Table of Contents

DEAR READER:
Looking back at 2002.

An Open Letter to the Women of Marin County:
The breast cancer bogeyman isn t there.

THE HOPKINS HEALTH WATCH:
Prozac for kids, statin lowers LDL not death rate, C-reactive protein predicts some strokes, More on insulin and PCOS.

EXPERTS IN THE FIELD:
Dr. Dean Raffelock on postpartum depression and the brain.

LETTERS FROM MY READERS:
The biochemistry of pregnenolone, high progesterone, chemo and infertility.

DEAR READER,

Looking back at 2002

The medical news in 2002 was alternately saddening, rewarding and entertaining. I found it very entertaining, after enduring a decade of scorn from the medical profession about the efficacy of transdermal progesterone application (through the skin), that a birth control skin patch was approved by the FDA and is now being advertised in all the major media. I guess hormones can be absorbed through the skin after all!

It was very rewarding to receive a phone call from Dr. Helene Leonetti last week, telling me that her study comparing PremPro with Premarin and progesterone cream was complete, was soon to be published in a major peer-reviewed medical journal, and that it is to receive third prize at the American College of Obstetricians and Gynecologists Annual Clinical Meeting this spring.

Progesterone Protects the Uterus

Dr. Leonetti s study effectively proves that progesterone cream protects the uterine lining (the endometrium) as well as progestins do. Most of you know that in conventional medicine, women who have a uterus are always supposed to be given a progestin along with their estrogen to protect them from uterine cancer. In spite of the many negative side effects of the progestins, many doctors have hesitated to prescribe progesterone cream instead, for fear it would not protect the endometrium. In Dr. Leonetti s study, uterine tissue was examined before, during, and after using either PremPro (Premarin plus Provera) or a combination of Premarin and progesterone cream. The group using progesterone cream was found to be as well protected as the PremPro group. This should put to rest any concerns that physicians may have about using progesterone cream for hormone replacement.

Irrefutable Evidence

Then there was the huge Women s Health Initiative Study (WHI), part of which was ended after five years (three years early) because of a clearly greater risk of invasive breast cancer, heart disease and strokes among women using PremPro [Premarin plus Provera].

Following close on the heels was a study from the Breast Cancer Detection Demonstration Project, part of a nationwide breast cancer screening program, and it showed that estrogen-only hormone replacement (ERT) increases the overall risk of ovarian cancer by 60 percent.

This past fall, a large study out of Canada showed that having a mammogram made no difference whatsoever in whether or not a woman died of breast cancer. In other words, women who had a mammogram died in the same numbers as those who hadn t had one.

These studies are both rewarding and saddening. Rewarding because I can say, "I told you so," and saddening because they clearly show that conventional medicine s approach to women s health has in large part either not helped, or has harmed.

New and Overdue Warnings

In other news, in response to the WHI study, the FDA has ordered the makers of hormone replacement therapy drugs to include boxed warning labels on their products that highlight the increased risk for heart disease, heart attacks, strokes and breast cancer. They also include advice to use the drugs in the lowest dose possible for the shortest amount of time. At least they got one part right, which is to use the lowest dose possible. One has to wonder how physicians will determine the lowest dose possible, since most of them have never measured hormone levels before.

Predictions

Now I m going to make a prediction: because of the WHI study, and because conventional medicine doesn t understand the difference between natural progesterone and progestins, there s a good chance that progesterone will become a prescription item sometime in the next few years. Rumor has it that efforts are already underway in Congress to enact laws making all hormones prescription-only, including progesterone, DHEA and pregnenolone. The bad news about this is that it won t be so easy to obtain progesterone cream. The good news is that when millions of women begin demanding prescriptions for progesterone cream from their doctors, conventional medicine might begin to change. I don t know too many women who will give up their progesterone cream without a fight! Ironically, the WHI study is a perfect example that giving a medicine prescription status doesn t protect consumers.

