Lara Briden's Healthy Hormone Blog http://www.larabriden.com Natural treatment for better hormones and better periods Sun, 28 May 2017 03:31:18 +0000 en-US hourly 1 https://wordpress.org/?v=4.7.5 44428475 7 Best Natural Anti-Androgen Treatments for Hirsutism http://www.larabriden.com/best-natural-anti-androgen-treatments-hirsutism/ http://www.larabriden.com/best-natural-anti-androgen-treatments-hirsutism/#comments Thu, 25 May 2017 22:36:30 +0000 http://www.larabriden.com/?p=5046 Natural anti-androgen treatments reduce testosterone or block its effects. In women, androgen blockers can improve the symptom of unwanted facial hair (hirsutism), usually associated with PCOS. Anti-androgen supplements are not a stand-alone treatment for PCOS. You still need to fix the underlying driver of your type of PCOS. For example, if you have insulin-resistant PCOS, […]

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woman with a mustacheNatural anti-androgen treatments reduce testosterone or block its effects. In women, androgen blockers can improve the symptom of unwanted facial hair (hirsutism), usually associated with PCOS.

Anti-androgen supplements are not a stand-alone treatment for PCOS. You still need to fix the underlying driver of your type of PCOS. For example, if you have insulin-resistant PCOS, you need to quit sugar and take magnesium. By fixing the underlying driver of PCOS, you will restore normal ovulation which will naturally result in less testosterone and more estrogen and progesterone—all of which will help hirsutism.

⚠️  Tip: Both estrogen and progesterone have strong anti-androgen effects.

⚠️  Tip: Anti-androgen treatments can also help acne, but they’re not as effective as the dietary changes and supplements discussed in my latest acne post.

Natural anti-androgen treatments for hirsutism

Zinc improves ovarian function thereby decreasing androgens and increasing progesterone, which is a natural androgen blocker. In a recent clinical trial, zinc supplementation significantly improved hirsutism in just eight weeks. The recommended dose is 30-50 mg taken directly after dinner. Don’t take zinc on an empty stomach, or it could make you feel sick. See the 7 Ways Zinc Rescues Hormones.

Peony and Licorice combination. Peony (Paeonia lactiflora) inhibits the production of testosterone and promotes the activity of the enzyme aromatase, which converts testosterone to estrogen. Licorice (Glycyrrhiza glabra) reduces serum testosterone in women and contains phytoestrogens that block androgen receptors. Together, the two herbs have the synergistic effect of normalizing the pituitary hormones. Licorice raises blood pressure, so please consult a clinician about safe use.

Reishi mushroom (Ganoderma lucidum) inhibits 5-alpha reductase which is the enzyme that converts testosterone to the more potent DHT hormone. Reishi has many other health benefits including immune enhancement and stabilization of the HPA (adrenal) axis.

DIM (diindolylmethane) is a phytonutrient derived from vegetables such as broccoli, Brussels sprouts, cabbage, and kale. It blocks androgen receptors. Because DIM inhibits the aromatase enzyme, it could have the unwanted effect of decreasing estrogen, but clinically, I’ve found it to be quite effective for both acne and hirsutism. The recommended dose is 100 mg per day.

Saw palmetto (Serenoa repens) inhibits 5-alpha reductase. It did well in a recent clinical trial for androgenetic alopecia when it was combined with green tea, vitamin D, melatonin, and soy. Like DIM, saw palmetto can have the unwanted effect of decreasing estrogen. I don’t prescribe it mainly because I prefer other treatments like zinc, peony, and licorice.

Vitex agnus-castus lowers prolactin and so improves prolactin-induced androgen excess and hirsutism. High prolactin can induce androgen excess in two ways: 1) It increases the adrenal androgen DHEA, and 2) it up-regulates 5-alpha reductase. High prolactin is not common with PCOS which is one reason I usually don’t prescribe Vitex for PCOS. See the Do’s and Don’ts of Vitex.

Progesterone inhibits 5-alpha reductase and blocks androgen receptors. The best way to obtain progesterone is to ovulate and make your own. You can also supplement it. See the 7 Superpowers of Progesterone.

⚠️  Tip: There’s no progesterone in hormonal birth control.

⚠️  Tip: You don’t need all of these supplements. Start with your core PCOS treatment such as quitting sugar and taking magnesium, and then choose one additional anti-androgen treatment such as zinc.

Hirsutism takes a long time to improve

Facial hair or hirsutism is one of the most frustrating symptoms of PCOS and the slowest to improve. Even once you have all the right treatment in place, you may still have to wait six to twelve months to see an improvement.

Further reading:

What is your experience with natural testosterone blockers for PCOS? Please comment.

Yours in health,

Lara Briden

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The Serious Downside to Contraceptive Implants and Injections http://www.larabriden.com/downside-to-contraceptive-rods-implants-injections/ http://www.larabriden.com/downside-to-contraceptive-rods-implants-injections/#comments Mon, 17 Apr 2017 22:29:03 +0000 http://www.larabriden.com/?p=4942 When it comes to hormonal birth control, is a contraceptive implant (rod) or injection any better than the Pill? Pharmaceutical companies would like you to think an implant is better because they want you to choose it as your alternative birth control. But let’s be honest. A true alternative would be a non-hormonal method such as fertility […]

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Woman looking at arm.When it comes to hormonal birth control, is a contraceptive implant (rod) or injection any better than the Pill?

Pharmaceutical companies would like you to think an implant is better because they want you to choose it as your alternative birth control. But let’s be honest. A true alternative would be a non-hormonal method such as fertility awareness or the copper IUD. Implants or rods are basically “business as usual” and here’s why.

Just like the Pill, implants and injections work by shutting down ovulation. So just like the Pill, they switch off hormones and induce a kind of chemical menopause. That’s a pretty significant downside.

Depo-Provera injection completely suppresses both estrogen and progesterone, which is why it has the scariest side effects of any birth control (see below).

Implants are a bit gentler because they permit some estrogen. Their downside is that they annihilate all progesterone and therefore rob you of progesterone’s many benefits for mood, hair, thyroid, bones, and skin. Please read the 7 Superpowers of Progesterone.

