Natural Progesterone: What Role in Women's Healthcare? Part 4

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

SUMMARY

Natural progesterone appears to be an effective component of postmenopausal HRT and is preferable to standard progestational agents for women with worrisome lipid profiles or hypertension. Natural progesterone has fewer side effects than synthetic agents have, and it protects the uterus from estrogen-induced endometrial hyperplasia. Given the potential toxicities of exogenous estrogen, it is reasonable to speculate whether progesterone, together with a healthy lifestyle, could provide the cardioprotective effects we want for our patients.

As for osteoporosis prevention and treatment, there are certainly some promising data regarding the beneficial effect of natural progesterone on bone formation, particularly in corticosteroid-induced osteoporosis. We need more research on its effects, but if results are positive, there may come a day when women take natural progesterone, follow a healthy diet, exercise and perhaps avoid exogenous estrogen entirely.

In PMS, the data are confusing. We need more information on the proper route of administration, dosage, and patient selection before we can determine the appropriate role of natural progesterone. More research is also necessary concerning the use of natural progesterone for affective disorders or allergic symptoms. Topical application of progesterone for benign breast disease appears promising, but again, there are insufficient data to clearly know its benefit.

We need more good studies that look critically at the questions raised by existing research. Use of natural progesterone has appeal—it is essentially nontoxic, has few side effects, and is less expensive than synthetic progestins. Perhaps with renewed emphasis on women's health issues, the National Institutes of Health will make more funding available for this needed research. Unfortunately, since natural progesterone cannot be patented, we are not likely to see much corporate support for this type of research (except for studies investigating patentable delivery systems), We need to know effective doses and routes of administration to manage a variety of women's health problems in this arena, as in many others related to "alternative" and "natural" medicine. 

NATURAL PROGESTERONE: PRIMARY POINTS 

• Natural progesterone has fewer side effects than synthetic agents do, and it protects the uterus from estrogen-induced endometrial hyperplasia.
• It appears to be an effective component of postmenopausal HRT and is preferable to the standard progestational agents for women with worrisome lipid profiles or hypertension.
• There is some evidence that progesterone alone—without estrogen—could have a significant effect on the prevention and management of osteoporosis. However, more research in this area is clearly needed.
• Whether progesterone is effective for PMS remains unclear. There are no studies that prove its effectiveness or long-term safety. However, the treatment is essentially benign, and anecdotal reports support its use.
• Some intriguing studies suggest a role for progesterone in the management of affective disorders, allergic symptoms, and benign breast disease. However, the data are too sparse to support treatment recommendations.

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