Conventional Medicine Gives itself a Failing Grade

I was happy to see that the Journal of the American Medical Association (JAMA) is looking at itself and its competitors with a critical eye. According to the Associated Press, one study "reviewed 359 studies published between 1989 and 1998 in JAMA, the New England Journal of Medicine, the Lancet, the British Medical Journal and Annals of Internal Medicine. Only 26 studies reported straightforward statistics that clearly assessed the effect on patients."

Wish List for 2003

The Osteoporosis Society of the United Kingdom recently trumpeted a study purporting to show that natural progesterone cream does not improve bone density. Unfortunately they made the same mistake that others have made in progesterone and bone studies: they randomly selected healthy post-menopausal women (ages 52 to 65) for the study. I ve said it before and I ll say it again: progesterone does not increase bone density unless there is bone loss! In other words, if you give progesterone to a woman with normal bones, or minimal bone loss (which is normal during perimenopause), it s not likely to show much effect. However, had the researchers chosen to study women with measurable bone loss, they would have seen results. I haven t been able to find out what dosage of progesterone was used, how often it was used, or how long the study lasted.

Obviously, this is frustrating because so many women could be helped with this crippling disease by using natural progesterone along with good vitamin/mineral supplementation, good diet, and weight-bearing exercise. Some women also need estrogen and/or testosterone to gain bone strength.

Thus, at the top of my wish list for 2003, is a large bone density study of women with measurable bone loss, using natural hormones.

Next I d like to share a letter I wrote after giving a talk about breast cancer in Marin County , CA . I shared some of this with you in the last newsletter, but I d like to give you the whole picture. This letter will also be published on my website www.johnleemd.com, so people can easily share it with others.

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AN OPEN LETTER TO THE WOMEN OF MARIN COUNTY

The breast cancer bogeyman isn t there.

Despite the many town meetings and consultations with supposed experts, the people of Marin remain puzzled and concerned about their incidence of breast cancer, which is 40 percent higher than the present rate in the rest of the U.S. Marin women are told that their higher risk of breast cancer is most likely due not to some hidden environmental poison but to their demography, meaning that Marin women indulge in life style factors that appear to favor breast cancer occurrence. This is not of much help unless one knows what the factors are, how they cause breast cancer, and how to correct them, if possible. Women ask: What is so different about their life style that increase their risk of breast cancer so dramatically?

The answer is not difficult to find. Typically, across the U.S., less than 50 percent of women ever see a doctor for menopausal concerns. Menopause is a natural transition in women s lives, not a disease requiring treatment. Women who see doctors for menopausal concerns were often given prescriptions for hormone replacement therapy (HRT). However, half of these women either ignored the prescriptions or abandoned them because of undesirable side effects. On average, only 15 percent of menopausal women use conventional HRT for five years or more. In Marin, 75 percent of postmenopausal women, we are told, use HRT for five years or more. This makes a huge difference in breast cancer incidence.

As you probably recall, last July the Journal of the American Medical Association (JAMA) reported that the Women s Health Initiative study was stopped due to unacceptable increases in breast cancer, heart disease and strokes occurring in women using conventional HRT, compared to women not using HRT. Six months earlier, JAMA had published the Chen study (also called the Puget Sound study) showing that five years of conventional oral HRT increased the risk of breast cancer by 70 percent, compared to women not using HRT.

Now, here s where doing the math comes in. If you compare the incidence of breast cancer in community A (in which only 15 percent of postmenopausal women use HRT) with that of community B (in which 75 percent use HRT), and you know that HRT increases the breast cancer risk by 70 percent, it is obvious that the breast cancer incidence in community B will exceed that in community A by at least 40 percent. Voila! The mystery is solved. There is no need to continue searching for an environmental bogeyman hanging about in Marin County . The major cause for the extra breast cancers in Marin is the extra proportion of women using conventional HRT.

