Progesterone Low or Estrogen Dominance: Overview
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Female problems seem to be on the rise. Between 40% and 60% of all women in the West suffer from PMS. In addition, women suffer from a plethora of symptoms, some menopausal and others not. Something quite serious seems to be happening. There is strong evidence that that the proper hormonal balance necessary for women's bodies to function healthily is being interfered with by a number of factors.
Research has shown that many women in their 30s - some even younger - will occasionally not ovulate during their menstrual month.[1] Without ovulation, no corpus luteum results and no progesterone is made. A progesterone deficiency ensues and several problems can result from this, one being the month-long presence of unopposed estrogen with all its attendant side-effects.
A second major problem results from the interrelationship between progesterone loss and stress. Stress combined with a bad diet can induce cycles where ovulation does not occur. The consequent lack of progesterone interferes with the production of the stress-combating hormones, worsening stressful conditions that give rise to further anovulatory cycles and so continues the vicious cycle.
Another major factor contributing to this imbalance between estrogen and progesterone is the industrialized world now live in, immersed in a rising sea of petrochemical derivatives. They are in the air, food and water and include pesticides and herbicides (such as DDT, dieldrin, heptachlor, etc.) as well as various plastics (polycarbonated plastics found in babies bottles and water jugs) and PCBs. These estrogen-mimics are highly fat-soluble, not biodegradable or well excreted, and accumulate in the fat tissue of animals and humans. These chemicals have an uncanny ability to mimic natural estrogen and thus are given the name "xeno-estrogens" since, although they are foreign chemicals, they are taken up by the estrogen receptor sites in the body, seriously interfering with natural biochemical activity. Drinking sodas out of plastic bottles is one of the leading causes of estrogen dominance.
Extensive research is now revealing an alarming situation worldwide, created by the inundation of these hormone-mimics. In their book, Our Stolen Future, authors Theo Colburn of the World Wildlife Fund, Dianne Dumanoski of The Boston Globe, and John Peterson Meyers, a zoologist, have identified 51 hormone mimics, each able to unleash a torrent of effects such as reduced sperm production, cell division and sculpting of the developing brain. These mimics are not only linked to the recent discovery that human sperm counts worldwide have plunged by 50% between 1938 and 1990 but also to genital deformities, breast, prostate and testicular cancer, and neurological disorders.
Causes & Development
Dr. John Lee, MD has discovered a consistent theme running through women's complaints of the distressing and often debilitating symptoms of PMS, peri-menopause and menopause: too much estrogen or, in other words, estrogen dominance. Now, instead of estrogen playing its essential role within the well-balanced symphony of steroid hormones in a woman's body, it has begun to overshadow the other players, creating biochemical dissonance. Even natural estrogens should not be prescribed unless it is clear that a deficiency exists.
Signs & Symptoms
Female hormone imbalances can manifest in many and diverse symptoms. More specific suggestions regarding individual hormone levels may be made elsewhere in this report.
Diagnosis & Tests
The hormone issue is a complicated one. There are three types of natural estrogen, and multiple degradation pathways and metabolites. Depending on the area of concern, a skilled natural doctor should be able to recommend those tests which will yield the most information, and guide you into balance. While a therapeutic trial of progesterone may help a condition of estrogen dominance, specific laboratory testing on a doctor's recommendation should be conducted prior to hormone replacement. Blood, saliva, or urine measurements may be made. Your doctor should be aware that the timing of specimen collection in relation to your cycle is important in progesterone testing. The best time is day 21 - 24 of your cycle (sooner if cycle is shorter and later if cycle is longer). If progesterone levels are normal, elevated estrogens can be reduced by means other than progesterone use.
The need for testing is seen in the situation of two menopausal women having similar symptoms but one with elevated estrogens (or an imbalance of estrogens) and the other with low estrogens. Both may have normal or low levels of progesterone. Giving natural estrogen to a woman in menopause seems the logical thing to do, but may make the situation worse if her levels are already too high. Giving a women low in estrogen, more progesterone won’t solve the underlying deficiency.
Treatment & Prevention
Dr. Lee has been able to balance the estrogen-dominance effect through the use of transdermal natural progesterone cream.
Anti-aging Benefits of Natural Progesterone
1. Progesterone is a primary precursor in the biosynthesis of the adrenal corticosteroids. Without adequate progesterone, synthesis of the cortisones is impaired and the body turns to alternate pathways. These alternate pathways have masculine-producing side effects such as long facial hairs and thinning of scalp hair. Further impaired corticosteroid production results in a decrease in the ability to handle stress, e.g., surgery, trauma or emotional stress.
2. Many peri- or post-menopausal women with clinical signs of hypothyroidism, such as fatigue, lack of energy, intolerance to cold, are actually suffering from unrecognized estrogen dominance and will benefit from supplementation with natural progesterone.
