Positive Health Online

There are few women who would turn down the chance to look and feel younger if a magic pill were offered. But is HRT really such an elixir, or could it actually shorten life? New evidence suggests that researchers and doctors may have been looking at the wrong hormone for fifty years, and that natural progesterone may be nature's benevolent answer to HRT.

Women, even more than men, are vulnerable to the image that society projects on them: that "real women" should look young, slim and wrinkle-free. The rest of womankind, the ones with the menopausal mood swings, greying hair and a middle aged spread, if not exactly seen as crones, are rarely given the status or the attention of their younger rivals. This is putting it crudely, but such fears lurk not far below the surface of most women. In some it breeds a desperation that can drive them to take a drug to keep them younger, even when they know it might be killing them.

The latest verdict on HRT is not good. But a new and natural alternative is now available, using the hormone progesterone and if necessary, natural oestrogen too.

Some doctors believe that progesterone is the primary hormone replacement that women should have been using all along. It has been shown to be protective against cancer and heart disease and to actually reverse osteoporosis. It can increase libido, rejuvenate the skin, and help reduce middle aged spread by increasing metabolism. It is also anti-depressant, diuretic and can reduce hot flushes. But first the bad news. What is HRT and why are women being given it?

The Forgotten Hormone

Women, we have been told, need oestrogen because it is this hormone that drops dramatically at menopause. Therefore, goes the argument, putting it back will reverse the devastating symptoms that some women endure. This reasoning ignores important facts.

Oestrogen does decline at menopause, but this is far from the drastic reduction we have all been led to believe. In fact, according to Dr Graham Colditz of the Harvard Medical School oestrogen only falls at menopause by approximately 15%. The body continues produce to significant amounts of oestrogen in the fat cells, adrenal glands, muscles, liver and brain. It is the other female hormone, progesterone, that drops to almost zero. Postmenopausal women produce less progesterone than men do! Yet only a few researchers have stopped to ask whether progesterone might be the hormone that women really need.

True, most HRT formulas now include a amount of synthetic progestogen, but that is dangerously different from the natural hormone, progesterone. Many progestogens are made from, and behave more like, testosterone; some behave more like oestrogen. These altered, synthetic versions of progesterone cause havoc in the body because progesterone is needed to make other key hormones – the body is like a cook who needs eggs to make a cake, but is given cheese instead – a distorted and unbalanced set of hormones are inevitably produced and the body is thrown completely out of balance. Almost unbelievably, although natural progesterone was known to be benign and beneficial as early as the 1940's, since then it has become a virtually forgotten hormone.

Doctors, led to believe that real progesterone was either not available or not usable, routinely prescribe synthetic progestogens believing them to be equivalent to progesterone. But since synthetic progestogens are highly toxic and have very different effects on the body from the real hormone, tragically in the confusion progesterone itself was also given a bad name. Now doctors in England and America are rediscovering that the hormone that everyone overlooked is not only non-toxic: it may also turn out to be the very hormone that women have been praying for.

The Oestrogen Myth

The female hormone, oestrogen, has become a modern myth. Most women and their doctors now believe that oestrogen makes them sexy, gives them younger skin, banishes hot flushes and depression, halves their risk of heart disease and protects them from osteoporosis. Almost none of this is true.

Oestrogen is the hormone that is responsible for the changes that take place in a girl as she reaches puberty. Under the influence of oestrogen her sexual organs mature and she grows breasts, female curves and pubic hair. From then on, for the first half of every month, oestrogen stimulates and builds up the lining of the womb in anticipation of a fertilised egg. It also encourages the growth and lubrication of the lining of the vagina.

This stimulating effect of oestrogen helps to explain why, in excess, it is toxic. Oestrogen stimulates breast tissue: it can encourage the development of fibrocystic breasts, and supplementing with oestrogen is known to increase a woman's risk of breast cancer. It also stimulates the lining of the womb, the endometrium, increasing the risk of endometrial cancer, and encouraging the growth of fibroids.

Some researchers make light of these factors, claiming that we should offset the slight risk of cancer against the protection the hormone gives from heart disease and brittle bones. But the risk that a woman takes when she supplements with oestrogen is not slight. Supplementing with oestrogen significantly increases a woman's chances of getting breast cancer, and her risk of developing endometrial cancer trebles, which is why women who have not had a hysterectomy are also given a synthetic progestogen. It is recognised that progesterone protects against the toxic effects of oestrogen, but alas the synthetic, distorted form given brings further damage.

Heart Protection Questioned

And does oestrogen reduce a woman's risk of heart disease? It has long been known that the oestrogen in the contraceptive pill increases the risk of heart and cardiovascular disease. In fact it encourages blood clotting, and makes the body hold salt and water which can lead to high blood pressure (hypertension). Both these conditions will contribute to stroke, embolism, thrombosis and heart attack.