How Conventional HRT Causes Breast Cancer

You might ask how conventional HRT causes breast cancer. This, too, is not difficult to explain. Conventional HRT, established over four decades ago, uses oral doses of an estrogen (usually Premarin, estradiol or estrone) plus a progestin (a synthetic substitute for progesterone). There are several errors in this treatment program. The dosage of estrogen is usually eight times greater than needed, and is often given to women who are not deficient in estrogen. Good studies show that over 60 percent of women aged 50 to 80 continue to make estrogen sufficient for body needs, and therefore need no supplemental estrogen. Menopause means the cessation of monthly periods, but not cessation of all estrogen production.

Estrogen, unopposed by progesterone, is a known cancer-causing agent, especially for the breast, uterus and ovary. The progestin used is a synthetic compound that is totally foreign to the body, and is considerably different from real progesterone, the hormone it is intended to replace. Real progesterone protects against estrogen-induced breast cancer, as well as endometrial and ovarian cancer. Synthetic progestins do not protect against breast cancer, and may increase the risk. When a woman is younger and making all her own hormones, her ovaries make monthly surges of several different estrogens plus progesterone and testosterone. These hormones are not unhealthy in any way. Normal healthy production of sex hormones in proper amounts and proper balance does not cause cancer.

Later in life, when hormones become deficient or out of balance, symptoms arise. In the U.S., 50 percent of women over age 35 have anovulatory periods, meaning monthly menstrual periods without ovulation. Progesterone is made in the body by ovarian follicles after successful ovulation. No ovulation, no progesterone.

On the other hand, diets high in sugar and highly refined starches result in higher levels of estrogen than do more balanced diets. Compared to women in less industrialized countries, U.S. women generally have higher estrogen levels. Thus, the typical hormone imbalance in U.S. women is higher-than-needed estrogen and low progesterone, a condition called estrogen dominance. Proper treatment for this hormone imbalance involves diet change and replacement of progesterone to restore the normal healthy ratio of progesterone to estradiol (the most potent of our estrogens, and the one that is most likely to cause breast cancer). When the proper ratio between progesterone and estradiol in tissue cells is maintained, breast cancer is very rare. In this matter, saliva testing is far superior to blood serum testing in gauging tissue cell levels of hormones, as explained in our book.

Unfortunately, U.S. medical practice went awry about four decades ago when it was assumed that menopausal symptoms were due purely to estrogen deficiency, and menopause was a disease requiring treatment with estrogen. Thus, women were routinely given estrogen prescriptions without even testing the patient s need for it. In the mid-1970s, it became apparent that estrogen therapy increased by six-fold the incidence of endometrial (uterine) cancer. Knowing that progesterone prevented endometrial cancer, U.S. medical practice added a synthetic progestin (medroxy progesterone acetate or Provera) to the therapy. This worked to prevent endometrial cancer but, as we now know, did little or nothing to prevent breast cancer, and may actually increase the risk. Conventional HRT thereby increases the likelihood of estrogen dominance, which is a major factor in our present epidemic of breast cancer.

Just recently (January 9^th), the Food and Drug Administration (FDA) ordered new warnings on the labels for hormone replacement therapies using estrogen and a synthetic progestin. They must highlight the increased risk of heart disease, heart attacks, strokes, and breast cancer caused by conventional HRT. FDA Commissioner Mark McClellan is quoted as saying "There are risks and benefits that women need to consider in their individual circumstances. Women should consult with their physicians and find the therapy that works best for them." Hopefully, women will be able to find a physician who knows about the benefits and safety of progesterone, and how to individualize hormone balancing needs.

There are many pathways to estrogen dominance, including diet, stress, trans-fatty acids, and others featured in our book. Fortunately, almost all of them are preventable. Conventional HRT is one of the largest such factors. It can easily be modified to be safe and effective. If HRT is limited to (1) giving hormones only to patients truly deficient in one or another of them, (2) using bio-identical hormones rather than synthetic ones, and (3) achieving normal physiologic levels rather than excessive pharmacologic levels, then hormone balance problems can be successfully and safely treated. Our book describes the other known pathways to estrogen dominance and teaches the reader how to avoid them.

