Dearest: It is with great pleasure that I finally welcome internationally recognized pioneer and expert in the study and use of the hormone, progesterone, and on the subject of hormone replacement therapy -- a physician we have quoted and whose theories we've spoken about for years in Power Surge . . . D R. J O H N R. L E E Dr. John Lee graduated cum laude from Harvard and the University of Minnesota Medical School in 1955. For nearly a decade, Dr. Lee used transdermal progesterone in his medical practice - its use resulting in a reversal of osteoporosis. Dr. Lee, who retired from a 30 year family practice a few years ago, has since been writing and travelling around the world speaking to doctors, scientists and lay people about progesterone. Dr. Lee has taught a very popular course on "Optimal Health" at the College of Marin for 15 years. In 1994, Dr. Lee wrote, "Natural Progesterone: the Multiple Roles of a Remarkable Hormone." Co-authored with Virgina Hopkins:, Dr. Lee wrote the best-selling, "What Your Doctor May Not tell You About Menopause: The Breakthrough Book on Natural Progesterone" (Warner, 1996). His newest book is, "What Your Doctor May Not Tell You About Premenopause: Balance Your Hormones And Your Life From Thirty to Fifty" (Warner, 1999). Welcome to Power Surge, Dr. Lee. Let me begin by asking about the perpetuation of the myth that all women's problems are due to a lack of estrogen and not enough focus is placed on the importance of progesterone. Did you originate the theory of "estrogen dominance," and can you explain exactly what estrogen dominance is? Dr. John R. Lee: Greetings. It's a pleasure to be here. The important principle that we must all observe is the principle of balance. In particular, the balance between estrogen and progesterone implies that it is not the absolute amount of either hormone present, it is the balance between the two. Mother Nature's plan is that estrogen was never produced totally in the absence of progesterone. When estrogen is unopposed by progesterone, it has dangerous side effects. When estrogen is dominant in the balance, those side effects will occur. Therefore progesterone supplementation is needed to restore balance. Dearest: Thank you, Dr. Lee. I have so many questions, but see we have a slew of them from the audience, so I think we'd best go to them directly. Let me add that I'm thrilled you overcame your cyber-phobia and agreed to make Power Surge your first online chat :) Dr. John R. Lee: Only with assistance! And patient assistance! Dearest: Thank you :) Suburban, go ahead with your question for Dr. Lee. Suburban M: Dr. Susan Love I said that I should not rub the cream on my breasts, may increase cell growth? Dr. John R. Lee: There is no study that indicates any risk of increased cell growth in regards to progesterone. Spud0812: I stopped cycling last June, started using Progest, by Dec I was feeling good, then I had 2 periods again and all my symptoms returned..will they subside again? Dr. John R. Lee: This is still part of the perimenopausal fluctuations of estrogen. The absence of periods does not indicate that estrogen has fallen to zero. It may still fluctuate in sufficient amounts to have another set of periods occur. In general it's important to use the progesterone during the right time of the period which is two weeks before the expected period, stopping one or two days before the actual period. If no period comes, wait 12 days and start that two weeks of progesterone again. The definition of menopause is no periods for 12 months. The fact that you had a period or two just showed that your estrogen flucated enough for a month or two to cause a monthly period. What symptoms are you having? Spud0812: Fatigue, dizziness, and some anxiety and insomnia. Dr. John R. Lee: Those are non-specific symptoms that may have other causes. If it's water retention, weight gain, breast swelling, it's due to estrogen rising. If it's hot flashes then it may be fluctuating, particularly falling again. Your symptoms may indicate other factors that may need attention such as diet, stress, exercise, sleep patterns and so on. You also think in terms of thyroid and hypoglycemia. Perimenopause may exacerbate other problems that have been just under the surface. LSA82383: Dr. John, this is Lisa Peterson from MN. So glad to have you in this chat! I know from what I have learned from you that I would not hesitate to use natural progesterone with any hormonal cancers. Are there any mainstream studies going on right now that would indicate to any oncologists the safety and effectiveness of treating with natural progesterone? Dr. John R. Lee: Hi Lisa! Good to hear from you! My sister from MN is visiting to escape the cold. Yes, I would refer you to Bent Formby. He has a paper published in the journal -- hold