Natural Progesterone

40 Questions & Answers – Carol Petersen with Dr. Mercola

I’ve conducted two wonderful interviews with Carol Petersen on bio-identical hormones.

So, when I saw her recent interview with Dr. Mercola, where they did a deep dive into natural progesterone, I thought it was worth amplifying. Hormones, as a subject, interest me because they can help so many people, especially women, and there are so many lies and untruths in the space.

With thanks to Carol Petersen and Dr. Mercola.

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Carol Petersen

• Accomplished Compounding Pharmacist: Carol Petersen has decades of experience in compounding pharmacy, specializing in bio-identical hormone replacement therapy to enhance patient well-being.

• Educational Background: She holds a degree from the University of Wisconsin School of Pharmacy and is a Certified Nutritional Practitioner.

• Leadership and Professional Involvement: She has been actively involved with several professional organizations, including the International College of Integrated Medicine, American College of Apothecaries, and the Alliance for Pharmacy Compounding. She also founded and chaired the Compounding Special Interest Group for the American Pharmacists Association.

• Advocacy for Integrative Medicine: Currently, she serves as the chair of the Integrated Medicine Consortium, promoting holistic approaches to health care.

• Media and Advisory Roles: Carol co-hosts the radio show “Take Charge of your Health” in the New York area and is a Medical Advisory Board member for the Centre for Menstrual Cycle and Ovulation Research.

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Here are short summaries of our two previous interviews.

Hormones - Lies are Unbekoming

• Journey into BHRT: Carol Petersen's path began with the pioneering work of Dr. Katharina Dalton on PMS and bioidentical progesterone, eventually leading to the inclusion of a variety of hormones for individualized treatments in compounding pharmacy.

• Inspiration for Specialization: Initially hesitant, Petersen's early focus on PMS broadened into a comprehensive exploration of endocrine health, sustaining her interest for over 30 years.

• Explanation of BHRT: Bioidentical hormones are identical to those naturally produced by the human body, unlike altered molecules developed by pharmaceutical companies that may not mimic natural hormone activity accurately.

• Misconceptions and Challenges: Major medical organizations often conflate bioidentical hormones with synthetic alternatives, leading to widespread confusion in both medical literature and public perception.

• Evolving Landscape of Hormone Therapy: Compounding pharmacies have enabled personalized BHRT, offering alternatives to traditional hormone therapies like Premarin, and allowing for tailored dosing to restore a better quality of life.

Beyond Surgery - Lies are Unbekoming

• Initial Advice for Women Facing Hysterectomy: Carol Petersen emphasizes the importance of hormone restoration for women recommended for hysterectomy due to conditions like PMDD, PCOS, or heavy bleeding. She stresses that correcting hormonal imbalances before and after surgery can significantly improve quality of life.

• Challenges with Conventional Approaches: Petersen highlights that traditional medicine often leads women to hysterectomy without exploring non-surgical options like progesterone supplementation, which can address heavy bleeding and hormone imbalances, particularly during perimenopause.

• Success in Preventing Surgery: Using bioidentical hormones, Petersen has effectively reversed symptoms leading to hysterectomy, such as heavy bleeding, often by supplementing with progesterone during the follicular phase and balancing with Vitamin A.

• Post-Surgery Hormone Restoration: For women who have undergone hysterectomy or oophorectomy, Petersen recommends restoring a comprehensive range of hormones—including progesterone, testosterone, DHEA, and estrogens—to manage the significant hormonal imbalances caused by the loss of reproductive organs.

• Economic and Cultural Barriers: Petersen points out that financial incentives drive gynecologists to recommend surgeries like hysterectomy, while societal conditioning and a lack of awareness limit the consideration of hormone therapy as a viable alternative. She advocates for more education and support to empower women to explore non-surgical options.

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Carol Petersen and Dr. Mercola

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Analogy

Think of your body's hormone system like a modern home's climate control system. Progesterone is the main thermostat that regulates not just temperature, but humidity, air quality, and ventilation throughout the house. In a healthy home, this master control system keeps every room comfortable by making constant micro-adjustments.

