Frequently Asked Questions

Hormone Balancing

I tried using progesterone creams to help with menopause symptoms. I felt really good at first, but after awhile a lot of of the symptoms started to get worse. What happened?

Dr. Kalish: You have experienced what I refer to as "super saturation" of progesterone, which is common with women that use progesterone creams. The creams build up in the layer of fat just underneath the skin and in fact turn out to be a very poor choice of delivery system for most women I have worked with.

The only group I have seen tolerate the creams well are women far past menopause, in their 70's and 80's. In these older women extremely small amounts of the creams can work well. For younger women the creams have several drawbacks: in addition to the rise of progesterone to levels that are too high, they also do not allow one to deliver the hormone in a manner that will precisely reset the cycle since it is difficult to gauge how much progesterone you are applying on any given day. The programs I have had the most success with use progesterone in a liquid, gel, oil-base or pill form.

With these types of delivery systems you can create a program that exactly mimics what the ovaries are supposed to be doing. When these graduated programs are repeated month after month the connection between the brain and the ovaries (hypothalamic-ovarian axis) is reestablished and your body will start to cycle normally again on its own. Without a graduated program you are simply flooding the system with progesterone and hoping the body can sort through what a normal cycle should be.

The side effects you experienced happen to most women the first month of progesterone use due to the sensitization of estrogen cell receptor sites that the creams create. When a woman has low progesterone relative to her estrogen levels and uses creams, the estrogen that is circulating in the bloodstream will have a suddenly stronger effect and she will experience typical estrogen dominance symptoms including mood swings, irritability, in some cases headaches and fluid retention. With proper dosing schedules and delivery systems this can be minimized.

Additionally, most women with marked deficiencies in progesterone output also have low cortisol and DHEA levels which need to be addressed and are the underlying cause of most ovarian hormone output problems.