Medical FAQ

Your Questions Answered

Q: How do I find a holistically minded doctor in my area?
Q: I've been going through menopause for 2 years - when will it end?
Q: Does progesterone help raise estrogen levels?
Q: Is there a relationship between hair loss and menopause?
Q: How do I know if I might be at risk for getting osteoporosis?

Q: Do I need to take magnesium if I'm using calcium?
Q: How much calcium should I take, and what kind of calcium is best?
Q: How does exercise influence bone health, and what kind is best?
Q: What's the difference between synthetic progestins and natural progesterone?
Q: What's the difference between wild yam and progesterone?

Q: What is USP Progesterone?
Q: Does natural progesterone have any side effects?
Q: What's the difference between synthetic and natural estrogen?
Q: What is PMS?
Q: What is natural progesterone's role in PMS?

Q: What is natural progesterone's role in cardiovascular health?
Q: Will using natural progesterone with oral birth control pills alter their effectiveness?
Q: How much natural progesterone should I use?
Q: What is estrogen's role in menopause?
Q: My daughter is in her twenties and has been diagnosed with amenorrhea. What is it?

How do I find a holistically minded doctor in my area?

Physicians who specialize in women's health and are trained in natural therapeutics can provide you with guidance to help you determine what natural options are available to you. For referrals to holistically oriented physicians in your area, you may want to contact one of the medical associations listed in our resource section. After receiving a referral from one of these organizations, you should call the physician's office and inquire directly about their practice. If their practice is not suitable for your needs, they may be able to give you the name of another physician in your area.

I've been going through menopause for 2 years--when will it end?

The transition through menopause may last anywhere from 6 months to 10 years, and is different for each individual, although the average length of time is two years. Anything you can do to optimize your health and keep stressors to a minimum can help you through this transition. Many women find that the right combination of herbs, nutrients, lifestyle changes and natural hormones can help them manage most of the symptoms associated with menopause. Others find they may need some medical intervention and pharmaceutical agents.

Does progesterone help raise estrogen levels?

There is no evidence that supplementing with natural progesterone will raise estrogen levels in the body. From salivary test results we know that women using natural progesterone cream do not by and large see an increase in their estrogen levels. We do know that progesterone and estrogen, like many of the hormones in the body, work synergistically. The presence of progesterone sensitizes estrogen receptors in the body, making circulating estrogen levels work better without changing the actual levels of estrogen. Progesterone performs this role with other hormones as well. Since women's bodies have the ability to produce some estrogens after menopause, many women find that supplementation of progesterone is enough, or at least part of the picture for addressing symptoms. For women who are very thin, who have had hysterectomies at a younger age, or have certain risk factors, like high cholesterol or heightened bone loss, some form of estrogen or phytoestrogens may be necessary to completely fulfill their bodies' needs. Keep in mind that the balance of the different hormones is important and should be tailored to the individual.

Is there a relationship between hair loss and menopause?

The most common cause of hair loss is low thyroid function, which is common among menopausal women. Other causes include, but are not limited to the following: changes in hormone levels (a significant decrease or increase), increased testosterone and other androgenic hormones, a change in the balance between estrogen and androgenic hormones, increased stress (physical or emotional), and heredity. Any time sudden hair loss is experienced, one must consider events which took place up to three months prior to the hair loss, as factors affecting hair loss can take up to three months to have an effect. Subsequently, any treatments for hair loss should be given at least three months to have noticeable effects.

How do I know if I might be at risk for getting osteoporosis?

Osteoporosis, like many conditions, is associated with certain risk factors, which means that if your health and circumstances match some of the criteria below, you would be considered to have a higher risk for developing the disease relative to someone who did not fit any of the criteria. This information was based on the comparisons of groups of individuals who had osteoporosis with groups of individuals who did not have osteoporosis. Having one or more of the risk factors does not dictate that you would get osteoporosis, just as fitting none of the criteria would not ensure that you did not get the disease. Risk factors that have been established for osteoporosis include, but are not limited to, the following:

Known risk factors:

Being female
Having a family history of osteoporosis (there exists a link between mother and daughter)
Being Caucasian or Asian (individuals of these ethnic groups tend to show lower bone density than African or Hispanic women)
Having a small body frame
Being post-menopausal
Having a hysterectomy (total ' both ovaries and uterus)
Having a history of absent or infrequent menses (amenorrhea)
Having inadequate calcium intake
Having inadequate exercise
Being a smoker
Having excessive alcohol consumption
Having a history of long-term glucocorticoid therapy
Having a history of long-term use of anticonvulsants, antacids, and diuretics
Having a history of hyperthyroidism, thryotoxicosis, Cushing's disease, or type 1 diabetes

Possible Risk Factors

Having excess protein in the diet (leading to a low systemic pH level)
Having a high caffeine intake (3 + cups or 150 - 300 mg/day leads to an increase in urinary calcium, magnesium, and sodium loss)
Having a high phosphorous diet (notably soda pop and red meat)

Do I need to take magnesium if I'm using calcium?

