Bitter Pills To Swallow – progesterone cream unregulated and unproven as a hormone replacement treatment – Brief Article
The most seductive marketing term at the moment is the word ‘natural’. Big supermarket chains and even industrial giants like Monsanto realise that the easiest way to guarantee a constantly ringing cash register is to label a product ‘natural’, ‘organic’ or ‘vegetarian’. Discerning folk who ordinarily might not touch a drug with a bargepole will willingly swallow it if it is packaged as a wholly natural and organic supplement — particularly if they are told that it is something their body is missing.
Consider the extraordinary marketing of so-called ‘natural’ progesterone. Several years ago, an extremely pleasant and enthusiastic Californian doctor named John Lee flew over to the UK to present his theories about the role of ‘natural’ progesterone in preventing menopausal symptoms. Many dozens of alternative practitioners came to hear Lee declare that women entering the menopause were not suffering from oestrogen deficiency but ‘oestrogen dominance’ due to the presence of huge numbers of oestrogen mimics (pesticides, hormones used in farming, industrial waste) in the environment. The problem during menopause isn’t too little oestrogen, said Lee, but too little progesterone.
His prescription for women entering the menopause (or women suffering from a variety of female complaints) is to use a rub-on cream containing a certain percentage of ‘natural’ progesterone.
The reason for using a rub-on cream is to circumvent the body’s response to outside hormones as toxic substances. When hormones like progesterone are taken by mouth, the liver quickly breaks it down, rendering it mostly ineffective. Rubbing on or injecting progesterone enables it to bypass the liver and reach the bloodstream directly.
The effect of Lee’s talk (and his books on the subject) and the marketing campaigns of a number of vitamin companies selling progesterone creams has been galvanic. Although Lee’s evidence consisted mainly of the experience of 62 of his own patients, many practitioners and patients alike were persuaded that the solution to most female complaints is to correct ‘hormone imbalance’ through ‘natural’ progesterone.
It’s important to get something straight. The only progesterone that is ‘natural’ is the variety produced by the female body. Every other type, even those derived from natural sources like soyabeans or wild yam, are put together in the test tube. When you use cream derived from wild yam, you are not putting a ‘natural’ substance into your body. What’s present in the cream has been adulterated, undergoing a series of chemical steps to synthesise a substance from yam into something chemically equivalent to what your body makes.
The most clever aspect of marketing natural progesterone as a cream is that it neatly circumvents the stringent laws for drug safety. It is possible to get the rub-on cream in the US by mail order because it is considered a cosmetic. It is available in the UK only by prescription, but the creams have not undergone the full breadth of drug safety evaluation.
There are also no standards for the amount of progesterone contained in the creams. In one survey of 27 brands of rub-on progesterone creams, 11 contained more than 40mg progesterone per ounce of cream, five contained between two and 15mg per oz and 11 had 2mg or less per oz. 
The issue of how much progesterone is contained in the cream is pertinent when you consider the minute doses required by the body to keep things ticking over.
During the menstrual cycle of the ordinary woman, progesterone blood levels range from 0.5 to 20 nanograms per ml, according to Harrison’s Principles of Internal Medicine. This amount is the equivalent of one part per billion in weight. With the rub-on cream, women could be enhancing the progesterone concentration in the blood by four or five times.
In one study of rub-on progesterone applied to breast tissue, both progesterone and oestrogen levels increased by four times, and yet any blood levels of progesterone were short-lived.  According to this same article, the average amount absorbed is about 10 per cent of the applied dose, so that if you are using 50mg of progesterone, you’d absorb about 5mg.
If this massive increase is happening locally, whether by shot, pessary or cream, we have no idea what on earth it’s doing, although high concentrations of progesterone in breast tissue has been linked with a higher risk of breast disease. 
The cornerstone of Lee’s hypothesis (and that is, after all, all it is thus far) is that rub-on progesterone can prevent osteoporotis.  However at least two studies of rub-on creams have shown that the rub-on creams do not slow bone loss. 
‘Natural’ progesterone is a drug with unknown dangers — hormone replacement dressed up as a natural supplement. In our zeal to undergo a natural menopause, it’s important that we don’t fall prey to the same marketing interests that gave us sex hormones and a whopping increase in breast cancer.
Lynne McTaggart is editor of What Doctors Don’t Tell You, a monthly newsletter which exposes dangers and unproven practices in medicine. Annual subscriptions cost [pounds][pound]34.95.
(1.) Townsend Letter for Doctors, July 1996.
(2.) P Mauvis-Jarvis, et al, Percutaneous Absorption of Steroids, Academic Press, 1980
(3.) Fertil Steril, 1992; 57; 492-3
(4.) Int Clin Nutri Review, 1990; 10: 384-9
(5.) Lancet, 1998; 351: 1255-6; Townsend Letter for Doctors, 1999; 197; 121
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