by Dr. John R. Lee

These are the kinds of letters, faxes and phone calls that Dr. Lee and Dr. Hanley receive every day from women whose premenopausal symptoms cleared up after they began using a natural progesterone cream. It may sound too good to be true, but it's merely a case of supplying the body with what it needs to maintain balance. You've read about how out of balance our estrogenic environment has become; it's no wonder women are feeling much better when they use some progesterone.

Unlike estrogen, progesterone is not a generic name but is the name of the hormone produced by the corpus luteum after ovulation, and in smaller quantities by the adrenal gland. It is synthesized in humans in a biochemical pathway leading from cholesterol to pregnenolone to progesterone. In turn, progesterone is the precursor of corticosteroids and testosterone. Progesterone is also synthesized, in copious amounts, by the placenta during pregnancy.

Progesterone is a specific molecule made by mammals and has multiple roles in your body. It effects every tissue in your body including the uterus, cervix, and vagina, the endocrine (hormonal) system, brain cells, fat metabolism, thyroid hormone function, water balance, peripheral nerve myelin sheath synthesis, bone cells, energy production and thermogenesis, the immune system, survival and development of the embryo, and growth and development of the fetus. Though referred to as a sex hormone, progesterone conveys no specific secondary sex characteristics and as such cannot be called a male or female hormone.

Progesterone is highly fat-soluble compound exceedingly well absorbed when applied transdermally or onto the skin. According to hormone researcher David Zava, Ph.D., progesterone is by far the most lipophilic, or fat-loving, of the steroid hormones. It circulates in the blood, carried by fat-soluble substances such as red blood cell membranes. Some 70 to 80 percent of ovary-made progesterone is carried on red blood cells and thus is not measured by serum or plasma blood tests. This progesterone is available to the body for use, and readily filters through the saliva glands into saliva where it can be measured accurately. The remaining 20 to 30 percent of progesterone in the body is protein-bound and is found in the watery blood plasma where it can be measured by serum or plasma blood tests. However, only 1 to 9 percent of this progesterone is available to the body for use. That is why saliva testing is a far more accurate and relevant test than blood tests in measuring bio-available progesterone.

The fall of progesterone levels at menopause is proportionately much greater than the fall of estrogen levels. While estrogen falls only 40 to 60 percent from baseline on average, progesterone can decline to nearly zero. Furthermore, anovulatory cycles will cause low progesterone levels on and off throughout the premenopausal years.

UTERINE ENLARGEMENT AND FIBRIODS

The uterus is one of the first organs to manifest symptoms when a woman's hormones are out of balance. Two of the most common uterine symptoms of premenopause syndrome are an enlarged uterus, and uterine fibroids. Women with PMS often experience painful periods (dysmenorrhea) which are most often caused when the endometrial lining of the uterus extends into the muscular wall of the uterus (adenomyosis). When shedding of the endometrium occurs (menstruation), the blood is released into the muscular lining, causing severe pain. Conventional medicine treats this pain with NSAIDS (non-steroidal-anti-inflammatory drugs) such as ibuprofen, but ignores the underlying metabolic hormonal imbalance that caused it. The problem can often be simply resolved by restoring proper progesterone levels, which restores normal growth and shedding of the endometrium.

Estrogen dominance causes the uterus to grow, and without the monthly balancing effect of progesterone, it doesn't have the proper signals to stop growing. In some women this results in an enlarged uterus that presses on other organs, such as the bladder, and often on the digestive system, and generally causes discomfort and heavy menstrual bleeding. In other women estrogen dominance results in fibroids, which are tough, fibrous, non-cancerous lumps that grow in the uterus. Some fibroids can grow to the size of a grapefruit or cantaloupe, causing constant bleeding and such heavy menstrual periods that the blood loss is akin to hemorrhaging.

Fibroids always shrink at menopause, but the most common course of action a doctor takes when a patient comes in with a fibroid is to remove the uterus. The explanation given is that a fibroid is too difficult to remove without irreversibly damaging the uterus. But in most cases this is no longer true. If you do end up needing to have a fibroid surgically removed, find a doctor who can do it without removing your uterus with it. If you have many small fibroids, it may be more difficult to remove them. On the other hand, their smaller size may make it easier to treat them without surgery.

