Wednesday, November 21, 2007

Can You Get Too Much Progesterone?

For today's posting, I want to relate a personal story. I hope that you will further trust your body, your symptoms and 'how you feel'. Be your own best patient advocate when you are discussing options with your doctor or nurse practitioner.

A personal story

Some six months into my surgically induced menopause, I began to feel like a hypochondriac for the first time in my life. I had located a local doctor who agreed to prescribe natural HRT and I was in great anticipation of significant results. Instead, I began experiencing unusual joint stiffness and pain, mobility problems, and swelling of my wrists, hands and feet. This was a problem that worsened by the day.

When I developed tendonitis in my dominant hand, my physician did not see a hormone connection, but rather saw the situation as 'repetitive stress'. She prescribed an anti-inflammatory cream, then anti-inflammatory capsules, then referred me to a chiropractor for deep heat treatments and acupuncture. Soon both hands were affected, and the swelling began to worsen. All the while, any small amount of relief from the pain was very short-lived. Then there was a great deal of discomfort with an Achilles tendon in one foot. Had I suddenly developed fibromyalgia or some strange type of arthritis? Why did it feel as though my joints and tendons were staging some sort of revolt? I had to wonder about the hormone connection.

In my case, natural hormone replacement therapy preceded the onset of these joint/muscle/tendon problems. My physician had prescribed a very strong progesterone cream, which I had been using twice a day, for some three months. I had noticed weight gain, sleepiness, swelling in my hands and fingers, and when the tendonitis/carpal tunnel set in, I asked repeatedly if the hormone treatment might be causing some of the discomfort. One day, after another session of acupuncture for the pain and swelling, I asked the question again. This time, the technician remarked that pregnant women often get similar symptoms, such as carpal tunnel, and that the problems usually resolve after childbirth. Aha! Since pregnant women have very high levels of circulating progesterone, I was beginning to put the pieces together. Hormone imbalance was the culprit once again.

Now, in case you are misinterpreting my story as some sort of attack on progesterone cream, let me offer reassurance. I have personally done a great deal of investigation into progesterone cream, both over-the-counter versions and stronger prescription versions. I still believe that it is extremely beneficial for women, both before and after menopause. However, in my situation, excess progesterone became a problem. A small amount of women can actually experience a paradoxical response, where the treatment result is very opposite of what is expected. There are few known side effects when progesterone is administered in physiologic doses, amounts intended to mimic natural body production.

My body was giving many, many signals that an imbalance was getting worse. When my doctor would not listen, I decided to trust my instincts, my symptoms and my body. I promptly located another physician!

Soon, a consultation with a naturopathic doctor confirmed my suspicion about the high-dose progesterone cream. I then located a new doctor, who specializes in natural hormones and anti-aging medicine. He prescribed a compounded lozenge which contains a much smaller amount of progesterone, tailored to my specific needs, along with DHEA and some other complementary hormones. The carpal tunnel has slowly resolved as a result of the new treatment.

Why do I share this story? In retrospect, I find this chain of events very instructive. Natural hormone replacement therapy, in my opinion, is more art than science.

In order to achieve health and wellness, we must learn to trust ourselves and listen to what our body is trying to tell us. In spite of the challenges, natural hormone replacement therapy is still my choice. Stress, diet, age, environmental exposures (xenoestrogens) and body type all have an impact on hormone levels. Each woman is unique and her doctor must see her as such.

I have read many accounts of women having to switch doctors several times as they navigate through the natural HRT jungle. It's part of the challenge--but well worth the effort.