However, modern life has created a situation where we're living with all our windows forced partly open (plastics, environmental toxins, processed foods), causing the system to work harder and harder to maintain balance. Adding more heat (estrogen) isn't the solution when your house is unable to regulate itself properly due to these forced openings. What's needed is a restoration of the master control system (progesterone) to regain proper regulation.

Just as a broken thermostat can make some rooms too hot while others freeze, or create humid conditions that promote mold growth, insufficient progesterone leads to systemic imbalances affecting sleep, anxiety, bone health, and cancer risk. And just as it would be foolish to try to regulate each room's temperature individually without fixing the master control system, it's ineffective to try addressing individual hormone-related symptoms without restoring proper progesterone function first.

The modern "smart" thermostat is designed to continuously monitor and adjust multiple environmental factors simultaneously - exactly like progesterone does in a healthy body. But no thermostat, no matter how advanced, can maintain proper conditions if the house's fundamental ability to regulate itself is compromised by multiple forced openings to the outside environment.

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12-point summary:

1. Natural progesterone is a crucial hormone that almost every adult should consider supplementing with due to widespread exposure to environmental toxins, particularly plastics and PUFAs that create estrogen dominance.

2. Traditional hormone testing through blood, urine, or saliva is largely ineffective because hormones compartmentalize in tissues. Prolactin testing (costing as little as $4) is a better indicator of estrogen dominance.

3. Progesterone has immediate effects on anxiety and sleep, can prevent/treat breast cancer, resolve fibrocystic breast disease, and is crucial for bone health. One-third of bone is composed of collagen, requiring specific amino acids for proper formation.

4. The optimal calcium/phosphorus ratio should be 1.1-1.3 for bone health. Excess phosphorus, common in modern diets and sodas, is a powerful aging molecule.

5. 99.9% of people may be insulin resistant. The brain requires about 150 grams of glucose daily and cannot survive on ketones alone, making very low-carb diets potentially problematic for hormone balance.

6. Synthetic progestins (commonly prescribed) work oppositely to natural progesterone and should never be used. Natural progesterone from wild yams is chemically identical to what our bodies produce.

7. Almost all hysterectomies are considered unnecessary and result from a history of low progesterone. Post-hysterectomy treatment typically ignores the need for progesterone, leading to other health issues.

8. Transmucosal delivery (vaginal, oral, rectal) is the most effective route for progesterone administration, requiring doses between 25-100mg, while creams may need up to 2,000mg in severe cases.

9. The gut microbiome significantly impacts hormone balance, with some organisms producing estrogen while others block it. Candida and heavy metals can also disrupt hormone balance.

10. Vitamin E is the ideal delivery vehicle for progesterone as it both dissolves the hormone effectively and provides additional benefits through its antioxidant effects.

11. Progesterone dosing should be based on symptom relief rather than blood tests, and doses might be needed every 15 minutes until symptoms resolve in acute situations.

12. Most people consume less than 3-5 grams of collagen daily, which is insufficient for optimal bone health. Proper protein digestion and absorption become increasingly important with age.

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40 Questions & Answers

Question 1: What is natural progesterone and why is it considered one of the most important hormones in the body?

Natural progesterone is a bioidentical hormone that impacts health in numerous ways, including bone density, estrogen balance, and neurological function. It's essential because it helps address estrogen dominance, which affects almost everyone due to environmental exposures. The hormone is so crucial that it's suggested almost every adult should seriously consider supplementation, particularly because we live in a 21st century environment loaded with toxic substances that are almost impossible to avoid.

Question 2: How does the presence of plastics and microplastics affect hormone balance in the body?

Plastics and microplastics harm the body primarily by activating estrogen receptors - they are estrogen mimetics. These substances are found in almost every tissue of the body and cause estrogen dominance by mimicking estrogen's effects. Their mechanism of action is similar to that of linoleic acid (PUFA), causing comparable problems but without the oxidative metabolism seen with PUFAs.

Question 3: What is estrogen dominance and how does it affect both men and women?

Estrogen dominance occurs when there's too much estrogen effect relative to progesterone in the body. This affects both men and women, not because men necessarily have extra estrogen, but because they experience estrogen receptor activation from enormous exposure to plastics and microplastics. The condition can lead to anxiety, sleep problems, headaches, and increased cancer risk.