3. Estrogen and most of the synthetic progestins increase intracellular sodium and water uptake. The effect of this is hypertension. Natural progesterone is a natural diuretic and prevents the cell's uptake of sodium and water, thus preventing hypertension.
4. Whereas estrogen impairs homeostatic control of glucose levels, natural progesterone stabilizes them. Thus, natural progesterone can be beneficial to both those with diabetes and those with reactive hypoglycemia. Estrogen should be contraindicated in patients with diabetes.
5. Thinning and wrinkled skin is a sign of lack of hydration in the skin. It is common in peri- and post-menopausal women and is a sure sign of hormone depletion. Both estrogen and progesterone restores skin hydration.
6. Progesterone serves a role in keeping brain cells healthy. A disorder such as premature senility (Alzheimer's disease) may be, at least in part, another example of disease secondary to progesterone deficiency.
7. Progesterone is essential for the healthy development of the myelin sheath which protects the nerve cells. Low progesterone levels lead to recurring aches and pains.
8. Progesterone creates and promotes an enhanced sense of emotional well being and psychological self-sufficiency.
9. Progesterone is responsible for enhancing the libido. [John R. Lee, M.D., Slowing the Aging Process with Natural Progesterone, BLL Publishing, CA, USA, 1994, p.14]
Complications
Estrogen's role in osteoporosis is only a minor one. Estrogen replacement will reduce bone breakdown, but only progesterone increases new bone growth or deposition. Progesterone deficiency results in bone loss. In a three year study of 63 post-menopausal women with osteoporosis, women using transdermal progesterone cream experienced an average 7 to 8% bone mass density increase in the first year, 4 to 5% the second year, and 3 to 4% in the third year. Untreated women in this age category typically lose 1.5% bone mass density per year.[3] Dr. Lee believes that the use of natural progesterone in conjunction with dietary and lifestyle change can not only stop osteoporosis but can actually reverse it - even in women aged over 70.
Effects of Estrogen Dominance
1. When estrogen is not balanced by progesterone, it can produce weight gain, headaches, bad temper, chronic fatigue and loss of interest in sex - all of which are part of the clinically recognized premenstrual syndrome.
2. Not only has it been well established that estrogen dominance encourages the development of breast cancer thanks to estrogen's proliferative actions, it also stimulates breast tissue and can trigger fibrocystic breast disease - a condition which wanes when natural progesterone is introduced to balance the estrogen.
3. Excess estrogen implies a progesterone deficiency. This, in turn, leads to a decrease in the rate of new bone formation in a woman's body by the osteoblasts - the cells responsible for doing this job. Although most doctors are not yet aware of it, this is the prime cause of osteoporosis.
4. Estrogen dominance increases the risk of fibroids. One of the interesting facts about fibroids is that, regardless of the size, fibroids commonly atrophy once menopause arrives and a woman's ovaries are no longer making estrogen. Doctors who commonly use progesterone with their patients have discovered that giving a woman natural progesterone may cause fibroids to atrophy.
5. In estrogen-dominant menstruating women where progesterone is not peaking and falling in a normal way each month, the ordered shedding of the womb lining doesn't take place. Menstruation becomes irregular. This condition can usually be corrected by making lifestyle changes and using a natural progesterone product. It is easy to diagnose by having a doctor measure the level of progesterone in the blood at certain times of the month.
6. Endometrial cancer (cancer of the womb) develops only where there is estrogen dominance or unopposed estrogen. This, too, can be prevented by the use of natural progesterone. The use of the synthetic progestins may also help prevent it, which is why a growing number of doctors no longer give non-human estrogens without combining them with progesterone drug during HRT. However, all synthetic progestins have side effects.
7. Water logging of the cells and an increase in intercellular sodium, which predispose a woman to high blood pressure or hypertension, frequently occur with estrogen dominance. These can also be side effects of progestins use. A natural progesterone cream often resolves this problem.
8. The risk of stroke and heart disease is increased dramatically when a woman is estrogen-dominant. [Leslie Kenton, Passage to Power, Random House, UK, 1995]
References & Further Information
[1] Lee, John R., M.D., Natural Progesterone: The Multiple Role of a Remarkable Hormone, BLL Publishing, California, USA, 1993, p.29.
[2] Kenton, Leslie, Passage to Power, Random House, UK, 1995, pp.19-20.
[3] Lee, John R., M.D., "Osteoporosis Reversal: The Role of Progesterone," International Clinical Nutrition Review (1990), 10: pp.384-391.
You can develop a clearer understanding of the nature of your condition and the interplay of female hormones by reading an informative book such as Natural Hormone Balance by Uzzi Reiss, MD, or What Your Doctor May Not Tell You About Premenopause and What Your Doctor May Not Tell You About Menopause by John Lee, MD.
