Progesterone cream primer: pushed aside for years by its headline-grabbing cousin estrogen, progesterone is finally getting the attention it deserves

Hormones can be a woman's best friends--or her worst enemies. Throughout life, the key to hormone harmony lies in balance, particularly as we age. During perimenopause, estrogen and progesterone production typically begin to fall, paving the way for menopause. But trouble starts because progesterone frequently plummets while estrogen production simply slows. The result: estrogen dominance, a condition that can lead to weight gain, fatigue, mood swings and bloating, as well as increased risk of heart disease, osteoporosis and certain cancers.

For many women, the key to correcting estrogen dominance is simple--applications of low-dose progesterone cream. Erika Schwartz, MD, author of The 30-Day Natural Hormone Plan, frequently recommends progesterone cream to her patients, often with "remarkable" results.

Hormone Dilemma

Progesterone cream, a member of the "bioidentical" hormone family, is gaining popularity as women search for alternatives to the conventional medical management of menopause, hormone replacement therapy (HRT). A controversial practice for more than 30 years, HRT relies mostly on pharmaceutically developed synthetic hormones. In 2002, researchers called an early halt to the Women's Health Initiative, a study examining risks and benefits of HRT. The reason: an increased risk of stroke, heart disease and breast cancer among participants.

Media coverage about these dangers left many women in medical limbo. Whether they were concerned about long-term risks or simply hoping to ease the discomforts of hot flashes, low libido and insomnia, women found they had few choices in conventional medicine. The search led many women to bioidentical hormones, and progesterone cream in particular.

Making Sense of Molecules

Bioidentical hormones, made of soy and yam extracts, are perfect molecular matches with the hormones the body produces, while synthetic supplements are essentially foreign substances. The structure of something as small as a molecule might not seem all that important, but our bodies notice. The mismatched molecules of synthetic progesterone, known as progestin, have been linked to migraines, depression, breast cancer, birth defects and an increased risk of stroke.

On the other hand, progesterone cream, which has been available for more than 25 years, has repeatedly been shown to be safe and effective. It is easily absorbed through the skin, and clinical trials show that it can protect against heart disease-related conditions, as well as fight hot flashes, reduce water retention, improve sleep quality and rev up the libido.

Most bioidentical hormones come in several forms, including patches, pills and creams, and require a doctor's prescription. Progesterone cream is the exception. Still, experts recommend either a saliva or blood test to determine appropriate treatment.

"Progesterone cream is not for everyone," notes Schwartz. It can ease menopausal symptoms, like night sweats, hot flashes, mood swings and anxiety, she explains, as well as mild premenstrual syndrome (PMS). "But more severe symptoms may require higher, prescription doses. Anything over 50mg per unit dose should be supervised by a knowledgeable physician or licensed nurse practitioner."

How to Use Progesterone Creams

Experts recommend looking for one that is manufactured in a Food and Drug Administration-certified laboratory or has the approval of the United States Pharmacopeia (USP). Focus on the best-known brands, and those that have been tested in clinical trials, or ask your health food store personnel for recommendations. Follow the label directions carefully. A typical dosage is 1/4 tsp. applied one to two times daily. If you are still menstruating, use the cream right after ovulation (about 10 to 14 days before your period); if you are menopausal, you can use progesterone cream daily, but many experts recommend a "three weeks on and one week off" cycle. Schwartz notes that it may take a month or more to experience some improvements.

QUICK TIP: Are Your Hormones Unbalanced?

Symptoms associated with low progesterone include painful, heavy periods, cysts, mood swings, sleep problems, panic attacks/anxiety, and endometriosis.

SOURCE NATURALS PHYTO-ESTROGEN CREAM contains isoflavone phytoestrogens, pomegranate juice and red clover extracts, and is designed to pass through skin layers more easily than nonliposomal creams.

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WISE ESSENTIALS WILD YAM PROGESTERONE+ contains 490mg of USP progesterone per ounce (24mg per 1/4 tsp.).

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HOME HEALTH FEMGEST PROGESTERONE CREAM is an organically based formula that also contains aloe and grapefruit extract.

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EMERITA PRO-GEST BODY CREAM, the company's top seller, is a clinically tested formula with 450mg of USP progesterone per ounce. The cream is paraben-free.

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