Health Articles
Posted on August 15, 2017 11:08 AM by Dr. Zimmer
The use of “natural” progesterone creams, along with other so-called "natural" hormone replacement therapy, has skyrocketed in the last decade. It has led to the rise of numerous alternative health clinics (M.D.’s, Nurse practitioners, Physician Assistants, Chiropractors, Naturopaths) specializing in the prescription of "natural" hormone therapy. With few exceptions, women who present to these clinics with any health problem are found to need a “natural” hormone prescription.
I have treated countless patients and have received  emails from women all over the world (U.S., Canada, Netherlands, Japan, Europe, Saudi Arabia) who are suffering from life altering symptoms thanks to using “natural” hormone replacement therapies. The biggest culprit is the use of progesterone creams. The stories typically follow a similar pattern. She started using hormone replacement because someone determined that she was “estrogen dominant” and needed balancing. She initially experienced a reduction in symptoms with the start of hormone replacement therapy (sometimes a significant benefit), only to develop an array of new symptoms (anxiety attacks, depression, insomnia, headaches, fatigue, etc.) months later. Most who experience this scenario have the gut feeling that these new symptoms are being caused by the use of their progesterone, but they are afraid to stop using it because they could not bear to go back to having their old symptoms along with these new ones. They are paralyzed by not knowing what to do next. Many times, and I am shocked by how often, they are told that they just need more progesterone! Yikes!
If you are thinking about starting hormone therapy or if you are already doing so, I am here to WARN you to be very careful. Your over-all, long-term health could be in real danger! This warning applies to anyone taking these “natural” hormones, even the ones who have experienced an initial benefit from taking them. And, the most important warning to you is that NO ONE in the health profession is using hormone replacement in a natural manner. NO ONE!  Let me prove it to you!
Creating A Hormone Balance Is Impossible
Let me ask you a few very simple questions that you do not need medical experience or training to answer. First, do you think it is important to have your hormones be in balance or is it better for them to be out of balance? Secondly, if your hormones are out of balance for a period of time, do you think it is possible you may experience some negative health symptoms? The answers to these first couple of questions are obviously that proper hormone balance is important and hormones being out of balance can certainly cause health concerns. Now I ask what is your perfect hormone balance, does it stay the same month to month and is it the same as other women you know? The answers are that you have no idea what your hormone balance should be (and neither does your doctor), hormone levels can change monthly depending upon numerous factors and hormone balance can be significantly different among women!
As noted, hormone balance changes constantly depending on many factors (natural cycle changes, stress, illness, diet, exercise, toxic exposure to endocrine disrupters, and many more). One of the major factors is stress. High stress can cause a significant change in sexual hormonal production. What person do you know who never has stress or who has stress that stays the same at all times? Let me give you the perfect familiar example. How many times have you heard the story of a couple who is trying to have a child, but cannot get pregnant? Going through infertility treatments is VERY stressful. Then, after spending a lot of money (stressful) and without results (emotionally stressful), they give up and decide to adopt a child. What happens next? Yep, they soon find out that they are expecting.
Another good example is how testosterone levels drop in service men going through Navy Seals BUDS training. At the end of training they have testosterone levels well below most women reading this article. Stress changes hormone balance.
Everyone, and I mean everyone, who prescribes hormones to their patients will tell you that proper hormone balance is extremely important. That is why many, but not all, utilize hormone testing (blood, urine, saliva) to measure your levels before and after you start using “natural” hormone replacement. The ones who prescribe hormones without testing or who only test at the beginning of treatment, but never again, are guilty of malpractice. Unfortunately, that includes a majority of practitioners who prescribe hormone therapy. The ones using testing multiple times during treatment are guilty of believing that they actually have the ability to create hormone balance in their patients with the use of testing. They, at least, are trying to provide hormones in a way that is perceived to create balance. But, make no mistake, they are fooling themselves on many levels.
The major problem with hormone testing is the question of accuracy. First, each type of testing has limitations in the ability to accurately test hormone levels, whether it is urine, blood or saliva. For example, cortisol levels can accurately be tested in saliva. But, sex hormones like estrogen, progesterone and testosterone are not as accurately measured in saliva and may not reflect hormone levels in body tissue. This is especially true when hormone replacement creams are being used. Secondly, tested hormone levels vary from lab to lab and they vary from sample to sample, even at the same lab. This lack of reliability in testing makes it all but impossible to determine specific levels of hormones in order to prescribe the accurate use of hormone replacement.  Thus, the best that any practitioner can do is to get a “ball park” estimate of what your hormone levels are at any given point in time. They most certainly cannot determine, from this testing, a dose of hormone replacement that will create balance in your system.
Creating Hormone Imbalance Is Inevitable
Think about the big picture for a moment. It is a fact that no one knows what your perfect hormone balance should be at any given time of the month (keep in mind that your levels of especially estrogen and progesterone vary greatly within your monthly cycle). It is a fact that your hormone levels can change depending upon many outside and sometimes uncontrollable factors. It is a fact that testing is inaccurate, at best, and cannot be used to determine specific dosing of female hormones. With these facts in mind, tell me how your doctor determined the specific amount of hormone replacement you needed to create a balance? Additionally, almost all prescriptions are for a steady dose of hormone instead of varying the dose to account for changes during the month. This fact alone illustrates how the idea of creating a proper hormone balance cannot be achieved. Thus, the new imbalance that they are creating in you may end up causing a whole new set of health conditions and future problems.
Take a look at the month long hormone test from one of my patients who was using progesterone cream.