For women and medical workers who seriously wish to reduce the present epidemic of breast cancer (46,000 U.S. women will die of it this year), I advise reading our book, What Your Doctor May Not Tell You About Breast Cancer, now published as a paperback. Women who learn to avoid estrogen dominance will greatly reduce their risk of breast cancer and a host of other undesirable side effects of estrogen dominance. Doctors who learn how to do hormone balancing properly will have patients who stay healthy. And you don t have to spend millions of dollars looking for a breast cancer bogeyman who isn t there.

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THE HOPKINS HEALTH WATCH

C-Reactive Protein Predicts Some Strokes

One of the ways to take a pulse is to feel one of the large carotid arteries that run up the front of the neck on either side of the esophagus. Thickening of the carotid artery walls can interrupt blood flow to the brain and cause a stroke. According to researchers at the National Heart, Lung, and Blood Institute in Bethesda , Maryland , a high level of C-reactive protein (a measure of inflammation) can be an indicator of thickening of the carotid artery in women.

Inflammation tends to increase with aging, but can also be associated with food allergies, stress, lack of antioxidant vitamins and essential fatty acids such a fish oil, and lack of exercise.

Arterioscler Thromb Vasc Biol 2002;22:1512-1513,1662-1667.

More on Insulin and PCOS

Many young women have polycystic ovary syndrome (PCOS), where cysts on the ovaries cause pain during ovulation, PMS, and excess hair growth on the face, legs and arms. It s been known for some time that PCOS is associated with high insulin levels, which stimulate the ovarian production of androgens (male hormones). In a study of obese and non-obese women with PCOS, various hormones were measured with interesting results.

Researchers measured blood levels of six markers, including estradiol, testosterone and androstenedione. The average levels of testosterone and androstenedione in obese PCOS women were significantly higher than those in non-obese PCOS women.

This is yet another indicator that obesity can contribute significantly to hormone imbalance. PCOS disappears rapidly in most women when they cut sugar and refined carbohydrates from their diet.

Nobumasa et al, Reprod Med Biol 2002; 1: 49 -54.

Statin Lowers LDL but not Death Rate

An important study published in the Journal of the American Medical Association (JAMA) underscores what Dr. Lee has been saying for many years: lowering cholesterol numbers with drugs does not solve the problem of heart disease.

The study involved 10,000 participants with moderately high LDL levels and compared "usual care" (weight reduction, good diet, exercise, no smoking etc) with those taking a common statin drug (Pravachol [pravastatin]). After four years, 28 percent of those on the statin drugs reduced their LDL significantly, while 11 percent of those in the "usual care" experienced a similar drop.

Here s the clincher: there was no difference between the groups in the rate of death, heart attack and heart disease. In other words, changing cholesterol numbers in isolation does not save lives. Given the many negative side effects of the statin drugs, not to mention the expense, it would be nice if this study put an end to the widespread conventional medicine practice of putting people with high LDL on statin drugs. But don t hold your breath—just refuse the drugs when offered!

One of the best ways to help create a healthy cholesterol profile is to reduce or eliminate sugar and refined white flour from the diet to lower insulin levels. Deficiencies in omega-3 oils and excess iron can also create cholesterol problems. Dr. Lee s booklet, …Commonsense Guide to a Healthy Heart, gives many suggestions for improving cholesterol profiles and creating overall good heart health.

JAMA December 18, 2002 ;288:1998-3007,3042-3044.

FDA Approves Prozac for Kids

You may have heard the announcement on the evening news not too long ago, that the FDA has approved Prozac for the treatment of depression and obsessive compulsive disorder in kids, based on two studies. In one study, done only for 19 weeks, the children taking Prozac grew about half an inch less (on average) than the children taking placebo. The children in the placebo group also gained an average of two pounds more than kids in the Prozac group. Furthermore, we know nothing about the long-term effects of these types of drugs on brain development.

Mind you, doctors have been handing out antidepressants to kids for years, but the FDA ruling puts the official stamp of approval on the practice, and will undoubtedly greatly increase the number of prescriptions written for the elementary school crowd.

One can only wonder how much of the depression in these kids comes from subsisting on starvation diets of soda pop and junk food; spending hours a day playing video games and watching TV; getting no exercise; and being exposed to pesticides and other toxins. Where s the research on these factors?

