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Emma H.        22/01/2017

12 basic things you should know in relation to (not only) endometriosis

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 Help Note with Moisturizer Cream on Dry


This blog does not contain medical advice.


When doctors gave me two options – either a strong hormonal therapy, or a partial hysterectomy (because ”otherwise the disease will spread and become much worse, which is unacceptable”) – I first needed a few deep breaths to gather strength and say that I will think about it. Then I went home, spent a few days crying, and made a decision (which was mercifully supported by a couple of newly found doctors): This is not the moment for drastic solutions just yet. I will look for more alternatives. And natural progesterone cream is one of them!

Before I give you the basic information I’ve come across during my extensive research, I need to stress that if you decide to start using natural progesterone cream, I believe you should read both books mentioned below. Just as it’s not true that you can simply pop synthetic hormone pills and not care about anything, it’s not true that you’ll just apply the cream twice a day and your troubles will go away. If you’ve been diagnosed with endometriosis, they most probably won’t. In fact, I think you’d better count on endometriosis and related troubles staying (to a certain degree). Endometriosis is a complex multi-system disease and needs to be addressed on many levels. But its symptoms can be greatly reduced, if you take appropriate measures.

Now back to progesterone cream. The endocrine system (i.e. our hormones) is very complicated; female hormones even more so. Before you start using any hormonal therapy, you should have a good notion of how the female cycle works, what organs influence it (hypothalamus, pituitary gland, ovaries, as well as the adrenals), and which hormones are part of the interplay (estrogens, progesterone, testosterone, together with cortisol and insulin). Ideally, you should also know how your cycle behaves and which phase you are currently in. (In my case, it has become pretty easy as I have various pains and issues during various phases of my cycle, and I’ve become quite skilled at reading them.) And then you need to get to know how natural progesterone cream works and how it can help you with your problems.

This article is based on two books written by the greatest expert on natural progesterone cream Dr. John R. Lee (and his co-authors Jesse Hanley, M.D., and Virginia Hopkins). The books are called Dr. John Lee’s Hormone Balance Made Simple [1] and What Your Doctor May Not Tell You About Premenopause [2]. The authors have coined the term “premenopause” that covers women from the age 30 to 50 who have to face various gynaecological problems like fibroids, cysts, painful or tender breast, premenstrual syndrome (PMS), fertility issues, problems with menstruation, or endometriosis, as well as “minor” troubles like weight gain, fatigue, irritability and depression, migraines, memory problems, or cold hand and feet.

This article focuses on presenting basic facts on natural progesterone cream in relation to endometriosis. If you suffer from any of the above mentioned problems, I believe you should read the book on premenopause, as it’s an invaluable source of information.

The authors put great emphasis on diet and lifestyle changes and explain the correlations between diet, sleep, strenuous exercise, or stress with the above mentioned women’s issues.

So, what should you know before buying natural progesterone cream? Here are 12 basic pieces of information you should keep in mind.

Natural Medicine

What is natural (bioidentical) progesterone cream?

Natural progesterone cream contains a certain amount of natural (bioidentical) progesterone. It is applied on skin on any part of the body (ideally those parts that contain less fat – hands, inner arms, under the knees), mostly twice a day, always during a certain phase of the cycle. It is used in order to increase the amount of progesterone in the body, thus correcting hormonal imbalances.


What’s the difference between natural and synthetic “progesterone”?

The word “natural” doesn’t mean that the progesterone in the cream comes from natural sources (which it does, but so does synthetic progestin). It means that the progesterone found in the cream has completely the same molecular structure as progesterone produced by our body. That’s why it’s also called “bioidentical”.

Synthetic progesterone (whose correct name is “progestin”) is also manufactured from natural substances but has been changed so that its structure differs from the natural progesterone found in our bodies (even if by a single atom). Pharmaceutical companies do this to be able to patent such substance. (Natural progesterone cannot be patented because patenting isn’t allowed with substances occurring in the nature or living organisms.)

If someone tells you that progesterone and progestin is the same thing, you can use the following argument: The female body produces approximately 300 to 400 mg of progesterone during the first trimester of pregnancy. If you administered an even much smaller amount of synthetic progestin to a pregnant woman, it would be harmful to the developing fetus.