But wait, don’t those little rods you put in your arm contain progesterone? Nope. There’s no progesterone in any type of hormonal birth control. Injections and contraceptive implants contain the progestin steroid drugs medroxyprogesterone acetate, levonorgestrel, and etonogestrel. Progestin drugs don’t give the same benefits as progesterone for hair or mood or skin. Instead, they give side effects which are the opposite of progesterone. Please read The Crucial Difference Between Progesterone and Progestins.

Medroxyprogesterone acetate is the progestin in the Depo-Provera injection. The drug is also used orally as Provera to treat abnormal uterine bleeding and other conditions. By severely suppressing both estrogen and progesterone, Depo-Provera damages bones and so earned its ‘black box’ warning from the FDA. It also causes the troubling side effect of ‘unstoppable’ weight gain and can set women up for some distressing withdrawal symptoms called an ‘estrogen storm.’

Levonorgestrel is the progestin in the implants Norplant and Jadelle. The drug is also used in many oral contraceptives, hormone replacement, Plan B morning-after pill, and the hormonal IUDs Mirena and Skyla. Because levonorgestrel is derived from testosterone, it causes androgenic (male hormone) side effects such as acne, hair loss, and weight gain. Levonorgestrel and other progestins were linked with anxiety and depression in the 2016 Danish study of 1.1 million women.

Etonogestrel is the progestin in the implants Nexplanon or Implanon. The drug is also used in Nuvaring and the progestin-only Pill Cerazette. Like levonorgestrel, etonogestrel can cause mood problems, but it is less androgenic (testosterone-like) than levonorgestrel and so slightly less likely to cause acne, hair loss, and weight gain. Like all progestins, etonogestrel can cause insulin resistance.

Both levonorgestrel and etonogestrel implants can cause ovarian cysts, which makes sense when you consider that their main action is to disturb and suppress ovarian activity. And all types of contraceptive implants can cause erratic bleeding.

What’s with all the crazy bleeding on contraceptive implants and injections?

The side effect of erratic bleeding is referred to as “irregular menstruation,” which I would argue is a misnomer. The random bleeds that occur on implants are not real periods or menstruation. Instead, they’re random bleeds or “anovulatory cycles.”

What’s the difference between a real period, a Pill-bleed, and an anovulatory cycle?

A real period is the final event in a menstrual cycle in which ovulation occurred and progesterone was made. In other words, a real period is a withdrawal bleed from natural progesterone. The timing of a real period is about the healthy functioning of your ovaries.

⚠️  Tip: Ovulation is the primary hormonal event of a healthy menstrual cycle.

A Pill-bleed is a withdrawal bleed from a pharmaceutical progestin such as levonorgestrel. The timing of Pill-bleed is about the dosing of the drug. There is no reason to bleed monthly when on hormonal birth control. For more information about Pill-bleeds, please watch the short animation Why Hormonal Birth Control Can Never Regulate Periods.

An anovulatory cycle or “breakthrough bleed” is a bleed that occurs when the uterine lining has been exposed to estrogen, but not progesterone. Estrogen causes the uterine lining to build up until it cannot hold any longer and at which point it sheds. Anovulatory bleeds also occur with conditions such as polycystic ovarian syndrome (PCOS).

⚠️  Tip: Hormonal IUDs permit little or no bleeding, but they do permit some ovulation and some progesterone, which is better than none. In that sense, Mirena gives a more “natural cycle” than does the Pill. Read The Pros and Cons of Mirena.

If we agree that progesterone is important and that ovulation is the only way to make it, it changes the entire conversation about birth control.

Non-hormonal birth control

The main advantage of non-hormonal birth control is that it permits ovulation and the production of progesterone.

The best types of non-hormonal birth control are:

  • Fertility awareness method (FAM), which is highly reliable contraception, even for women with irregular cycles.  You can do it on your own after receiving online training or reading Taking Charge of Your Fertility. Or you can do it with the assistance of technology such as Daysy Fertility Calculator or Natural Cycles (the first phone app to be certified as contraception).
  • Condoms, which are one of the oldest methods of birth control and still one of the best. Check out new brands such as the crowd-sourced unbreakable condom Hex.
  • The cervical cap (Femcap) and diaphragm (Caya), which are effective female barrier methods.
  • The copper IUD, which is highly effective and non-hormonal and nothing whatsoever like a contraceptive implant. It should not be lumped together with implants into the category of ‘Long-Acting Reversible Contraception’ (LARC).
  • Vasalgel, which is a non-hormonal method coming soon for men.

What about implants and injections for endometriosis?

Endometriosis is a serious inflammatory disease. In addition to surgery and natural immune-modulating treatment, endometriosis does sometimes require hormonal suppression with birth control.  But even then, I think that Mirena IUD can be a better option than implants. Please read Endometriosis: 5 Natural Treatments that Really Work.

What’s your experience with contraceptive implants? Please comment.

Yours in health,

Lara Briden

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Why Stress Hits Hard in Your 40s http://www.larabriden.com/real-reason-stress-hits-hard-in-your-40s-adrenal/ http://www.larabriden.com/real-reason-stress-hits-hard-in-your-40s-adrenal/#comments Mon, 06 Mar 2017 03:46:51 +0000 http://www.larabriden.com/?p=4882 In your 40s, you may find you don’t cope with stress as well as you did. You’re not imagining things, and you’re definitely not alone. Women are three times more likely to suffer anxiety, depression, and insomnia during the five years before menopause. These years are called perimenopause and it’s a vulnerable time. Not just because […]

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perimenopauseIn your 40s, you may find you don’t cope with stress as well as you did. You’re not imagining things, and you’re definitely not alone. Women are three times more likely to suffer anxiety, depression, and insomnia during the five years before menopause.

These years are called perimenopause and it’s a vulnerable time. Not just because you’re busier than ever with career and family, but also because you’ve suddenly lost the progesterone that used to calm and stabilize your stress response system (hypothalamic-pituitary-adrenal or HPA axis).

⚠️  Tip: HPA axis dysregulation is the medical term for “adrenal fatigue”.

⚠️  Tip: For more detail about how progesterone deficiency causes perimenopausal depression, please read this fascinating paper: “Ovarian Hormone Fluctuation, Neurosteroids and HPA Axis Dysregulation in Perimenopausal Depression”.