PREMENSTRURAL SYNDROME (PMS)

Premenstrual syndrome (PMS) is by far the single most common complaint of premenopausal women. Current estimates are that severe PMS occurs in 2.5 to 5 percent of women, and mild PMS occurs in 33 percent of women. PMS was first described in 1931 as a "state of unbearable tension," a description most women can understand to a certain degree. Some women have PMS from the time they begin having menstrual cycles but for most, PMS begins in the premenopausal years, around the mid-thirties, and becomes increasingly severe as the years go on. Although it's possible to create a list of dozens and dozens of PMS symptoms, the most common are bloating/water retention and the resulting weight gain, breast tenderness and lumpiness, headaches, cramps, fatigue, irritability, mood swings, and anxiety. In women with severe PMS, irritability and mood swings can become outbursts of anger and rage. By definition PMS symptoms occur in the two weeks before menstruation and sometimes for a few days into menstruation.

You should know right up front that there is no magic bullet for PMS. A little bit of progesterone will help a lot, and in some women it solves the problem, because it offsets the effects of environmental estrogens and anovulatory cycles, but PMS is a multi-factorial problem that needs to be handled on many physical levels as well as on the emotional level. You'll discover more about the emotional level when we talk about the emotional side of premenopause in the next chapter.

Stress is almost always involved in PMS. Stress increases cortisol levels, which blocks progesterone from its receptors. Therefore, normal progesterone levels do not mean that supplemental progesterone is not needed. Extra progesterone is necessary to overcome the blockade of its receptors by cortisol. When a woman discovers she has a handle on controlling her PMS, it will help her manage stress better. Then lower levels of progesterone will work normally again.

For years it was assumed that since PMS symptoms occur when progesterone levels are normally relatively high, that it was progesterone that was causing the symptoms. Theoretically, symptoms could relate either to elevated progesterone levels or progesterone deficiency (estrogen dominance). Elevated levels of progesterone are unlikely since, during pregnancy, progesterone levels are 10 to 20 times higher than normal mid-cycle levels and similar symptoms do not occur. Progesterone deficiency (estrogen dominance) is much more likely since many of the symptoms correlate with estrogen dominance symptoms, most notably water retention, breast swelling, headaches, mood swings, loss of libido, and poor sleep patterns.

A woman's response to her own cyclical hormones is extremely individual, and this is part of the reason that it has been so difficult to pin down the causes of PMS. Estrogen levels that cause anxiety and bloating in one woman will have virtually no effect on another. A woman who sails through an anovulatory cycle with hardly a ripple is in complete contrast to the woman who is plagued by migraines or anger premenstrually when she doesn't ovulate. Birth control pills and premenopausal hormone replacement therapy (HRT) will cause a long list of side effects (including PMS) in many women, while others will say they feel fine. This is why it's so important that you become familiar with your own body and your own symptoms, and don't let anybody tell you that what you're experiencing is "just an emotional problem," or that an antidepressant or tranquilizer is all you need.

PMS AND THE STRESS CONNECTION

You know from the chapter on hormone balance that stress increases your levels of cortisol, a hormone released primarily by the adrenal glands in response to feelings of fear, danger or even a sense of competition. In excess, cortisol can stimulate feelings of irritability, anger and rage. Cortisol is also released when you push yourself to work through tiredness day after day. Think of cortisol as a backup energy system. Like the batteries that back up your electronics when the electrical power goes out, you can't just keep using them to give you full power, or they'll wear out and you'll also lose that source of energy. In the same way, you can't depend on your cortisol and your adrenal glands to keep taking you beyond your physical limits or eventually you will create depleted organs and chronic fatigue.

Since cortisol and progesterone compete for common receptors in the cells, cortisol impairs progesterone activity, setting the stage for estrogen dominance. Chronically elevated cortisol levels can be a direct cause of estrogen dominance, with all the familiar PMS symptoms.

High cortisol levels also affect blood sugar. Cortisol sends glucose (blood sugar) flooding into the cells. The initial rush of glucose into the cells may feel great, but twenty or so minutes later your body will be working overtime to produce more glucose and you'll be searching the cupboards or your desk drawers for candy bars, cookies and potato chips to get your blood sugar and your energy back up. The majority of those empty calories will be converted to fat and if you keep up the pattern long term, you'll be struggling to keep your weight down and your energy up.