Question 4: Why is blood or serum testing for estrogen levels considered ineffective?

Blood or serum testing for estrogen is considered ineffective because estrogen hormones compartmentalize in tissues rather than circulating in the blood. Testing blood, serum, or urine provides misinformation that's worse than not testing at all, as it doesn't reflect what's actually happening in the body's tissues where the hormone primarily resides.

Question 5: What makes prolactin testing a superior indicator of estrogen dominance?

Prolactin testing is superior because, unless there is a pituitary tumor, prolactin increases when estrogen effects are high. It serves as a functional test rather than a momentary snapshot, and elevated levels can be reduced by progesterone. This test is also much more affordable, potentially costing as little as $4, compared to conventional hormone testing.

Question 6: How does progesterone influence anxiety and sleep patterns?

Progesterone helps with sleep in two ways: by calming adrenaline, which allows you to relax and sleep (rather than forcing sleep), and through its metabolite pregnenolone, which can help induce sleep. It can quickly flip the anxiety switch off, providing almost immediate relief from anxiety symptoms, making it particularly effective when taken before bedtime.

Question 7: What is the connection between progesterone deficiency and breast cancer risk?

Progesterone deficiency is strongly linked to breast cancer risk, particularly in conjunction with estrogen dominance. Breast cancer is the number one cancer killer of women, and progesterone imbalance/estrogen dominance is considered a major factor in most cases. Painful or tender breasts are often an indicator of this imbalance and should be addressed promptly.

Question 8: How does fibrocystic breast disease relate to hormone imbalance?

Fibrocystic breast disease is often a clear indicator of severe hormone imbalance, particularly relating to the estrogen-progesterone ratio. The condition can be effectively treated with progesterone supplementation, and when combined with iodine, can lead to the resolution of breast lumps. This serves as a red flag for knowing when someone is severely out of balance with their estrogen-progesterone ratio.

Question 9: What are the key differences between natural progesterone and synthetic progestins?

Natural progesterone is bioidentical to what the body produces and works as intended, while synthetic progestins are fraudulent versions that work oppositely to natural progesterone. Progestins are closer to estrogen in their effects than to progesterone and should never be used. Natural progesterone can be derived from wild yams and is chemically identical to what our bodies produce.

Question 10: Why is vitamin E considered an ideal delivery vehicle for progesterone?

Vitamin E is considered ideal for progesterone delivery because it not only dissolves the progesterone effectively but also provides additional benefits through its antioxidant effects. It helps balance excess estrogen activity and works against the negative effects of PUFAs. This delivery method was developed by Dr. Ray Peat and is considered one of the most effective ways to administer progesterone.

11: What are the different routes of progesterone administration and their relative effectiveness?

The most effective route is transmucosal administration - either vaginal, oral (gum/under tongue), or rectal. Creams and gels work but may require higher doses. Transmucosal administration is considered superior because it ensures better absorption, while with creams, progesterone must first dissolve in skin oils before being absorbed. The dosage form significantly impacts the amount needed for effectiveness.

Question 12: How do dosing requirements for progesterone vary between individuals and conditions?

Dosing is highly individualized and should be based on symptom relief. With transmucosal delivery, doses might range from 25 to 100 milligrams, while creams might require up to 2,000 milligrams in severe cases. The severity of symptoms, length of progesterone deficiency, and individual absorption rates all affect dosing needs. Some people may need higher doses initially until their body is restored.

Question 13: What role does progesterone play in bone health and osteoporosis prevention?

Progesterone is crucial for bone health, working alongside proper protein intake, particularly collagen. The conventional approach of using bisphosphonate drugs actually kills osteoclasts, leading to weaker bones despite appearing denser. Progesterone helps build proper bone density when combined with appropriate calcium/phosphorus ratios and protein intake.

Question 14: How does the calcium/phosphorus ratio impact bone density and overall health?

The optimal calcium/phosphorus ratio should be between 1.1 to 1.3. Excess phosphorus is a powerful aging molecule, and many diets, particularly carnivore diets, can lead to problematic phosphorus levels. This ratio is crucial for proper bone formation and overall health, and it's one reason why soda consumption can be particularly harmful due to its high phosphorus content.