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EXPERTS IN THE FIELD

Medical Treatment for Postpartum Depression …And Why it Doesn t Work

by Dean Raffelock, DC, DIBAK, DACBN, CCN, Dipl. Ac.

Dr. Dean Raffelock is a chiropractor, a diplomate in acupuncture and applied kinesiology, and a certified clinical nutritionist. He is also a website host for the Institute for Functional Medicine and in private practice in Boulder, CO and the lead author of a new book called A Natural Guide to Pregnancy and Postpartum Health: The first book by doctors that really addresses pregnancy recovery (Avery, 2003). This article was excerpted from that book.

Most cases of postpartum depression (PPD) can be very effectively treated with a combination of progesterone, nutritional and adrenal support, and in some cases, thyroid supplementation. However, conventional medicine persists in treating women who have PPD, or even the milder version, "baby blues," with drugs and psychotherapy. While talking to a trusted friend or psychotherapist is often helpful, the usefulness of the drugs most often prescribed for women with PPD has not yet been proven.

Most physicians treat PPD with various psychiatric drugs that, in effect, trick the brain into thinking it has more neurotransmitters than it actually does—specifically, that levels of one or two very important brain neurotransmitters, serotonin and norepinephrine, have been increased. Serotonin and norepinephrine are fundamental to a healthy body because they carry nerve signals and messages throughout the brain and rest of the nervous system. They have a profound effect on mood and self-esteem, as well as on many other important functions within the body. A deficiency of these neurotransmitters can lead to depression, anxiety, insomnia, anger, obesity, and a host of other serious ailments.

In the vast majority of cases of PPD that are related to low serotonin or norepinephrine levels in the brain (vs. a hormonal imbalance), the underlying cause is a deficiency of the nutritional precursors that the body needs to make these neurotransmitters. Interestingly, not only do the psychiatric drugs most commonly prescribed for PPD not increase serotonin and norepinephrine levels, but they actually cause the body s reserves of the nutritional precursors needed to produce them to be used up more rapidly, worsening the state of nutritional deficiency.

The most common class of drugs that physicians prescribe for PPD are known as selective serotonin reuptake inhibitors, or SSRIs, the best-known of which is fluoxetine (Prozac). Other medications in this category include citalopram (Celexa), paroxetine (Paxil), and sertraline (Zoloft). These agents act by keeping serotonin in the synapses (the spaces between nerve cells) in the brain for a longer period of time. They also pull serotonin out of the "serotonin stores" in the brain cells and put it into the synapses. However, as we learn so tragically from time to time when we hear of mothers on medication for PPD who harm or even kill their children, these drugs don t always work.

Why are so many people apparently suffering the effects of low serotonin levels? Serotonin and a group of neurotransmitters called the catecholamines—adrenaline (epinephrine), noradrenaline (norepinephrine), and dopamine—which are predominantly made by the adrenal glands—work together and need to be in balance within the nervous system. As the general level of stress with which we live has gone up, our adrenal glands have been induced to make more catecholamines. The brain then is faced with the need to make more serotonin to maintain a proper balance. It is estimated that the level of stress most of us face on a daily basis is 100 times higher than that faced by our grandparents. The world keeps getting more complicated, and our nervous systems keep trying to adapt. We have reached a point where many people s brains are having trouble making enough serotonin to match the levels of adrenal catecholamines required to cope with life.

There are a number of other factors that make it more difficult for our brains to produce enough serotonin. The brain needs a steady supply of the amino acid tryptophan and vitamin B₆ to make serotonin. Proteins in foods contain a very small percentage of tryptophan as compared with other amino acids. Only about three percent of the tryptophan in food is actually converted into serotonin in the brain.

