The Basic Facts

This is a summary of What Your Doctor May Not Tell You About Menopause, by John R. Lee, M.D. with Virginia Hopkins, 1996, Warner Books. Information from Dr. Lee's Newsletters and Dr. Ray Peat's books is also incorporated. Dr. John R. Lee worked as a family physician until he retired in 1989. This book tells of his years of detective work that started with an experimental use of natural progesterone cream for the treatment of osteoporosis. It lead to the discovery of a whole array of symptoms that result from progesterone deficiency. I strongly urge everyone to read this book. Dr. Lee's this book is available online at and at his Web site. Dr. Ray Peat is an endocrine physiologist/nutrition consultant who pioneered the physiological study of progesterone as well as formulation and application of natural progesterone cream and oil. His newsletters and books written for general public can be found at Dr. Ray Peat's Web site. I recommend Progesterone in Orthomolecular Medicine as an excellent Introduction.

For more up-to-date information, read Hormone Balance; a Matter of Life and Health by Kristine B. Klitzke, R.N. 2002, Sound Concepts, Inc. (available online at


Normal Estrogen - Progesterone Cycle




Related Events

Day 1, Menstruation


A few milligram(mg) per day

If pregnancy does not take place, the uterine lining is shed (menstruation), and another monthly cycle starts.

Day 3



GnRH from hypothalamus stimulates the pituitary to send follicle stimulating hormone to the ovary, initiating follicle (egg sack) maturation and thickening of uterine lining.

Day 10

Surge to high


Mature follicle releases estrogen to promote thickening of uterine lining and to stimulate the pituitary gland's secretion of luteinizing hormone that induces ovulation.

Day 14, Ovulation


Starts to rise
up to 30 mg/day

If ovulation fails, Progesterone is not produced.

Day 24

Drops to low level

Drops to low level

If the egg is fertilized, progesterone from ovary continues to rise. Any drop in progesterone level results in menstruation or miscarriage. Later during pregnancy, the placenta produces up to 3000 to 4000 mg/day of progesterone .

Day 1, menstruation



The drop in estrogen and progesterone level triggers menstruation as well as GnRH secretion in hypothalamus.

After menopause

estradiol: 15% of premenopausal level
estrone: 40 to 50% of premenopausal level


Estrogen still produced in fat, muscle and skin cells by converting androstenedione produced in the ovary and adrenals. Low level of progesterone still produced by adrenals and brain.

Multiple roles of progesterone and the effects of progesterone deficiency

  • Stimulates new bone formation and prevents/reverses osteoporosis.
    Bones are continually renewed. In the renewal process, bone cells called osteoclastds dissolve or resorb old bone and osteoblasts produce new bone. Bone loss occurs when more bone is resorbed than is being produced. Progesterone stimulates osteoblasts-mediated new bone formation. Dr. Lee's patients treated with progesterone cream demonstrated remarkable bone mass gain. Those who had more advanced osteoporosis gained the most (average 23% gain in bone mineral density in three years).

    Bone loss in pre-menopausal women occurs with progesterone deficiency that results from anovulatory cycles (menstruation without ovulation). Women athletes who train too hard often have anovulatory cycles and develop osteoporosis, indicating exercise alone dose not prevent bone loss.

    Progesterone cream combined with some nutritional supplement and moderate exercise is one of the safest, most effective, and logical bone loss prevention/reversal treatment known to date. It is also effective for men who is at risk of osteoporosis after surgically or chemically removing male hormone due to prostate cancer. All other alternatives such as estrogen, Fosamax (a biphosphonate), Evista, calcitonin, and fluoride have limited effectiveness and unpleasant, if not serious, side effects. Fluoride is a potent enzyme inhibitor and causes pathologic changes in bone, making bone brittle. The rest derive their benefits by inhibiting resorption of old bone and loss of calcium. None of them work on formation of new bone. Accumulation of old bone slows down the formation of new bone and make bone brittle by third to fourth year of use.