The argument that oestrogen therapy could protect women from heart disease is based on the observation that it lowers cholesterol, but this is no longer recognised as proven protection against heart disease. Furthermore the study, reported in the New England Journal of Medicine (15 April 1993), which led to the claim that HRT almost halves the risk of heart disease was found to be seriously flawed: an editorial in the same journal criticised the study and called it "speculative". In the 1960's there was a trial to see if oestrogen could prevent heart attacks in men. The experiment had to be stopped because their rate of heart attacks increased sharply.

So oestrogen increases women's cancer risk, and seems to be bad news for heart disease too, but at least we know it prevents osteoporosis, don't we? No, sadly it does not. A recent study also published in the New England Journal of Medicine (14 October, 1993) concluded that HRT failed to protect women from osteoporosis. Only women who had taken HRT for more than seven years – far longer than most women stay on the drug – had a slower loss of bone density, and even those who had taken it for ten years or more were not protected from fractures.

This is serious news. Millions of women are taking oestrogen in the belief that it will keep them young, when it seems there is a real danger that it might not even keep them alive.

Progesterone Slows Ageing Skin

The belief that oestrogen makes skin look younger turns out to be another myth. Researchers reported as early as 1965 that oestrogen makes the skin thinner; it was progesterone, they found, that helped rejuvenate ageing skin by restoring depth, smoothness and moisture.

Nor is it true, except by wishful thinking, that oestrogen increases libido. In men libido is related to testosterone. Now doctors using the new natural approach to HRT are hearing from their women patients that raising their body's natural progesterone helps to bring back their sexual feelings too.

But what about the claim that oestrogen makes women feel good? Because this hormone has become associated with sexiness and ooh la la, this in itself may suggest to women that they feel good on it. There may also be some truth in this. However oestrogen increases the body's retention of salt and water which can cause bloating and weight gain, factors not usually associated with good feelings; and when the body swells the brain swells too, easily triggering irritability and depression. Depression, pioneering doctors in the field now believe, is closer to estrogen's true effect on mood.

Yet there are some benefits to be had from oestrogen. Hot flushes, although not directly caused by lack of oestrogen, can indeed be reduced by it. However hot flushes are triggered by the hypothalamus as a response to low oestrogen and progesterone. In many cases the far safer hormone, natural progesterone, will abolish hot flushes without having to use oestrogen at all. Oestrogen can also be helpful for vaginal dryness although often progesterone will solve this problem too.

The Progesterone Revolution

In 1994 the Nutrition Line brought to London an American doctor with a revolutionary point of view. For fifteen years, John Lee MD. has been treating women with natural progesterone instead of oestrogen. The term 'natural progesterone' is used by Dr Lee and others to mean the hormone identical to the one produced by the body. It is generally made (or synthesized) from a variety of yam. Natural progesterone, he believes, is the hormone that modern women are most often missing. Far from endorsing the idea that women need extra oestrogen, Dr Lee believes that many are already suffering from too much, a syndrome which he has named "Oestrogen Dominance".

Dr Lee began to recommend a natural progesterone cream to some of his patients after hearing a talk by Ray Peat PhD, professor of Blake College, Oregon. One of the problems with natural progesterone is what to dissolve it in. It doesn't dissolve well in alcohol, and the solvents that do work can be highly toxic. Ray Peat, who had been studying female hormones for many years, had ingeniously solved the problem by patenting a method for dissolving it in vitamin E. The resulting cream could be applied to the skin and absorbed into the body much more efficiently than taking it by mouth.

Dr Lee had been looking for some way to protect women from osteoporosis when oestrogen was contra-indicated (for instance after breast cancer). Being open minded, and having no alternative to offer these women, he began suggesting that they apply progesterone cream, hoping that it would in some way help slow down bone deterioration.

Osteoporosis Reversed

To his astonishment, after a few months, bone mineral density [BMD] tests began to show that the women who were using the progesterone cream (and not taking oestrogen at all) had increased their bone density. When he suggested the cream to his other menopausal patients he got the same results.

It is important to realise at this point just how extraordinary this was. Oestrogen, although it may slow down bone loss, can never reverse it. Taking calcium, boron or other nutrients, can help slow down bone loss, but it will not regenerate. No other substance has been shown to restore bone growth. And the reversal with progesterone was not small. Women who had lost a great deal of their bone density, and had already suffered fractures, eventually (over a number of years) regained the bone density of thirty five year olds. Thirty five is about the age when a woman's bone density is at its peak. Typically Dr Lee's patients showed a 10% increase in the first year followed by 3-5% each following year. Even more important, their rate of non-trauma related fractures dropped to zero. Over the years Dr Lee has treated thousands of women for osteoporosis in this way. His work has been published in the International Clinical Nutrition Review, Medical Hypotheses and the Townsend Newsletter for Doctors.