Progesterone regulates the HPA axis

Did you know that progesterone plays a huge role in regulating your HPA axis? Progesterone is not just a reproductive hormone. It’s also a brain hormone and a nervous system hormone. Progesterone promotes neurogenesis (new nerve growth) in the hippocampus, which regulates your HPA axis. It also converts to a neurosteroid called allopregnanolone (ALLO), which acts just like the soothing neurotransmitter GABA and is your “hormonal Valium”.

Progesterone ⇒ neurogenesis and GABA ⇒ healthy happy HPA axis (adrenal function)

The end of progesterone

As you approach menopause, you will find it harder and harder to ovulate. That means you’ll lose your only way to make large amounts of progesterone. It’s not all bad. Menopause transition is a natural, normal process — not a failure on your part! Eventually, you will adjust to the small amount of progesterone made by your adrenal glands, and you’ll recover your ability to cope with stress.

Here’s how I see it. Perimenopausal progesterone withdrawal is the price we pay for having enjoyed decades of wonderful progesterone and all its many benefits for brain, bones, and metabolism. The fact that progesterone has to end with menopause should just make us more grateful that we had it at all. (And more determined to not switch it off with hormonal birth control.)

⚠️   Tip: 45 is the average age for the onset of the menopause transition or perimenopause. For some women, it can start up to a decade earlier.

How to survive the great progesterone crash of perimenopause

More rest and self-care. You are in a vulnerable time but it will not last forever. You have permission to slow down and look after yourself at least until you get to the other side of menopause. Being in my late 40s finally convinced me to meditate regularly.

Magnesium is a powerful stress-reliever. It boosts GABA, blocks glutamate, reduces adrenaline, regulates cortisol, and promotes sleep. If you take one supplement during perimenopause, let it be magnesium. (See 8 Ways Magnesium Rescues Hormones.)

Taurine is an amino acid that calms the brain by boosting GABA and blocking glutamate and adrenalin. It’s obtained from animal products but it’s depleted by estrogen, so women have a higher requirement for taurine than men. I prescribe a combination of magnesium and taurine for almost every perimenopausal patient.

Ashwagandha (also called Withania somnifera) is one of my favorite herbal medicines. Like all so-called “adaptogen” herbs, it stabilizes the HPA axis by reducing neuroinflammation at the hippocampus. It also has direct anti-anxiety and sleep-promoting effects (hence the Latin name somnifera or “sleep-inducing”).

Progesterone. Your brain and adrenal system will eventually adapt to a reduced postmenopausal level of progesterone, but in the meantime, if you’re suffering, you can take natural micronised progesterone. A capsule works better than a cream for perimenopausal mood symptoms because the liver converts progesterone to allopregnanolone (ALLO). For more information about natural progesterone, please see my last perimenopause post What Estrogen Does In Your 40s (and How Progesterone Can Help).

What’s your experience with perimenopause and perimenopausal treatments? Please comment.

Yours in health,

Lara Briden

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When Period Pain Is Not Normal http://www.larabriden.com/when-period-pain-is-not-normal/ http://www.larabriden.com/when-period-pain-is-not-normal/#comments Sat, 11 Feb 2017 00:57:17 +0000 http://www.larabriden.com/?p=4849 Do you suffer bad period pain?  You shouldn’t have to. Period pain is common, so we tend to think it just goes with the territory of having periods. But most normal period pain will disappear with the right diet and supplements. Put it this way: If it doesn’t disappear, then it’s not normal period pain. […]

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When period pain is not normalDo you suffer bad period pain?  You shouldn’t have to.

Period pain is common, so we tend to think it just goes with the territory of having periods. But most normal period pain will disappear with the right diet and supplements.

Put it this way: If it doesn’t disappear, then it’s not normal period pain. It’s strong period pain and might be a sign of an underlying medical condition like endometriosis.

What is normal period pain?

Normal period pain (primary dysmenorrhea) is a bit of cramping in your lower pelvis or back. It occurs during the first day or two of your period and improves with ibuprofen. It doesn’t interfere with your daily activities.

Normal period pain is caused by the release of prostaglandins in your uterus and usually improves as you get older.

Severe period pain (secondary dysmenorrhea) is throbbing, burning, searing, or stabbing pain that lasts for many days and can even occur between periods. It doesn’t improve with ibuprofen, and it’s so bad you vomit and sometimes miss school or work.

Severe period pain is caused by an underlying medical condition such as endometriosis or adenomyosis, and it can get worse as you get older.

How to treat normal period pain

Here are a few simple strategies for normal period pain:

Dairy-free diet. Removing normal cow’s milk from the diet is the simplest and most reliable ways to get rid of period pain. By removing dairy, you’re avoiding the inflammatory protein A1 casein, which means less inflammation, less histamine, and therefore less period pain (see What Dairy Does to Periods). Dairy is not the only inflammatory food. Wheat, vegetable oil, and high histamine foods are other common drivers of period pain.

Magnesium is effective for both prevention and acute care of period pain. For example, you can take 300 mg of magnesium throughout the month to dial down prostaglandins. You can then take extra magnesium during your period to relieve the pain (just don’t take so much that you cause loose bowel).

Zinc reduces prostaglandins and improves blood circulation to the uterus. It did well in a recent 2015 clinical trial for the period pain of teenage girls. I test for zinc deficiency and then prescribe 20-30 mg zinc taken daily throughout the month.

Turmeric. Like magnesium, turmeric is great for both prevention and acute care. I recommend a daily dose of a standardized extract for prevention, and then more as needed during the pain. Turmeric also substantially lightens periods.

Give yourself three months with these treatments. If you don’t notice substantial improvement, then ask yourself and your doctor: “Is something else going on?”

Do you have endometriosis?

Endometriosis affects one in ten women, and it’s a big deal. Endometriosis is not just painful periods. It’s actually a whole body inflammatory disease which is characterized by lesions which are very similar to uterine lining (endometrium), except they’re not located inside the uterus. They’re called endometriosis lesions or endometriomas (chocolate cysts), and they cause widespread pain and scarring.