Why is progesterone important?

Progesterone is one of steroid hormones that are produced by the body. It is produced from the hormone called pregnenolone. It is produced primarily by the ovaries in the middle of the cycle (after ovulation) and, in smaller amounts, by the adrenal glands, and in even smaller amounts by the nerve cells (Schwann’s cells).

Progesterone acts as a precursor to the majority of other steroid hormones (meaning that these hormones are produced from it), including cortisol, androstenedione, estrogens and testosterone. It is important to note that using supplemental progesterone will not lead to the increase of these other hormones. The natural transformation happens before progesterone reaches the bloodstream.

The main function of progesterone is to counter the effects of estrogen. (That’s why it is extremely useful for treating estrogen dominance.) However, progesterone affects the functioning of many organs and tissues in the body, including the uterus, cervix, vagina, the whole endocrine system, fat metabolism, thyroid hormones, water retention, myelin synthesis in nerve cells, bone cells, thermoregulation, immune system, or fetus development.

Homeopathic Bottles

What is natural progesterone made of and how to choose a quality product?

Both bioidentical and synthetic progesterone (as well as other hormones) are made of plant extracts, namely from a substance called diosgenin found in wild yam (Dioscorea villosa) and soy beans.

When choosing a cream, make sure you pick one that expressly states “progesterone” as part of its content. If it says “diosgenin” or (wild yam) “extract”, you will not be supplying your body with any progesterone! The body cannot transform diosgenin into progesterone.

Make sure you know how much progesterone is contained in one dose. For example, the producer of my cream (Pro-Gest) expressly says that ¼ teaspoon of the cream contains 20 mg of progesterone. You will find more on dosage below but, please, also keep in mind that you should avoid creams with too low dosage of progesterone (approx. 5 mg per dose). As I explain below, low doses of progesterone will result in the creation of more estrogen receptors, which can lead to the worsening of estrogen dominance symptoms.


What’s the difference in taking progesterone transdermally and orally?

There is a big difference between applying natural progesterone on you skin (transdermal application) or taking a pill (oral application). When applied transdermally, progesterone is absorbed into the fat layer below, and then through a network of capillaries into the bloodstream. The absorption is gradual; it starts immediately, peaks after 3 or 4 hours, starts decreasing after 8 to 12 hours, and fades away after 24 hours.

When a progesterone pill is taken, 95% of the progesterone it contains is inactivated in the gastrointestinal tract before it can even reach the bloodstream. That’s why the dosage must be much higher. Moreover, this process burdens the liver, which has to transform and excrete the unusable metabolites out of the body.

If you still have your doubts about transdermal application, remember that it has been found out that hormonal birth control works very efficiently through patches, using much lower amounts of the active substance than pills.


How should the cream be used?

It is best to apply the cream twice a day, a smaller dose in the morning and a bigger one in the evening (progesterone can have calming effect).

To make sure the creme is well absorbed, it is better to apply it on those parts of the body that contain less fat and have a better capillary network – face, neck, upper chest, breasts, inner arms, hands or feet. You should rotate the place of application and find what suits you best.

Please note

that contrary to progesterone,

estrogen cream should not be applied to face, neck or breasts!

When should natural progesterone cream be used?

Progesterone cream can be used when there is too much estrogen and too little progesterone the body. However, the total values or estrogen and progesterone are irrelevant. What is relevant is the ratio between the two. The ratio of progesterone to estrogen in premenopausal women should be 200:1 (i.e. 200 x more progesterone than estrogen).

For more information on estrogen dominance and other issues that can be alleviated by using natural progesterone cream, please read the recommended books. The authors state several times that you should start using the cream only when you are absolutely sure you need to increase your progesterone level.

They also stress that estrogen and progesterone levels should be verified by a saliva test, not measured from the blood plasma or serum. The blood test can be very misleading when measuring levels of hormones applied transdermally. Hormones that enter the body through the skin become immediately bio-available, which will be reflected in tissues like the saliva glands. They do not cumulate in the bloodstream because they are efficiently sent directly to tissues. Therefore, if you apply 15 to 30 mg of progesterone a day, it is possible that your blood levels of progesterone will not even become elevated, or will only be elevated slightly.