Many Progesterone Benefits

But that is not the end of the story. After they had been using the natural progesterone for a while, Dr Lee's patients brought him other information. Those who were still having periods reported that their premenstrual tension had vanished. Others told him that their fibrocystic breasts were clearing up. Women who had suffered from water retention for years no longer needed diuretics.

Women who had been suffering from depression were starting to feel good. Some women with low thyroid function found that their thyroid function improved, and women with fibroids found that they shrank or were sufficiently contained that surgery could be avoided.

Oestrogen Dominance

As the pattern unfolded Dr Lee began to piece together what was happening. Hormone tests showed him that many of the women were progesterone deficient. This was true even among younger women who should have been producing the hormone. What could be causing this?

Progesterone is the hormone secreted by the ovary in the second half of the menstrual cycle. It is made by the empty follicle (or egg sac) after it has released an egg in the process of ovulation. This is a critical event to understand: women only make progesterone when they ovulate; if they fail to ovulate they make no progesterone.

But why should that be so important? The answer has to do with oestrogen. In spite of the dangers, oestrogen is of course a totally essential female hormone while it remains in balance. But progesterone has the role of keeping oestrogen in balance; it is said to oppose oestrogen. So when a woman releases no egg during her cycle she will experience unopposed oestrogen, or 'oestrogen dominance' a condition which Dr Lee now believes to be widespread.

The symptoms of oestrogen dominance include water retention, breast tenderness, PMS, mood swings, depression, loss of libido, heavy or irregular periods, fibroids, cravings for sweets and weight gain (especially around the hips and thighs). It was these symptoms that began to reverse when Dr Lee prescribed natural progesterone.

Nature's Answer

But progesterone production naturally stops in all women as they approach menopause. Did nature intend all women to suffer from oestrogen dominance? Of course not. Evidence suggests that women living in the third world do not experience the menopausal symptoms common in the Western world. Clearly diet plays a part. It is known that many fresh foods contains progesterone-like ingredients. The Mexican yam, for instance, contains diosgenin a substance which needs few changes to become progesterone itself. The once popular herb sarsaparilla contains another close relative. Dr Lee believes that traditional diets contained, and in some parts of the world still contain, enough progestogenic foods to keep women in balance right through the menopause and beyond.

Oestrogen Pollutants

A more sinister element is also involved. Not only have most Western women been exposed to synthetic hormones via the pill and other hormone treatments, they also live in a very polluted world. Many of the chemicals in our food and environment, including pesticides and substances found in plastics, washing up liquid, hair dyes, cosmetics, spermicides, drinking water and even breast milk are like oestrogen, or oestrogenic, and are capable of having effects similar to oestrogen in the body. They have come to be called xenoestrogens (foreign oestrogens). Dr Lee is not alone in believing that men, women and children in the Western world now get a thorough overdose of toxic and highly undesirable estrogens.

The xenoestrogens are very potent. Dr Lee believes that one consequence may be that women exposed to these chemicals use up the eggs in their ovaries too quickly, often reaching a state of "burn out" by their mid thirties, far younger than nature intended. After that they would have periods but would no longer ovulate or only occasionally, so that for the next fifteen years or so until menopause they would not be making progesterone and would suffer the symptoms of oestrogen dominance: infertile, uncomfortable and with an increased risk of breast and endometrial cancer.

Interestingly it is also in the mid thirties that osteoporosis often silently begins. And although nutrition and exercise are an important part of maintaining bone health Dr Lee now believes that osteoporosis is primarily a disease of progesterone deficiency. While oestrogen can only slow down the loss of bone in a very limited way, it is almost certainly progesterone that stimulates the cells, called osteoblasts, that are responsible for laying down new bone.

In view of all the evidence, it does not seem that women should expose themselves to yet more oestrogen by taking HRT. But are they not protected by the synthetic progestogens that are included in this treatment? No. Although a progestogen was originally added to HRT formulations to protect women from the increased risk of endometrial cancer, it has been shown to do the opposite. Synthetic progestogens can cause cancer, unlike natural progesterone which has been shown to be protective, and they have many other toxic side effects.

Rebalancing Naturally

So what can women suffering from hot flushes, depression, fatigue, middle aged spread, creeping osteoporosis and nothing but the prospect of a downhill slide do?