Pain is the main symptom of endometriosis, but it’s not the only symptom. Other symptoms include bleeding between periods, pain with sex, and a puzzling array of digestive and bladder problems. For example, one of my patients suffered recurring bladder pain and was given course after course of antibiotics that didn’t help. She had no period pain but she finally asked her gynecologist: “Could this be endometriosis?”. On further investigation, it was discovered that yes, she did have endometriosis lesions on her bladder and urethra, and they were the cause of her bladder problems.

This kind of story is not uncommon. It typically takes more than ten years to diagnose endometriosis, and in the meantime, girls and women suffer. Of all the teens who report chronic pelvic pain, 70 percent will go on to be diagnosed with endometriosis.

Don’t let that happen to you. Don’t suffer a decade of crippling pain being told it’s “just period pain”, and there’s nothing you can do. Please watch the film “Endo What?”. Please speak to your doctor. Tell her how many pain-killers you take. Tell her the pain is so bad you can’t go to work. And ask her outright if it could be endometriosis.

You and your doctor and all of us wish there was an easy way to diagnose endometriosis. A blood test for endometriosis does not yet exist, but looks like one is coming. Normal ultrasound can’t do the job, although specialized ultrasound can detect some aspects of the disease.

At the present time, laparoscopic or keyhole surgery is the only way to definitively diagnose and treat endometriosis. It sounds scary, but surgery is something you should at least consider because early excision surgery can sometimes eradicate the disease. Even when surgery isn’t a cure, it significantly reduces pain and inflammation and can give you a window to get results with other pharmaceutical and/or natural treatments.

For more information about both conventional and natural treatment of endometriosis, please see my post Endometriosis: 5 Natural Treatments that Really Work.

Yours in health,

Lara Briden

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7 Ways Zinc Rescues Hormones http://www.larabriden.com/7-ways-zinc-rescues-hormones/ http://www.larabriden.com/7-ways-zinc-rescues-hormones/#comments Tue, 17 Jan 2017 07:08:32 +0000 http://www.larabriden.com/?p=4784 Looking for a simple solution to your period problems? Before you reach for a “women’s” supplement like Vitex or maca or natural progesterone, please consider the humble mineral zinc. Zinc is effective treatment for acne, PCOS, period pain, and many other periods problems. Second only to magnesium, zinc is the supplement I prescribe most often for […]

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Looking for a simple solution to your period problems? Before you reach for a “women’s” supplement like Vitex or maca or natural progesterone, please consider the humble mineral zinc.

Zinc is effective treatment for acne, PCOS, period pain, and many other periods problems. Second only to magnesium, zinc is the supplement I prescribe most often for women’s health.

7 benefits of zinc

  1. Regulates cycles. Zinc nourishes ovarian follicles (eggs) and so promotes ovulation. And regular ovulation is the only way to achieve both regular menstrual cycles and a good supply of estrogen and progesterone. Your ovaries love zinc!
    ⚠️  Tip: Please allow three months to see improvement because ovarian follicles take 100 days to grow. For more information about the 100 days, see my book Period Repair Manual, and my post Road Map to Progesterone.
  2. Blocks excess androgens (testosterone). Zinc inhibits overactivity of the enzyme 5 alpha-reductase and reduces the conversion of testosterone to dihydrotestosterone (DHT). That’s one way it treats PCOS symptoms such as acne and hirsutism (facial hair). Another way it can treat hirsutism is by inhibiting excess prolactin. See 4 Causes of Androgen Excess.
    ⚠️  Tip: Because it’s involved in so many different enzyme pathways, zinc has different effects in different people. For example, it reduces the abnormally high androgens of PCOS-sufferers, but it can also raise androgens to a healthy level in both men and women. But just to be clear: Zinc will never raise testosterone above normal levels.
  3. Clears skin. Zinc is arguably the perfect medicine for acne. In addition to blocking excess androgens, it kills bacteria and opens pores by reducing keratin production. It works best when combined with an anti-acne diet. Please see my latest acne post.
  4. Maintains collagen. Zinc maintains the integrity of collagen in connective tissue and hair, and it’s particularly good for the hair loss associated with thyroid disease.
  5. Supports thyroid. Together with iodine and selenium, zinc is essential for the synthesis and activation of thyroid hormone. In fact, it’s closely interlinked with thyroid hormone:  Zinc promotes thyroid hormone, which, in turn, promotes the better absorption of zinc.
  6. Dials down cortisol and the stress response. Zinc is essential for the healthy functioning of the hippocampus, which is the part of the brain that regulates the HPA (hypothalamic-pituitary-adrenal) axis and cortisol. (The HPA axis is more accurately termed the HHPA or hippocampal-hypothalamic-pituitary-adrenal axis.) For a great discussion of zinc and the hippocampus, please see Zinc: an Antidepressant by Dr. Emily Deans.
  7. Reduces inflammation. Zinc has powerful anti-inflammatory properties, which is why it relieves period pain. It’s also a key component of the natural treatment protocol for the inflammatory condition endometriosis. Please see Endometriosis: 5 Natural Treatments that Really Work.

Who needs zinc?

Deficiency affects at least a third of the world’s population (probably more). Your body cannot store zinc, so you need to eat or supplement it quite regularly.

Best food sources include oysters and red meat, so if you’re vegetarian, you’re probably deficient. Other causes of deficiency include alcohol, stomach medication, hormonal birth control, underactive thyroid, and some types of blood pressure medication.

Testing for zinc deficiency

I routinely screen for deficiency with the simple and inexpensive test “plasma zinc” (reference range 11-23 umol/L or 70-150 ug/dL). It’s not a perfect test because most zinc is inside the cells, not in the plasma. So someone with a ‘normal’ test can still be deficient. I also look at history (eg. vegetarian or medication), and deficiency symptoms such as hair loss, dermatitis, impaired immune function, and white spots on the fingernails.

Dose and safety

I prescribe 20-30 mg per day (or short-term higher dose for acne), and I give it in the form of citrate or picolinate taken directly after food. That minimizes the gastric irritation or nausea that can occur with zinc.

Long-term supplementation of more than 80 mg interferes with copper and iron metabolism and can impair the function of the immune system and possibly the hippocampus.

What is your experience with zinc? Please comment.