The production of serotonin does not take place in a single step, but is a complicated biochemical process, and each of the steps along the way requires specific nutrients. Your body must have enough iron and vitamin B₃ (niacin) to convert tryptophan into a compound known as 5-hydroxy-L-tryptophan (5-HTP) and enough other B vitamins plus the mineral magnesium to convert vitamin B₆ to pyridoxyl-5-phosphate (P5P), the active form of this vitamin. Without enough 5-HTP and P5P available in the brain, serotonin can not be made at adequate levels. Doctors cannot simply give their patients serotonin to take orally or intravenously because it does not pass through the blood-brain barrier. The only way that the brain can get serotonin is to make it from the specific nutritional precursors available to it at the time.

The adrenal hormone cortisol, which is produced in response to stress, converts trytophan into a chemical called kynurenine, which cannot be converted into serotonin. If you drink coffee, smoke cigarettes, drink alcohol, eat chocolate, take diet pills, or just have a lot of stress in your life—and what mother doesn t?—your body may produce too much cortisol, increasing the tryptophan that is converted to kynurenine and limiting the amount available to produce serotonin.

The safety of SSRIs for the babies of nursing mothers has not been proven. Some studies have linked the maternal use of Prozac to colic in nursing infants. A baby with colic can push the most even-tempered mother over the edge. For this reason alone, giving such a drug to a mom with PPD doesn t seem like the best way to support her recovery. While studies have shown that little or no drug circulates in a baby s bloodstream, others that have looked at the concentrations of the drug in babies brain tissue have found much higher levels. Nothing is known about the possible harm this can do to a newborn.

Some mothers choose to take the drugs and not to nurse. This deprives their babies of the most perfect food they can be given, and deprives both mother and child of the important bonding that comes with breastfeeding. Mothers with PPD who miss out on the bonding experience of breastfeeding may end up feeling even more distant from their babies.

One potential side effect of SSRIs is a feeling of numbness, of separateness from others. Feeling numb does tend to blunt depression, but it may do so at the expense of a new mother s feelings of intimacy with her baby. Other common side effects of SSRIs include nausea, sleepiness, insomnia, sexual dysfunction, headaches, trembling, indigestion, abdominal pain, and nervousness. SSRI drugs also seem to lift normal inhibitions against violence and suicide in some people, and thus may even play a part in enabling an overwrought woman to commit one of the worst crimes imaginable—causing serious harm to her child.

Many experts, including Harvard University psychiatrist and author Joseph Glenmullen, M.D., and Peter R. Breggin, M.D., psychiatrist, author, and director of the nonprofit International Center for the Study of Psychiatry and Psychology (ICSPP), warn that SSRIs are overprescribed and that their dangers are drastically underplayed.

Dr. Glenmullen s book, Prozac Backlash (Simon & Schuster, 2000), warns that SSRIs can cause symptoms similar to those of Parkinson s disease—including facial and body tics and muscle spasms that may persist even after the drug is discontinued—in at least 10 percent of those who use them. This finding implies that SSRIs may create dangerously low levels of the neurotransmitter dopamine in some people. Moreover, the long-term effects of Prozac and similar drugs are not known, but some studies indicate that permanent brain damage could occur because the constant artificial elevation of serotonin eventually burns out receptor sites in the brain.

Never stop using SSRIs abruptly, as this can cause serious withdrawal symptoms. Taper off gradually with the guidance of a knowledgeable physician, hopefully one who is experienced in giving you increasing amounts of the nutritional precursors as you wean off the drugs.

Many women suffer from a kind of depression that results not at all from low brain serotonin levels but from low levels of norepinephrine. Increasing serotonin levels with drugs does not help this kind of depression. On the contrary, it often makes people even more tired and depressed. Women with low serotonin levels tend to have a great deal of anxiety, while women with low norepinephrine levels feel like they fell into a deep, dark hole and just cannot muster the energy to get out. People with low norepinephrine levels are often dramatically helped by restoring normal thyroid and adrenal gland function. Tyrosine (along with the mineral iodine) is also the main nutritional precursor for all the thyroid hormones.

I believe that the vast majority of cases of PPD can be prevented and/or treated successfully without resorting to drugs that may harm you and your baby.