Question 15: Why is collagen crucial for bone health and what percentage of bone is composed of it?

One-third of bone is composed of collagen, and most people are unaware of this crucial fact. Without adequate collagen intake (specifically the amino acids proline, hydroxyproline, and glycine), proper bone formation is impossible. Most people consume less than 3-5 grams of collagen daily, which is insufficient for optimal bone health.

Question 16: How does the gut microbiome influence hormone balance?

The gut microbiome can significantly impact hormone balance in multiple ways. Some organisms can produce 17 beta estradiol, while others can block estrogen. A bad microbiome can cause recycling of estrogens, leading to massively high serum levels. Poor gut health can also affect hormone detoxification and metabolism.

Question 17: What is the relationship between Candida and hormone disruption?

Candida can be a significant issue in hormone disruption, particularly in relation to gut health. It can affect how hormones are processed and metabolized in the body, contributing to hormone imbalances. The presence of Candida can impact the body's ability to maintain proper hormone balance.

Question 18: How do heavy metals impact hormone function?

Heavy metals, particularly from mercury amalgams, can act as metallic estrogens. Some heavy metals can sit in progesterone receptors while others intensify estrogen effects. This creates another layer of hormone disruption beyond just direct hormone imbalances.

Question 19: What is the connection between thyroid function and hormone balance?

High estrogen can suppress thyroid functioning, creating a cascade of hormonal issues. However, it's recommended to address progesterone levels first before treating thyroid issues, as many thyroid symptoms may improve once progesterone balance is restored.

Question 20: How does cortisol impact hormone balance and what role does progesterone play?

Cortisol, particularly when elevated due to stress or low-carb diets, can cause the liver to produce glucose from proteins, leading to energy inefficiency and hormone disruption. Progesterone acts as an anti-cortisol blocker and can help moderate these effects, making it crucial for maintaining proper hormone balance.

21: What is the relationship between insulin, glucose, and hormone balance?

Insulin and glucose are described as the most primitive and powerful hormones. When insulin resistance occurs or blood glucose swings happen, it triggers large adrenaline surges. Progesterone can help moderate these glucose swings, particularly when taken at mealtimes. This is especially important for insulin resistant individuals, which may be as many as 99.9% of people.

Question 22: How do low-carb and carnivore diets impact hormone function?

Low-carb and carnivore diets can force the body to produce cortisol and adrenaline to create glucose from proteins, which is energy inefficient and stressful on the body. Even without carb intake, blood sugar may remain elevated due to this stress response. The brain requires glucose and cannot survive on ketones and lactate alone, needing about 150 grams of glucose daily.

Question 23: What are the dangers of polyunsaturated fats (PUFAs) in relation to hormone health?

PUFAs act similarly to excess estrogen, causing comparable problems by increasing intracellular calcium levels and water retention. They can destroy mitochondrial function and, like plastics, activate estrogen receptors. It's nearly impossible to be PUFA deficient as almost every food contains the minimum required amount (0.5-1 gram daily).

Question 24: How does serotonin impact hormone balance and health?

Elevated serotonin can contribute to cystic issues and is somewhat similar to estrogen. Taking supplements like 5-HTP for sleep when experiencing high estrogen can compound problems by creating high serotonin levels. This can worsen existing hormone imbalances and related symptoms.

Question 25: What is the connection between histamine, mast cells, and progesterone?

Mast cells have their own hormone factory, and when estrogen dominance occurs, histamine is released. However, when adequate progesterone is present inside the mast cells, histamine release is prevented, helping to control histamine-related symptoms.

Question 26: How does liver function impact hormone balance and detoxification?

The liver is crucial for hormone detoxification, particularly in processing estrogens. Poor liver detoxification, often due to lacking sulfur groups or methyl groups, can lead to hormone imbalances. However, bioidentical hormones are less stressful on the liver compared to synthetic ones since they don't introduce foreign chemicals.

Question 27: What is the first pass liver effect and why is it important?

The first pass liver effect occurs when hormones are taken orally and go through initial liver processing. While some view this as problematic, it's actually a natural process as all blood circulates through the liver every 90 seconds. With bioidentical hormones, this process is less concerning than with synthetic hormones.