Yours in health,

Lara Briden

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The Right Way to Test Progesterone http://www.larabriden.com/right-way-test-progesterone/ http://www.larabriden.com/right-way-test-progesterone/#comments Mon, 05 Dec 2016 01:00:56 +0000 http://www.larabriden.com/?p=4616 Next time your doctor orders a progesterone test, please stop for a minute, and ask yourself: “When is the right day to do this test?” Of course, you’d hope your doctor would ask herself the same question, and then guide you to the correct day.  But if your doctor is like other family doctors, she […]

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The right way to test progesterone.Next time your doctor orders a progesterone test, please stop for a minute, and ask yourself: “When is the right day to do this test?

Of course, you’d hope your doctor would ask herself the same question, and then guide you to the correct day.  But if your doctor is like other family doctors, she has surprisingly little knowledge of the female hormone cycle.  She may not know when to test.

Your brief window of progesterone

You make progesterone for just a brief 10-14 days after ovulation, which is the 10-14 before your period. That’s your luteal phase. It doesn’t matter how long your cycle turns out to be.  Your luteal phase is the final 10-14 days leading up to your period. You cannot expect to see any progesterone before then.

Progesterone luteal phase.

Test progesterone when it’s highest, which is about halfway through your luteal phase. It’s when you are 5-7 days after ovulation, and 5-7 days before your period.

If your cycles are regular, it’s pretty easy to figure out. Simply identify the date of your next expected period, and then count 7 days before. For example:

  • 21-day cycle: Test progesterone on approximately day 14
  • 28-day cycle: Test progesterone on approximately day 21
  • 35-day cycle: Test progesterone on approximately day 28

⚠️ Tip: Day 1 of your cycle is the first day of real, heavy menstrual flow. Days of pre-period light flow or “spotting” are counted as the final days of your previous cycle.

If your cycles are not regular, it’s a bit trickier. The best plan is to try to detect ovulation and then count 7 days after. There are three ways to it:

  • Watch for fertile mucus and twinges in your pelvis. When you see these physical signs of possible ovulation, count 5-7 days later, and then have the blood test. (Physical signs suggest ovulation, but they do not confirm it.)
  • Test with LH ovulation test strips. Start testing your urine a few days before you think you’ll ovulate. When you see the double line indicating LH surge, count 5-7 days later, and then have the blood test.
  • Chart your basal body temperature (BBT). Using an ovulation thermometer, take your early morning resting temperature. You will see it rise 0.5℃ (0.9℉) after ovulation. When you see your temperature rise, count 4-6 days later, and then have the blood test.  BBT charting is a way to confirm ovulation, and also a great way to assess progesterone all on its own! (Without a blood test.)

⚠️ Caution: If you suffer PCOS, you may have chronically elevated LH, and so cannot rely on ovulation test strips.

A final “accuracy check-in” with your actual period

Don’t interpret your progesterone result until your period has actually arrived. Wait for your period, and then ask: “Was the test done within 14 days before my period?

If not, then it is not a valid luteal phase test, and it cannot be used to diagnose progesterone deficiency or estrogen dominance (Read: Why I Don’t Use the Term Estrogen Dominance).

⚠️ Tip: If you’re certain you ovulated, but your period does not come within 14 days — do a pregnancy test!

The “no-progesterone zone”

No progesterone zone.There are three situations in which there’s no point testing progesterone because you can be certain you have none.

  • Pre-ovulation (follicular phase). And remember: if you have long cycles, your follicular phase is many weeks long—the majority of your cycle.
  • Hormonal birth control.  Almost all types of hormonal birth control switch off progesterone. The only exception is the hormonal IUD (Mirena or Skyla), which permits some ovulation (but not regular ovulation).
  • Post-menopause.  Unless you take bioidentical progesterone, you will have almost no progesterone after menopause.

Interpreting your progesterone result

To confirm ovulation: If your serum mid-luteal progesterone is less than 1.8 ng/mL (5.5 nmol/L), then you did not ovulate. Instead, you had what is called an anovulatory (non-ovulation) cycle, which is a problem. Anovulatory cycles are common with polycystic ovarian syndrome or PCOS. Your strategy is to correct the underlying reason for PCOS, and therefore start to ovulate again. That’s how you’ll make progesterone.

⚠️ Tip: These reference ranges are for progesterone serum or blood tests. I don’t use saliva testing to assess mid-luteal progesterone.

To assess optimal progesterone: You want your serum mid-luteal progesterone to be greater than 8 ng/mL or 25 nmol/L, and the higher the better. (Read: The 7 Superpowers of Progesterone.) But don’t panic if your result is at the low end of normal. Progesterone fluctuates widely over the course of ninety minutes, so a low-normal reading may simply mean the blood was drawn at a low point.

⚠️ Tip: The best way to assess “optimal progesterone” is to chart basal body temperature (see above).

To check the safety of bioidentical progesterone: In general, the only reason to test progesterone during supplementation is to check if you’re getting too much. Take a few days off the cream or capsules before you test. If you’re post-menopausal, your serum reading should stay at the follicular phase level (less than 1.8 ng/mL or 5.5 nmol/L). You’re certainly not aiming for luteal phase levels! If you’re using a progesterone cream, your salivary reading could go quite high, but that’s usually transient. We can discuss post-replacement testing more in the comments.

What is your experience with progesterone testing? Please comment.

Yours in health,

Lara Briden

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7 Superpowers of Progesterone http://www.larabriden.com/superpowers-benefits-progesterone/ http://www.larabriden.com/superpowers-benefits-progesterone/#comments Fri, 04 Nov 2016 03:09:44 +0000 http://www.larabriden.com/?p=4491 Progesterone is a startlingly beneficial hormone, and almost all of us could do with more than we have. Progesterone acts on your breasts and uterus, so it’s essential for healthy reproduction and periods. But did you know it also acts on your brain, immune system, and detoxification enzymes? Progesterone does a lot more for you than just […]

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Superpowers of progesteroneProgesterone is a startlingly beneficial hormone, and almost all of us could do with more than we have.

Progesterone acts on your breasts and uterus, so it’s essential for healthy reproduction and periods. But did you know it also acts on your brain, immune system, and detoxification enzymes? Progesterone does a lot more for you than just fertility and easy periods. It soothes, nourishes, energizes, strengthens, and rescues your body in ways you never imagined.

