Do you need the `Menopause Miracle'?


Prevention investigates the latest menopause breakthrough-natural progesterone-to help you decide if it's right for you Maybe you've heard other women talking about the new "miracle in a jar" that whips menopausal symptoms. Maybe your doctor's mentioned it. Maybe you've seen the raves of "satisfied customers" in the ads of the companies that sell it.

It's natural progesterone, a plant hormone derived from wild yams or soybeans. If you have heard about it, you no doubt have two questions: One, what is it? And two, should you be using it?

Well, don't reach for that "miracle in a jar" just yet. Prevention has taken a closer look at the claims for the OTC creams, as well as two new prescription forms of natural progesterone. We've uncovered some good reasons to consider taking natural pro-gesterone-it may help reduce your health risks and ease the discomfort of menopause-but not by itself, and not in some overhyped cream that may not contain any progesterone at all.

Here's the straight scoop on the "other" menopause hormone.

What Is Progesterone-and Why Do I Need It?
Progesterone is the "other" female hormone your body produces besides estrogen. It helps regulate your cycle, nourishes the lining of your uterus in preparation for pregnancy, and helps maintain it should conception occur. But its job is also to prevent estrogen from causing the lining to thicken too much. So, when an egg is not fertilized, progesterone levels drop, causing the lining to be shed in a menstrual period.

As you approach menopause, your ovaries slow down and stop producing progesterone since you ovulate less frequently or not at all. By the time you reach menopause, the drop in progesterone is almost 100%. Estrogen, on the other hand, drops by about 90%, since there are other sources of estrogen in the body.

If you're given estrogen at menopause, a progestin (or synthetic version of progesterone) is added to your hormone therapy to prevent the estrogen from causing a buildup of tissue in your uterus, which can lead to endometrial (uterine) cancer.

Though a progestin acts like your body's own progesterone in some ways, it's not its chemical twin-with good reason. When taken by mouth, natural progesterone is quickly digested, broken down by the liver, and excreted. That means it doesn't get to the uterus in sufficient doses to offer any protection. So researchers developed synthetic substitutes or progestins that are easily absorbed. The latest breakthrough, however, is micronized progesterone, which is formulated by breaking the particles into very tiny pieces so they pass untouched through the liver and are absorbed by your body.

Unlike estrogen, which has been shown to protect your heart, prevent osteoporosis, lower your risk of colo-rectal cancer, and perhaps even prevent Alzheimer's, there's no scientific evidence that progesterone does anything more than counteract the effects of estrogen on your uterus. So other than that, why do you need it? And why do you need a natural version when a synthetic will do?

Synthetic Progesterone: HRT "Bad Guy"
Well, for one thing, the synthetic progestins-which experts often refer to as a "necessary evil"-in current hormone replacement therapy (HRT) formulations appear to produce most of the unpleasant side effects associated with HRT: mood changes, depression, irritability, bloating, breast tenderness, and headaches. "None of these is common," says Vanessa M. Barnabei, MD, PhD, associate professor of OB/GYN at the Medical College of Wisconsin in Milwaukee. "But they can be significant enough to cause problems for some women." And they can be significant enough to encourage women-as many as 38%-to stop filling their prescriptions for HRT after one year. Even more-60%-stop taking it after two years. Natural progesterone, on the other hand, has far fewer side effects in most women.

There may be other reasons to take a natural progesterone-but this is where it gets controversial. Its advocates claim that natural progesterone alone can relieve the symptoms of menopause with none of the risks and fewer unpleasant side effects than progestin. Some, like John R. Lee, MD, say it can stave off osteoporosis, calm premenstrual syndrome and endo-metriosis, and eliminate fibrocystic breasts and ovarian cysts, among other problems. Dr. Lee, a retired California family physician, has also suggested that menopausal symptoms aren't caused by lack of estrogen but by lack of progesterone. He promotes his highly controversial view in a popular book, What Your Doctor May Not Tell You About Menopause (Warner Books, Inc., 1996).

Critics scoff, calling these claims quackery. And many health experts worry that women will turn to easy-to-get OTC natural progesterone creams instead of HRT, depriving themselves of the scientifically proven benefits of estrogen to protect their hearts and bones.

Controversy aside, there is some evidence that natural progesterone can be very beneficial-if you're also taking estrogen postmenopausally. For example, natural progesterone may be better than synthetic at preserving more of estrogen's beneficial effects on the heart. And in at least one set of studies, women who took natural progesterone along with estrogen said they felt better emotionally.