on I'm looking for the specific reference to give you -- and he's coming out with two more papers in the near future. Annals of Clinical and Laboratory Science, 1998, Vol. 28, page 360, June. "Progesterone inhibits growth and induces apoptosis in breast cancer cells: Inverse effects on Bcl2 and P53." That's the title of the article. LSA82383: Thank you. Dr. John R. Lee: That would knock the socks off of any conventional doctor. Dearest: Dr. Lee, can we try a little free association? I'll throw out a word and you give me the first thought that comes to mind, ok? Dr. John R. Lee: OK. Dearest: I'll give you some words and please give me your first reaction. Let's start with "Premarin." Dr. John R. Lee: Number one pharmaceutical estrogen sold -- pregnant mare's urine. Dearest: Ok, how about Provera? Dr. John R. Lee: Poison. Dearest: Tamoxifen? Dr. John R. Lee: Worthless. Dearest: Prometrium? Dr. John R. Lee: Good idea, wrong dose. Dearest: Wrong dose - 200 mg? What is the right dose? 100 mg? Dr. John R. Lee: The right dose should be given as a cream for transdermal absorption and the right dose is the normal physiological dose, usually about 15-20 mg per day. Dearest: Thank you and finally - soy isoflavones? Dr. John R. Lee: All isoflavones probably have beneficial effects and that's why beans, garlic, and many other foods are healthy. Even the whites on the inside of the orange peel. Don't overdo it on the soy. The people around the world that eat soy actually eat fermented soy products and not the soybean itself. Also, they almost always eat it with seaweed and a protein because soy chelates out minerals and blocks protein absorption. Dearest: Can you give us an example of fermented soy products on the market, please. Dr. John R. Lee: Miso and tempeh. Tofu is not, strictly speaking, fermented. Dearest: In my studies of isoflavones, I have read that the research has been done using unfermented soy products - i.e., soy protein powders. RCHCTH: Please explain an anovulatory cycle (with heavy flow) and your recommendations to cope with it. (using Femgest) Dr. John R. Lee: Anovulatory means that ovulation did not occur. Since ovulation did not occur, it means that no progesterone was made. That means you were estrogen dominant straight through the month. That results in heavier periods. The treatment is to supply the progesterone that would have normally been supplied by ovulation. This typically means from day 12-26 of a period that is 28 days apart. But many women differ in the timing of ovulation and may find adjustments to that time schedule may be more effective and a little trial and error is justified. Each person is unique. Dearest: There are countless people who say "Dr. Lee recommends this cream or Dr. Lee recommends that cream" in order to push their own products. Your thoughts? Dr. John R. Lee: Let's keep brand names of progesterone out of the chat -- I don't endorse any one progesterone cream -- I recommend creams that contain my recommended dosage. I recommend creams that contain 450 to 500 mg of progesterone per ounce. TSWAHL: Is the use of progesterone cream safe after breast cancer and is it effective if the tumor was PR-neg? Dr. John R. Lee: The test for progesterone receptor presence or absence is not a very accurate test. Progesterone receptors are stimulated to be made by estrogen itself. It is highly unlikely that any tumor driven by estrogen would have no cells that lack progesterone receptors. If there in truth were no progesterone receptors then it could do no harm because the cell could be unaware that any progesterone is present. Chances are the receptors are there, and therefore the cell will respond to the message of progesterone which is a prevention against breast cancer. If a phone line came by your house, but you didn't have a phone, you would be unaware of it -- that's how it is with progesterone. The message of progesterone to breast cells is to stop them from becoming breast cancer cells. So therefore, there is no reason ever to not give progesterone to try to help someone prevent or stop breast cancer. In 3,000 breast cancer biopsies Dr. Zava found only one in which there were truly no progesterone receptors. It's a rare congenital defect. Bitsy2: I've hd a complete hysterectomy, am on Premarin, but would Climara be better? Also, last couple of days hd some small soreness & some pains in one breast, but don't feel a lump? Dr. John R. Lee: The word "hyster" refers only to the uterus. What you're actually talking about is the doctor removed your ovaries as well as your uterus. With the ovaries gone you need to supplement progesterone. Bitsy2: yes he did, as well as cervix I do use the cream I am very small, not much body fat 5', 105 lbs. Dr. John R. Lee: The body makes estrogen in body fat but your true deficiency is in