Progesterone Dosage Recommendations

Replacing progesterone can help many conditions, but it's main benefit is to block estrogen, insulin and adrenaline.

Many benefits include:

Progesterone is a natural antidepressant, since it affects the receptor sites for many neurotransmitters in the brain.

It helps to control insulin, a hormone that creates fat, causes hypoglycemia, raises blood pressure, and causes diabetes.

Progesterone also eliminates symptoms of estrogen dominance such as cramps, PMS, breast tenderness, migraine headaches, and hot flashes, and it helps to prevent every cancer caused by estrogen, most notably breast and prostate cancers.

It helps to block excess adrenaline, which can cause the following symptoms; anger, road rage, restless leg syndrome, teeth grinding (Bruxism), depression, anxiety, fibromyalgia, irritable bowel syndrome (IBS), brain fog, PTSD, autism, bed-wetting, leg cramps, TMJ, headaches, ADHD, interstitial cystitis, PMDD, occipital neuritis, plus many others.

Increases libido.
Enhance weight loss.
Prevents and treats osteoporosis.

I suspect there is a world-wide epidemic of low progesterone levels in both men and women. People can inherit a genetic predisposition for low progesterone from either parent, or both.

Amount, Application Site, and Timing for Progesterone Cream

There is a lot of controversy over the proper amount of progesterone to use, where to place it, and the timing of dosing. I usually recommend the following to begin with in most situations where progesterone is prescribed:

Progesterone cream: 1 pump is 1/4 tsp & equal to 50 mg (for external use only)

Apply 1/4 tsp to the inner forearm and rub both forearms together. Use three times per day, one to three minutes before breakfast, lunch, and dinner.

Please note:  Dosing progesterone before meals is optional. It can help to control adrenaline by controlling insulin and preventing low blood sugars which will stimulate adrenaline release.

Another advantage to replacing progesterone is that it is difficult to overdose with this hormone. Consider the following: Around day 20 of a woman’s monthly cycle, the progesterone level in the blood peaks at about 26 to 28 ng/dL. When she is pregnant, the placenta starts pouring out progesterone in the second and third trimesters, and the level goes up to about 450 ng/dL.

When a person uses 300 to 400 mg per day of transdermal progesterone, the blood level will measure about 8 ng/dL.

Recommendations for the dosing of progesterone are wide-ranging, perhaps because of the body’s capacity to tolerate fluctuations in progesterone levels.

Progesterone is a classic example of a hormone that should be adjusted by symptoms rather than blood tests. Prescribing progesterone in the form of a bio-identical cream means the dose can easily be titrated.

For example, if one of the goals is to eliminate hypoglycemia, once a patient no longer gets sleepy after eating, or between three and four in the afternoon, he or she is at least getting enough progesterone. The same can be said if premenstrual women no longer have cramps or PMS, and if postmenopausal women no longer have hot flashes. Once end-points like these are achieved, the patient can start titrating the dose to lower amounts.

Timing is crucial for a patient to derive the benefits of progesterone for hypoglycemia. This is because supplemental progesterone stays in the bloodstream for only five to six minutes. There are hundreds of progesterone receptor sites throughout the body, and once progesterone attaches to a site it is no longer available to affect insulin levels.

For this reason, I recommend applying progesterone cream one to three minutes before main meals. The dose before lunch is especially important for managing hypoglycemia, since the body seems to put out the most insulin in the afternoon, causing sleepiness between three and four pm.

Cycling Progesterone:

One of the controversies about progesterone supplementation for women concerns whether or not to cycle it, imitating how the body produces progesterone during the reproductive years. In my view, cycling progesterone makes sense only if the woman is trying to get pregnant—certainly not a consideration in postmenopausal women.

Cycling progesterone limits the dosage to 14 days per month. This means the body is not experiencing the benefits of progesterone the other 16 or 17 days. Given the pivotal role that progesterone can play in managing various health conditions, the more rational approach is to have the patient use it daily.

Younger women who are trying to get pregnant should cycle progesterone, not using it from day 1 to day 10 of their cycle.

If you prefer to Cycle, you can follow the guidelines below:

Menstruating women:

Menstruating women are advised to use topical progesterone 5 to 7 days after the first day of your period and continue until the next period begins. Day 1 is the first day of your menstrual bleed. If your period is irregular, start using topical progesterone 7 days after you begin a period and teach your body to learn a new cycle. Stop whenever your period comes back again, and repeat, or apply as recommended by your healthcare provider.

Women with no ovulation like in the case of PCOS can pick a day and start 7 days after the first day of the period and continue until the period starts again.

I see no rationale for cycling progesterone in men.

Generally, the application site does not need to be rotated. However, there may be some benefit to changing sites periodically to allow them to become desensitized.

Since the point is to get progesterone into the bloodstream, the cream should be applied where the skin is thin and there is a good blood supply. The inner forearm, the upper chest, the back of the neck, and the cheeks are all good candidates—the last three are areas where blushing can occur, indicating good blood supply.

Over-the-counter progesterone creams often recommend applying the cream over fatty areas—the abdomen or the breasts, for example. However, when applied in these areas the progesterone gets absorbed into fatty tissue and can cause weight gain.

For men, as for women, the inner forearm is the site I usually recommend for application. However, since progesterone inhibits both aromatase (thereby lowering estradiol) and 5-alpha reductase (it lowers dihydrotestosterone, DHT), a scrotal application may be a good idea for men, especially if the patient has an elevated PSA.

