by Amy Medling, founder of PCOS Diva
PCOS & Progesterone Supplements
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women and leading cause of female infertility. PCOS directly affects a woman’s hormonal balance creating a domino effect which disrupts the body’s everyday functions, especially when it comes to reproductive and metabolic functions. Specifically, progesterone imbalance can lead to increased risk for miscarriages, pregnancy complications and preterm delivery, irregular cycles, insomnia, waking in the middle of the night, infertility, miscarriages in the first trimester, mid-cycle spotting, anxiety and restlessness, PMS and mood swings, and significantly elevated risk for uterine lining (endometrial) overgrowth (hyperplasia) and uterine cancer. Regaining a balance of progesterone with PCOS is a top priority. While PCOS can be managed with a combination of diet, lifestyle, and mindset upgrades, supplements are often necessary, and progesterone is a popular choice.
Both fertility and menstruation are largely controlled by progesterone, a steroid hormone produced when women ovulate during the second half of the menstrual cycle.
Progesterone’s main role is to prepare the endometrium, the innermost lining layer of the uterus, for possible pregnancy. On top of that, it also prevents the body from having muscle contractions that would otherwise cause the body to reject an egg. When your body is producing high levels of progesterone, you will not experience ovulation.
When pregnancy does not happen, the body lowers progesterone levels and triggers menstruation. When conception occurs, progesterone continues to function to help feed the growing uterus via blood vessels.
When the body is unable to produce the right amounts of progesterone, ovarian imbalances occur. This can trigger overstimulation of male hormones (androgens) which results in irregular periods and pregnancy problems.
Progesterone and PCOS
Several studies in humans have indicated that, in those with PCOS, there is receptor resistance to progesterone in the cell nucleus within those organs which possess progesterone receptors. Progesterone resistance means there is a reduced responsiveness of target tissues to the available progesterone.
Increasingly, progesterone is on the list of supplements recommended by doctors who seek to treat the root cause of PCOS. Sometimes supplements can increase the amount of progesterone present at the right time so that balance is restored, and regular periods return, sleep improves, your mood is more balanced, libido increases, your cycle regulates, and mid-cycle spotting reduces, hot flashes diminish, and inflammation lessens.
Synthetic vs Bioidentical Progesterone for PCOS
Let’s first differentiate between progesterone and progestin. Progesterone is a naturally occurring hormone in the human body. It can also derive from plants where it is structurally and chemically identical to the human version. This is often called “bioidentical” or “natural” progesterone. Progestin is a completely synthetically produced substitute and has a different structure than progesterone.
Synthetic hormones were developed to mimic many of progesterone’s effects on the body and last longer in your system than natural progesterone. Unfortunately, the chemical and structural differences can have side effects including low libido and mood swings. Some studies indicate taking synthetic progesterone can lead to an increased risk in developing breast cancer. This led to the development of what we call bioidentical progesterone.
Bioidentical hormones are derived from plants such as yams, carrots, and other root vegetables. They are still manufactured in a lab, but the result is identical to what your body produces, thus the name “bioidentical”. You may wonder why we can’t just eat these plant sources instead of taking a supplement. Technically we can. However, the concentration per source is so low that those with already low levels may need to eat an unreasonable amount to get the intended effect and results.
Different Types of Natural Progesterone
There are three types of natural progesterone: Prometrium, compounded suppositories, and OTC creams.
Prometrium is the brand name for a type of bio-identical progesterone medication known as micronized progesterone. Prometrium can help restore progesterone levels and restart your body’s natural menstrual cycles. Your doctor may prescribe Prometrium if your periods have stopped for several months, if you went through menopause, or if you’re currently undergoing estrogen replacement therapy. Prometrium may also lower your risks for uterine cancer.
Sometimes referred to as Progesterone Vaginal Suppositories or PVS, this type of progesterone replacement is for vaginal use only. It works by directly stimulating the body into having menstrual periods. More than helping with pregnancy and regular menstrual cycles, suppositories also reduce lining overgrowth in the uterus in post-menopausal women who are undergoing estrogen replacement therapy.
These are the progesterone products you see on “health & wellness” shelves. Most formulations make use of wild yams or soybeans, primary sources of natural progesterone. They’re considered safe for use, but these are not regulated by the FDA so they don’t guarantee efficacy against symptoms of menopause or low progesterone levels. As with any supplement, consult with your doctor before buying an OTC progesterone cream.
When, How, & Warnings About Using Progesterone Supplements
Should everyone who has PCOS and/or struggles with regular periods take progesterone? No. Dr. Felice Gersh explains, “The biological effects of progesterone depend on the dose, the duration of the stimulus, and the presence, levels, and function of other hormones such as 17 Beta Estradiol, testosterone, thyroid, melatonin, DHEA-S, cortisol, and oxytocin. The woman’s age can also play a role. The application of progesterone as a therapeutic modality is complex and is absolutely not one which should be undertaken without medical supervision. The prescription should be individualized as far as its dose, and absolutely should be formulated by a quality pharmacy. Additionally, the goals involved with its use should be clearly delineated, and the woman using the progesterone must be closely followed and monitored. Depending on the specific needs and situation of the patient, other hormones may be indicated to be prescribed as well.”
Work with your practitioner to see if progesterone is right for you. Then work together to find the right dosage. Dosage can range anywhere from 15-50mg a day. Women who cycle are typically advised to use topical progesterone during their luteal phase, days 14 to 28 of the cycle. If a period is irregular or absent, one would typically start progesterone on day 14 and teach your body to learn a new cycle, then stop when a period comes back.
For more info on progesterone therapy and PCOS please read Natural Progesterone for PCOS.
Amy Medling, best-selling author of Healing PCOS and certified health coach, specializes in working with women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms. In response, Amy founded PCOS Diva and developed a proven protocol of supplements, diet, and lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health, and happiness.
- Asi N, Mohammed K, Haydour Q, et al. Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev. 2016;5(1):121. Published 2016 Jul 26. doi:10.1186/s13643-016-0294-5
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