    Note: Recent studies indicate Human Growth Hormone (HGH) therapy is also effective in regenerating bone tissue and cartridges as well as other organ tissues. For more information you can read Grow Young With Hgh : The Amazing Medically Proven Plan to Reverse Aging by Ronald Klatz, Carol Kahn. Enrich offers highly effective and affordable HGH precursor supplement product called Enjuvenate. You can order this product by calling 1-800-307-3366 (distributor# R474315R, product# 13708).

  • Provides the precursor for adrenal cortex hormones (corticosteroids). Progesterone is the major precursor of the important corticosteroid hormones (aldosterone and cotisol) made in the adrenal cortex. They are responsible for mineral balance, sugar control, and response to stress of all sorts, including trauma, inflammation, and emotional stress. A lack of corticosteroids can lead to fatigue, immune dysfunction, hypoglycemia, allergies, and arthritis. Often, progesterone supplementation effectively resolves these problems. When progesterone from ovaries is absent or low, adrenal gland steps up its hormone production that includes androgenic (masculinizing) hormones as well as progesterone. This causes facial hair growth and thinning of hair.

  • Cures variety of skin problems .Acne in adult women, seborrhea (flaking itching skin), rosacea (rose-colored, flaking inflammation of skin), psoriasis (red, scaly patches), and keratoses (hard hornlike bump) are known to clear up by progesterone cream treatment.

  • Promotes Myelin sheath production Myelin sheath protects nerve fibers and speeds nerve signals. Weak myelin sheath interferes with nerve signal transmission and increases pain.

  • Eliminates the need to take estrogen replacement.
    Dr. Lee treated post-menopausal women who could not use estrogen replacement and discovered that most of them do well just with progesterone. A recent study has shown that 2/3 of 65 to 80 year old women tested for blood serum estradiol levels had levels high enough (5pg/ml) to protect bones without any hormone replacement therapy.

    In general, post-menopausal women produce estradiol at 15% of pre-menopausal level and estrone at 40 to 50% of pre-menopausal level. Estrone is produced mainly in fat cells by converting androstenedione produced in the ovary and adrenals. Estradiol is produced in the gut and lever from estrone.

    Progesterone helps the body use estrogen better by increasing the estrogen receptor sensitivity. Being a precursor of androstenedione, progesterone supplementation may also help estrogen production.

    Both estrogen and progesterone, when taken orally, must be processed by the liver and in the process, thickens bile and promotes gallbladder disease. Estrogen pills also increase production of the enzymes renin and angiotensin in the kidneys, which cause an increase in blood pressure. To avoid these adverse effects, patch, cream, or gel can be used.

  • Progesterone and depression In most cases, progesterone can alleviate depression that accompany PMS, menopause, postpartum depression, etc. (Note: Progesterone is known to have "calming" effect, which can give euphoric feelings. however, Gillan Ford in her book, Listening to Your Hormones describes her experience of progesterone injection not helpful at all with her depression/PMS and that only estrogen's stimulating effect could help her. Elizabeth L. Vliet also describes her estrogen therapy for PMS in her book Screaming to be Heard. It is unfortunate that they did not know about natural progesterone cream at the time and only tried less effective forms of progesterone supplementation. Dr. Ray Peat points out that progesterone injection was not a very effective way of administering progesterone because of the ineffective or toxic solvent used. Further more, he warns that the brain stimulating action of estrogen can make a woman feel that she has more energy, but this brain stimulating effect of estrogen is damaging to the brain and a possible cause of Alzheimer's Disease. See Newsletters on Aging. )

  • Maintains pregnancy.A sudden drop in progesterone level results in menstruation or miscarriage and the fertilized egg is aborted. RU - 486 mimics a sudden drop in progesterone level by blocking the progesterone receptor sites.

    (Note: A large dose of birth control pills containing synthetic progestins and synthetic estrogen is often used as morning after pills. It's exact effects in blocking pregnancy is not known. One possibility is the toxic effects it has on the ovaries, uterus, and the egg. Both the synthetic estrogen and synthetic progestins used in the birth control pills are toxic and many women experience strong side effects using large dose as morning after pills. Interestingly, the mini pills which contain synthetic progestins alone seem more effective and have far less side effects compared to regular pills which contain synthetic estrogen as well as progestins.)

