Evergreen. You can learn all about it on the first page of my website at drlindseyberkson.com.

I wrote Carol while shadowing some of the docs at Dr. Brownstein’s holistic clinic, which women need higher dosages of progesterone.

Now the range may be, in some women, anywhere from 50 mg to 2,500 mg. Depending on their history or pathologies, as well as present issues.

This is what very progesterone savvy Carol answered:

“Some women have a long history of progesterone deficit  ...can be PMS, PCOS, infertility, hysterectomy, estrogen after hysterectomy, PMDD, heavy bleeding. 

“It can take a lot of progesterone depending upon the person. 

“Sometimes in the range of a few thousand mg in creams for sure. 

“Endometriosis is a tricky one because needs progesterone but candida likely involved and have to deal with that first.  

“Progesterone, hydrocortisone, testosterone can allow candida to overgrow more. 

So you must identify and treat fungal issues ideally prior to initiating hormone replacement. I always test for candida IgA, IgG and IgM when I am first testing for baseline hormones; about to start BHRT on a patient. Berkson

“I recommend monitoring symptoms like anxiety, hot flashes, breast tenderness which can resolve in hours with enough progesterone.

Thanks Carol!

Knowledge is power.

Keep learning and collaborating are key.

Keep in mind: progesterone can be used in both genders.

Progesterone therapy can sometimes even be applicable in children. With conditions of anxiety, ADHD and others. Though that is not our first-go to.

Hope you are still enjoying your holiday.

Off the the office to shadow some more.

Always good to keep learning.

Dr. B.

References:

StatPearls [Internet].Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

Physiology, Progesterone