For practitioners who prescribe progesterone cream, I recommend having some available in the office. This makes it convenient to demonstrate to patients how to use it. Because the cream is absorbed so quickly, they can experience rapid relief of symptoms.

For example, a woman with a menstrual migraine will typically be relieved of it within minutes after applying the cream. A patient who appears to have too much adrenaline will quickly feel calmer and will be better able to focus.

Other Considerations:
I am not sure why transdermal progesterone cream can lead to high salivary levels of progesterone but I recommend ignoring such test results. Progesterone cream has been around for 70 years, and I am not aware of any serious side effects. I have used high doses of progesterone cream with thousands of patients without any deleterious effects.

I have never done saliva testing, but I assume all of my patients would have very high levels. Here too, I have always felt more comfortable treating patients rather than reference ranges.

Natural, bio-identical progesterone is also available in oral form as a troche or capsule (i.e., Prometrium), and some health practitioners think oral progesterone promotes better blood levels of progesterone than transdermal progesterone cream.

However, oral progesterone gets absorbed primarily via the GI tract. It goes straight to the liver, where it converts into allopregnanolone, a hormone that is not recognized by progesterone receptor sites. As a result, it stays in the bloodstream and is falsely interpreted on blood tests as a high level of progesterone. Allopregnanolone causes drowsiness, which is why oral progesterone is recommended to be taken at night. Transdermal progesterone cream, on the other hand, does readily attach to receptor sites, after which it cannot be detected by blood level tests.

Side Effects:
In some cases, progesterone replacement may produce side effects, which are usually short-lived and can be managed by reducing the dose temporarily.

For example:
Because women have large numbers of progesterone receptor sites around the nipples, some women may experience some discomfort in this area when they start taking replacement progesterone. Lowering the dose will eliminate this right away, after which it can be gradually titrated back up.

Sometimes when progesterone blocks adrenaline it will unmask symptoms of a low thyroid, such as fatigue, that had previously been undetected. In these cases, the underlying low thyroid condition also needs to be addressed.

Occasionally progesterone can initially stimulate estrogen receptor sites and cause uterine bleeding or breast tenderness. This usually indicates that the progesterone level is too low. The patient may not be using it correctly or the dose may need to be increased.

Acne:
In rare cases, progesterone can down-regulate testosterone and may first show up as a problem with acne. In other situations, for example PCOS, it can lead to a lowering of testosterone and help to eliminate acne. In the first instance I would recommend cutting back on the dose temporarily; the situation is usually self-limiting.

Headaches:
In extremely rare cases progesterone replacement may cause headaches. In such cases I recommend applying the cream around the inner ankles so there are more receptor sites for it to attach to on the way to cranial circulation. Alternatively, simply reduce the dose.

Re-emergence of adrenaline-type symptoms:
Occasionally a patient on progesterone supplementation for adrenaline dominance will experience the benefits of lowered adrenaline initially, only to have a sudden reemergence of adrenaline-type symptoms: anger, sleep disturbance, and restlessness, for example.

I suspect the reason is that progesterone levels are 20 times higher in the brain than in other tissues (which is why progesterone is used to treat brain swelling following traumatic brain injuries).

Hypoglycemia:
Progesterone seems to prevent hypoglycemia and weight gain by affecting insulin receptor sites on cells so the cells do not take up sugar. If progesterone is preventing insulin from pushing sugar into brain cells, the body may continue to detect low sugar levels in the brain cells and continue to release excess adrenaline.

In such cases, I recommend decreasing the amount of progesterone by at least 50 percent, and perhaps stopping the dose at bedtime. This is yet another example of the importance of treating patients rather than lab tests.

Women with Fibroids, Endometriosis, Ovarian Cysts, Fertility Issues

Progesterone Suppositories permit a high dose of this hormone to be administered to the entire pelvic region. This can be very beneficial for helping to heal fibroids, endometriosis, and ovarian cysts, as well as to help a woman conceive.

I suspect that the most common reason a woman cannot get pregnant is a low progesterone level. To help with conception, progesterone suppositories should be used twice a day from day 11 to day 28 of a woman’s cycle. Progesterone should not be used from day 1 to day 10 of her cycle because it can prevent ovulation. Once she conceives, she can continue using the suppositories at least through the first trimester. This will help prevent morning sickness as well as a miscarriage.

Any woman with a history of miscarriages should use progesterone suppositories, as should any woman with severe morning sickness or hyperemesis gravidarum. Other potential uses for progesterone suppositories are to prevent toxemia of pregnancy, preeclampsia, gestational diabetes, premature labor, and postpartum depression.

Women who use progesterone throughout their pregnancies are often blessed with extremely happy babies who grow up to be exceptionally intelligent. A woman in her third trimester normally has very high levels of progesterone, in the range of 460 ng/mL, which provides tremendous benefit to the fetus—especially, I suspect, the developing brain.

For many years I have wondered why infants born prematurely are not given bio-identical progesterone.

Suppositories are typically provided in 400 mg doses. I recommend one suppository twice a day intravaginally. I also recommend including progesterone transdermal cream, 50 mg per 1/4 tsp applied to the forearm three times a day (before meals) and again at bedtime.

Progesterone Suppositories can be obtained through a compounding pharmacy.

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