Figure 1: Estradiol and Progesterone Test 1
Look at Figure 1: Estradiol and Progesterone Test 1 above. As you can see from the legend of this test, found on the bottom left side, that the (black circles) represent progesterone. The Blue shaded area represents the expected normal ranges for progesterone during the monthly cycle. At the beginning of the cycle there is typically little progesterone being produced. Thus, the Blue shaded area is towards the bottom. Right after ovulation progesterone is produced in significant amounts. You can see how the Blue shaded area goes way up after this time. If the egg is not fertilized progesterone levels fall drastically and menstruation begins. If in balance, all of the (black circles) should fall somewhere within the Blue shaded area. You can see that the progesterone levels (black circles) are buried across the top indicating super high levels of progesterone throughout this patient’s cycle.
The (black squares) represent estrogen levels and the Green shaded area shows the expected levels of estrogen for the female cycle. At this point estrogen was not high and was basically at normal expected levels. Notice, however, at the very bottom of this test that her testosterone levels were off the chart high (182.6)!
This patient started taking progesterone cream about 1 year prior to this test.  Notice the complete imbalance she had created in her body. Her progesterone and testosterone levels were abnormally very high. We then waited 7 months to see if her level of progesterone would come back down to normal. The results of this follow-up test are shown in Figure 2: Estradiol and Progesterone Test 2. You can see that even after 7 months her levels of progesterone (black circles) were still grossly elevated throughout her cycle. But now her levels of estrogen (squares) had also increased significantly. Her testosterone continued to be off the chart high.
Figure 2: Estradiol and Progesterone Test 2
Explaining What Happened…
I think that it is important to evaluate how this patient got herself into this mess.
Progesterone cream dissolves in fat and can thus be stored in your fatty tissue. The levels of progesterone steadily increase within fat tissue with prolonged use. After a while, the amount being added every month, along with the amount being released from the fatty stores, causes elevated progesterone levels throughout the female cycle. So, instead of supplementing a little progesterone during a short period of time the body becomes subjected to elevated levels throughout the female cycle.  The body can then take the extra progesterone and make it into either testosterone or extra estrogen. Excess testosterone can also be made into estrogen. (See Figure 3: Hormone Synthesis below) Thus, the body is thrown into a dangerous hormonal imbalance that does not serve to promote proper health.
Figure 3: Hormone Synthesis
The ironic part of this is that Dr. Lee, the father of the progesterone cream movement, had this to say about hormone balance:
    “There’s no doubt that it’s not a good idea for most women to take large doses of progesterone in any form over a long period of time. That’s just not good medicine, it’s not balanced, it’s not common sense, and it’s bound to cause trouble sooner or later.”
So, one of the founders of the progesterone cream movement himself acknowledged that creating an imbalanced state is not good medicine and is bound to cause trouble sooner or later. And, he is correct. If you use "natural" hormone replacement you will create a new imbalance in your body. No one can argue that this is wrong. The only question is what this new imbalance will do to your body.  Unfortunately, many women have found the answer to this question and it is not good.
What Can You Do?
Notice that I use "quotes" around the word "natural" throughout this article. This is because the word is misunderstood when it comes to hormone replacement therapy. It makes you think that this is a natural way to use hormones. But, the word natural only applies to the chemical form of the hormone. It has NOTHING to do with the hormone being used by your body naturally. When people refer to natural hormone replacement they are only noting that the chemical formed being used is identical to the form found in your body. There are benefits to using chemical forms that are identical to those found in your body, instead of unnatural forms. However, water is also natural. But, if you drink too much you can cause serious health problems. Don't be fooled into thinking that "natural" equates to being good or safe.
As I have illustrated in this article, it is IMPOSSIBLE to use hormones the way your body would for the numerous reasons listed. Look again at the blue shaded area of the tests above. Notice that progesterone only increases for about 4-6 days during your cycle. Then days later it should drop quickly and significantly. All women do not experience the rise or fall at the same time during the cycle. So, tell me how you are going to take progesterone to only increase levels for 4-6 days, let it level off for a day and then have it drop drastically days later? Most doctors tell you to take the same level of progesterone cream for two weeks after ovulation! Clearly, that does not match the natural pattern.
The problem is that I currently do not see how anyone could use progesterone creams or any hormone replacement for a prolonged period of time without creating this potentially dangerous imbalance. I have challenged dozens of practitioners who prescribe hormones to explain how they can create balance in light of the facts I have outlined in this article. To date, none have been able to give an answer. I find it interesting that they fight so hard, though, to defend their position that they are creating balance when they are not. The reason is because deep down they know that creating an imbalance is not good and if they admit this then that leaves them with having to acknowledge that what they are doing is not as good as they pretend. In other words, it is rightfully hard for them to admit that balance is important, while also admitting that it is impossible for them to achieve balance.
If you are one of those women who have been taking hormone replacement therapy and think you may be experiencing side-effects from the new imbalance you have created in your body, you should take action to get off of these hormones as quickly as possible. If you need help, feel free to email me as so many have already. I am happy to give you some direction. It is likely that you would benefit from setting up a 1/2 hour out of state phone consult or an in person consult if you live in or near Indianapolis.
You may be surprised to find out, after reading this article, that I am NOT completely against the use of natural hormone replacement. There are cases when symptoms are so life altering that short term use of hormone replacement makes sense to get symptoms under control. Also, there are medical situations which require total hysterectomy at a younger age where long-term hormone replacement may be needed. If you are considering starting hormone replacement therapy, I suggest you only taking them for a short period of time (2-4 months) in order to overcome whatever symptoms you may have. It is important to take certain nutrients in order to improve your hormone metabolism for protection. Again, feel free to email me with questions or to set up a nutritional consult.
I have preached for years for patients to educate themselves and ask questions when it comes to health care decisions. The person who believes that their doctor knows what they are doing simply because they are a doctor is a fool! My hope is that this article sheds some light on the topic of "natural" hormone replacement by giving you a look at the other side of the coin.