Calcium supplementation without magnesium may interfere with the absorption of magnesium from the diet. This can result in less movement of magnesium into the bone and lead to greater bone demineralization (breakdown). Because a high calcium intake can intensify a magnesium deficiency and vice versa, both of these minerals should be supplemented.

How much calcium should I take, and what kind of calcium is best?

The National Institute of Health Consensus Conference on Optimum Calcium Intake recommends 1,000 to 1,500 mg of calcium per day which includes calcium obtained through the diet (avg. intake through diet is 700 mg/day in the U.S.). Many physicians feel that calcium supplementation above and beyond that obtained through the diet can be achieved through the ingestion of 500-800 mg daily of a highly absorbed form of calcium. Intestinal absorption of calcium generally declines with age. Factors that can reduce calcium absorption may include: a high fiber diet, use of diuretics, alcohol consumption, corticosteriod use, and decreased stomach acid (HCl). Highly absorbable forms of calcium include the following: calcium-citrate, calcium-malate, calcium-lactate or calcium-gluconate. These forms may also be referred to as calcium amino acid chelates. Calcium supplements from dolomite, bone meal products, and some antacids are not recommended due to their potential for containing aluminum.

How does exercise influence bone health, and what kind is best?

Physical activity is the main non-pharmacological way to build up bone after normal bone growth is completed. Exercise helps improve posture and mobility, can reduce chronic pain, increase physical confidence, and improve coordination and balance. The best activities are those that are weight-bearing exercises, or exercises that put stress on the bones (e.g. walking, tennis, running, stair-climbing, and low-impact aerobics). These exercises help build and maintain stronger bones while increasing muscle mass. Weight training may also be helpful, as the pull of the muscle on the bone against the force of gravity that occurs when weight lifting can create changes in the bone tissue which stimulate bone formation. Improving muscle tone may also help reduce falls, decreasing the potential for fractures.

What's the difference between synthetic progestins and natural progesterone?

"Natural" progesterone (also termed USP Progesterone) refers to a single molecular structure that is "bio-identical" to the progesterone molecule that the body makes. Synthetic "progestins" or "progestogens," do not exactly duplicate the body's own progesterone molecule. They mimic the body's progesterone closely enough to bind to progesterone receptor sites and have some progesterone-like effects, but they do not deliver the full range of "messages" that a natural progesterone molecule would. As such, synthetic progestins are not recommended for use during pregnancy; pregnancy requires progesterone. Synthetic progestins will not increase the serum or salivary levels of progesterone. In fact, synthetic progestins may cause a decrease in the body's levels of natural progesterone by blocking the process of progesterone production. In contrast, research studies show that topical (skin) applications of natural progesterone may increase salivary and serum levels of progesterone. Natural progesterone is available through topical applications, oral micronized progesterone, injectable progesterone, vaginal gel, suppositories, and sublingual drops or troches.

What's the difference between wild yam and progesterone?

Wild yam, Dioscorea barbasco, is a herb that has been used historically in herbal medicine for women's health. Some of the actions of wild yam include smooth muscle relaxation and a mild diuretic effect. Contrary to some information provided by companies producing wild yam products, wild yam does not convert into progesterone in the body. This conversion can only occur in a laboratory setting. The body may absorb wild yam extract through the skin, which may in turn have some effect on menopausal symptoms, yet research on both oral and topical applications of wild yam extract demonstrate no change in progesterone levels in the body.

What is USP Progesterone?

United States Pharmacopoeia (USP) Progesterone simply means progesterone that exactly duplicates the progesterone naturally produced in the body, or "bio-identical" progesterone. The title "USP Progesterone" differentiates natural progesterone from synthetic progestins or progestogens.

Does natural progesterone have any side effects?

Progesterone binds with progesterone receptor sites in the brain and causes a calming effect on the central nervous system. In excessive amounts, progesterone may have a relaxing effect on the brain, and may cause drowsiness. In a very small group of women who are extremely sensitive, progesterone of any kind may aggravate hormonal headaches or PMS symptoms. There are no long-term adverse effects noted for supplemental progesterone in amounts that replicate physiological levels of progesterone in the body.

What's the difference between synthetic and natural estrogen?