progesterone and that's what you need to correct first. Two thirds of all women with their ovaries remove continue to make enough body fat to produce enough estrogen. You need to correct the progesterone deficiency first and then look at the Nov 98 issue of my newsletter to determine if you need estrogen -- give the progesterone 3 months. Dearest: Dr. Lee, here is Chris92's question...."Had a hysterectomy in Apr. '97 and have had many prbms. with estrogen replacement. Currently taking Climara (1/2 patch). Problems I'm still having are NO LIBIDO, weight gain, breast swelling, headaches, and fatigue. Asked my dr. about progesterone. Said I didn't need it. What can I do? Dr. John R. Lee: You can either try to educate your doctor or change doctors. Your doctor is wrong in saying you don't need progesterone. Within a month or two after a hysterectomy progesterone falls to zero. The reason he made that statement is because the only thing he knows about progesterone is that it protects against cancer of the uterus and he thinks because you have no uterus that you don't need it. He is apparently unaware of all the other beneficial roles of progesterone, which you can read about in my books. The right dose of estrogen will be found to be about 1/10 of a patch. (for the other question too.) JazzTahoe: Thank you! I'm DES, 41, stopped cycle. I use your book recommended diet-vitamins - 1/4 tsp. progesterone cream 4 mos I had tried everything, this works. Dr said to stick with it. Cycle is back & lite. Breasts are Huge and hot flashes still strong with sweats. What else can I do but be patient. Thanks again so much! Dr. John R. Lee: You should not ever take supplemental estrogen. You can try isoflavones or herbs, getting the advice of an herbalist or naturopath for example. Exercise, vitamin E, stress reduction also might help. JPLJAXX: What diagnostic test(s) do you recommend to evaluate balance between estrogen and progesterone? Dr. John R. Lee: Good question. One is the clinical test of observing the body. The body is your best laboratory and each woman should know that she is the master laboratory technician because only she knows how her body is working. Second test is the saliva hormone assay for progesterone and estradiol, taken about 5 days after presumed ovulation. The goal is to arrive at a saliva progesterone level 150 to 200 times greater than estradiol (by saliva assay). That, we think, is harmony with your natural balance for most women. CFP Friend: Dr. Lee - What do you do in February as far as using the cream and when do you stop. Short Month. Dr. John R. Lee: Taking off 3 or 4 or 5 or 7 days each month is fine -- it doesn't have to be an exact number. Desdot58: I applied the cream for 15 days then stopped. I got a massive headache for three days. Did I use too much? Dr. John R. Lee: I recommend about 15-20 mg per day for women still having periods, and you should really do it for three cycles and then report what happens -- for two weeks before the period. The headache is probably due to excessive estrogen, which hopefully will subside in the next few months. Betljuce9: I have had a hysterectomy and had rapid weight gain and swelling breasts and no libido since then. My doctor says I dont need progesterone because I am not childbearing. I am on Premarin 1.25 mg now. Anything I can say to change his mind quickly? Dr. John R. Lee: Do your best to correct your doctor's knowledge, but I have no way to predict how long that will take. I think you'll find your question answered in detail earlier in the chat. You don't need your doctor's permission to use progesterone in the correct manner. Your dose of estrogen is 4 to 10 times higher than it should be. Eskanders: Have been suffering from spotting for the last 9 years after tube ligation. Used progesterone for three months. It only took care of my hotflashes. Dr. John R. Lee: If you'll use it in the right sequence during the month -- day 12 to day 26, or day 10 to 25, 15 to 20 mg per day, in my experience in another couple of months the spotting will go away. Sja4home: I have panhypopituitarism and do not produce any hormones whatsoever. Despite the fact that I cycle Estratab 1.25 and Prometrium 200mg, I haven't gotten a period in 3 years. Any suggestions? Dr. John R. Lee: How are you cycling the estrogen and progesterone? Sja4home: Estratab days 1-30, Prometrium days 1-14 Dr. John R. Lee: Use about 1/4 of the amout of estradiol for no more than 21 or 24 days and then stop. If you don't quit the estrogen for a week it doesn't give the uterus a chance to shed. The progesterone dose is also way to high. If you use progesterone cream in the way I recommend, you should start cycling. Mhkilgore: What do you think of the Combi Patch for someone who has irregular periods and is in the throes of peri-meno? Dr. John