Signs, symptoms & indicators of Progesterone Low or Estrogen Dominance:
Lab Values - Hormones Reduced/low progesterone level
High progesterone level
Symptoms - Food - Preferences
Sugar/sweet craving
Symptoms - General
Constant fatigue
Symptoms - Metabolic
Low energy/stamina
Hyperactivity
Temple-based headaches
Symptoms - Mind - Emotional
Impatient/hostile disposition
Symptoms - Mind - General
Reduced/poor mental clarity
Short-term memory failure
Symptoms - Muscular
Leg cramps caused by walking
Symptoms - Reproductive - Female Cycle
Pre/menstrual depression
Having hot flashes
Studies indicate that progesterone can sometimes minimize hot flashes. Natural progesterone cream has been clinically demonstrated to provide relief from hot flashes in some women.
Breast soreness during cycle
Irritability related to cycle
Painful menstrual cramps
Water retention before menstruation
Hot flashes between/hot flashes during & after period
Symptoms - Reproductive - General
Difficulty conceiving children
Symptoms - Skin - General
(Possibly) jaundiced skin
Conditions that suggest Progesterone Low or Estrogen Dominance:
Autoimmune Multiple Sclerosis
Progesterone has been shown in animal studies to promote the formation of new myelin sheaths [Human Reproduction 2000 Jun;15 Suppl 1: pp.1-13, J Steroid Biochem Mol Biol 1999 Apr-Jun;69 pp.97-107, Mult Scler 1997 Apr;3 pp.105-12]
Physicians have known for years that pregnancy can suppress some forms of immune response, such as allergies. In the early and mid-1980s, several doctors observed that MS patients had fewer symptoms during pregnancy and post-partum recovery. This may be due to the high progesterone level in the blood of a pregnant woman. Progesterone tends to be anti-inflammatory. Progesterone therapy may therefore be useful for MS especially as a medical report noted the association between enlarged adrenal glands and MS. Progesterone, being a steroid, often helps the adrenals deal with inflammation.
Other studies have indicated that symptoms are worse during periods when the progesterone to estrogen ratio is low.
Environment / Toxicity
Copper Toxicity
Elevated estrogen levels often increase serum copper levels to more than double normal values, while at the same time red blood cell levels, where copper is important, may actually be lower. This may contribute to some of the psychological or other symptoms seen during pregnancy or with birth control pill use.
Hormones
Low Male Testosterone Level
Testosterone is converted into estrogen naturally. When this conversion is overactive the result is too little testosterone and too much estrogen. High levels of estrogen also trick the brain into thinking that enough testosterone is being produced, thereby reducing the natural production of testosterone.
Hirsutism
Low Sex Drive
Loss of sex drive often correlates with a progesterone deficiency, not an estrogen deficiency.
Icon Hypothyroidism
Progesterone increases sensitivity of estrogen receptors, and can therefore redirect estrogen activity and inhibit many of unopposed estrogen's undesirable side-effects, which includes interference with thyroid hormone activity.
Infections
Yeast / Candida Infection
Lab Values
Low Total Cholesterol
Cholesterol is the raw material used to make progesterone, and is therefore its immediate precursor.
Lab Values - Hormones
Elevated estrogen levels (confirmed)
Mental
Anxiety
Panic Attacks
It has been reported that women with low progesterone levels experience less intense or less frequent panic attacks after progesterone supplementation. In some cases, sublingual progesterone in olive oil has produced immediate benefit.
Metabolic
Edema (Water Retention)
Progesterone has also been used in the treatment of idiopathic edema under the premise that some women with idiopathic edema either do not ovulate or have a luteal phase deficiency.
Ovarian function was investigated in 30 women with postural idiopathic edema by measuring plasma estradiol and progesterone levels between the 21st and 23rd days of the menstrual cycle. Plasma progesterone concentrations were found to be lower than 5ng/ml in 53% of the cases and lower than 10ng/ml in 83%. The ovarian dysfunction most frequently observed was inadequate corpus luteum, i.e. progesterone deficiency with normal plasma estradiol levels. In virtually all patients the initial disorder in capillary permeability, as evaluated by Landis' test, was fully corrected by progesterone administered orally. However, clinical improvement was less marked with treatments of short duration (2-3 consecutive cycles). In view of the complex cause of the disease, combined treatments in which progesterone might well play the major role are usually required. [Presse Med 1983 Dec 10;12(45): pp.2859-62 (translated)]
Skin-Hair-Nails
Cold Hands and Feet
Cold hands and feet, often caused by low thyroid function, may be a symptom of estrogen excess or low progesterone influencing thyroid function.
