By Dr. Steve Zielinski,
Pharm.D, FACA
Colonial Village Pharmacy
Before menopause occurs, usually the balance between progesterone and estrogen falls out of balance causing symptoms similar to Peri-Menopause.
While estrogen production drops almost 50% during menopause, many of the menopausal symptoms begin before the drop in estrogen levels occur. There is a book by R. LEE titled Natural Progesterone (for physicians)and What your doctor may not be telling you about menopause (for general audiences) details the wide-ranging misconceptions that have led to the medical approach that has emphasized estrogen and forgotten progesterone, which is really unfortunate.
Natural progesterone, unlike synthetic progestins, has no known side effects when taken at or near physiological doses. Physiological (rather than pharmacologic) doses are much smaller and intended to bring hormone levels into normal ranges rather than using these hormones as drugs. These levels can be accomplished by 100mg per day oral, 25-50 mg per day sublingual, or 20-30 mg per day of a transdermal cream. These doses reflect a general regimen and should be adjusted by the actual progesterone:estradiol ratios and the familiarity with the dose regimen of the product selected.
There are advantages and disadvantages to each mode of therapy. Oral dosing is familiar to most women, but a higher dose of progesterone when given orally is needed to take into consideration first pass liver metabolism. Sublingual dosage forms help bypass the first pass metabolism, but while absorption is fast, so is elimination, and requires divided daily doses. Trans-dermal creams absorb well through the skin and need only one or two applications per day. “But too a lot of women a little dab just doesn’t seem like enough. So sometimes women use a little to much. Which ever dose is used we typically will retest salivary hormones after 6 months just to reassess the estrogen:progesterone ratio.
If you are looking for more information regarding progesterone or estrogen:progesterone balancing give us a call. Colonial Village Pharmacy, 7945 Big Bend Blvd.Webster Groves, MO 63119, 314-962-1065. www.colonialvillagerx.com.