Benefits of progesterone

  1. Boosts energy by stimulating thyroid and heating up metabolism. That’s why your body temperature goes up half a degree when you make progesterone after ovulation. It also stabilizes communication between the hypothalamus and adrenal glands, and so relieves HPA dysregulation (also known as “adrenal fatigue”).
  2. Soothes mood and rescues sleep because of the Valium-like effect of its metabolite allopregnanolone (ALLO). ALLO is a neurosteroid that interacts directly with GABA receptors in the brain. Progesterone also up-regulates the DAO enzyme and so relieves the anxiety symptoms of histamine intolerance. Finally, it stimulates sleep centers in the brain and is essential treatment for premenstrual and perimenopausal insomnia.
  3. Nourishes hair and clears skin because it reduces male hormones (androgens) by inhibiting the enzyme 5-alpha reductase. The result is faster-growing hair, less skin oil (sebum), and fewer skin break-outs. One day, I’d love to see natural progesterone go head-to-head against the anti-androgen drug spironolactone. My money would be on progesterone as the better treatment.
  4. Lightens periods by counteracting estrogen’s stimulating effect on the uterine lining.
  5. Prevents autoimmune disease because it modulates immune function, reduces inflammation, and up-regulates detoxification enzymes.
  6. Builds bones and muscle by stimulating osteoblasts (bone-building cells) and the growth of new muscle.
  7. Protects against cancer by counteracting estrogen’s stimulating effect on breast and uterine tissue. It may even have a future role as treatment for breast cancer.

Conditions associated with progesterone deficiency:

  • PCOS
  • heavy periods
  • fibroids
  • acne
  • hair loss
  • endometriosis
  • autoimmune disease
  • premenstrual syndrome (PMS)
  • premenstrual migraines
  • infertility
  • perimenopause
  • menopause
  • osteoporosis

Physical signs of progesterone deficiency:

  • Short luteal phase, the time between ovulation and your period.
    It should be at least 11 days.
  • Low temperatures in the luteal phase.
  • Fertile mucus in the luteal phase.
  • Premenstrual spotting.

How can you get more progesterone?

There are really only two options:

  • Make more yourself by ovulating regularly, which requires a whole-body approach. As I explain in my book Period Repair Manual, it’s not as simple as taking something to boost progesterone. You need healthy, happy ovarian follicles for all the 100 days leading up to each and every ovulation, and that means correcting underlying issues with inflammation, insulin resistance, and thyroid  (to name just a few). For more information about how to ovulate, please see my book and also my post: Road Map to Progesterone.
  • Take bioidentical or natural progesterone, which is available as either a transdermal cream or a capsule. Cream is best for general symptoms, but capsules are best to relieve perimenopausal sleep problems (because an oral dose delivers more of the beneficial sedating metabolite allopregnanolone). A safe dose is about 20 mg in a cream, or 50 to 100 mg in a capsule. It generally works best taken only during the luteal phase, or in a pulsed fashion if there is no luteal phase. For more information, please see Chapter 10 of my book and speak to your doctor or naturopath.

⚠️ Tip: There is absolutely NO progesterone in any type of hormonal birth control. In fact, one of the biggest problems with hormonal birth control is that it causes profound progesterone deficiency. Read: The Crucial Difference Between Progesterone and Progestins.

What is your experience? Can you suggest any additional superpowers?

(For a more detailed analysis, and many more citations, please also see Dr Jerilynn Prior’s series of articles: Preventive Powers of Ovulation and Progesterone.)

Yours in health,

Lara Briden

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How to Prevent and Treat Post-Pill Acne http://www.larabriden.com/prevent-treat-post-pill-acne/ http://www.larabriden.com/prevent-treat-post-pill-acne/#comments Fri, 07 Oct 2016 20:19:49 +0000 http://www.larabriden.com/?p=4402 Coming off birth control doesn’t have to be a nightmare for skin. True, it was a nightmare last time, which is why you returned to the Pill after an only few months. But this time will be different, because this time, you know about post-Pill acne. You know it will get worse for six months, and then it will get better. And this […]

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Post pill acneComing off birth control doesn’t have to be a nightmare for skin. True, it was a nightmare last time, which is why you returned to the Pill after an only few months. But this time will be different, because this time, you know about post-Pill acne. You know it will get worse for six months, and then it will get better. And this time, you know how to treat it.

What causes post-Pill acne?

Certain types of hormonal birth control suppress sebum (skin oils) to “childhood levels”, which is a bit frightening when you think about it. Adults are supposed to have more sebum than children, so it’s an abnormal situation. Your skin responds by up-regulating sebum, and that up-regulation can persist for months even after you stop the Pill (see the diagram below).

post-pill-acne-mechanism

Post-Pill acne is the result of  1) Rebound sebum production as withdrawal from a sebum-suppressing drug, and 2) Androgens (male hormones) from your ovaries as they kick back into action. (Your ovaries also start to make estrogen and progesterone, which are good for skin.)

The withdrawal process doesn’t last forever, but it does last a few months.  Post-pill acne usually peaks about 3-6 months off the Pill, which is just when you were about to lose hope.

post-pill acne duration

But please don’t lose hope. You’ll get through Post-Pill acne (usually within twelve months), and you can use natural treatments to ease the way.

Natural treatment of post-Pill acne

For best results, start treatment a couple of months before you stop the Pill. That way, your skin will be less reactive, and better able to withdraw from the drugs.

  • Avoid normal A1 cow’s dairy. Dairy causes acne because it spikes a hormone called IGF-1 (see Insight into acne) and because it contains an inflammatory protein called A1 casein. There’s very little A1 casein in butter and heavy cream, so they’re usually okay. There’s no A1 casein in ricotta, goat or sheep dairy, so they’re okay. All other dairy is a problem for skin (yogurt, cheese, ice cream, milky coffees).
  • Quit sugar (concentrated fructose). Sugar causes acne because (like dairy) it spikes IGF-1. Sugar is the concentrated sugar you get from desserts, honey, fruit juice, and dried fruit (whole fruit in moderation is okay). Sugar is a problem for skin for everyone, but it is particularly bad for sufferers of the hormonal condition PCOS (polycystic ovarian syndrome). Do you know if you have PCOS? If not, please talk to your doctor, BUT don’t let her talk you back onto hormonal birth control because the Pill is not good treatment for PCOS. It worsens the insulin resistance that causes PCOS.

