More on the `natural' progesterone cream

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Last months report about a British study which showed poor absorption of a popular topical cream called Pro-Gest drew some say it isnt so responses from readers. Enthusiasm for progesterone cream stems from the work of John R. Lee, M.D., author of a widely read book, What Your Doctor May Not Tell You About Menopause (New York: Warner Books, 1996). He claims, The makers of Premarin and other estrogen manufacturers would have us all believing that estrogen loss is the major hormonal factor in osteoporosis in women. The most important factor, he says, is the lack of another female hormone, progesterone, which should be applied topically in its natural form.

Unfortunately, the only evidence to support his claim is anecdotal. For example, Dr. Lee has followed 62 of his own patients who used natural progesterone for at least three years and showed increases in bone density in the lumbar spine. Since the book does not mention the more crucial issue of whether the women showed a reduced fracture rate, a call was made to Dr. Lee. He provided an updated anecdote, saying that there were only three fractures in his practiceall were due to trauma.

Has anyone conducted a larger study to confirm his results? It would be great if someone conducted a large, double-blind randomized controlled trial, he answered, Who is going to do it? Theres no large profit to be made as there is with a drug. But Pro-Gest and other progesterone creams are expensive, and their manufacturers appear to earn high profits without the testing required of drugs. A two-ounce tube of Pro-Gest sells for $31 at our local health food store, and though progesterone is listed among the many natural ingredients, no claim is made that the hormone itself is natural. A call to Transitions for Health in Portland, Oregon, makers of Pro-Gest, elicited assurance that the progesterone in its product is natural. It is from the wild yam that is converted in the body to a bio-identical progesterone, that is, the same progesterone produced by the body, said the Pro-Gest spokeswoman. Why doesnt the label say that its natural? We have a labeling issue with the FDA, she explained, because our product is sold as a cosmetic.

Dr. Lee, who says he has no affiliation with the Oregon company, explained why he often used the brand name in his writing. Pro-Gest was the only progesterone cream available when I conducted my study, but since I began to write about the product many other companies now produce their versions. As for poor absorption shown in the new British study, Dr. Lee claims that the investigator erred by testing the womens blood for progesterone levels rather than their saliva. The latter test, he said, is the more accurate measure.A search of the medical literature turned up no proof to support this contention, though Dr. Lee did send an undated paper presented at a menopause conference. Another search of the medical literature found no proof for Dr. Lees contention that progesterone is more important than estrogen in preserving bone density.

For a second opinion on the progesterone cream issue, HealthFacts turned to the countrys best known physician supporter of natural medicine. Andrew Weil, M.D., author ofSpontaneous Healing, who was in New York City recently to address a physicians conference on botanical medicine, was asked about the validity of the numerous versions of progesterone cream. "There are several problems: The marketing of progesterone cream is somewhat questionable. Women think its a natural product, but the progesterone in it is synthetic, although it is the same as the bodys own progesterone. The other problem is the absorption. The standard gynecologists say, how do you know its absorbed? But the people promoting the product say you can tell through salivary testing. And that may be so, but I dont think we yet have definitive evidence about how salivary levels relate to blood levels. And lastly, theres the theory of the doctor [Dr. Lee} who is promoting the productthat menopausal symptoms can be treated with progesterone rather than estrogen I dont understand that."

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