Question 28: What are the implications of hormone compartmentalization in the body?

Hormone compartmentalization means hormones concentrate in tissues rather than circulating freely in the blood. This is why blood testing can be misleading - hormones may be present in tissues even when blood levels appear low. Understanding this is crucial for proper hormone assessment and treatment.

Question 29: How does methylation affect hormone balance and health?

Methylation is an important detox step performed by the liver. Poor methylation can affect how well the body processes hormones, particularly in detoxifying estrogen. Without proper methylation, individuals may have difficulty clearing adrenaline, leading to persistent anxiety.

Question 30: What are the specific concerns regarding hysterectomies and hormone balance?

Hysterectomies are considered almost 100% unnecessary if proper hormone interventions are made earlier. Post-hysterectomy treatment typically focuses only on estrogen replacement, ignoring the many other hormonal functions of the ovaries. This singular focus can lead to increased prolactin, which in turn stimulates parathyroid hormone and can contribute to osteoporosis.

31: How does progesterone influence PMS and PMDD symptoms?

Interestingly, women with severe PMS often show normal progesterone levels in blood tests, yet respond well to progesterone supplementation. This suggests their symptoms may be due to an overwhelming estrogen burden requiring higher progesterone doses for relief. PMDD treatment has been mistakenly focused on SSRI medications while avoiding progesterone, leading to unnecessary suffering.

Question 32: What is the relationship between protein intake and hormone health?

Adequate protein intake is crucial for hormone health, particularly as we age. Decreased digestive strength can limit protein breakdown and absorption, leading to structural decline. This affects not only muscles but also bones and overall metabolism. Many people restrict protein due to digestive issues, which can worsen their overall health status.

Question 33: How do emergency rooms typically mismanage hormone-related issues?

Emergency rooms often mishandle hormone-related symptoms, particularly in women experiencing heart palpitations and anxiety. Instead of recognizing these as hormone imbalance symptoms, they typically perform extensive cardiac workups. Progesterone administration in the ER could quickly resolve many of these cases.

Question 34: What are the common problems with conventional hormone testing methods?

Conventional hormone testing often provides misleading information because it measures hormones in blood, urine, or saliva rather than tissue levels where hormones actually reside. For example, estradiol levels can appear low in blood tests even after supplementation because the hormone has already moved into tissues.

Question 35: How does age affect hormone needs and balance?

Aging affects hormone needs particularly through decreased protein digestion and absorption, which impacts hormone production and function. Perimenopausal women experience their highest lifetime estrogen levels, yet are often prescribed additional estrogen when progesterone is actually the first hormone to decline.

Question 36: What role does progesterone play in menstrual bleeding patterns?

Contrary to common belief, progesterone dropping isn't what triggers menstrual bleeding. Progesterone has a biphasic activity - first enhancing endometrial building, then switching to a secretory form that assists in tissue breakdown. Women can maintain regular cycles while taking progesterone throughout their period.

Question 37: How does pregnenolone production impact overall hormone balance?

Pregnenolone is produced independently in Schwann cells along with progesterone and helps maintain myelin sheath health. The brain also produces progesterone independently. This local hormone production is particularly important for neurological health and function.

Question 38: What are the key differences between transmucosal and transdermal hormone delivery?

Transmucosal delivery (vaginal, oral, or rectal) is considered most efficient for progesterone absorption. Transdermal creams can work but often require higher doses because the progesterone must first dissolve in skin oils. Transmucosal delivery typically requires lower doses for effectiveness.

Question 39: How do birth control medications impact hormone balance?

Birth control medications, particularly those containing synthetic progestins, can create significant hormone imbalances. Early forms of synthetic progesterone used in birth control were found to cause birth defects. These synthetic hormones work oppositely to natural progesterone and can cause long-term hormonal disruption.

Question 40: What are the recommended protocols for initiating progesterone supplementation?

Initial progesterone supplementation should be based on symptom relief rather than blood tests. For anxiety relief, doses might be needed every 15 minutes until calmness is achieved. Starting doses can range from 25-100mg for transmucosal delivery, while creams may require higher amounts. Timing can include both daytime use for symptom management and evening use for sleep support.

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