The Scoop on Popular Menopause Creams

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Section: HEALTHY WOMAN "Many of my friends are using progesterone creams instead of hormone therapy to relieve their hot flashes and protect their bones. What do you think?"
Over-the-counter (OTC) progesterone creams seem to have a loyal following. There are dozens of brands in health food stores and on the Internet, touted as curing PMS as well as menopause symptoms. And the products can often be confusing. Some socalled progesterone creams don't actually contain any progesterone. They're derived from wild yams and/or wild yam extract and contain a plant compound called diosgenin. It's a precursor of progesterone, but your body can't convert it to the hormone. Only products marked "progesterone USP"-- meaning they contain pharmaceutical grade progesterone--are actually progesterone creams.

Until recently, there was only anecdotal evidence for the effectiveness of progesterone cream for relieving hot flashes. But a small study published in 1999 found that it significantly relieved hot flashes in 83% of the women using it. But it didn't prevent bone loss, a far more serious problem.

One reason that progesterone may help prevent hot flashes is because of something that happens as menopause approaches-what's called perimenopause. The majority of menopause symptoms-hot flashes, vaginal dryness, insomnia, mood changes --are the result of estrogen loss. But in perimenopause, your body first stops churning out progesterone while it's still producing estrogen, creating an excess of estrogen in relation to progesterone. The resulting imbalance between these two hormones may be part of what triggers hot flashes. (If this sounds confusing, the truth is probably that neither hormone's decline exclusively causes hot flashes.)

Typically, I'll use a prescription form of oral progesterone called Prometrium for perimenopausal symptoms. But if a patient wants to try one of these progesterone creams, I don't discourage her. It may help, and I don't think they will hurt. Just keep these cautions in mind.

> Progesterone creams will not protect you against postmenopausal bone loss.

> The creams should not be used as the progesterone component of hormone therapy if you are taking estrogen. Even though your body absorbs the progesterone in the cream, you only get about one-third the dose you get when you take oral progesterone, and that's not enough to protect your endometrium from the stimulating effects of estrogen, which can lead to cancer. To my knowledge, the manufacturers of the OTC creams don't recommend it for this use either.

> Creams vary in potency and in the amount of progesterone they actually contain. In the study I referred to above, subjects used 1/4 teaspoon of the cream daily, which contained 20 mg of progesterone.

> Read labels carefully. Unless you see "progesterone USP" on the label, don't waste your money.

PHOTO (COLOR): Pull the plug, and cool off with this.

PHOTO (COLOR)

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By Mary Jane Minkin, MD

with Toby Hanlon, EdD

Mary Jane Minkin, MD, is a board-certified obstetrician-gynecologist in New Haven, CT, clinical professor at Yale University School of Medicine, and coauthor of What Every Woman Needs to Know about Menopause (Yale University Press, 1996).

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