⚠️  But wait! How could dairy and sugar be causing your acne? They were never a problem before. Well, before the Pill (and on the Pill), your skin was less reactive and could cope with acne-causing foods. Now your skin is in the throes of Pill-withdrawal, and so cannot cope with dairy and sugar.

  • Take zinc. Zinc reduces keratin production, so it keeps pores open. It also kills bacteria and reduces testosterone. In many ways, zinc is the perfect medicine for post-Pill acne. It’s also one of the key nutrients depleted by hormonal birth control! See 7 Ways Zinc Rescues Hormones.
  • Consider taking DIM (diindolylmethane), which is a phytonutrient from broccoli. It blocks androgens (male hormones) and is one of the most popular natural treatments for acne.
  • Consider taking berberine, which is the active constituent in a number of popular herbal medicines such as goldenseal. Berberine works for skin because it’s antimicrobial, anti-inflammatory, and improves insulin sensitivity (thereby reducing the acne hormone IGF-1). Finally, berberine reduces androgens in women, which makes it a particularly good choice for PCOS. Don’t take berberine if you are pregnant or breastfeeding, and speak to your pharmacist before combining it with prescription medications. I generally recommend berberine not be used for more than eight weeks continuously. If you need it for longer, then take a week off, and then resume.

How long until skin improves?

You might see an initial improvement within a few weeks, but don’t worry if your skin then flares with stress or your next round of PMS. Real, lasting improvement is a longer-term project and should happen within 3-6 months. Continue treatment until your skin is truly better, and then you can stop the supplements and relax the diet somewhat. (Although you’ll probably never want to go back to a high-sugar, high-dairy diet.)

[This is an adapted version of a post I wrote as Menstruation Mechanic for Daysy Blog: Acne and birth control: How to prevent acne after going off the pill. ]

What is your experience with post-Pill acne? Please comment.

Yours in health,

Lara Briden

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Are You Eating Enough to Get a Period? http://www.larabriden.com/are-you-eating-enough-get-period-amenorrhea/ http://www.larabriden.com/are-you-eating-enough-get-period-amenorrhea/#comments Wed, 07 Sep 2016 23:52:41 +0000 http://www.larabriden.com/?p=4295 Lost your period? You might want to rethink your new diet of green smoothies and salads. Perhaps your digestion feels better off carbs. Or maybe you’ve been told that low-carb is the best way to treat your PCOS. Either way, a low-carb diet might be okay in the short-term but can become a real problem […]

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hypothalamic amenorrheaLost your period? You might want to rethink your new diet of green smoothies and salads.

Perhaps your digestion feels better off carbs. Or maybe you’ve been told that low-carb is the best way to treat your PCOS. Either way, a low-carb diet might be okay in the short-term but can become a real problem for periods in the long-term.

As an active woman, you need about 2100 calories per day. Are you reaching that? Your green smoothie gives you 200 calories, and your can of tuna plus half a sweet potato gives you about 250. So far, that’s only 450 calories, which is not even a quarter of what you need, and it’s already afternoon.

⚠️  Tip: Please don’t worry about actually counting calories. Aim for at least three full, solid meals per day—and you’ll be okay. If digestive problems prevent you from eating that much, then seek digestive treatment (see below).

Why low-calorie and low-carb diets stop menstruation

Too few calories trigger a starvation response in your hypothalamus that disrupts luteinizing hormone (LH) pulsatility and shuts down ovulation. Too little carbohydrate (but enough calories) does the same thing. Therefore, as a woman, you need more carbohydrate than a man. You also need plenty of protein and fat and micronutrients, but you cannot rely on them as your sole source of calories.

Signs you don’t eat enough carbohydrate:

  • Under-active thyroid and elevated reverse T3
  • Hair loss
  • Constipation
  • Insomnia
  • Amenorrhea (lack of periods)

Under-eating causes amenorrhea, and this is true even if you have a healthy body weight (BMI). Your hypothalamus cares less about body fat and more about whether you eat enough to keep up with your activity level. This is called energy availability and is the ratio between energy intake, body mass, and energy expenditure (exercise). If you don’t eat enough, your hypothalamus thinks you’re in a famine and makes the executive decision to halt reproduction.

Starvation-induced amenorrhea was a beneficial adaptive strategy throughout all of human history because it prevented us from trying to make babies when there wasn’t enough food.

⚠️  Tip: Under-eating is a common cause of Functional Hypothalamic Amenorrhea (FHA).

⚠️  Tip: Hormonal birth control doesn’t solve the problem of amenorrhea because Pill-bleeds are not periods.

Not every woman is the same. For example, your friend may eat even lower carb than you, and she’s fine. Your friend is different. She may have insulin resistance, and so is benefiting from a short term low-carb diet. Or she may be able to get away with fewer carbs because she has a different “ovarian set point” than you. For more information on ovarian set-point, please see Dr. Grazyna Jasienska’s book Fragile Wisdom

Energy is the key to understanding ovarian function. ~ Dr. Grazyna Jasienska

What if you have PCOS?

Didn’t you read somewhere that carbohydrates are bad for PCOS? True, too many carbohydrates (especially fructose) are bad for insulin resistance, but insulin resistance and PCOS are not the same things.

First things first: How was your PCOS diagnosed? If it was by ultrasound alone, then you may not actually have PCOS. PCOS cannot be diagnosed by ultrasound (read The Surprising Truth About PCOS). It’s diagnosed by a blood test for androgens and insulin.

If you’re avoiding carbs because someone saw polycystic ovaries on ultrasound, you may be on the completely wrong track.

But if, on the other hand,  you do have insulin-resistant PCOS (and not another type of PCOS), then Yes, you may need to reduce carbohydrate. More specifically, you need to quit sugar, which is the worst carb, because concentrated fructose causes insulin resistance and insulin-resistant PCOS. You may also want to reduce starch, but only until you bring your fasting insulin between 30-60 pmol/L (4-9 mIU/L).

What if you can’t digest carbs?

If you cannot digest carbs, it’s probably because you have small intestinal bacterial overgrowth (SIBO), which causes fermentation of FODMAPs in the small bowel.

⚠️  Tip: Rice and potatoes are not FODMAPS, so they are the easiest starches to digest.