The body naturally produces three main forms of estrogen: estrone (E1), estradiol (E2), and estriol (E3). Estrone is converted from estradiol in the liver. Synthesized in the ovaries and metabolized in the liver, estradiol is the most physiologically active form of estrogen. When taken orally, estradiol is converted into estrone in the small intestine. Estriol is the shortest-acting estrogen and has a weaker effect than estradiol and estrone. Estriol remains intact when supplemented orally, i.e. estriol is not converted into estrone, as is true with estradiol supplementation. Because estriol competes with estrone for receptor uptake when given in large or repeated doses, it may have an anti-estrogenic effect in selective tissues like the breasts or uterus. Estriol doses must be increased up to three times the dose of estradiol to achieve similar effects (e.g. reducing hot flashes and vaginal dryness in menopausal women). In Europe and China, estriol is the preferred form of estrogen for HRT. Many of the hormone replacement therapy and birth control pharmaceuticals in the U.S. contain estradiol, the strongest of the three forms of estrogen. Some of the estrogens produced in the United States exactly duplicate one of the three forms of estrogen produced in the body, estradiol, so technically they are "natural." Many physicians are now prescribing "Tri-est", or "Bi-est", names given to combinations of E1/E2/E3 and E2/E3 respectively. With a physician's prescription, licensed pharmacists may compound these combinations of natural estrogens. Other estrogens available differ chiefly in the source of the estrogen, e.g. whether they were derived from animal or plant products, or synthesized chemically. Synthetic estrogens are estrogenic compounds that are not found naturally in the human body. There is some debate as to whether estrogen from the urine of horses is "natural", but most naturally minded physicians agree that the use of estrogens derived from horses is not a "natural" approach for humans.

What is PMS?

Dr. Katharina Dalton, a British physician, originally coined the term "premenstrual syndrome" (PMS) in 1953 and soon after established the world's first PMS clinic in London. This syndrome certainly existed for many years before this time, but only in the last 50 has it been given attention as a medical disorder. Premenstrual symptoms have been defined as physical, mood, and behavioral symptoms that: 1) appear or change in severity during the luteal phase (second half) of the menstrual cycle; 2) do not exist in the same form or severity during the mid or late folllicular phase (first half of the menstrual cycle); and 3) disappear or return to their usual severity during the full flow of menses (Halbreich et al 1985). There have been over 100 symptoms attributed to PMS. Women can experience a variety of symptoms which may differ month to month or year to year. PMS may be attributable to hormonal changes, inadequate nutrition, lack of exercise, and physical and/or emotional stress. Researchers over the last forty years have identified four major types of PMS, determined by a woman's predominant symptoms. Dr. Guy Abraham developed the following classification system to help identify and treat PMS:

Type A ("anxiety"): anxiety, mood swings, and irritability
Type C ("carbohydrate" or "craving"): sugar craving, headaches, and fatigue
Type H ("hyperhydration"): bloating, water retention, weight gain, breast tenderness
Type D ("depression"): depression, memory loss, and confusion

Some women have only one group of symptoms, while others suffer with a combination of two or more symptom groups. Many symptoms related to PMS can be attributed to "estrogen dominance," a relative excess of estrogen activity in the body. Of the PMS types listed above, three may benefit from progesterone supplementation, to offset excessive estrogen activity: Types A, H, and C.

What is natural progesterone's role in PMS?

There are several different types of PMS recognized. Women who suffer from certain types of PMS may have a relative excess of estrogen, caused by either a low progesterone level or too much estrogen in relation to progesterone. This condition is often termed "estrogen dominance". Common symptoms of estrogen dominance include breast tenderness, bloating, irritability and mood swings. If your PMS is a result of excess estrogen or insufficient progesterone, then supplementing progesterone during the second half of your cycle (from the time of ovulation until menses) may help reduce PMS symptoms.

What is natural progesterone's role in cardiovascular health?

Natural progesterone may have a protective effect on the heart. Recent research showed that natural progesterone helped reduce spasms of the coronary arteries. Blood vessel occlusion by cholesterol plaques combined with vasoconstriction can severely restrict blood flow to the heart, resulting in a "heart attack". In a study by Miyagawa, et al, progesterone plus estradiol was protective against vasospasm, whereas estradiol plus medroxyprogesterone acetate (a synthetic progestin) allowed vasospasm, concluding that medroxyprogesterone increased the risk of coronary vasospasm, while natural progesterone did not. (Miyagawa K, Rosch J, Stanczyk F, and Hermsmeyer K: Medroxyprogesterone interferes with ovarian steroid protection against coronary vasospasm. Nature Medicine, Vol. 3, No. 3, 324-327.)

Will using natural progesterone with oral birth control pills alter their effectiveness?