Just the Facts, Ma'am
Unfortunately, there have been few scientific studies on natural progesterone. In fact, science knows very little about the progesterone you make in your body, let alone the kind made in a lab. But this much we do know: Natural progesterone-which, despite its name, is also created in a lab-is chemically identical to the hormone secreted during the luteal phase of your menstrual cycle, which is the two weeks after you ovulate.

The reason you need a lab to intervene is that wild yams and soybeans don't contain progesterone, but rather another chemical-a plant compound called diosgenin-that can be turned into a facsimile of your own progesterone, but only in a lab. You can't get it by eating the vegetables, nor by smearing them on your skin. Your own body can't transform a plant hormone into a human one.

In fact, OTC creams that contain natural progesterone-and despite the claims, not all do-actually have a pharmaceutical grade of progesterone added. (See "Beware the Yam Scam" on p 121.)

And while natural progesterone is readily absorbed through your skin, studies have found that it's very difficult for a woman to achieve normal levels of circulating hormone by applying it that way.

So what's your best choice right now? Several forms of natural pro-gesterone-suppository, lozenge, and capsule-have been available by prescription from pharmacies that specialize in compounding (making individual formulations in the exact dose your doctor orders). But your best bets may be the two newest products on the market:

The Pill
Chief advantages: Convenient as, well, popping a pill; scientific evidence says it protects your heart and uterus.

Called Prometrium, it's expected to be approved by the FDA for use in HRT this year. (It's recently been approved for other uses, so your doctor can prescribe it for HRT.) Because it's micronized, it can be absorbed by your body before it's destroyed by your liver.

Micronized progesterone has proven itself superior to progestins in a major study, the Postmenopausal Estrogen/Progestin Intervention Trial (PEPI). Progestins can diminish the protective effect estrogen has on the heart-mainly by blunting the estrogen-triggered rise in HDL, the good cholesterol. Natural progesterone taken orally, on the other hand, preserves more of estrogen's beneficial effects on the heart while preventing estrogen from building up tissue in your uterus.

In the PEPI study, the only real side effect noted by study participants was drowsiness. But that is "easily managed by taking the drug at bedtime," says principal investigator Trudy Bush, PhD, professor of epidemiology at the University of Maryland in Baltimore.

Vaginal Gel
Chief advantages: Progesterone is delivered directly to the uterus; study subjects report an emotional boost. Crinone is a natural progesterone-containing gel that's applied to the vagina, where it's readily absorbed and concentrated in the uterus. Unlike vaginal creams and suppositories, the gel doesn't cause a messy discharge. And in a series of studies involving 610 patients, it was effective at protecting women taking estrogen from endometrial cancer.

Michelle P. Warren, MD, director of the Center for Menopause, Hormonal Disorders, and Women's Health at Columbia-Presbyterian Medical Center in New York City, conducted those studies. "Our clinical trial also showed women felt better on progesterone than on estrogen alone. When you added the progesterone, we got a decrease in reports of headaches, depression, and mood swings that we did not expect," she says.

(The drowsiness reported by the PEPI women may, in fact, be related to the calming effect the women experienced in the Crinone studies. Progesterone was used as an anesthetic during the 1930s.)

Like Prometrium, Crinone has been FDA-approved for uses other than HRT, but physicians can still prescribe it as part of HRT.

If you're now taking or are a possible candidate for HRT, talk to your doctor about using natural progesterone with your estrogen. But hold off on treating yourself with OTC preparations until the scientific proof is in that they're something more than very expensive skin cream. *



By Nancy F. Smith with Toby Hanlon, EdD

Nancy F. Smith is the former executive editor of Self and a freelance writer in New York.

The "all natural" wild yam cream you bought promises to banish all your menopausal ills. Will it? Some women say the progesterone creams work wonders for them and make them feel better. But there's no reliable scientific evidence that these creams can provide relief from menopausal symptoms. It could be the powerful placebo effect: If you think you're getting a benefit from something, you will.

But if you want to try them, experts we spoke to say it's unlikely these creams can hurt you. Just be sure you're getting the best product for your money by checking what's on the label:

A cream contains natural progesterone if the progesterone is biologically identical to what your body makes. It doesn't refer to the source of it.

Unless a cream contains pharmaceutical-grade progesterone-look for "progesterone USP" on the label-it's likely to do nothing more than make your wallet a little skinnier.

Proponents of natural progesterone creams agree that it takes a minimum of 400 mg of progesterone per ounce to alleviate menopausal symptoms.

Be especially wary of creams that say they contain diosgenin, "a precursor to progesterone." Though it implies that your body can turn the yam into progesterone, it can't.

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