I'm confused (as usual).  I just read on another post that someone was on progesterone cream, but couldn't take HRT because of high risk factor.  Isn't progesterone cream a form of HRT??  What exactly is progesterone cream suppose to do?  I can't take - and don't want to take - any form of HRT therapy, but I was just curious about what the difference is.

*Sighs* Terminology is a real nightmare in talking about Hormone Replacement Therapy (in itself a stupid name, IMHO).

Yes, progesterone is a hormone and yes, if you are talking balanced HRT, it's part of it. It affects your estrogen levels, it can be converted to estrogen, so its use does have implications for those who must avoid estrogen use. It does, however, have a place in HRT for those who simply do not choose to use estrogen on its own.

Further, some use HRT to mean only the use of estrogen; others include progesterone; others mean the ovarian hormones estrogen, progesterone, and testosterone; others include other hormones as part of the package (DHEA, for example); yet others feel that anything that exerts a hormonal action or is part of a menopausal strategy (such as soy, herbals, vitamins, nutritional supplements, hormone precursors, and sheer voodoo) falls into that overall category.

Since I'm already on this riff, let me also point out the perils of "natural" in that they overlap with your question and further muddy the water. Some use the term to mean anything derived from a plant, however and wherever processed; some use it to mean anything that is not processed and is a "raw" plant substance; some use it to mean identical in chemical structure to the hormones our body made; some use NHRT to mean only tri/bi-est and progesterone, usually in cream form. This is further complicated by the fact that Premarin, the only commercial HRT currently made from an animal source, is made from a natural, biological substance: the urine of pregnant mares--although it falls into the "synthetic" (generally the term used as an opposite to "natural" ) category for those concerned about chemical processing or being bioidentical.

Are you dizzy yet? Like, it's not enough to have all the confusions of menopause, but we're not all even speaking the same language!

Bottom line: we all need to define our terms or at the very least indicate what we mean by some of the terms we all throw around.

For more info about progesterone and what it does, there's a whole separate forum here about it, not to mention information on the non-forum pages of this site. In the interests of staying on-topic in this forum, I'm not going to do more than refer you there.

Framboise, I have been told that I should be taking progesterone regardless of the fact I have not uterus. I did the meno-type test and found I was progesterone deficient and also testosterone as well. I live in Canada and am finding it hard to buy just the progesterone creams. My doctor has me on Vivelle patch which is just estrogen. She does have a patch that is combined with progesterone too, would it be adviseable to switch to that if I am having trouble getting the cream here? I am confused too and getting more so instead of getting the wiser.  How can that be after all the information out there that I have read.

Buttercup

Hi Buttercup... Check out Pete Heuseman- College Pharmacy (there are links all over PS to it) and give him a call... I have read that many PS women in Canada are able to get progesterone shipped to them from there, and he can answer so many of your questions.  

Buttercup: Could you just purchase Pro-Gest or Femgest or other progesterone cream via the Internet? Or do most places in the U.S. not ship to Canada? I know that I order my contact lenses from a supplier in Canada (they have my brand at the cheapest price) via the Internet. Just wondering.

Kalanie's suggestion that you work through a mail-order compunding pharmacy is a good one, since a prescription cream is generally superior to an otc one(more reliable, fewer ingredients, fresher, less expensive).

If your doctor won't write a prescription then, yes, I think I'd look into internet otc orders.

The combination patch helps many women, certainly, but it uses a progestin--a progesterone-like hormone that in many women has side effects that progesterone does not (being bioidentical). My personal observation is that women tend to do better on bioidenticals than synthetics (used to mean: non-bioidentical). There exists a certain small group of women who actually need to be on a synthetic because their bodies use the progesterone for other things rather than its intended purpose. A synthetic cannot be modified by the body, and hence continues to have progestin effects no matter what your body tries to do with it. But there are not a lot of women who fall into this category, and odds are that most women trying a hormone out for the first time will tolerate bioidentical better than synthetic.