Fluctuating blood sugar creates another type of negative feedback cycle, where high levels of sugar in the blood stimulate the release of adrenaline, which in turn stimulates the release of cortisol, which in turn causes a craving for quick calories, and so forth.

THE REWARDS OF NATURAL HORMONE BALANCE: A TESTIMONIAL

It's difficult to describe the relief that women feel when they balance their hormones and come out of the ill effects of premenopause syndrome. One of the best descriptions we've read comes from a woman named Linda, who has turned a longer version of the following letter into a brochure and is handing it out to any woman who will take it:

It's sad to say that Linda's story is not all that unusual. It is very common to hear stories from women whose symptoms are less severe, but who are suffering from similar problems. Dr. Lee has been (wrongly) accused of talking only about natural progesterone cream as if it is the magic solution to a woman's every problem, but this letter demonstrates why. Progesterone cream is certainly not a magic potion. But it is the best remedy we've found so far to counteract the effects of living in a state of xenohormone excess. We do not naturally need to supplement progesterone. Mother Nature has equipped us to live a long, healthy robust life given a wholesome environment. If we were living in a stress-free, unpolluted world; if we were eating whole, fresh organic foods; and if we got plenty of outdoor exercise, we probably wouldn't ever need progesterone.

NUTRITION AND HORMONE BALANCE:

How a good diet with the right foods can help balance your hormones.

Although natural progesterone can have wonderfully curative effects on the symptoms of premenopause syndrome, it works best when you eat wholesome foods, pay attention to possible food allergies, and take nutritional supplements. The rewards of eating a nutritious diet are more than worth the sacrifices. You'll decrease your risk of future heart disease, cancer, diabetes, osteoporosis and arthritis. If your diet has consisted largely of high calorie, nutrition-free foods such as candy bars and cookies, your energy and moods will improve dramatically. If you suffer from indigestion, gas, bloating, and constipation, you'll be happy to know that eliminating food allergens and good nutrition are nearly always a cure. You'll catch fewer colds and flus because your immunity will improve, it will be easier to drop excess fat, and your skin will clear up. In some cases, a well-designed, individualized diet, supplement and exercise program is all that's needed to restore balance during the premenopause years and beyond. Depending on your exposure to xenohormones, you may well find that you don't need to use natural progesterone.

What are these magical foods you're supposed to be eating? Which of the endless diets touted this month is the one to follow? Which of the hundreds of supplements found on health food store shelves should you be taking? There's no one answer for everybody, but this chapter gives you enough guidelines to begin to create your own personal hormone balance program.

Some women are coming from a lifetime of hardly thinking about what foods they put in their mouths, except for those times they've tried to lose weight. The more ambitious have gone to the bookstore for the latest best-selling diet books. Some say they've tried the high-carbohydrate, low-fat diets and felt worse than ever, while others say they feel great on such a diet but can't seem to stick to it. Still others swear by the popular diet books that promote balanced intake of fat, protein, and carbohydrates, while some feel them to be too regimented, unpalatable, or hard to follow. There's a lot of frustration around food for most women, and this is especially true of premenopausal women who are starting to gain some serious weight for the first time in their lives and can't seem to do anything to stop it.

Your first assignment is to stop worrying so much about the weight gain. This is not in any way an encouragement to become obese, but rather to let go of the starving model ideal. To the extent that you accept your womanly body you will be giving that gift of acceptance to the next generation of women as well! Mother Nature designed women so that they would put on little bit of weight premenopausally. It will get you through menopause more gracefully and protect you from osteoporosis and strokes. If you don't allow the weight gain to become obesity, the latest research shows that you won't be at a higher risk for heart attacks and cancer, especially if your keep your hormones balanced. You can assume that you are obese if your weight is interfering with your ability to move around physically, or if it is causing weight-related problems such as diabetes, arthritis, and difficulty breathing.

In spite of the charts and graphs and studies put out by everyone from the American Heart Association to the federal government, there is no one diet that is right for everyone. Nobody can hand you a piece of paper or a book that tells you exactly what you need to eat unless they have collected a lot of data first. Anyone who has done the work of figuring out their ideal foods and supplements can tell you that it's a process that takes some time, attention and tracking. It takes trying new things. It means getting rid of the processed foods you depend on for comfort and replacing them with real, nourishing, substantial whole foods. It also means paying close attention to how your body responds to different foods and eliminating those that are having adverse effects on your health. No one can do this for you. The good news is that it can be a fun piece of detective work with great rewards.

