This is Dr. Lam, founder of DrLam.com and the Adrenal Fatigue Center.
Today we’re going to talk about a very common question about women, which is how do I know
if I need progesterone and whether I have progesterone deficiency or not?
Now let us back up and take a look at the female hormones carefully.
Progesterone and estrogen are the two main balancing hormones in the female.
What progesterone does is to balance the effect of estrogen.
Likewise, estrogen will balance the effect of progesterone.
When either one is deficient, then the other becomes prominent.
In other words, if you think progesterone deficiency is the same as not enough progesterone,
which leads to an increase in estrogen effectiveness, progesterone deficiency can be looked at the
same as what we call estrogen dominance.
Without proper progesterone, the estrogen effect can be overwhelming.
This is why people ask whether they need progesterone replacement or not.
What are the causes of progesterone deficiency or estrogen dominance?
It is oftentimes related to many factors.
Number 1, remember that estrogen is made in three places in the body: in the ovaries,
in the adrenal glands, as well as in the fat cells.
If you have a lot of stress, the adrenal glands will put out more estrogen.
If you have sugar in your diet or you have PCOS, then the body’s ovaries can produce
more estrogen.
If you have more fat in your tissues, then automatically your estrogen output will go
up.
Progesterone is usually made to oppose estrogen imbalance, as we said before.
However, this balancing process may be deficient.
For example, if you have a lot of stress, emotional or physical, the body is going to
shunt some of the progesterone away to make cortisol in the adrenal glands.
As a result, the progesterone level may go down.
Similarly, if you have too much estrogen from the adrenal output and from fat tissues, and
you don’t have enough progesterone to balance it, then you’re going to have a progesterone
deficiency situation.
Laboratory tests can often measure, to a certain degree, the free progesterone and free estrogen
and their ratios by saliva.
Serum has problems with the free levels except for testosterone.
So for progesterone and estrogen, it’s not quite there yet.
However, it is not 100% accurate.
It does give us an idea.
We know physiologically, the body produces approximately 20 milligrams of natural progesterone
a day.
Now, remember, this is natural progesterone.
This is not the same thing as progestins.
They are medications such as what is called Provera and birth control pills.
Progestins are synthetic compounds that are prescriptions, which have the opposite effect
as natural progesterone.
When we talk about progesterone here, we’re talking about natural progesterone and not
progestins.
Now progesterone, as we said earlier, has an opposing factor to estrogen, so if you
have increased estrogen, with symptoms such as endometriosis, fibroid, fibrocystic breast
disease, and certain forms of cancer, then progesterone can be indicated.
Now, the use of natural progesterone, however, has to be quite carefully titrated because,
in certain people, it actually can make matters worse.
In other words, remember that progesterone is a pro-growth and pro-gestation compound,
so in certain types of fibroids, in certain types of people, fibroids can get worse and
grow in the presence of natural progesterone.
Is there a strict formula for progesterone replacement?
The answer is no.
It’s very important if you suspect that you have hormonal imbalances, to see somebody
who really understands how the body works from a natural hormone perspective.
A laboratory test from the serum is not very helpful but it very, very important to have
a detailed history.
Some trial and error is oftentimes necessary.
If you start small, especially if you have adrenal fatigue, the consequences can be quite
minimal and can be quite beneficial.
However, for people who are in adrenal fatigue in advanced stages, progesterone, because
it is metabolized by the liver, can actually make things worse.
Simply taking progesterone because you read somewhere that it is good for your hormonal
balance can actually be a wrong thing to do.
Or even if it is the right thing to do at the wrong time at the wrong dosage can make
things worse.
So do be very careful.
Do not simply just take progesterone if you have adrenal fatigue because you can have
surprises and relapses and those are not very happy episodes, okay?