Progesterone and the Cascade of Aging

[music] KATHY: Welcome to the BioBalance Healthcast. I’m Dr. Kathy Maupin. BRETT: And I’m Brett Newcomb. And today we’re going to be talking about the second in the hormone trilogies. We talk a lot about testosterone and testosterone being the trigger event or the first domino that falls in the cascade of aging and the subsequent deterioration that comes from the cascade of aging. And the second one of those dominos that falls is a difference hormone, and it’s called progesterone. And progesterone, I guess they’re all unique. They each have their own specific things that they do. KATHY: They have their role. Everything in your body has its specific role. And progesterone’s role is to balance estrogen and to prepare the lining of the uterus, this is the original role, to prepare the lining of the uterus. BRETT: The original role and then there’s the revised role. KATHY: No, and then there’s the role that happens after you start aging. The real function of progesterone is to balance estrogen in the second half of the cycle. It doesn’t even occur until day 14 or when ever your ovulation day is. And then on ovulation we get exposed to progesterone to balance out the estrogen, to make a nice cozy home for an embryo to implant. And if there’s no embryo, then what happens is it sheds. So 14 days is all we make it and then it sheds and we have a period. And when we have a period, progesterone drops to almost nothing and our estrogen drops as well. Testosterone stays the same, it’s stabilizing. And then we start all over again the next month. Estrogen first and then testosterone is always there and progesterone starts on day 14. So it’s this never-ending cycle until you hit peri-menopause or menopause or after your testosterone leaves or decreases then our progesterone starts dropping or is nonexistent and our estrogen is unbalanced. BRETT: So that’s the issue. When the progesterone isn’t there even though you’ve gone through menopause and you’re not having that same 28 day cycle. If your progesterone drops then the negative effect of that is that your estrogen is larger by comparison, it’s bigger than it should be? KATHY: You know estrogen isn’t produced after menopause. But after TBS, it’s still being produced. It’s the last hormone to go. So the first thing is testosterone, then progesterone going down or stopping. And then we still have estrogen. So estrogen is making the lining very thickened and it’s making it unstable. And so that’s why people bleed a lot. Before menopause there’s a lot of bleeding and fibroids grow because fibroids grow under the influence of estrogen. And progesterone usually holds them at bay. BRETT: Fibroid tumors? KATHY: Fibroid tumors in the uterus. And that can cause bleeding or a hysterectomy. So that whole imbalance is the reason for many difference procedures and problems in OB/GYN. BRETT: So you were telling me in ACOG, which is? KATHY: The American College of OB/GYN, which I’m a fellow in ACOG. BRETT: That ACOG does acknowledge the existence of PMS. KATHY: Progesterone dropping is PMS. It does cause PMS. BRETT: So it’s a real event, it really does happen; women really do suffer from it. But they don’t agree that it’s triggered by, that it’s precipitated by the drop in progesterone. But experientially. KATHY: Right, and physiologically it makes sense because if you draw blood work with people with PMS then you compare it to people who don’t have it. There are several studies like this. Then the progesterone is low during that second cycle in people with PMS. BRETT: So we’re back to the issue of correlation verses causation. You can track it and say look this data flow is consistent across the spectrum, but they’re willing to say yes it’s consistent but they’re not willing to say it’s causative. And at the end of the day does it matter if there’s a treatment that makes people feel better? KATHY: Right that’s true but they say that PMS is a lack of serotonin. Serotonin is a neuro-transmitter and low and behold progesterone stimulates serotonin. So, they are telling us, well yes we know that progesterone is in the cycle and we know, in the second half of the cycle, and we know that PMS is in the second half of the cycle but they’re skipping the hormone that causes it. And they’re getting to the outcome which is a lowered neurotransmitter called serotonin and that gives us depression. BRETT: It’s like the color wheel that you learn about in grade school. You put these two colors together and you get this color. And they say yea that color exists but they don’t say you put these two together to get it. KATHY: Yes and there have been a lot of studies on this and they don’t recognize or acknowledge the studies that it is progesterone in between these two things. BRETT: Right they say you have testosterone, you have progesterone, you have serotonin, you have depression but they’re all independent little colors on the color wheel and they’re not saying you pull them together in these combinations to get this. KATHY: Right and get the outcome. Now lack of testosterone can cause a drop in serotonin as well. And we see depression with lack of testosterone. So often times when dealing with depression after you’ve ruled out situational depression we’ve talked about that, situational depression and depression from a family history source, or an endogenous source, has no cause and it has no relationship to hormones. When you’ve ruled those out, then you get to, let’s look at a women’s, cycle; let’s look at her levels of estrogen, testosterone and progesterone. But we can only look at progesterone in the second half of cycle so we have to do multiple blood draws. And we often find that testosterone