Progesterone and Hormone Supplementation

Progesterone is a female sex hormone produced in the ovaries, and in smaller quantities, in the adrenal glands. During the last two weeks of the menstrual cycle, progesterone becomes the dominate female hormone as it prepares the body for pregnancy.

Progesterone is the counterbalance of estrogen and regulates the effects of estrogen in a woman’s body. Progesterone and estrogen are designed by nature to work together. This is why many physicians treating hormonal problems include it in their regiment guidelines. We do not prescribe estrogen without progesterone.

When it was found that Estrogen replacement alone, without concomitant progesterone supplementation, could increase a women’s chance of contracting uterine cancer, researchers and physicians thought to counteract this risk by prescribing progesterone in the form of a synthetic version called “progestin.”

Why? The issue of patentable versus non-patentable. Progestins can make a lot of money for the manufacturer, progesterone can not. It didn’t take long for the side-effects of progestins to become known: Weight gain and bloating, anxiety and high-blood pressure, PMS-like symptoms and more.

Is Progesterone safer?
Not all doctors and researchers agree that progesterone is any better or any safer than progestins.

Progesterone and hormone supplementation.
Progesterone is almost mandatory in many women, progestins are not.

In July 2002 when the Woman’s Health Initiative released their findings that hormone replacement therapy (HRT) was dangerous, somehow, progesterone was singled out as being the cause of excessive breast cancer risks by the general media. This was not the case at all. A portion of the study cited above, was discontinued because of breast cancer risk in those women using a combination of synthetic hormones; that derived from horse urine mixed with progestins, not progesterone.

How different are progestins from progesterone?
In pregnancy, progesterone protects the human fetus and maintains a healthy pregnancy. Progestins cannot be taken during pregnancy because they can cause birth defects. Progestins are used in birth control pills to prevent pregnancy.

Do progestins and progesterone sound like the same hormone to you?
Further, the side effects of progestins can include breast tenderness, depression, edema and bloating. Progesterone does not seem to cause any of those side effects. In fact, it usually reduces such symptoms.

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Hormone Replacement Therapy – Study Comments

Researchers writing in the Journal of the British Menopause Society say “Many women have been denied or have discontinued HRT because of the fear of risks, which may not have been put in perspective or fully understood.”

Davey DA. Hormone replacement therapy: time to move on? J Br Menopause Soc. 2006 Jun;12(2):75-80.

Hormone replacement therapy: time to move on?
The risks and benefits of hormone replacement therapy (HRT) need to be put in perspective. In the analysis of clinical trials, emphasis is often placed on relative risks, statistical significance and 95% confidence intervals, whereas, from a clinical perspective, more may be gained from a consideration of the absolute and attributable risks of therapy.

The Council for International Organizations of Medical Sciences recommended that the frequency of adverse events be categorized as ‘rare’ if less than 1/1000 but more than 1/10,000, and as ‘very rare’ if less than 1/10,000. In the analyses of the Women’s Health Initiative (WHI), the attributable risks were ‘appreciable’ (i.e. more than 1/1000) only in women aged over 70 years, with the exception of the risks of venous thromboembolism and stroke. The women in the WHI trial do not represent the relatively younger, healthy, postmenopausal women most commonly prescribed HRT, who are probably at much lower risk.

Moreover, the WHI trial did not take into account the benefit of relief of menopausal symptoms, which is, for many women, paramount and outweighs the ‘rare’ long-term risks. Age may be a useful guide to risks and some simple guidelines for management, based on age, are suggested. Many women have been denied or have discontinued HRT because of the fear of risks, which may not have been put in perspective or fully understood. The care of postmenopausal women is not static, and sufficient has now been learned to enable each menopausal woman, with the help of her medical adviser, to come to a balanced and reasonable decision.

Testosterone in Post Menopausal Women

An article in the medical journal Current Opinion in Obstetrics & Gynecology says that testosterone therapy is a promising option for treating women with HSDD (very low libido or desire)

Somboonporn W.Androgen and menopause.Curr Opin Obstet Gynecol. 2006 Aug;18(4):427-32.

From the article abstract:

PURPOSE OF REVIEW: Androgen therapy is being increasingly used in the management of postmenopausal women. The most common indication is to improve sexual function. The aim of this review is to evaluate current knowledge pertaining to testosterone and sexual function in postmenopausal women.

RECENT FINDINGS: The change of testosterone levels during the menopause transition remains controversial. A correlation of endogenous testosterone levels and sexual function is still inconclusive. A Cochrane Review and recent randomized control trials have, however, consistently demonstrated that short-term testosterone therapy in combination with traditional hormone therapy regimens improves sexual function in postmenopausal women, particularly surgically menopausal women with hypoactive sexual desire disorder.

An adverse effect on the lipid profile has been identified which appears to be mostly associated with oral methyltestosterone. Data for other effects of testosterone and long-terms risks are lacking. Testosterone may act in a variety of ways in different tissues. This is, however, an area that requires further investigation.

SUMMARY: Testosterone therapy is a promising option for treating women with hypoactive sexual desire disorder after surgical menopause. Two remaining questions need to be answer: who is most likely to benefit from testosterone therapy and what are the long-term health risks?

Low Testosterone Levels are Associated with Coronary Artery Disease

Researchers say that low testosterone levels are associated with coronary artery disease in male patients with angina.
Rosano GM, Sheiban I, Massaro R, Pagnotta P, Marazzi G, Vitale C, Mercuro G, Volterrani M, Aversa A, Fini M. Low testosterone levels are associated with coronary artery disease in male patients with angina.Int J Impot Res. 2006 Aug 31

From the study abstract
Historically, high androgen levels have been linked with an increased risk for coronary artery disease (CAD.) However, more recent data suggest that low androgen levels are associated with adverse cardiovascular risk factors, including an atherogenic lipid profile, obesity and insulin resistance.

The aim of the present study was to evaluate the relationship between plasma sex hormone levels and presence and degree of CAD in patients undergoing coronary angiography and in matched controls.

We evaluated 129 consecutive male patients (mean age 58+/-4 years, range 43-72 years) referred for diagnostic coronary angiography because of symptoms suggestive of CAD, but without acute coronary syndromes or prior diagnosis of hypogonadism. Patients were matched with healthy volunteers. Out of 129 patients, 119 had proven CAD; in particular, 32 of them had one, 63 had two and 24 had three vessel disease, respectively. Patients had significantly lower levels of testosterone than controls (9.8+/-6.5 and 13.5+/-5.4 nmol/l, P<0.01) and higher levels of gonadotrophin (12.0+/-1.5 vs 6.6+/-1.9 IU/l and 7.9+/-2.1 vs 4.4+/-1.4, P<0.01 for follicle-stimulating hormone and luteinizing hormone, respectively). Also, both bioavailable testosterone and plasma oestradiol levels were lower in patients as compared to controls (0.84+/-0.45 vs 1.19+/-0.74 nmol/l, P<0.01 and 10.7+/-1.4 vs 13.3+/-3.5 pg/ml, P<0.05). Hormone levels were compared in cases with one, two or three vessel disease showing significant differences associated with increasing severity of coronary disease. An inverse relationship between the degree of CAD and plasma testosterone levels was found (r=-0.52, P<0.01).

In conclusion, patients with CAD have lower testosterone and oestradiol levels than healthy controls. These changes are inversely correlated to the degree of CAD, suggesting that low plasma testosterone may be involved with the increased risk of CAD in men.