What dosage is recommended to premenopausal women?

Let’s start with the golden rule:

Use progesterone cream only when you are absolutely sure

you need to increase progesterone levels in your body.

And find the lowest effective dosage possible!

If your problems are less serious than endometriosis (see list at the beginning of this article), the authors recommend 15 to 20 mg (possibly 30 mg) of progesterone a day, the last 14 days of your cycle. This is the amount that is produced by a healthy premenopausal (age approx. 30 to 50) female body.

The first phase of your cycle (period up till ovulation) can vary in its length. The second phase (just after ovulation to the beginning of the next period) is always 14 days. This is exactly the time when the body produces progesterone, and therefore, the time when the cream should be applied. If you know you’ve ovulated, start applying the cream the next day, and continue for 13 days. If you don’t know when you ovulate but your cycle is regular, simply count 14 days backwards from the expected date of your next period.

If your cycle is not even regular, here’s what the authors recommend: “If you’re bleeding on and off through the month and you’re not sure when your period is beginning, use your intuition and pick a day that you will call day 1 of your menstrual cycle. Begin taking the progesterone on day 12, and depending on the length of your normal menstrual cycle, stop taking it between days 21 and 28, and start again on day 12.” [2]

Unfortunately, I cannot provide more extensive information in this article. I warmly recommend reading the two books if you plan to give natural progesterone cream a try, or even better, cooperate with a doctor or pharmacists who work with such creams.

If you’re interested in the cream in relation to menopause, read What Your Doctor May Not Tell You About Menopause by the same authors.

School Notebook

What dosage is recommended for endometriosis?

Because endometriosis is a serious illness, the authors recommend, for the first 4 to 6 months, to apply the cream before ovulation, which will induce environment similar to the first trimester of pregnancy. I assume that this is a recommendation for women who are NOT using any other hormones to treat endometriosis. The authors do not mention interaction with any other hormones and it is important to consult the use of the cream with your doctor. (By the way, the books contain recommendations for women who have had a hysterectomy.)

Apply the cream from day 5 or 8 to day 26 of your cycle (if your cycle lasts 28 days). If your cycle is longer or shorter, apply the cream proportionately to the basic rule. The dosage is higher for the first 4 to 6 months, 40 to 60 mg of progesterone a day. If the disease is extra strong, you can increase the dosage up to 80 mg of progesterone a day for a short period of time. The progesterone will limit the production of endometrial tissue, which should help your body deal with the symptoms and further progress of the disease.

After the first 4 to 6 months, the dosage should be reduced to the smallest effective dose possible. The authors also underline that it is important to work with a doctor is you take progesterone in higher amounts.

I personally believe that if “regular” doctors don’t even blink and put you on a (synthetic) hormonal therapy or recommend a hysterectomy, they will not even be willing to consider natural progesterone cream. (I have seen a reaction or two from a doctor saying that natural progesterone’s effect has not been proven.) Well, I prefer to supply my body with a biodientical hormone that it is familiar with, even if I have to fool it into thinking it’s pregnant for a few months. Then I will do my best to go back to the “regular” smaller dosage the last two weeks of the cycle. I think it’s still much better than synthetic progestin, with its higher risk of various cancers, heart attack or stroke. And much better than an irreversible removal of my uterus.


What to expect when you start using the cream and can there be an overdose?

When you start using natural progesterone cream, be ready for a week or two of increased estrogen dominance symptoms. The cream may temporarily increase the sensitivity of estrogen receptors in the body. Possible worsened symptoms should go away after no more than two cycles, though.

As for possible overdose with natural progesterone, the authors say that the risk is extra small and is much higher with using oral progesterone pills.

However, if you overuse with progesterone long term, progesterone receptors will get deactivated after a few months, and the cream will stop working. Possible negative effects of progesterone overdose include sleepiness, lethargy, or feeling drunk. However, these are related to extremely high doses. 20 mg of natural progesterone a day in the second half of the cycle has no side effects.

The authors also warn that if you do not remove the primary cause of your problems (i.e. mostly of estrogen dominance), natural progesterone will not work as well as you need. I’ll mention a few related issues below.

