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Should You Opt for Natural Progesterone Treatments for Endometriosis?

Hormone therapy may be prescribed to help treat endometriosis pain and discomfort. Here’s what to know about the different types of hormones available.

By Meryl Davids Landau

Medically Reviewed by Kacy Church, MD

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Progesterone creams and suppositories are used to help treat endometriosis.
Progesterone creams and suppositories are used to help treat endometriosis.
iStock.com; B. Boissonnet/Alamy

Treating endometriosis with hormone therapy is common. Many doctors prescribe a combination of estrogen and progesterone — typically via a birth control pill — to help treat endometriosis, a condition in which tissue similar to the lining of the inside of the uterus, called the endometrium, grows outside the uterus. Sometimes, though, your doctor will prescribe progesterone alone.

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This hormone comes in two different forms. One, called progestin, is synthetic; the other, natural progesterone, is made in the lab from plant material.

If you’re going on progesterone to help ease pelvic pain and other endometriosis symptoms, is there a reason you should use one type rather than the other?

The Benefit of All Progesterones

The reason doctors prescribe progesterone is that, taken continuously, it tends to “thin the lining of the uterus … and has similar activity against endometriosis lesions themselves,” according to "Medical Treatments for Endometriosis," an article on the Brigham and Women’s Hospital website.

“Progesterone can quiet the endometrial tissue in the abdomen,” by limiting its growth, explains Amanika Kumar, MD, a gynecologic oncologist at the Mayo Clinic in Rochester, Minnesota.

RELATED: What to Do When Sex Hurts With Endometriosis

The exact role progesterone plays in the development or exacerbation of endometriosis is not well understood. But a mouse study published inPLoS Onein October 2019 found that animals given progesterone before endometriosis lesions were introduced subsequently had less disease progression and inflammation.

Different Forms of Synthetic Progesterone Are Available

Synthetic progesterones, known as “progestins,” are available in several different forms. Pills include Aygestin (norethindrone acetate) or progestin-only birth control pills such as Camila and Nor-QD (norethindrone).

The intrauterine device Mirena (levonorgestrel) also releases progesterone solo. And the birth control injection Depo-Provera (medroxyprogesterone) is progestin-only.

What Is Natural Progesterone?

Also known as a bioidentical hormone, natural progesterone is a hormone derived from plant fats and oils. It is altered in the lab to more closely resemble the progesterone in the body. Products are labeled United States Pharmacopoeia (USP) progesterone, which means they meet standards for product quality.

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Natural progesterone is available by prescription in several products made by pharmaceutical manufacturers. These include Prometrium (progesterone, USP), in 100 milligram (mg) and 200 mg capsules, and the vaginal gel Crinone.

Natural progesterone can also be manufactured in local compounding pharmacies. Here, your doctor orders any dosage, and the pharmacy creates the drug in that amount specifically for you. Compounding pharmacies make progesterone products in capsules, topical creams, and vaginal suppositories.

Is Natural Progesterone Safer Than Progestin?

According to an article published in Harvard Women’s Health Watch, women typically flock to bioidentical hormones because they think they might be safer than synthetic hormones.

What We Know About Natural Progesterone

But as the article notes, natural progesterone has not been studied in the same large, long-term clinical trials as synthetic hormones have been. The famed Women’s Health Initiative (WHI), for example, followed more than 160,000 women over 15 years (its primary study was for progestin and estrogen treatment together, for women around menopause). In results published in January 2013 inObstetrics and Gynecology, researchers concluded that long-term use of these hormones in tandem increases cardiovascular, breast cancer, and other risks.

Still, smaller studies have found health benefits of natural over synthetic progesterone. A review of three studies published inSystematic Reviewsin July 2019 concluded that natural progesterone “was associated with lower breast cancer risk compared to synthetic progestins” (when taken along with estrogen therapy). The study authors note that no good research has tracked the difference for heart attack risk or stroke, other problems identified in the WHI.

Why Is Progesterone Preferred to Progestin by Some Physicians?

Some gynecologists, especially those practicing integrative or holistic gynecology, prefer natural progesterone to synthetics when treating women with endometriosis.

“Natural progesterone has far more anti-inflammatory properties, fewer side effects, and is very versatile in how it can be used,” says Anita Sadaty, MD, a gynecologist in Roslyn, New York, who prescribes the natural version for most of the endometriosis patients she treats with this hormone.

Dr. Sadaty selects the delivery route depending on the woman’s needs and desires. Vaginal suppositories are used for local pelvic pain control; topical creams help with mild symptoms; and oral pills quell pain as well as aid the sleep issues, breast tenderness, and irritability that can accompany endometriosis, she says.

Doctors May Not Know Enough About Treating Endometriosis

Asked why more doctors don’t prescribe natural hormones, Sadaty says, “There is a lack of understanding regarding the differences between natural and synthetic versions of progesterone. Additionally, most doctors are not educated in how to dose or use natural progesterone.”

All Types of Progesterone Carry Warnings

As with the synthetic versions, all natural progesterones made by pharmaceutical companies must carry a black box warning, alerting users to the potential risks discovered in the WHI.

Drugs compounded by a local pharmacy are not required by law to include this warning. But as the Harvard Women’s Health Watch article notes, this doesn’t mean they are safer, just that the compounding pharmacies do not have to detail the risks.






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Date: 03.12.2018, 16:59 / Views: 93352