Menopause Relief in a Tube?

Last summer, millions of women were left in a hormone lurch when news broke about the perils of long-term hormone replacement therapy (HRT). Afterward, Christiane Northrup, alternative medicine and women’s health guru, sang the praises of natural pro-gesterone cream on The Oprah Winfrey Show. The makers of these creams are still giddy. Between the kudos on Oprah and the HRT-induced panic, retail sales for one of the largest producers of natural progesterone cream soared 41 percent.

If you’re among those who tuned in and shelled out, you may wonder whether your money was well spent. That depends. To find out if you’re a good candidate for natural progesterone cream—and what to do if you’re not—read on.

First, it helps to know a bit about progesterone’s role in the body. A hormone produced predominantly by the ovaries, progesterone teams up with estrogen to prepare the uterus for pregnancy. Once a month, if no fertilized egg materializes, progesterone’s job is to trigger menstruation.

Around age 40, hormone levels begin to fluctuate as the ovaries head into retirement. During these years, known as perimenopause, estrogen levels wax and wane as the body recruits the hormone from other sites, such as muscle and fat tissue. But progesterone levels are directly linked to ovulation—no egg, no progesterone —so as ovulation grinds to a halt, pro-gesterone production does, too.

Eventually, menopause robs women of up to 75 percent of their estrogen and nearly 100 percent of their progesterone—and that’s when the signature symptoms of “the change” really kick in: hot flashes, night sweats, insomnia, anxiety, and mental fuzziness. Some women are tormented by these problems for years, while others barely notice the biochemical shift. It’s like the difference between a hormonal head-on collision and a speed bump.

No one knows exactly which hormone (or lack thereof) is responsible for which symptoms. But most Western experts think estrogen is the main player. HRT combines estrogen and progestin (a synthetic form of progesterone), but the progestin is there primarily to blunt the risk of endometrial cancer that HRT can bring. Not only does estrogen smooth the hormonal transition, but it’s also been thought to protect women from heart disease and osteoporosis. Unfortunately, the study publicized last July put the kibosh on that notion—for some women, it found, HRT actually upped heart attack risk—and also showed that HRT can raise the risk of breast cancer and blood clots.

That’s where progesterone creams come in. They’re made from Mexican wild yams, and alternative practitioners have been using them for years; they claim progesterone can do just as good a job as estrogen of curbing menopausal symptoms without raising risk for any serious disease. Retired family physician John Lee has been the most outspoken advocate for the creams, and in his book What Your Doctor May Not Tell You About Menopause, he even suggests they can protect against breast cancer and osteoporosis. That notion has since been debunked, but many women swear by the creams for symptom relief.

There’s at least one compelling study to back them up. One of the few sizable, double-blind clinical trials on natural progesterone cream was conducted in 1999. Of 102 menopausal women, half were given natural progesterone cream while the other half got a sham salve. After one year, 83 percent of those rubbing on the real deal saw their hot flashes decrease in frequency and intensity or vanish altogether; only 19 percent of those using the ersatz cream noted an improvement.

“This study proved that the best thing progesterone cream does is help with hot flashes,” says Susan Doughty, a spokesperson for the American Menopause Foundation and an ob-gyn nurse practitioner in Portland, Maine. Lately, Doughty has been prescribing progesterone cream to patients weaning themselves off HRT.

Synthetic versions of progesterone are available (in pill form), but alternative experts prefer the natural ones, at least for women whose symptoms are relatively mild. That’s because the molecular structure of natural progesterone is an exact replica of the ovaries’ own progesterone, so the body is able to recognize it and put it into action immediately. For that reason, it’s apt to cause fewer side effects than synthetic versions, which can lead to breast pain, bloating, headaches, and depression—some of the very symptoms women are looking to assuage.

Keep in mind, however, that as with many so-called natural products, the creams aren’t 100 percent natural. It’s true, the active ingredient originates from Mexican wild yams. But most creams don’t contain straight-up yam. Instead, the tuberous veggie is shipped to a laboratory, where a compound called diosgenin is extracted and pro- cessed into the ingredient that’s structurally identical to a woman’s own progesterone. (Some creams do contain only the natural yam, but they also have no actual progesterone, since the key ingredient wasn’t extracted.)

And natural creams may not work for everyone. For the 20 percent of women whose symptoms are extreme (the head-on collisions), over-the-counter creams probably won’t do the job. But there are stronger versions that may. Prescription-strength natural pro-gesterone is available in a high-dose topical cream (it’s mixed in the pharmacy according to a doctor’s instruction, so it doesn’t have a brand name), an intra-vaginal gel (Crinone), or even a new pill called Prometrium. The downside of the pill is that you have to swallow ten times the amount of progesterone you’d otherwise apply with a cream. And as dosages increase, so do risks of side effects.

There’s also one more option. While long-term HRT can be a health hazard, there’s no reason to throw out the baby with the bathwater. “For short-term treatment of hot flashes, mood swings, skin thinning, and even hair loss, we haven’t found a substitute for it,” says Geoffrey Redmond, an endocrinologist and director of the Hormone Center of New York, in Manhattan. “And breast cancer risk doesn’t rise until four or more years of use.”

Still, if hot flashes are your main concern, progesterone cream may well be your best bet. It might even make your skin feel good, too.

User’s Guide to Natural Progesterone
What it is: a topical ointment whose strongest selling point is its ability to quash hot flashes. The cream’s active ingredient, diosgenin, is most often derived from Mexican wild yams.

Dosage: Massage a quarter teaspoon (20 milligrams) of cream into the palms, inner thighs, or abdomen twice a day. If you no longer menstruate, lay off the cream one week a month to simulate progesterone’s natural ebb and flow. Otherwise, stop using the cream during your cycle. For prescription creams or tablets, follow your doctor’s instructions.

Risks: There are no known long-term risks. However, excess progesterone may cause depression, bloating, and mood swings. If your menopausal symptoms intensify or new ones pop up, have your physician test your progesterone level to make sure you haven’t overdone it.