The basic phenomena observed and established by Dr. Peat and Dr. Lee are:
1. Women's health issues are caused largely by "Estrogen dominance" where estrogen / progesterone balance is lost due to too much estrogen, too little progesterone or both.
2. Correcting this imbalance using bio-identical (as opposed to fake) progesterone and nutritional supplements will correct or prevent most of the problems such as PMS and pre and post menopausal discomfort and health crisis.
Their reasoning is sound, their observations well informed, and millions of women, including me, have been following their advice and finding it helpful. Yet, there are so much medical myth yet to be dispelled. Most doctors are not informed. As recent as May of 2008, one of my readers contacted me to consult what went wrong with her doctor prescribed natural progesterone supplementation regimen, that made her bleed every week with pulsed schedule and feel awful with overdose. To end all that myth, misunderstandings, and disinformation once and for all, I decided to review up-to-date data and clarify some nagging questions that needed to be answered.
First I looked for a solid proof that pre- and peri- menopause put women in "Estrogen dominance". That was not hard at all. There it was published in 1996 Journal of Clinical Endocrinology and Metabolism by Nanette Santoro, et al[6]. (New Jersey Medical School). That's more than 10 years ago. So, anything written since then about pre and peri menopause that does not take this study into consideration is probably not worth reading.
Now, if you have done some net search and visited the web sites backed by mainstream medical communities and U.S. government, you already KNOW, as your reproductive system gets older, your estrogen gradually decreases, and you probably have no clue what happens to your progesterone level, but it did not seem to matter. For PMS, some site told you it may be caused by progesterone because PMS only happens during the time progesterone is secreted. And if you dig a little deeper, you will find plenty of clinical and experimental studies that seem to back up their recommendations, but at a closer look reveal serious flaws of overdose (more on this later).
You also learned that the best treatment is birth control pills, be it PMS or pre- and peri- menopause symptoms, to boost estrogen, to regulate your periods with fake progesterone, and the contraception is the added bonus[7]. Of course, you have probably encountered plenty of Web sites like this one that warn you about those "mainstream" medical approaches.
Why the myth persists? And why are they perpetuating it ?(more on this later). Progesterone does not cause PMS, neither the low estrogen level causes the premenopausal symptoms. It is estrogen dominance (often high estrogen and low progesterone) that causes them. All that miseries women go through during PMS and the years leading up to the transition are not caused by the low estrogen level or the secretion of progesterone. Quite the opposite. Let's put to an end to all that myth and the ill informed medical practice of giving estrogen and fake progesterone to women with already elevated estrogen level and reduced progesterone level. For most women, the low estrogen level becomes an issue only shortly before her period stops all together.
The next question is what the Estrogen Dominance (high level of estrogen before ovulation and the high level of estrogen along with the low level of progesterone in the latter half of the cycle) does to a woman. By 1993, Dr. Peat already had pretty good idea about what, how, and why of Estrogen Dominance symptoms. Actually, by 1977 Katharina Dalton, a British doctor, has written The Premenstrual Syndrome and Progesterone Therapy[8] based on her success with natural progesterone. Dr. Peat lists about 30 manifestations of Estrogen Dominance in his Progesterone in Orthomolecular Medicine and explained the underling mechanism at molecular level. Has there been any follow up studies to confirm their finding and insights?
Search engines can find any topic you can think of. However, I would not hold my breath to find concerted effort in hormone related prevention or wellness research, or public campaigns to disseminate the correct information. It isn't happening even for a disease reaching epidemic proportions like diabetes. It seams that in modern medicine, the research tend to concentrate on diseases that are expensive to treat, with a focus on developing new patentable drugs and the cutting edge treatment methods, in other words, where serious money can be made. The exceptions might be those countries with socialized medicine (e.g. England, Canada and Scandinavians) or countries with limited resources (e.g India and China) that have a strong incentives to take "a stitch in time save nine" approach seriously.
One of the fields that seem to have a good accumulation of research is the assisted reproductive treatments that uses hormones to stimulate ovulation, which induces the exact hormonal imbalance as estrogen dominance[9]. It even has a name, Ovarian Hyper Stimulation Syndrome, OHSS for short. It is potentially a life threatening condition (didn't we know it!) with massive fluid shift similar to bloating only exponentially amplified. The established guideline for the prevention of OHSS is to give the women progesterone* after ovulation as luteal phase hormonal support. In fact, the effect of progesterone in reducing bloating/swelling is so strong that it has been demonstrated to save brain injured patients[10] [11].
Now, never mind about the fact that if she is given progesterone and some nutritional advice to restore the hormone balance, she probably can get pregnant on her own. That will be another topic.
* Should not be confused with all those fake progesterone doctors and drug companies and even your government have been heavily promoting as cure-all contraceptive/HRT to the detriment of women's health. The only substance qualified to be called "progesterone" is the real, natural, bio-identical progesterone. The use of fake progesterone for fertility treatment is totally unwarranted. They come with a long list of side effects both to the baby and to the mother, while real progesterone is safe and readily available (after all, it is identical to what your body makes). You need to make sure what you are getting is real progesterone, because an average doctor doesn't seem to know the difference.