THE LIGHT AND DARK SIDES OF SOY

How to eat soy so that it helps.

Today, it's all but impossible to find a health-related magazine or TV show that doesn’t shout out the benefits of soy foods for the prevention of menopause symptoms, breast and other cancers, heart disease and osteoporosis. In the past decade, the soy industry has poured hundreds of millions of dollars into the research, marketing and advertising of soy foods, and it has been well rewarded for its efforts. However, while we agree that certain soy foods, eaten in moderation, can be a healthy addition to the diet, we believe that women who are eating soy with every meal, or even every day, may be damaging their health. Soy has its good side, but it also has its bad side, which has been largely ignored by those rushing to cash in on this nutritional fad.

Traditional Asian soy foods such as tofu, tempeh, and miso have been a dietary staple in that part of the world for centuries, and they are increasingly found in Western diets. Western food manufacturers have also developed a slew of new soy foods, using these little beige beans as an ingredient in protein powders, hot dogs, burgers, cheese, cereals, sports bars, and other convenience foods. Soy milk, texturized soy protein, and soy cheese have been touted as nutritious alternatives to cow's milk products and meat. Supplement companies create pills from soy phytochemicals and advertise them as natural medicines for relief of menopause symptoms, or as protection against cancer, heart disease, or osteoporosis. Soy powders are sold as supposedly healthy meal alternatives. Some of these products are good for you, and some are best avoided. In this chapter you’ll find out how to eat soy foods so they enhance your health….

SOY AND MENOPAUSE

With all that we know about the pitfalls of conventional medicine's treatment of women in menopause, it makes sense that women are turning to “natural” approaches to relieve menopausal discomforts. The beneficial effects of estrogen on these discomforts are indisputable, but as women become more informed they see that the risks – especially of breast cancer – may be too great to justify its use. Others stop using conventional HRT because of side effects, and look to natural remedies to help them control their menopause symptoms.

This growing interest in natural solutions for treating menopausal symptoms has prompted the food and supplement industries to develop alternatives to conventional pharmaceutical estrogens such as Premarin. The soy foods industry has been poised to benefit most from this search for natural remedies for menopause because of soy's high phytoestrogen content.

The lay press and the soy industry have widely promoted the message that soy phytoestrogens act, in effect, as surrogate estrogens. Such a message gives women the impression that they can use soy to naturally relieve symptoms of falling estrogen levels at menopause. While the research does show that isoflavones behave like estrogens in the body the conclusion that they are all the medicine a woman needs to help her through menopause is not borne out by recent clinical studies on soy and menopausal symptoms.

Soy phytoestrogens have very little effect on vasomotor symptoms such as hot flashes, night sweats and vaginal dryness. In one comprehensive study from the Bowman Gray School of Medicine in North Carolina, researchers looked at the effects of soy phytoestrogens on women aged 45 to 55 with menopausal symptoms. This study was big news because the women who took a phytoestrogen-rich soy supplement reported a 50 percent decrease in the severity of their hot flashes. What most news stories didn't mention, however, is that the placebo group reported a 35 percent reduction. Furthermore, this study showed small reductions in the severity of hot flashes, but none on their frequency. In other words, these women were having just as many hot flashes as they did before they added soy foods or supplements, but the intensity of those hot flashes were diminished. While decreased intensity is certainly a good thing when it comes to hot flashes, soy estrogens are clearly not as potent as many forms of conventional estrogen replacement which often eliminate hot flashes quickly and completely.

A recent study of women with vasomotor symptoms at the Mayo Clinic showed no benefits from soy protein isolates, which have high levels of phytoestrogens. This has also been Dr. Zava’s experience in analyzing saliva hormone level results accompanied by detailed questionnaires; soy phytoestrogens simply don’t work well to control vasomotor symptoms. The isoflavones in soy are aromatase inhibitors which lower the levels of estrogens made by the body, which is counter-productive to controlling vasomotor symptoms.

Soy phytoestrogens do have the estrogenic effect of stimulating the growth of breast cancer cells in tissue cultures. Several studies presented at a recent soy symposium showed that soy protein isolates stimulate the growth of normal breast cells much the way that natural estrogens do, and of course this would add to breast cancer risk if progesterone is not present.