Menopause Hot Flashes and Night Sweats
John Lee, MD claims that he uses topical progesterone for menopause hot flash symptoms in the book, "What Your Doctor May Not Tell You about Menopause.". One study showed that 83% of women that used progesterone cream reduced or eliminated their hot flashes from menopause using progesterone. The study was done at St. Luke's Hospital in Bethlehem, Pennsylvania. They randomly assigned 102 healthy menopausal women to either a placebo or topical transdermal Natural Progesterone Cream. 30 of the 43 (69%) in the treatment group initially complained of hot flashes. While 26 of the 47 (55%) in the placebo group complained of hot flashes. 83% (25) of the progesterone cream patients reported that their hot flashes either reduced or were eliminated altogether. 19% (5) of the placebo group reported the same reduction of symptoms of hot flashes of menopause.
Hot flashes and nights sweats are not totally biochemical. There is an emotional component to them as well. At my church, I had one woman that was complaining of hot flashes and night sweats. So I gave her a sample bottle of Progestelle to try. I saw her a month later, and asked if she had tried it. She said, "No, I never tried it. My husband I and went to Maui for 2 weeks and the hot flashes disappeared. Now, I am back, and the hot flashes are still gone." I suspect that stress and the way you react to stress changes the brain chemistry and body chemistry.
For those patients, where progesterone alone does not work well enough, I give them 0.5 mg/day of topical natural estriol every other day, but not every day. Do not take topical estriol every day. The excretion rate of estriol is slow. So if you take topical estriol every day you will have a build up of estriol which is not good. Usually, estriol is not needed.
The body produces 3 natural estrogens - estradiol (E2), estriol (E3), and estrone (E1). Estradiol is the strongest estrogen, it produces the "femaleness" of a women, the breasts and hips. Too much estradiol for too long will increase breast cancer rates. In contrast, estriol and estrone are weak estrogens that go into the estrogen receptor and block estradiol. Physicians are backing away from estrone because breast cancer patients seem to have a higher level of estrone. I, myself, like to use estriol for my patients.
Estriol is the hormone of pregnancy. It goes up over 100 times over baseline during pregnancy. And what do we know about pregnant women? Women that are pregnant many times have a smaller chance of breast cancer and endometrial cancer. And women that are pregnant have high levels of progesterone and estriol. Therefore, giving natural progesterone and natural estriol may actually decrease breast cancer and endometrial cancer rates. Natural Progesterone and natural estriol are likely to be fairly safe.
Progesterone increases vaginal lubrication and slightly thins the skin and generally makes the skin complexion better. Estriol, in contrast increases the skin thickness for passage of the baby through the birth canal. So if you have vaginal dryness use natural bioidentical progesterone to increase vaginal lubrication. Sex drive should also increase. If progesterone does not work to increase vaginal lubrication, then you may be simultaneously taking a xenoestrogen that is causing vaginal dryness. Estriol is the hormone to use for vaginal atrophy. Estriol will increase the thickness of the vaginal skin, this will get rid of bleeding on intercourse for those with vaginal atrophy. Be careful of the cream base that the estriol is in as many of the cream bases contain some kind of phytoestrogen or xenoestrogen.
Implausible as it may seem, the medical mainstream establishment does not completely understand why hot flashes and night sweats happen. Here is an excerpt from John Lee, MD's book, "What Your Doctor May Not Tell You About Menopause," page 128 about hot flashes and menopause.
Around age 45 to 50, sometimes a little earlier or later, estrogen levels begin to fall. When they fall below the levels necessary to signal the uterine lining to thicken and gather blood, the menstrual flow becomes less and/or irregular, eventually stopping altogether.
Let's zero in and take a closer look at hot flashes, the hallmark of menopausal symptoms. The prevailing explanation is as follows: Recall that an area (which we'll call the GnRF center) in the brain's hypothalamus monitors estrogen and progesterone level. When levels fall, the center makes GnRH, which stimulates the pituitary to make hormones (FSH and LH), which in turn result in the ovarian production of estrogen and progesterone. The rise in these hormones inhibits further production of GnRH. At menopause, estrogen levels and progesterone levels are usually already low. The ovaries no longer respond to the FSH and LH prompt.
When a women's ovaries don't respond to th FSH and LH signals by ovulating, the hormone signaling system can go awry. In effect, the hypothalamus begins "shouting," trying to tell the pituitary to tell the ovaries to ovulate. The inability of the ovaries to respond is most likely due to a final depletion of eggs and their surrounding follicle cells. This over reactivity of the hypothalamus and pituitary signal begins affecting adjacent areas of the brain, which we'll call the vasomotor center (specifically the arcuate nucleus of the hypothalamus that controls capillary dilation and sweating mechanisms), and these are the women who do get hot flashes and night sweats. In addition to hot flashes and night sweats, the heightened activity of the hypothalamus can cause mood swings, fatigue, feelings of being cold, and inappropriate responses to other stressors. Many women will have symptoms of hypothyroidism despite normal thyroid levels.
In a nutshell:
1. The GnRH center effectively signals to increase estrogen and progesterone synthesis.
2. Elevated estrogen and progesterone inhibit GnRH release.
3. After menopause, the ovaries no longer make estrogen and progesterone.
4. Lack of estrogen and progesterone response results in increased activity of the GnRH center.
5. Heightened GnRH activity activates the vasomotor center, causing hot flashes and perspiration.
It is important to recognize that the GnRH cneter monitors both estrogen and progesterone. Thus, since the postmenpausal woman continues to make estrogen in respectable levels and makes little or no progesterone, hot flashes may well respond to progesterone supplementation alone. Hot flashes will also respond to much smaller doses of supplemental estrogen when progesterone is added. Even synthetic progestins like Provera (medroxyprogesterone acetate) or Megace (megestrol acetate) have been found effective in treating hot flashes, further indicating that estrogen per se is not the only factor in hot flashes.
The truth is that estrogen is only one part of the menopause picture and certainly is not a cure-all. In fact, these days I hear more complaints about the side effects of taking estrogen than I do about menopausal symptoms.
In my clinical experience, progesterone alone works well for most patients with menopause symptoms. Chronic xenoestrogen exposure in the form of lotions, laundry detergent, shampoos and lotions causes the estrogen receptor to "become sleepy". The chronic large load of xenoestrogens causes the estrogen receptor to down regulate. Because of the load of xenoestrogens on your skin, you become less sensitive to estrogen.
Bioidentical progesterone "wakes up" the estrogen receptor, and your body regains its original sensitivity to estrogen. And it seems like you are getting more estrogen even though you are not. This is because the progesterone "wakes up" the estrogen receptors.
This is why for most women progesterone alone will work to stop hot flashes and night sweats. Your body has stopped producing progesterone, and the estrogen receptors are being "woken up" by the progesterone to make it seem like you are getting more estrogen. That is why most of the time you do NOT need estrogen, only progesterone.
Bioidentical progesterone alone is fine for most women suffering from menopausal symptoms.
There are some patients that have very low estradiol. These women usually have fear / stress / anxiety issues. Because these women have fear / stress / anxiety issues, their body makes cortisol. Because they make so much cortisol, their estradiol production is low. The cortisol production steals from estradiol production. These patients have horrendous hot flashes and night sweats. I suggest that the patient goes to a church seminar at www.beinhealth.com to get rid of the fear / stress / anxiety.