(to becontinued)
[1] Progesterone in Orthomolecular Medicine by Raymond Peat, PhD, available at Dr. Ray Peat's Web site.
Every time I read it, it impresses me how much was know in biology by mid 1970s, and infuriates me to see that even today, more than 30 years later most doctors are still clueless. And it is sickening to realize we still have to fight against FDA who is stepping up their campaign to scare off the consumers by questioning the efficacy and the safety of bio-identical hormones from compounding pharmacies and supplement companies, all the while the same substances that is packaged by big drug companies at ridiculously high doses are left unquestioned.
[2] What Your Doctor May Not Tell You About Breast Cancer, by John R. Lee, M.D. David Zava, Ph.D, and Virginia Hopkins, 2001 Cahners Business Information.
The co-author David Zava is a big name in breast cancer research and saliva hormone test field. If you want to know why estrogen and the chemicals that mimic estrogen cause cancers, and how progesterone protect you against it, all at molecular level, this is the book to read. You will find the effective prevention strategies self evident, calling early detection a prevention is a spin, and why the mammography is actually bad for your breast.
[3] What Your Doctor May Not Tell You About PreMenopause, by John R. Lee, M.D. Jesse Hanley, M.D., and Virginia Hopkins, 1999, Warner Books.
[4] What Your Doctor May Not Tell You About Menopause, by John R. Lee, M.D. with Virginia Hopkins, 1996, Warner Books.
This is the first of the series. The courage to go beyond what other doctors are doing and the intellectual integrity behind it, you will know when you read it. The unfortunate aspect of this book is that it gives you an impression that no one need to take estrogen for menopause, which is not quite true and he repeatedly corrected later.
[5] Lee, John R., M.D., "Osteoporosis Reversal: The Role of Progesterone," International Clinical Nutrition Review (1990), 10:384-391.
The first study to show Osteoporosis can be reversed. It is heard to believe that most of the well established journals did not take it serious enough to publish it. Today no one questions about the fact that you can increase your bone mass at any age, and that all three factors (nutrition, use of muscle, and hormone balance) can contribute to the reversal. You knew, didn't you?
[6] Santoro N, Brown JR, Adel T, Skurnick JH. Characterization of reproductive hormonal dynamics in the perimenopause. J Clin Endocrinol Metab. 1996;81(4):1495-1501.
They collected urine every morning for 6 month from women at various reproductive stages (5 to 6 women in each group) and measured the metabolites of estradiol and progesterone, as well as LH and FSH. Their clever method of analysis made the data clean and easy to understand. A land mark study that was expanded into much larger studies, the Study of Women's Health Across the Nation (SWAN) and the Daily Hormone Study (DHS). Any hormone study that does not take this study into consideration is not worth reading.
[7] Ismail Hassan, Khaled Mk Ismail, Shaughn O'brien PMS in the perimenopause. J Br Menopause Soc. 2004 Dec;10 (4):151-6 15667751
"The simplest approach may be to give oestradiol transdermally and to administer the progestogen by the intrauterine route using the levonorgestrel intrauterine system." is their conclusion. It is clear to them that estrogen alone can take care of the symptoms. But in case she wants to keep her uterus, levonorgestrel intrauterine system can prevent the uterine cancer and avoid PMS like symptoms Provera causes. It even works as contraceptive. Natural progesterone? not quite sure, but why bother? seems to be their attitude. The case is closed as far as they are concerned. That was exactly what was prescribed to me after my hysterectomy in 1985 and in a few years I found my health slowly deteriorating. They flush their knowledge of latest this or that, but no fundamental changes in their approach, which I assume reflecting the current state of the mainstream medicine. Anyhow, I cannot give a serious consideration to any perimenopause study that does not mention Santoro et al. 1996. Also to suggest progesterone/allopregnanolone causes depression is such a spin and disinformation.
[8] Katharina Dallton, The Premenstrual Syndrome and Progesterone Therapy., Year Book Medical Publishers, Inc., Chicago, 1977.
I have not read this book yet.
[9] Abbas Aflatoonian, M.D., Tahereh K. Bidgoli, M.D. Prevention is the ideal treatment of OHSS!!! Iranian Journal of Reproductive Medicine Vol.3. No.2 pp:51-61, 2005
A good review with good focus and good balance.
[10] Wright et al., ProTECT: A Randomized Clinical Trial of Progesterone for Acute Traumatic Brain Injury, Ann Emerg Med. 2007;49:391-402.
After 20 years of animal experiments, they finally had the opportunity to take it to the clinical trial. The astonishing success of this landmark study is changing the landscape of hormone research.
[11] Ann Emerg Med. 2007 Jun 21; : Does Progesterone Have Neuroprotective Properties? Donald G Stein, David W Wright, Arthur L Kellermann Brain Research Laboratory, Department of Emergency Medicine, School of Medicine (Stein, Wright).
According to Dr. Peat, progesterone protect a lot more than your brain. As the name suggests, it protects pregnancy, the fetus and the mother from ill effects of stress and toxic substances. But you don't have be pregnant or even woman to have the protective effects of progesterone. The brain injury patients they saved in ProTECT were all men.
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