The other problem I have with the combination patch is the one I have with all combination products when you are first trying out the combination: you can't adjust the hormone doses individually. If you happen to need that exact dose of both, great--you're home free. If you don't, however, it is impossible to tweak one or the other to get to a better combination.  Creams are especially nice for this, since you can (slowly over some weeks) adjust your dose until it balances your estrogen correctly. You can also tweak your progesterone dose on a short term basis if you find, as I do, that you need a little more in times of stress.

With respect to your testosterone, you might be glad to hear that your body can make testosterone out of progesterone, and for many women, taking progesterone allows them to bring their own levels up without further supplementation.

Good luck with it, whichever path you decide to take--

I was reading this along with other info, specially what you told me Framboise on the HRT board and the paper you sent me NancyV. It certainly sounds like a less risky idea to me to take natural progesterone on a long-term basis, and not risk synthetic progestins eventually blocking the estrogen receptors and producing other problems.  Still, my confusion stems from the idea that synthetic progesterone apparently does what it's supposed to, that is replace "that" hormone and is not able to convert itself to other hormones which may be deficient at the time, depending on our fluctuations, but what happens to the bio-ident. progesterone? Could it just literally go anywhere and convert itself into other hormones? That is why I am so confused about whether we know or not what we need, without constantly measuring our different levels.  Also, what would happen if we took other hormones, DHEA, testosterone etc. while we are taking synthetic progestins?  

I feel ok at the moment, taking bio-ident estradiol and the synthetic progestin, (except for anxiety problems), but from all I have heard about synthetic progesterone,  it might not be a bad idea to change.

I know there are books which most probably explain these differences, which I will eventually try to get hold of (in Bs. As. I think I'll visit the university library to see if I can find something there in biology) but in the meantime, I will be visiting my gyn on Friday and I wanted to get together as much info as I could.

I know this is complicated, and I don't  want to put anyone out, but just a few words explaining that to me would be great if anyone can.Thanks,Barbaraxxxxx

When we take bioidentical progesterone, our bodies can treat it as a raw material, like food. Like food, we use that raw material to make whatever our body needs at the moment, based on a programmed-in need hierarchy. For example, if you are extremely stressed and take progesterone, enough of that progesterone is going to be turned into cortisol to make up whatever quantity is "enough" for the current stressor. There are whole realms of feedback loops that control our interacting hormone levels. When we are menopausal and the supply of raw material dwindles, we juggle available resources even more frantically. Provide some raw material and this eases up the strain. Provide the total sum of needed raw material, and everything gets done. But it's a dynamic process, always.

But that very dynamism works to our benefit, and that's why we don't need to measure every single hormone and precursor. If we put in enough, loosely defined as meeting our general day-to-day needs, then most of the time the feedback mechanisms and interconversions will spread it around in the most efficient way to meet as many needs as possible.

If, however, we are taking a progestin, that can't be converted to the other things we need. We get the progestagen (generic term for the class that encompasses both progesterone and progestin) benefits, but the rest of our needs, the things that progesterone is normally converted to, have to scramble for other ways of being done. If we have healthy adrenal glands and our ovaries put out enough testosterone and we have plenty of estrogen to spare, we can get by. If we do not, we're going to exist in a "rob Peter to pay Paul" state that may (or may not) eventually catch up with us.

Taking supplements may help make up the gap (that is, the DHEA, Testosterone,etc you mention), but may not, depending on what the body decides to do with them. That's the big unknown, you see: what is our body going to do with it all. And the answer lies not in a any lab value (that we know how to measure today, at least), but in the experience of trying it and listening to our body to see how well it works out.

Thanks so much Framboise (again).  I visited my gyn these evening, had a pretty long conversation - by no means did she agree with me, although she did admit that the progestin could have adverse effects over a long period of time.  What she did tell me however, is that for several years after menopause, our ovaries continue to produce testosterone (that's possible I'm sure, but obviously in smaller quantities).  For the anxiety problem, she didn't seem to think it was so important, and was more concerned that I was doing okay physically.  So, like you say Framboise, it is a question of listening to what my body says and taking it from there.

Thanks again,

Barbara