Natural Progesterone-What Role in Women's Healthcare?

Whether it's right for your patient depends on the specific setting

by Jane L. Murray, M.D. (September 1998)

ABSTRACT

Natural progesterone (which has a chemical structure identical to that of the hormone produced in humans) is essentially nontoxic, has few side effects, and is less expensive than synthetic progestins. It may be more effective than its synthetic counterparts in certain situations, such as postmenopausal HRT. Its use in other settings, such as osteoporosis prevention and treatment, shows promise. Data are unclear concerning its role in the premenstrual syndrome, affective disorders, menstrual-related allergy symptoms, and benign breast disease. Natural progesterone’s various routes of administration allow clinicians to determine the most effective dose and delivery for each patient. (Women's Health In Primary Care 1998: 1(8):671-687)

INTRODUCTION

Today's popular women's health literature is replete with suggestions for using natural hormones to prevent and treat a variety of health problems.^1-6 Natural progesterone is often promoted as an alternative to synthetic progestins for two reasons:

• It appears to have fewer side effects in many women.⁷
• It may have more benefit for lipid profile enhancement,⁸ osteoporosis prevention,⁹ and the treatment of menopausal symptoms,¹⁰ premenstrual syndrome (PMS), ^11,12 and endometriosis.¹³

A cultural move toward that which is "natural" and away from man-made chemicals is a current theme voiced by consumers of health care. Many women express the desire to take charge of their own health by eschewing mainstream medical treatment and prescription drugs, and by seeking help from so-called alternative health care providers who recommend nutrition, nutritional supplements, and lifestyle adjustments, as well as natural hormones in the form of creams and phytoestrogens in whole foods. In fact, it has been established that nearly one third of Americans seek care from alternative health care practitioners¹⁴—much of this care for women's health concerns.

Primary care clinicians are confronted daily with questions from patients regarding alternative approaches to many women's health problems. This article will provide an overview of mainstream medical research about natural progesterone and its potential uses to help women with a variety of health issues. With such information, primary care clinicians may be better equipped to answer patients' questions, and may more knowledgeably utilize natural progesterone in those circumstances where it may be appropriate or even preferable to synthetic progestational agents and other drugs.

TERMINOLOGY

First, a word of clarification. The term natural in the context of hormone discussions does not necessarily mean that the hormone in question is derived from a source in nature. The term refers to an agent that has a chemical structure identical to that of the hormone molecule produced in the human body. Conjugated estrogens, for example, contain hormones derived from a natural source—horse urine. However, conjugated equine estrogens have a chemical structure different from that of any of the estrogens produced in humans.

Conversely, micronized progesterone is manufactured in a laboratory from chemicals derived from plants (Mexican wild yams and soy), yet it has a molecular structure identical to that of the progesterone produced in humans. Throughout this paper, the term progesterone refers to the chemical substance made in humans, which is shown in (Figure 1). Synthetic analogues of progesterone are often labeled progestogens, progestins, or progestational agents.Unfortunately, the medical literature and common usage often interchange these synthetic terms with the word progesterone—with much confusion.

Synthetic analogues of progesterone have been developed to make the hormone available orally and to produce longer lasting and more potent effects than would be available from progesterone itself. Most of these compounds were first developed for use as contraceptive agents. Many of them bind to receptors for glucocorticoids, androgens, and mineralocorticoids, as well as those for progesterone^l5 explaining the diverse side effects many women experience while taking progestins: acne, menstrual irregularities, migraines, striae, and weight gain. Emotional side effects can include depression, mood swings, and irritability.

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