Menopause Matters: Kate Wells
The benefits of progesterone after menopause go far beyond reproductive health, this powerhouse hormone plays a vital role in everything from mood to metabolism.
While at a women’s empowerment event in Denver recently I became involved in a long discussion about the importance of progesterone in women’s health after menopause.
Several of the women in the huddle had been informed by their practitioners that, because they had hysterectomies, they did not need to use progesterone. To this day, many practitioners still don’t understand the differences in types of hormone replacement and the many ways that progesterone has a positive effect on the body and the brain.
Estrogen gets so much attention – it’s a major growth hormone – it drives so much about fertility and is a major player during the years we get our periods. Just as important but rarely discussed is the hormone progesterone. After the menopausal transition, estrogen still grabs the headlines, with nary a word about the other major hormone – progesterone.
Understanding The Benefits Of Progesterone After Menopause Starts With The Uterus:
A quick recap of the story of estrogen and progesterone function in the uterus.
Defining Day One of the period as the first day of the cycle, estrogen made in the ovaries starts to rise around day six and starts the growth of the cells that line the uterus. Rising estrogen levels signal an egg to be released around day 15. The egg travels along the fallopian tube towards the uterus.
The egg has a sac around it called the corpus luteum and this is where most of the progesterone is released. In reproduction, progesterone is important for making sure the uterine lining is structurally sound so that a fertilized egg can be implanted and grow successfully.
If the egg is not fertilized, then both estrogen and progesterone levels start to drop and this drop in progesterone level triggers the uterine lining to shed…and the women gets her period. And then it starts all over again.
Mythy-Hysterectomy Doesn’t Need Progesterone:
Let’s look next at the myth that a woman who has had a hysterectomy doesn’t need progesterone.
While estrogen is important for growing the uterine lining – progesterone’s role is to stop the growth and to enrich the uterine lining so it can maintain a pregnancy.
These two hormones are two sides of a teeter totter; both are needed for a successful pregnancy. Estrogen is needed for growth; progesterone is needed to balance that growth and make sure it doesn’t get out of hand. The term “estrogen dominance” is used when there is too much estrogen in relation to progesterone…often this isn’t too much estrogen, it’s too little progesterone.
When hormone replacement first became available on a wide scale it was manufactured to have estrogen-like compounds and progesterone-like compounds. Scientists knew that women needed to have both hormones and so made combination hormone replacement.
The Progesterone-Like Compounds:
The plot thickens though. These hormones made by pharmaceutical companies do not have the same chemical structure as the hormones made by the body (i.e. they are not bioidentical). In consequence there are side effects as the body tries to work out what to do with these alien compounds. The progesterone-like compounds are known as progestins.
The Women’s Health Initiative Study which stopped in 2002 found that progestin use can result in an increased risk for stroke and so medical guidance to practitioners was, “Use hormone replacement if you must but then stop as soon as possible”. A second message was “if a woman doesn’t have a uterus, she doesn’t need progestins”. Too right! Progestins use does carry risk.
What was missed in all of this was the need to separate out the two categories of hormones: pharmaceutical hormones (synthetic estrogens and progestins which don’t have the same chemical structure as those made in the body) from hormones made to match the structure of the hormones made in our bodies – estrogen and progesterone. Doctors confused “progestin” and “progesterone”, and they still do.
The myth therefore lives on “women don’t need progesterone if they have had a hysterectomy.”
Ah – there is yet more to this story of hormone wonderfulness
Progesterone, the bioidentical kind, the stuff we make itty bits of now that we are post-menopausal, is actually a wonder hormone. Yes, it protects the uterus but there is so, so much more that it does. Let us count the ways:
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Promotes normal sleep patterns |
Supports optimal thyroid function so we have energy |
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Calms the brain and reduces mood swings |
Improves how the body uses estrogen |
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Reduces cholesterol |
Balances out estrogen in breast and the brain |
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Help cognitive function and memory formation |
Increases scalp hair (you have to love this one) |
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Is a diuretic flushing fluid out of the cells |
Helps burn fat for energy (and this one too) |
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Helps the body use glucose effectively and improves insulin resistance |
Is an anti-depressant |
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Helps bones stay strong |
Helps normal cell death |
That’s just 14 ways that progesterone helps the body. There are receptors (little doors) for progesterone on cells all over the body.
Are you in love with progesterone yet? Oh baby, I am! At age 62, I could not live this busy, engaged, balanced, active life I lead without it.
Why Do Progesterone Levels Drop?
As we get into our forties, while we still get our regular cycles, the eggs we have left in our ovaries are getting tired and old. It becomes harder for an egg to mature each month and be released from the ovary.
Although there is some progesterone made from the adrenal gland and the ovary, if there is no egg released, there will be no corpus luteum, and if there is no corpus luteum there will be no surge of progesterone in the second half of the cycle. By our mid to late forties, it is a rare month that we actually ovulate and make much progesterone.
This is really where it all goes to hell in a handbasket for many women. Their bodies are still making estrogen, but it’s not balanced by enough progesterone. Look back at the list of things progesterone does; this is the time when women start to experience mood swings (oh, the rages, the sobbing), weight gain, fatigue, foggy thinking, and more.
So, Is It Safe To Use Progesterone?
For the vast majority of women–absolutely. Whether for balancing out estrogen in perimenopause to making sure we have progesterone sufficiency in all the years we live after menopause, progesterone is super important to our health and wellbeing.
The body is designed to have a backup system, small amounts of progesterone are made by the adrenal glands. However, the pace of life these days, the stresses from toxicants in our food, water, air, and all the rest of the stressful things, often means that the adrenal gland will prioritize making cortisol over progesterone.
And besides, if we regularly used to make more than 20 mg of progesterone a day during our reproductive phase, the small amount that could come from the adrenal gland is like trying to cover a dining table with a napkin…it’s just not enough to be effective.
I was quietly delighted when a couple of the ladies in our huddle who had been so adamant that they did not need progesterone came back the next day and said, “I looked it up, I found the difference between progestins and progesterone and realize I do need progesterone”.
Mission accomplished! I love my job.