Reducing carbs to relieve bloating is okay in the short-term, but it’s not a solution in the long-term. Why? Because you need carbohydrate to have periods, and you need FODMAPS to feed your intestinal bacteria.

The long-term solution is to fix SIBO with a two-month course of antimicrobial herbs and HCl digestive enzymes (taken after a meal). Please consult your local clinician for help, and keep going with treatment until you can eat all gentle-carbs without bloating.

How long will it take to get your period?

Once you’ve increased calories and starch, you should see a period within 3-4 months. If not, then it’s time to do more detective work. See Chapter 7 of my book for a full troubleshooting discussion of amenorrhea. And if you’re looking at the herbal medicine Vitex, please understand that it will not work until you also increase your food intake.

Do you have an eating disorder?

If you’re frightened by the idea of eating more, then you may need to consider if you have an eating disorder. Approach it with self-love and self-forgiveness, and reach out for help. Here are some places to start:

Eating disorder is incredibly common. You’re not alone, and you need not feel ashamed. Ask for help.

Yours in health and love,

Lara Briden

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What Estrogen Does in Your 40s (and How Progesterone Can Help) http://www.larabriden.com/what-estrogen-does-perimenopause-how-progesterone-can-help/ http://www.larabriden.com/what-estrogen-does-perimenopause-how-progesterone-can-help/#comments Thu, 28 Jul 2016 01:45:02 +0000 http://www.larabriden.com/?p=4207 Hot flashes, sleep problems, mood swings, and crazy heavy periods. Is this menopause already? And you’re only 42? No, menopause may still be a decade away. This is perimenopause, which is the 2-10 years of hormonal change that precede menopause. Perimenopause can be a tricky time and often causes more symptoms than menopause itself. Conventional medicine has […]

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Estrogen rollercoaster of perimenopause Hot flashes, sleep problems, mood swings, and crazy heavy periods. Is this menopause already? And you’re only 42? No, menopause may still be a decade away. This is perimenopause, which is the 2-10 years of hormonal change that precede menopause.

Perimenopause can be a tricky time and often causes more symptoms than menopause itself. Conventional medicine has surprisingly little to offer. Your doctor will say you’re too young for hormone replacement, so she will likely prescribe the Pill or an antidepressant, or tell you just to ride it out.

“There has to be a better way!” you say. And fortunately, yes there is. It all starts with understanding what estrogen is really up to.

Estrogen goes on a roller coaster ride

Contrary to current medical belief, your estrogen is probably not on a slow, gradual decline in your 40s. In fact, it would be a lot nicer if it was (see “Low-Estrogen Type of Perimenopause” below). Instead, it’s fluctuating wildly. It’s soaring to levels that are almost twice what you had you were younger—only to crash down again to almost nothing. (And then to do it all over again the very next month.) I call this the estrogen roller coaster of perimenopause, and it’s very unpleasant.

High estrogen causes breast pain, heavy periods, fluid retention, and irritable mood. Crashes to low estrogen cause depression, hot flashes, and night sweats. (Hot flashes are not caused by low estrogen per se, but rather by a rapid rate of decline from high to low.)

Low estrogen type of perimenopause

The estrogen roller coaster is the most common type of perimenopause, but another type is a slow and steady decline in estrogen. With low-estrogen perimenopause, there are no heavy periods or intense PMS. Instead, periods become lighter and lighter and fade away. Low-estrogen perimenopause can cause mild sleep disturbance, but generally, it’s a much easier road. For treatment ideas, see my post The Ups and Downs of Estrogen. Part 1: Estrogen Deficiency.

Progesterone becomes seriously deficient

Your estrogen is crashing up and down, so some progesterone would be nice. Why? Because progesterone counterbalances estrogen. For example, progesterone calms your nervous system, while estrogen stimulates it. Progesterone boosts your thyroid, while estrogen suppresses it. Progesterone thins your uterine lining, while estrogen thickens it. And finally, progesterone prevents breast cancer, while estrogen promotes it.

And just when you need progesterone more than ever, it is quietly exiting the scene. As I say in my book, progesterone is like a beloved friend who never stays as long as you’d like. Progesterone was hard enough to make in your 20s and 30s. As you move into your 40s, you will ovulate less frequently, and therefore make less and less progesterone. See Road Map to Progesterone.

⚠️  Tip: Magnesium is my favorite nutrient for boosting progesterone. It’s also incredibly soothing for flashes, sleep disturbance, and other symptoms of perimenopause.

Natural treatment of perimenopause

Two key strategies:

  1. Prevent estrogen from spiking too high by supporting its healthy detoxification. That means reducing alcohol and maintaining healthy intestinal bacteria. You can also consider supplementing iodine (see my iodine post), and a broccoli extract called diindolylmethane (DIM), which promotes estrogen clearance. For more information and treatment ideas, see The Ups and Downs of Estrogen. Part 2: Estrogen Excess.
  2. Consider taking natural progesterone, which is almost the perfect treatment for perimenopause because it relieves symptoms of both estrogen excess and estrogen deficiency. It also stabilizes the HPA (adrenal) axis and supports thyroid function, which further benefits mood and wellness. Natural progesterone is available as a capsule (Prometrium) or a topical cream, and it’s safe as long as you stay around a dose of 20 mg in a cream, or 50-100 mg in a capsule. Natural progesterone does not promote breast cancer, and according to new research, it may even be effective for treating breast cancer.  For more information about the safe use of progesterone, please speak to your doctor or naturopath.

⚠️  Tip: Natural progesterone is also called bioidentical progesterone or micronized progesterone, which is the term your doctor prefers. Don’t use the word “natural” when speaking with your doctor.

⚠️  Tip: Natural progesterone is very, very different from the progestins of birth control and conventional HRT. See my post The Crucial Difference Between Progesterone and Progestins.

⚠️  Tip: Progesterone lightens periods. For treatment for the heavy, flooding periods of perimenopause, please see my Heavy Period post.

The good news

If you work now to reduce estrogen spikes, then your estrogen receptors can better adapt to the permanent decline in estrogen that’s coming in your 50s. In other words, treat perimenopause now, and you’ll have an easier menopause transition later.

Have a question about perimenopause or natural progesterone? Please comment.

Yours in health,

Lara Briden

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