The Importance of Progesterone: All About Balance

Progesterone is well-known for its role in regular menstrual periods and healthy pregnancies.

Progesterone itself is a remarkable hormone which acts on your brain, breast, bone, ovaries, and uterine tissue. It’s not a coincidence that estrogen acts on these same tissues. Progesterone is the brake to estrogen’s gas pedal, and the balance of these hormones is critical for optimum function and wellness.

But did you know that progesterone helps with sleep, mood, irregular or heavy periods, and can help prevent endometrial cancer? In addition, it helps to build bone and has positive cardiovascular effects. Here are a few ways studies have shown that progesterone can promote health and wellness:

  • Prevents Endometrial Cancer and Lightens Menstrual Flow: Progesterone has been key in opposing estrogen to prevent endometrial hyperplasia (overgrowth) and prevent endometrial cancer. Progesterone can lighten menstrual periods by balancing estrogen’s stimulating actions on the uterine lining. It is given to women with PCOS (polycystic ovarian syndrome) who have irregular and skipped periods to shed the thickened lining of the uterus. Progesterone-containing IUDs have become a popular solution to managing heavy periods in perimenopausal women along with cyclical or continuous oral progesterone supplementation.

 

  • Promotes Restful Sleep: Progesterone has a calming effect on our brain. Progesterone is rapidly converted in the brain into allopregnanolone which acts through the GABAA receptors to calm anxiety and promote sleep (Friess et al., 1997). A good example of this is progesterone’s overall mellowing of mood as we see in the third trimester of pregnancy. Sleep disruption is found in 31% of early perimenopausal women and increases to 38% by late perimenopause (Dennerstein et al., 2000). Randomized double blind crossover trials in men (Friess et al., 1997) and menopausal women (Schussler et al., 2008) clearly document significant increases in early rapid eye movement sleep, decreased sleep interruption, and no changes in morning neurocognitive function (Schussler et al., 2008).

 

  • Has Protective Effects on Bone: Progesterone promotes bone forming activity by binding to osteoblasts (cells that secrete the matrix for bone formation). Estrogen and progesterone balance bone remodeling so that estrogen reduces bone resorption while progesterone stimulates bone formation (Prior, 1990; Seifert-Klauss and Prior, 2010).

 

  • Reduces Breast Tenderness: Breast tenderness (or mastalgia) is a concern for 33% of early perimenopausal women (Dennerstein et al., 2000). Clinical evidence shows breast tenderness occurs when estrogen (E2) levels exceed the normal midcycle peak. Progesterone is a well-known and effective therapy for breast tenderness occurring, as it commonly does, premenstrually (Hale et al., 2003). Progesterone can also help significant symptomatic improvement of breast tenderness in perimenopausal women (Dennerstein et al., 1985).

 

  • Can Treat Hot Flushes and Night Sweats: In those women who cannot take estrogen, oral micronized progesterone has recently been shown to be an effective therapy for postmenopausal hot flushes and night sweats (Hitchcock, 2012).

 

  • Energy Booster: Progesterone is known to increase the thyroid hormone, T4, which increases your body temperature at a calorie requirement of 300 kcal/d (Barr et al., 1995). This is why your temperature increases after ovulation, from increased production of progesterone. Rationale follows that progesterone supplementation may help with weight stabilization in the perimenopausal period along with a minimum of 30 minutes of vigorous activity and a proper nutritious diet (which is always recommended).

 

  • Has Anti-Androgen Effects: Progesterone is a natural blocker of 5 alpha reductase and reduces androgens (male hormones). It protects the hair follicle from the effects of testosterone. It is the reason for more hair growth in women during pregnancy. In addition to hair benefits, it can also combat acne. We see this when certain progesterone/progestin-containing birth control pills are recommended for acne patients.

 

  • Has a Positive Effect on the Cardiovascular System: Estrogen is known for stimulating the production of HDL cholesterol which is the good cholesterol in our body. Natural progesterone, not progestins, have been found to support and not negate the positive effects of estrogen on HDL.

 

Studies have shown progesterone has cardiovascular safety in terms of endothelial function, weight, blood pressure, waist circumference, inflammation, coagulation, and cholesterol or lipid profile (Prior, 2014).

In conclusion, I hope you will agree that progesterone itself is a remarkable hormone. It is important to remember that a healthy balance of all hormones and nutrients, as well as a healthy lifestyle, contribute to achieving the best outcome.

 

Julie Thomson, MD, MSc, CCFP

Papillon Medical Dermatology Laser Centre

 

 

References:

Hitchcock CL, Prior JC (2012) Oral Micronized Progesterone for Vasomotor Symptoms in Healthy Postmenopausal Women – a placebo-controlled randomized trial. Menopause 19: 886-893.

