What is PROGESTERONE?

Progesterone and oestrogen are the 2 main hormones made by ovaries of menstruating women.

It is the hormone made by the corpus luteum prior to ovulation and increasing rapidly after ovulation to become the major female gonadal hormone during the latter 2 weeks of the menstrual cycle.

Progesterone is necessary for the survival of the fertilized ovum, the resulting embryo, and the fetus throughout gestation when the synthesis of progesterone is taken over by the placenta.

The synthesis of progesterone originates in the ovary as a product of cholesterol which is synthesized from acetate.

From progesterone are derived other sex hormones and corticosteroids.

Progesterone is the main precursor of cortisone synthesis by the adrenal cortex.

Natural progesterone contributes to good health in women for a variety of problems.

In ovulating females, progesterone is mainly produced by the ovary, with smaller amounts made in the adrenal cortex in both sexes, and in the testes of males.

Within the cytoplasm of cells, mitochondria convert cholesterol to pregnenolone, which is converted to progesterone or DHEA, depending on cell types and body needs.

With the development of the corpus luteum and ovulation, the ovarian production of progesterone rises from 2-3 mg per day to an average of 22 mg per day, peak production being as high as 30 mg per day, a week or so after ovulation.

After 10 or 12 days, if fertilization does not occur, ovarian production of progesterone falls dramatically. This sudden decline in progesterone levels triggers the shedding of the secretory endometrium (the menses) leading to a renewal of the entire menstrual cycle.

During pregnancy, production of progesterone is taken over by the placenta which secretes an ever-increasing supply, reaching 300-400 mg per day during the third trimester.

Progesterone as it is secreted into the bloodstream, is bound within a water-soluble protein called cortisol binding globulin. only a small portion of progesterone (2-10%) circulates unbound through the plasma.

Progesterone derives from cholesterol, so like cholesterol, it is fat soluble.

Ovaries and testes are formed early in the life of the embryo.

By the 3rd week, more than 500,000 follicles are being formed in the embryo's ovary, and each follicle supposedly contains an ovum (egg)awaiting full development after puberty.

Any of these follicles, upon ovulation, becomes the corpus luteum that produces the progesterone necessary for the survival of the fertilized egg.

Damaged or dysfunctional follicles will not be able to pop an egg or produce sufficient progesterone later in life.

Dysfunctional follicles, which cause progesterone deficiency, lead to ovarian cysts.

These cysts will usually clear up after proper progesterone levels are restored, but the ovary still may not be able to produce a viable egg.

It is also follicle dysfunction which causes many early miscarriages.

Miscarriages caused by luteal phase failure, in which the follicles ovulate normally but fail to continue to produce progesterone at levels necessary for successful implantation of the fertilized egg and development of the embryo, can be prevented by progesterone treatment.

Pamela is 40 years old. She is having difficulty having another baby.

She had her first baby 4 years ago, and had been pregnant several times since then, but each pregnancy resulted in an early miscarriage.

Repeated early miscarriages are often caused by luteal phase failure.

Women like Pamela do not have trouble getting pregnant, their problem is getting the embryo to survive and not miscarry.

Pamela needs to maintain her progesterone levels to support her pregnancy. This can be done with progesterone supplementation.

Normally, when an egg is fertilized, chemical messages are sent to cause the follicle to increase its production of progesterone to 30-40 mg per day, which is double or triple what is made during the monthly cycle when the woman is not pregnant.

The level of progesterone increases gradually until well into the 3rd month of pregnancy.

By that time, the placenta is well developed and is producing progressively more progesterone within the uterus. In the final 3 months of pregnancy, progesterone production reaches 300-350 mg per day, more than 20 times higher than normal.

When prescribing progesterone for luteal phase failure, most physicians choose injectable progesterone or vaginal progesterone suppositories in excessive doses (several hundred mg per day) to produce serum levels of progesterone similar to levels in the early pregnancy.

But serum levels of progesterone are misleading because 90% of bioavailable progesterone is carried by red blood cells and only 10% is bioavailable in the blood serum.

As a result of this misunderstanding, the success rates for this approach are usually less than 30%.

It is more effective to give patients transdermal natural progesterone.

Progesterone creams ca easily supply the proper dose of 30-40 mg per day, or more if needed.

ProgesterAll is a cream formulation that provide 450-500 mg of progesterone per ounce (28.35 g). 1/4 of a teaspoon of cream supplies about 20 mg. This dose can be applied at bedtime and in the morning to provide 40 mg per day.

Avoid creams made with wild yam, herbs or other active ingredients.

As soon as pregnancy is confirmed by a blood test, a woman at risk of miscarriage, should start using a progesterone cream that supplies that dosage. Women who are already using progesterone cream should simply continue if they become pregnant and increase the dose. After the 1st month of pregnancy, the dose can be increased gradually to 60-80 mg per day.

After the 3rd month of pregnancy, progesterone production in the placenta increases so much, that in theory, supplemental progesterone become less important. However, most of women feel more comfortable continuing the cream throughout the pregnancy and stopping one week before their expected delivery date.

At that time the baby triggers its own delivery by excreting cortisol in its urine. This reduces progesterone's uterine effects and allows uterine contractions.

In the mother's body, the steep fall in progesterone that occurs with delivery stimulates the production of the hormone prolactin, which turns on milk production.

Women who suffer from postpartum depression often find relief when they use a little bit of natural progesterone cream.

Progesterone in proper amounts at the proper time is essential to conception and maintaining a healthy pregnancy.

​References

Lee, John R. Natural Progesterone: The Multiple Roles of a Remarkable Hormone. Jon Carpenter Publishing, 2000

ProgesterAll – Important News (johnleemd.com).