Why is Progesterone Replacement Necessary?

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Many doctors do not prescribe Natural Progesterone during or after Menopause.  Many still use synthetic progestins that were predominant in the past. The use of progesterone has been controversial to say the least. Natural Progesterone is becoming more widely accepted as more studies show the multiple benefits.

Prolonged use of synthetic progestins can cause bloating, headache, fatigue, weight gain, increased symptoms of PMS, coronary artery disease, DVT or blood clots, and other health problems. Whereas micronized bioidentical or natural progesterone in not usually associated with any of these complications.  In fact some studies show that natural progesterone does just the opposite!

Progesterone is secreted only by the ovary and therefore at, during, and after menopause the level falls to zero. There are Progesterone receptor sites in the uterus, vagina, blood, bone, brain, and breast. Treatment with natural Progesterone has actually been found in many studies to protects against osteoporosis, coronary artery disease and cardiovascular disease.  Many feel a balance of progesterone to estrogen is necessary for these effects.  Many of studies in the past used only progestins.  That is not bioidentical or natural Progesterone.

Progesterone moderates many side effects of excess estrogen reducing fluid retention, bloating, and headaches. Natural progesterone is synergistic to estrogen’s effect on bone health and lipids. However, many doctors do not treat patients with Progesterone after hysterectomy because the opinion has been in the past that it is not needed. However, Progesterone has been shown in some studies to protect against heart disease and osteoporosis. Progesterone also has other benefits. It helps with general wellbeing and sleep.

If you are menopausal and still have a uterus and are taking estrogen, then progesterone counterbalances the stimulating effect on the uterus. Progesterone replacement can decrease the chance of bleeding and may in fact decrease the chance of uterine hyperplasia in this situation. If you are taking estrogen without progesterone there is a risk of increased uterine stripe and endometrial proliferation. This should be evaluated with pelvic sonography with a calculation of uterine stripe depth and further workup which is outside the scope of this discussion.

Progesterone can also be used to treat perimenopausal and PMS symptoms. This treatment certainly may help with anxiety, stress, and concentration.  In this instance we would need to evaluate your clinical situation and blood work to determine the correct course of action.

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