R. Lee: The Combi Patch contains estrogen and Provera, right? Mhkilgore: I think it's estrogen and progesterone...not really sure provera is a no no, correct? Dr. John R. Lee: As I said earlier, as far as I'm concerned, Provera is poison. Mhkilgore: It contains estradiol and neta Dearest: CombiPatch delivers the progestin norethindrone acetate (NETA) and the estrogen 17 beta-estradiol. Dr. John R. Lee: That's a progestin, and it's probably 10 times too much estrogen. Mhkilgore: Even the lower dose of 0.05/0.14? Dr. John R. Lee: It's a moot point if you're taking a progestin. DJW MEW: What dose do you recommend for men as a preventative measure against prostate cancer? I mean dose of natural progesterone cream. Dearest: Revival is being used to treat men with prostate cancer at Johns Hopkins. Dr. John R. Lee: OK, I recommend 8 to 10 mg of progesterone cream daily for the prostate. Catalina5: Progesterone production is minimal in postmenopausal women? Why should they use supplemental progesterone? Dr. John R. Lee: If we lived in an ideally clean environment free of petrochemical pollution and xenoestrogenic pesticides, ate a perfect diet, got plenty of exercise and didn't have too much stress, we probably wouldn't need it. But we're awash in a sea of estrogenic substances which we need to balance with progesterone. Natprogest: Do you think Chronc Fatogie, Fibromyalgia, Lupus, etc., can be partially related to hormones? How do you handle critics say NP is "snake-oil"? I dont believe so I have used it for 3 years and love it! Dr. John R. Lee: I ignore the critics unless they have something to teach me. I often hear from women with auto-immune diseases that they improve a great deal with the use of progesterone cream. Wingy54: Is it a problem for a women on continual HRT to still get a period Dr. John R. Lee: What do you mean by continual HRT? And why are you on it? And how old are you? Wingy54: I'm 44. Yes, Estrace .5, micronized progesterone 100 mg per day with no breaks. Dr. John R. Lee: Why are you taking it with no breaks? Wingy54: Because I don't want a period Dr. John R. Lee: Your period is your body's way of cleansing the uterus every month. It's not healthy or balanced to not get one if you're not menopausal yet. I recommend you follow the instructions in my new book for creating hormone balance! BOZA3: Many symptoms pointing to estrogen dominence, should I dc estrogen and use NP only TAH 14 months ago for borderline low mal ovarian cancer also hypothyroidism x 5 years. Dearest: Please don't use abbreviations in your questions. Thank you. Dr. John R. Lee: Yes, could you retype the question without the lingo? I'm cyber-illiterate also. BOZA3: Should I discontinue the estrogen and use natural progesterone cream had total hysterectomy 14 months ago boderline low malignancy ovarian cancer. Dr. John R. Lee: You're best off gradually reducing the estrogen so that you don't get hot flashes. But then you can try just progesterone and see how you do. Most women do fine with just progesterone. We don't have the specific research in yet, but all indications are that progesterone is protective against cancer in general. If I had cancer of any kind I would use it, and would avoid the estrogen. You can get an AMAS test to make sure the malignancy hasn't reccured. BOZA3: Thanks for your research Dearest: Unfortunately, we ran overtime and Dr. Lee has to leave, but we will continue with his colleague and co-author, women's health and nutrition writer and researcher, Virgina Hopkins. Virgina Hopkins: Hi everyone -- very glad to be here with you -- you're a powerful group! Dearest: Welcome, Virginia :) LHnMH: Had b/c 8 yrs ago, chemo induced menop., been using progest. 1 1/2 yrs- growing facial hair, tried increasing the progesterone...developed pimples on my chin.. should I increase or decrease? Virgina Hopkins: How much progesterone have you been using, and are you using the cream? LHnMH: 1/4 tsp. progesterone cream. Virgina Hopkins: Are you using it three weeks of the month? The symptoms you're describing are of androgen (male hormone) excess, which is what the ovaries produce when they're getting ready for menopause. LHnMH: Yes. Virgina Hopkins: At menopause your ovaries turn androstenedione into estrone in your fat cells. You could get a saliva hormone test done and see if you have excess, and then you'll know more about what to do. SUNR1DER: I had a TAH/BSO last Oct. 3. I'm 46, normal weight. Now using 2mg estradiol and .625 testosterone every mornin and progesterone cream in the evening. Until I ran out, I was taking an estrogen supplement Dearest: Spell out what TAH/BSO is please for those who don't know. Thank you. SUNR1DER: (total abdominal hysterectomy, bilateral salpingo oopherectomy) anyway, I was taking the Estroven and 25 mg of DHEA from