Bottles of Homeopathy Globules

What if the cream is not working?


There’s no specific mention in relation to endometriosis, but in relation to less serious issues the authors state three reasons for the cream not having the desired effect:

  • The dose is too high. – As I’ve explained above, if you overuse natural progesterone long term, progesterone receptors in your body will deactivate. That’s why you should follow the golden rule and always look for the lowest effective dosage.

  • The timing of application is not correct. – Applying the cream in the correct phase of the cycle is key for success. The aim is to mimic natural processes in the body. Progesterone has to be applied at the moment when the body is supposed to produce it itself. I’ve given you basic information above, and please read the recommended books if you want your progesterone therapy to be successful.

  • Effectiveness is prevented by other factors, e.g. stress or obesity. – Stress or obesity can undermine the effect of progesterone cream. Find more information below.


How does lifestyle affect natural progesterone therapy?

The authors pay close attention to lifestyle factors. I would like to mention three important mechanisms that need to be addressed in order for your natural progesterone therapy to be successful.

  • Progesterone and stress. – As I’ve already mentioned at the beginning of this article, progesterone is an important precursor for the production of other hormones. It’s interaction with the stress hormone cortisol is especially important. Cortisol is secreted when we find ourselves in a stressful situation. If we experience chronic stress, our cortisol level is chronically elevated (which can, by the way, lead to adrenal fatigue). Because cortisol is produced from progesterone, the more cortisol we need, the more progesterone we need. If you experience chronic stress, you will certainly not have enough progesterone to cover the body’s requirements! Even if you supplement with progesterone cream, after long term use progesterone receptors become deactivated and the cream will stop working. It’s a vicious circle that cannot be broken without removing stress from your life.

  • Progesterone and obesity. – This is an equation containing progesterone, estrogen and fat cells. We need progesterone to counter the effects of estrogen. Estrogen is stored and secreted by the fat tissue (among others). The more fat there is in our body, the more estrogen is produced (and the higher the probability of estrogen dominance). And the more progesterone we need. Again, using progesterone cream will not solve the problem unless we do away with the primary cause. That’s why changing our diet and lifestyle should be an integral part of the treatmen​t.

  • Progesterone and xenoestrogens. – Xenoestrogens are synthetic estrogens that have toxic impact on our body. They can be found in pesticides, plastic, acetone (nail polish and remover) and many other industrial substances (including cosmetic and household products). Xenoestrogens increase the level of estrogen in our body, thus contributing to estrogen dominance. The more xenoestrogens get into our body, the more progesterone we need to counter their effect.

As you can see my research of natural progesterone cream has been quite thorough. But I guess that’s understandable – I will be spending money and effort, so I want my actions to be meaningful and effective.

I hope this article made clear some of the basic concepts and will serve as an inspiration for your further reading!

My experience (updated)

After a week of applying the cream (20 mg of progesterone a day, after ovulation) my ovaries started to hurt, I clearly started retaining water and I had an increased appetite. That was more or less fine, I expected similar symptoms due to increased sensitivity of estrogen receptors. What I did not expect, however, was quite intense (and worsening) leg pain – both thighs and calves. The pain was always worse when I stopped moving (when I was sitting or lying for a period of time). I also experienced unusually strong heartbeat. I wasn’t able to find any information on such symptoms in relation to natural progesterone but I came to the conclusion that they were related to my blood circulation. I have to say that after a week they became so unpleasant, and so disquieting, that I decided to stop using the cream altogether. This led to some mild relief, and later a complete disappearance of the issues during my period. The period came five days later than usual but I have to say that it was weaker, and therefore, less painful.

These days, when my blog readers ask me about progesterone creams, I always recommend they work with a professional who will guide them.

[1] John R. Lee, Virginia Hopkins. Dr. John Lee's Hormone Balance Made Simple: The Essential How-to Guide to Symptoms, Dosage, Timing, and More. Hachette Book Group, 2006

[2] John R. Lee, Jesse Hanley, Virginia Hopkins. What Your Doctor May Not Tell You About Premenopause: Balance Your Hormones and Your Life From Thirty to Fifty. Hachette Book Group, 1999

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