Clin Endocrinol (Oxf). 2013 Aug;79(2):282-7. doi: 10.1111/cen.12128. Epub 2013 May 6. Progesterone therapy increases free thyroxine levels–data from a randomized placebo-controlled 12-week hot flush trial.

Prog Neurobiol. 2014 Feb;113:6-39. doi: 10.1016/j.pneurobio.2013.09.004. Epub 2013 Oct 27.Revisiting the roles of progesterone and allopregnanolone in the nervous system: resurgence of the progesterone receptors.

Jerilynn C. Prior​, 1 , 2 , 3 , * ​Thomas G. Elliott​, 1 , 2 ​Eric Norman​, 1 ​Vesna Stajic​, 1 and ​Christine L. Hitchcock​ Progesterone Therapy, Endothelial Function and Cardiovascular Risk Factors: A 3-Month Randomized, Placebo-Controlled Trial in Healthy Early Postmenopausal Women 1​PLoS One​. 2014; 9(1): e84698.

J.C. Prior​, Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology, and potential for perimenopause​Facts Views Vis Obgyn​. 2011; 3(2): 109–120.

The Importance of Estrogen

Today I would like to highlight some of the health benefits of estrogen – a key hormone for vitality and longevity in both men and women!  The majority of studies focus on estradiol (E2), though we know that estrogen exists in many different forms.  For that reason, we want to make sure that estrogen metabolism is healthy and that our metabolites promote wellness, not disease.  It is important to remember that a healthy balance of all hormones and nutrients, as well as a healthy lifestyle, contribute to achieving the best outcome with any treatment.

Here are a few ways studies have shown that estrogen can promote health and wellness:

  1. Cardiovascular Protection

Estrogen has been shown to promote the growth of new blood vessels and support the natural dilation of existing vessels.  It encourages energy production by supporting mitochondrial function (the small energy producers – or “powerhouses” – that are present inside each cell) and, in doing so, contributes to the health and survival of each individual cell!  Estrogen also limits cell damage by inhibiting fibrosis following cell injury.  If that weren’t amazing enough, it has significant antioxidant properties and contributes to healthier cholesterol levels.

  1. Cognitive Function

Estrogen has neuro-protective properties, which means that it helps to protect your brain cells.  This promotes better memory, cognition, and learning as we age!  It also plays an important role in energy regulation on a cellular level, which helps keep our brain cells – among others – in healthy working order.  Evidence suggests that it may also contribute to cellular repair.

  1. Feminine Health

Estrogen keeps the female intimate tissues healthy. When Estrogen levels are optimal, women are less likely to develop bleeding or pain with intercourse – a common issue in aging women, resulting from estrogen deficiency and thinning tissue.  It also promotes the natural lubrication of vaginal tissue and contributes to a healthy libido at any age!

  1. Bone Health

Estrogen is a key regulator of bone metabolism in both men and women.  It supports the activity of our osteoblasts – cells responsible for producing and maintaining strong and healthy bones.  When estrogen levels drop during menopause, our osteoblasts lose their bone-producing efficacy, which may contribute to the development of osteopenia or osteoporosis (bone loss/weakening).

  1. Gastrointestinal Health

Hormone therapy (specifically estrogen) has been associated with a reduced risk for developing colon cancer. Additionally, estrogen interacts with the microbiome (the living organisms in your gut) which plays a major role in an individual’s overall health and well-being.

By Stella Jansen van Rensburg, MD, MBChB, ABAARM, PgDPD

Papillon Medical Dermatology and Laser Centre

References:

Iorga, A., Cunningham, C.M., Moazeni, S. et al. The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy. Biol Sex Differ 8, 33 (2017). https://doi.org/10.1186/s13293-017-0152-8

Zárate, S., Stevnsner, T., & Gredilla, R. (2017). Role of Estrogen and Other Sex Hormones in Brain Aging. Neuroprotection and DNA Repair. Frontiers in aging neuroscience, 9, 430. https://doi.org/10.3389/fnagi.2017.00430

Krause, M., Wheeler, T. L., 2nd, Snyder, T. E., & Richter, H. E. (2009). Local Effects of Vaginally Administered Estrogen Therapy: A Review. Journal of pelvic medicine & surgery, 15(3), 105–114. https://doi.org/10.1097/SPV.0b013e3181ab4804

Cauley, J. (2015). Estrogen and bone health in men and women. Steroids, 99, 11-15. doi: 10.1016/j.steroids.2014.12.010

Barzi, A., Lenz, A. M., Labonte, M. J., & Lenz, H. J. (2013). Molecular pathways: Estrogen pathway in colorectal cancer. Clinical cancer research : an official journal of the American Association for Cancer Research, 19(21), 5842–5848. https://doi.org/10.1158/1078-0432.CCR-13-0325