    A person trying to use natural progesterone cream to sustain pregnancy must monitor the ovulation and conception closely and start using the progesterone right after the ovulation, and should not stop until the placenta starts to produce progesterone at about the third month. Also, many brands of natural progesterone cream contain herbs, but their effects on pregnancy and breast feeding are not well known. It is best to avoid those products that contain herbs during pregnancy and breast feeding.

  • Progesterone and brain
    Brain is another organ where progesterone is produced. Normally, brain cells maintain a high concentration of progesterone and brain injuries recover faster with progesterone. Animal studies have shown that the levels of prenatal exposure to progesterone correspond with the baby's brain size and learning ability. There are many reports of restored mental capacities in women and men who used progesterone cream.

    Major Cause of estrogen dominance/progesterone deficiency symptoms

    Estrogen dominance is a condition where estrogen's toxic effects are not countered by progesterone. When there is a progesterone deficiency, a woman experiences a variety of estrogen dominance symptoms. Progesterone is the key to a woman's hormonal balance.

    Before and around menopause

    1. Failed ovulation: commonly seen by 35. Age and stress are the major factors. Exposure to xenoestrogen chemicals in food and water may also cause early follicle burnout.
    2. Birth control pills: synthetic progestins commonly prescribed for HRT and birth control cause many symptoms similar to estrogen dominance, and too much estrogen in birth control pills may cause early follicle burnout.
    3. Hysterectomy: even when ovaries are left intact, the change in blood flow in the area can cause ovary dysfunction or atrophy.
    4. Low progesterone production at corpus luteum: A lack of vitamin A, an excess of carotene, uterine irritation, low thyroid are the known factors. Since progesterone can facilitate thyroid, progesterone supplementation or thyroid supplementation can break the vicious cycle of low thyroid and low progesterone.
    5. Overproduction of estrogen: Since fat cells produce estrogen, overweight can lead to overproduction of estrogen. Also when ovaries do not respond, increased estrogen production may result to stimulate ovaries.
    6. Failure to eliminate estrogen: Liver's ability to neutralize estrogen to eliminate it from the body can be impaired by various causes. Slow colon movement can cause resorption of estrogen from the intestines.
    7. Excessive conversion of progesterone to other hormones: Stress coping hormones such as cortisone are produced from progesterone. Thus, high stress can reduce the effects of progesterone and shift the hormone production in favor of other hormones. Large doses of progesterone have anti-stress effects and protect adrenal gland.

    After menopause
    After menopause (natural or surgically induced), ovaries no longer produce estrogen or progesterone.

    1. Estrogen replacement therapy: This is routinely used after natural or surgically induced menopause, and is the major cause of estrogen dominance after menopause. Estrogen should never be used without progesterone. Most post-menopausal women have enough estrogen without ERT. (If you are on ERT, quitting cold turkey is not recommended, reduce it gradually monitoring your body's response and increasing the progesterone dosage to help the transition.)
    2. Overweight: Since fat cells produce estrogen, overweight can lead to overproduction of estrogen.

    Synthetic progesterone (progestins) are NOT progesterone

    Synthetic progestins (e.g. levonorgestrel, medroxyprogesterone acetate in contraceptive and HRT pills) are different from natural (human) progesterone in their molecular composition. Synthetic progestins perform some but not most of the functions of natural progesterone. Birth control pills and Provera contain synthetic progestins, and are frequently prescribed for miscarriages, irregular or heavy bleeding, and various pre and post menopausal symptoms. Synthetic progestins come with a long list of side effects and health risks, many of which are serious (see pages 86-88 of Dr. Lee's book). Oddly, many doctors seem to have mistaken belief that medroxyprogesterone acetate (Provera) is identical to human progesterone. Natural progesterone cream is the best source of progesterone supplement and readily available. There is no reason to use synthetic progestins.
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