In the first place a good diet, high in fresh and preferably organic vegetables, and low in dairy products and meat, will establish a sound base. Women who have eaten healthily for several years, especially vegetarians, sometimes pass through menopause without bother. Xenoestrogens concentrate in dairy and meat fats, and synthetic estrogens are given to cattle as growth promoters. So if you eat meat, try to get organic sources and remember that we need much less protein than we think as we grow older. Beans and root vegetables are also good foods; some of these may turn out to contain progesterone precursors. Look out for yams. They will not necessarily be high in diosgenin (Mexican yam is a particular source) but they may contain some.

Nutrition

Nutritional supplements can also be very helpful at this time. Many women find that vitamin E reduces hot flushes, and there is also evidence that vitamin C with the bioflavonoid hesperidin can reduce them too.

GLA, found in Evening Primrose Oil and even more plentifully in Starflower Oil, provides the raw material for the body to make the protective and calming prostaglandin, PGE1 which can be helpful in modifying hormonal symptoms; for instance Starflower Oil can often relieve premenstrual problems. But to give your body the best chance of making PGE1 you also need the vitamins and minerals used in its production. Two minerals: zinc and magnesium; and three vitamins: vitamin C, vitamin B3 (niacin) and vitamin B6 (pyridoxine, or its active form pyridoxal-5-phosphate) are needed. It also helps if your diet is low in animal fats because they can block the synthesis of PGE1.

Herbs for Women

There are also some very useful herbs. It is possible to take Mexican yam as a herbal supplement. No one yet knows for sure what the body does with the natural sterols it contains (however Mexican yam has been used successfully as a contraceptive). It is possible (but unproven) that some may be converted into progesterone; some may be converted into the more 'male' hormones, DHEA and testosterone, that women's bodies also make. However these hormones are also thought to increase bone density and libido and to be helpful at the menopause.

The Chinese herbs Dong Quai, Schizandra and White Peony have been used for women's hormonal imbalances for thousand of years and will probably be found to contain progesterone precursors, or perhaps phytoestrogens, or both. (Phytoestrogens are weak plant estrogens that seem to be helpful. Dr Lee believes that they bind to the oestrogen receptors in the body and block some of the effects of stronger estrogens.) In China Ginseng is not recommended for younger women, but when a woman reaches menopausal years it is considered very good, particularly for increasing vaginal moisture and bringing back libido.

Bone Food

For taking care of your bones you need a good source of calcium (800-1000mg a day including what you get from food), magnesium (300mg) and 400 iu of vitamin D. The mineral boron is useful too, and since bone is fundamentally made from connective tissue vitamin C is also essential. In choosing supplements a good multivitamin/mineral formula should always be the foundation, to which is added the right combination formulas for specific needs, in this case probably a good menopause supplement and a good bone-nourishing or 'osteo' formula.

Progesterone – Natural HRT

Dr Lee has found, with the experience of working with thousands of women over a fifteen year period, that natural progesterone, simply and easily applied as a transdermal cream derived from Mexican yam, provides an almost perfect natural form of HRT. It will never raise progesterone above the level that the ovaries would normally produce (maximum 30mg a day) and it can safely be used for however long a woman feels she needs it [there are women in America who have used a cream to heal or prevent osteoporosis for over fifteen years]. Nor will it cause withdrawal bleeding, except occasionally in the first month or two. The only side effect reported was when a very high dose was deliberately used to test the effect; it caused temporary euphoria.

However it is recommended that you work with a practitioner at least for the first few months, because there is generally a two to three month adjustment period before the body settles down (at first progesterone may sensitise the oestrogen receptors and temporarily your symptoms may get a little worse before they get better, actually a sign that the treatment is working). There are now many doctors in the UK. who have studied Dr Lee's work and are prescribing natural progesterone cream.

References

A list of 37 scientific references and resource materials on this subject is available on request.

Further Information

Information on natural progesterone, Mexican yam and Chinese herbs for the menopause is available from Higher Nature, Burwash Common, East Sussex, TN19 7LX Tel: 01435 882880.

Doctors

If you would like to talk to a qualified nutritionist, or be put in touch with a doctor who uses natural progesterone call The Nutrition Line on 01435 882880 or Fax: 01435 883720

Books and video

Video: "Natural Progesterone". A talk by John Lee MD. 90 minutes NO56
Natural Progesterone by John Lee MD
Balancing Hormones Naturally by Kate Neil
All the above are available from ION Bookclub, Blades Court, 13 Blades Court, London SW15 2LR Tel 0181 877 9993.
This article was updated for Positive Health and reprinted with permission from The Nutrition Line, Burwash Common, East Sussex, TN19 7LX. Tel: 01435 882880