Using natural progesterone should not alter the effectiveness of oral birth control pills providing you keep taking the oral birth control pills as prescribed. Birth control pills may be progestin only pills (synthetic progestins), or a combination of progestins and estrogen. Adding supplemental progesterone will only increase the progestational effect in the body.

How much natural progesterone should I use?

Natural progesterone usage depends on your current hormonal and menstrual status. The following are general recommendations that should be confirmed or modified in concert with your health care provider. Please keep in mind these are general recommendations that may need to be modified for your specific situation. When selecting a progesterone cream, it should contain approximately 20 mg of progesterone per 1/4 teaspoon.

Women in their reproductive years:

Begin using natural progesterone after you have ovulated. Ovulation usually occurs 14 days before your period begins. Count your first day of bleeding as day one of your cycle. Assuming that you have a 28-day cycle, that means you probably ovulate on day 14. Adjust the following recommendations to coincide with your ovulation day:

Days 1-13: do not use natural progesterone.
Days 14 (ovulation) - 21: use 1/4 teaspoon of natural progesterone twice a day.
Days 22-28: use 1/4 to 1/2 teaspoon of natural progesterone twice a day.

Women who are perimenopausal:

Days 1 (first day of bleeding) - 7: do not use natural progesterone
Days 8-21: use 1/4 teaspoon natural progesterone twice a day
Days 22-28: use 1/4 to 1/2 teaspoon twice a day.

If your period begins early, STOP using natural progesterone while you are bleeding, count the first day of bleeding as day one, and begin the cycle again.

If your period is late, use the cream for up to 3 weeks (day 28 of your cycle), then take a week off. If your period has not started by the end of the week off, resume applying the cream for up to three weeks, or until your period starts. STOP the cream when your period begins, count the first day of bleeding as day one of your cycle, and begin the cycle over again.

Women who are menopausal:

Choose a calendar day (e.g. first day of the month) as day one
Days 1-7: do not use natural progesterone.
Days 8-30 (or 31): use 1/4 teaspoon of natural progesterone twice a day.
To apply, rub the cream into the palms of the hands, then finish by rubbing the excess into the inner arms, inner thighs, abdomen, or chest, rotating the areas where applied. Natural progesterone is best applied twice daily.

What is estrogen's role in menopause?

Estrogen production from the ovary begins to decrease as a woman enters perimenopause. It is estimated that estrogen levels drop to 40-60% of pre-menopausal levels. Other tissues in the body, most notably the adrenals and fat tissue, have the ability to produce estrogens. This accounts for some of the variation in estrogen production post-menopausally. The decrease in estrogen has been associated with a number of menopausal and perimenopausal symptoms. These include a change in cervical mucus causing vaginal dryness, thinning of the vaginal walls and changes in the endometrial lining which plays a role in irregular bleeding cycles. Although a decrease in estrogen has been associated with hot flashes, the mechanism is not completely understood, as evidenced by many women who supplement with estrogen but still suffer from hot flashes.

My daughter is in her twenties and has been diagnosed with amenorrhea. What is it?

Amenorrhea is defined as the absence of menstruation. Amenorrhea can refer to the cessation of menses for 6 months in a woman with a previously established menstrual cycle or the lack of onset of menstrual periods by the age of 16. Because the number one cause of amenorrhea is pregnancy, this is usually the first test a physician will order when evaluating a sexually active woman for this symptom. The menstrual cycle is a complex process orchestrated by a wide range of hormonal, physiological, and psychological factors including emotional stressors, body weight, diet, exercise, lactation, and hormones produced by the hypothalamus, the pituitary, and the ovaries. The hypothalamus, the regulatory center of the menstrual cycle within the brain, is even affected by emotional and psychological factors.

Body weight and exercise habits are important factors in the evaluation of amenorrhea. Menses frequently cease when a woman's percentage of body fat falls below 22% or if she is 20% or more below the ideal weight for her given height. Likewise, excessive body fat can also disrupt ovulation, causing menstrual irregularities, and, in some cases, amenorrhea. Menstrual abnormalities often occur in athletes and in women who exercise excessively. Some female athletes may also develop a disordered pattern of eating in response to competitive-type pressure, further reducing body fat levels and predisposing them to amenorrhea.

An imbalance or disease in any one of the hormone-producing organs can lead to amenorrhea. Keep in mind that amenorrhea is a symptom, not a diagnosis. All women who experience amenorrhea should consult with a physician to determine the cause of this symptom, because the absence of periods can be associated with numerous conditions, some of which are serious. Furthermore, if prolonged, amenorrhea places a woman at increased risk for developing osteoporosis, and possibly fractures later in life.