the health food store as well. After I ran out, the hot flashes came back pretty bad! what do you make of that? What do you suggest? Seems like I needed the extra estrogen maybe? Virgina Hopkins: That's a lot of estrogen, and stopping it suddenly would create hot flashes -- pretty bad! You could go back on and then gradually reduce the dose over a period of months, to the lowest dose that doesn't cause symptoms. Again, unless you're slim, you probably won't need it. Also, DHEA can easily cascade into other hormones in women, so it may be causing problems. SUNR1DER: I'm still on the prescription 2mg estradiol, I just stopped the supplement. why would I want to reduce estrogen if I'm already getting hot flashes? won't need what? but the problems started when I STOPPED the DHEA! Virgina Hopkins: Well you were taking a lot of things and then suddenly stopped some of them -- that's very confusing to the hormonal orchestra. I'm saying start the estrogen back up again to stop the hot flashes, and then *gradually* reduce the dose -- it's fluctuations in hormones that cause hot flashes. Does that make more sense? SUNR1DER: Oh, I see. I still don't see why I would reduce estrogen if I feel ok on it. Virgina Hopkins: It's always best to use the lowest possible dose of estrogen -- read the Nov 98 issue of the newsletter for details. SUNR1DER: Ok, great. Thank you! TKOVIA: Oh Brave, Patient & Wise one. What are your thoughts on Prempro, anything good? Virgina Hopkins: How can it be good when it contains "PRO" which is PROVERA? Dearest: Here! Here! TKOVIA: Ouch! JMcdon826: I am taking Fosomax & Premarin (plus synthroid) Should I be using progesterone instead Virgina Hopkins: Dr. Lee strongly recommends against the use of Fosamax and for the use of progesterone for osteoporosis. CHRIS92JH: If my dr. won't agree to progesterone, can I do it on my own? Where can I buy it? What would be an appropriate dosage. Had a complete hysterectomy-- ovaries and cervix 10 months ago. Only 29 yrs. old. Virgina Hopkins: It's always preferable to work in partnership with a health care professional, but you can buy progesterone over the counter and you'll find complete and detailed instructions in Dr. Lee, Dr. Hanley and my new book on PREmenopause (see link at the beginning and end of this transcript). Sunrisewd: Is the FDA concerned about natural progesterone Products? Virgina Hopkins: There's always the chance that the FDA will get a bee in its bonnet about natural progesterone. But if they make it prescription only we'll have millions of menopausal women storming dr.'s offices for it and that won't be all bad. Dearest: The FDA gets its knickers in a twist over anything natural :( Virgina Hopkins: Anything that competes with its buddies, the big drug companies. LSA82383: Hi Virginia, Lisa P. from MN: What are yours and Dr. Lee's thoughts about Human Growth Hormone and its being an adaptogen - also, is there any man who should NOT take nat. progesterone, and what is the dosage for men with prostate cancer? Virgina Hopkins: Hi Lisa! Did you see that Dr. Lee will be up your way in May? Dr. Lee has delved into human growth hormone (HGH) a bit and all indications are that in small physiological doses of the real thing it can help a great deal with some people who are truly deficient -- but there seems to be about a two-year window of opportunity to use it, after which it seems to lose its effectiveness. But there are lots of ways to increase HGH naturally -- sleep, exercise, meat, for example. LSA82383: Yes - we're trying to see if we can schedule him again too. Dearest: Dr. John Lee and co-author, Virgina Hopkins:, thank you for spending this time fielding our many questions about natural progesterone, HRT, menopause and the health issues endemic to women's health at midlife. Here are convenient links to Dr. John Lee's groundbreaking books, "What Your Doctor May Not Tell You About Menopause", and his new, "What Your Doctor May Not Tell You About Premenopause." Be sure to visit Dr. Lee's Web site. You can E-mail Dr. Lee or his colleague and co-author, Virgina Hopkins:, at info@johnleemd.com Virgina Hopkins: Feel free to send an e-mail for back issues of our newsletter. Dearest: Thank you for an extraordinary evening, Dr. Lee and thanks, Virginia, for continuing. Dr. John Lee: You were all great -- thanks for the opportunity. Dearest: Thnk you, Dr. Lee, and goodnight everyone. Disclaimer: Every guest in Power Surge is a highly respected professional whose opinions are his/her own. An appearance in Power Surge does not constitute an endorsement of a guest's views. None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read other transcripts by returning to the Library. Dearest aka Alice Stamm Power Surge Founder, Facilitator, Host Copyright©1994- by Power Surge. All Rights Reserved.