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LETTERS FROM MY READERS

Dear Dr. Lee

THAT S A GOOD QUESTION

Q: I understand that pregnenolone precedes progesterone in the cascade of hormones made from cholesterol. This would make it seem sensible to take pregnenolone rather than progesterone.

A : Pregnenolone is an intracellular intermediary in the biosynthetic pathway from cholesterol to progesterone. Let me explain that in English. Pregnenolone is not floating around in the bloodstream hoping to find a receptor the way other hormones are; it s made in the mitochondria of the cell, and is then almost immediately converted into progesterone. The ovaries production of progesterone occurs in the specific follicle that released an egg. If ovulation does not occur or if the follicle is dysfunctional, progesterone is not produced. Think of it this way: if you want to make a cake and you have all the ingredients, but you don t mix them and put them in the oven, the cake is not going to get made. Adding more ingredients won t solve the problem. In the same sense there s no reason to think that adding pregnenolone will increase one s production of progesterone. If someone is deficient in progesterone, that someone needs supplemental progesterone.

Q: I have advanced breast cancer and am about to undergo preoperative chemo. I am 38 years old and hope to not become infertile from the chemo—I understand I have a 50/50 chance. I have found it difficult to find information about preserving fertility while on chemo. Some recommend Lupron to put the ovaries at rest during chemo. Would progesterone, as well as helping with the cancer, help maintain menses?

A : Lupron could be a good choice as it stops all ovary hormone production for about three months, including estrogen, testosterone and progesterone production. Some estrogen production continues by conversion (by aromatase enzyme) of adrenal androgens to estrone in body fat.

Since the majority of breast cancer cells have functioning progesterone receptors, and the majority of breast cancers are estrogen-driven, if it were me being given Lupron, I would use progesterone. I would supplement with progesterone in doses of 15 to 20 mg daily for 25 to 26 days of the month. Progesterone should be considered as a sort of generic cancer protector that might help and will not harm.

In regard to chemotherapy creating infertility, I doubt supplemental progesterone will change the odds.

Q: I had a hysterectomy with ovaries removed three years ago. I'm 47 years young, 5'10", small boned, and 125 pounds. I recently had my hormones checked via saliva test. Results were: estradiol 7.04, progesterone 6,646, and testosterone 51.0.

I do not take conventional HRT. I use a progesterone cream twice a day. I use up a tube in two months. I also use a phytoestrogen body cream. I was extremely dry in my vagina so went to a compounding pharmacy and use sublingual once a day estriol 2.5 and testosterone 0.625 mg. I'm vegetarian so I eat tofu and drink soy. I still have extreme hot flashes and every time I put the creams on I get a hot flash. I never drink sodas, my diet is low sugar (once-in-a-while desserts), high fiber, fruits, vegetables, exercise five times a week or more. What is the problem? Why is my progesterone up so high?

A : Your progesterone dose is probably too high. I tell most women to make the tube last for at least three months. Since your salivary level is so high, I would recommend that you make the tube last for four months and then change to making it last three months.

The best approach to treating vaginal dryness is usually vaginal estriol—the recommended dose is just 0.5 mg twice a week. The usual daily dose for testosterone after ovaries are removed is just 0.5 mg given as a transdermal cream, although sublingual drops can also work well.

Being slim (very little body fat), it is likely that you are deficient in estradiol as well. You probably need about 0.025 estradiol given as oral tablets. However, at the moment your saliva estradiol is high. This may be due to conversion of excess progesterone into estrone and estradiol. You need to seriously reduce your progesterone dose and repeat the saliva test in two months or so.

Take Care Until Next Month,

John R. Lee, M.D.

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John R. Lee, M.D.
info@johnleemd.com
Copyright Hormones Etc. Inc., 2003 All rights reserved.
Reproduction of any kind is prohibited without express written permission of the author.

The John R. Lee, M.D. Medical Letter is a private medical letter based upon the opinions of its Editors. It is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice, but as a sharing of knowledge and information from the research and experience of the editors and a network of readers, health care professionals and scientists. We encourage you to make your own health care decisions based upon your own research and in partnership with a qualified health care professional