Female Hair Loss
Symptoms - Immune System
General fungal/yeast infections
Tumors, Benign
Fibroids
Estrogen levels have persistently been shown to be elevated in patients with uterine fibroids.
Tumors, Malignant
Breast Cancer
One study reported that women with the highest levels of estrogen were twice as likely to develop breast cancer as those with the lowest levels. [Journal of the National Cancer Institute, 17th April 2002]
Uro-Genital
Premenstrual Syndrome
Menorrhagia (Heavy Periods)
In a normal menstrual cycle, estrogen and progesterone regulate the buildup of the endometrium (uterine lining of blood and tissue), which is shed each month during menstruation. Menorrhagia can occur because of an imbalance between estrogen and progesterone. As a result of the imbalance, the endometrium keeps building up resulting in heavy bleeding when it is eventually shed. Since hormone imbalances are often present in adolescents and in women approaching menopause, this type of menorrhagia (dysfunctional uterine bleeding) is fairly common in these groups.
Premenstrual Syndrome PMS A (Anxiety)
Fibrocystic Breast Disease
The administration of natural progesterone is suggested by Dr. John Lee, MD and others to be a protective therapy that can reduce breast tenderness and the fibrocystic changes seen in FBD.
Susceptibility To Miscarriages
Vaginitis/Vaginal Infection
Yeast infections are more common among women with increased levels of estrogen. This is seen in those who use estrogen-containing birth control pills and among women who are pregnant. The increased hormone level causes changes in the vaginal environment that make it a media for fungal growth and nourishment.
Metrorrhagia
Counter-indicators:
Pregnancy-Related Issues
Hormone levels fluctuate at different stages of pregnancy, making it difficult to isolate any underlying imbalances during this time.
Risk factors for Progesterone Low or Estrogen Dominance:
Low Adrenal Function / Adrenal Insufficiency
The inner most layer of an adrenal gland is the zona reticularis which produces small amounts of sex hormones. Specifically, it produces androgen, estrogen and progesterone. Adrenal exhaustion can therefore cause hormone deficiencies.
Low Melatonin Level
One of melatonin's roles is the reduction of estrogen production in the body, and probably also reduction of the number of estrogen receptors. Studies have shown that the protective, estrogen-reducing effects of melatonin are significantly reduced by excessive exposure to light (including late night TV viewing) and probably electromagnetic fields, chemical pollutants such as pesticides and fungicides, and many commonly prescribed drugs, such as beta blockers for heart disease, high blood pressure and headaches.
Mental
Stress
Stress increases cortisol production; cortisol blockades (competes for) progesterone receptors. Additional progesterone is required to overcome this blockade.
Organ Health
Liver Detoxification / Support Requirement
Supplements and Medications
Non-human estrogen use
Current birth control pill use
Counter-indicators:
Natural progesterone use
(Normal/high) sublingual progesterone use
Taking excesssive/on normal dose/on low dose oral progesterone
On moderate/on low/on high dose progesterone
Symptoms - Immune System
Past general fungal/yeast infections
Symptoms - Metabolic
Pear-shaped body when overweight
Symptoms - Reproductive - Female Cycle
History of painful menstrual cramps
Progesterone Low or Estrogen Dominance can lead to:
Low Sex Drive
Loss of sex drive often correlates with a progesterone deficiency, not an estrogen deficiency.
Tumors, Malignant
Endometrial Cancer
High levels of estrogen without opposing progesterone can increase the risk of endometrial cancer. Using estrogen replacement therapy without taking progesterone or progestins is also related to a greater risk for endometrial cancer.
Uro-Genital
Metrorrhagia
Recommendations and treatments for Progesterone Low or Estrogen Dominance:
Vitex / Chasteberry
Vitex increases luteinizing hormone production while inhibiting the release of follicle stimulating hormone, leading to an indirect increase in progesterone and a normalization of prolactin levels. If taken regularly for several months, it helps to restore hormonal balance and alleviate PMS symptoms.
Evening Primrose Oil
Not recommended:
Korean Ginseng
Extract
DIM (di-indolmethane)/I3C (Indole-3-Carbinol)
DIM encourages the conversion of estrogens to safer forms and helps reduce elevated levels.
Hormone
Natural Progesterone
Estrogens and progesterone tend to be antagonistic hormones, each balancing the other. When progesterone levels are low, it can seem as though estrogen levels are too high, which may or may not be the case. Supplementation with natural progesterone corrects the real problem: progesterone deficiency.
Estrogen-balancing Medications
Before using estrogen balancing medications whether natural or not, laboratory testing should be conducted to confirm elevated levels.
Lab Tests/Rule-Outs
Test for Hormones
Nutrient
TMG (Tri-methyl-glycine)
TMG converts to S-adenosyl methionine (SAMe, an activated form of methionine) in the body. SAMe assists in the breakdown of estrogens.
