Progesterone Transdermal progesterone has been
shown to help patients with migraine head- aches, premenstrual syndrome, postpartum depression, uterine and ovarian polyps or cysts, and even seizures (since progester- one has been found to have anticonvulsant properties).
Continuous progesterone dosing is possible, although some providers advise a five-day withdrawal every month to avoid development of resistance to the medica- tion. Over-the-counter progesterone is available in a jar but some studies done by compounding pharmacies have revealed that medication creams may lose their effec- tiveness if the jar is opened repeatedly. Menopausal women who have risk fac-
tors for estradiol and testosterone use may still be given progesterone. Progesterone has beneficial effects on the uterine lining, the breast tissue, and adrenal support. Some women’s menopausal symptoms have been less problematic on progesterone alone.
Vaginal and Urinary Issues, and Libido
Vaginal estrogen prescription prepara-
tions are available for vaginal dryness, dyspareunia (painful sex), urinary issues, and even decreased libido (sex drive). Compounding pharmacies can prepare preparations, in cream or suppository form, with estriol; testosterone may be added as needed. Conventional pharmacies can provide certain vaginal preparations with estradiol in them. Low libido also may be helped with prescriptions for vaginal DHEA and even oxytoxin, both available from a reputable compounding pharmacy. Recurrent vaginitis can be treated with compounded vaginal probiotics. Chronic irritation and pain of the vulva have improved with certain prescribed vaginal products.
Birth Control
Bio-identical hormone preparations are used for balancing, to help obtain normal physiologic levels; birth control through these preparations has not been well studied. In fact, because progesterone does
balance estrogen, premenopausal patients must be aware of the need for nonhormonal birth control methods if they are using bio- identical progesterone.
Hormone Replacement Risks and Benefits
There are certainly risks and benefits to
any hormone prescription and these must be reviewed extensively with patients before they start any prescription. Risks of estrogen include clotting and cancer. Transdermal use of hormones minimizes the risk of clotting because the medication does not have to be metabolized in the gastrointestinal tract and subsequently avoids the liver. To minimize the risk of uterine cancer, progesterone is always prescribed when estrogen is pre- scribed. Breast cancer has many possible etiologies but bio-identical progesterone may have a protective effect on the breast tissue.
Synthetic progestin preparations actu-
ally have a negative impact on estrogen receptors. A connection between synthetic progestin and cardiac disease has been noted. Medroxyprogesterone acetate is a progestin which helps in some areas of the
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