is low when all the way across the cycle and that causes depression, even if the progesterone is normal. Now when progesterone is low and testosterone is low, which is what happens in our 40’s. We already have lost our testosterone, it’s dropped, and if we haven’t replaced it then our ovaries stop making a good level of progesterone. So the depression you might have survived from lack of testosterone, is now even worse, and it’s even worse in the second half of your cycle. Not your cycle. BRETT: No, no. One’s cycle, a cycle. KATHY: A woman’s cycle. So in that way by replacing one, the testosterone, we generally can get rid of depression in women prior to menopause, and we also need progesterone when it’s prior to menopause, and after menopause we just need testosterone and estrodial. That I have no answer for, that I don’t have a study for, I don’t have answer for and I can’t tell you why that happens. But progesterone doesn’t seem to get along with women after menopause. And we don’t give them enough estrogen to really warrant progesterone unless they have a uterus. And that’s another caveat. Medicine is really complex and when I start to take it apart into why we do everything, then I realize how complex it is, because in my mind I go through twenty neuron synapses. BRETT: It’s like a decision matrix that you have to go check, check, check, check, check to get to. KATHY: Which is why it’s very individualized and so important to go to someone who knows what your suffering from and what your cycle is or no cycle, if you’ve had a hysterectomy or not, knows all of your history, knows whether you’ve had your depression (or whatever symptom) evaluated, and puts it all together BRETT: It’s both a science and an art. You have to know the science, and you have to know the data. But the art comes in your skill of sort of riding the waves of the data to make an intervention. If you just look at the data and you don’t have the causal link then you’re back to saying there’s no color wheel, there’s just a set of colors on a continuum. Like a rainbow, they go from this color to that color. You have to be able to listen to what a patient is telling you, describe their symptoms, look at their data and then know empirically what has worked in your experience for that patient. KATHY: I’m not positive that every doctor needs to understand the physiology, but when my mind works and I’m looking at a patient, it really helps that I go back to the basic physiology of what’s going on. At this point in time, what hormones is she producing, what nuero-transmitters is she producing? And in my mind. BRETT: What side effects is she complaining of? Is she depressed? Is she lethargic, is she angry? KATHY: Has she gained weight, has she lost her libido? My main question when someone has signs of PMS, lack of progesterone, is how’s your libido? Now, their libido could be gone during the second half of the cycle and be okay on the rest if they’re so angry because they don’t have progesterone, they get that anger symptom of PMS. However most of them say. BRETT: So you’re telling me that when women get angry their libido is impeded? KATHY: Well who would want to have sex with someone that’s really, really, really angry? BRETT: Really mad, exactly, KATHY: I’m not sure if their libido’s impeded. That study hasn’t been done either. BRETT: But again, it’s not a causal connection, it’s a correlated connection. KATHY: It’s a correlated connection, I can’t put the cause and effect to that. But generally if I think this patient has PMS, clearly she has symptoms that start mid-cycle, and end with the end of the cycle. She has relief with a period. When she has a period she feels better. Patients usually say I only have one good week a month. That’s my favorite statement because then I know that is PMS. BRETT: And that’s your window of opportunity, is that one good week a month, the rest of it she’s like stay away from me, don’t touch me. KATHY: Right, it’s usually when they’re having their period. And that may be problematic for some people. BRETT: Because the progesterone is in the mix and that offsets the negative effect. KATHY: No, because their estrogen went down, their estrogen went down so they don’t need the progesterone. So right at a period both hormones drop, you’re asking me the questions that everybody asks me in my office. So when both hormones drop you don’t need the progesterone to balance your estrogen. The testosterone is still there, if you have testosterone. Now sadly if you’re 45 and your testosterone already dropped and you’re already getting PMS. I always view it as the red tent. Only it’s the male nomads leave the tent for a different reason and everybody’s living in the same tent, everything’s great, and then they hit 40 and there’s no sex drive so a portion of these guys are going to go gone, because we don’t have a sex drive anymore we don’t feel like we need them. No testosterone makes you feel like ‘what are you still doing here home, why are you here? I don’t need you anymore’. It makes your brain think like that. So that’s the first step. Then if they were lucky enough to live to 50 and they got to mid 40’s then half the month, I’m not trying to be demeaning to women, they tell me that they do this, they’re screaming and yelling at their children and they’re screaming at husbands that no one is doing anything right. Then another portion of the men are like ‘see you later’. I mean PMS breaks up marriages. I mean it really does. BRETT: Yea it absolutely does. KATHY: If you don’t fix it. And then we get to those last little nubbin of guys that were so kind and nice and then they get to menopause then that’s it they’re done, because no sex, sex hurts for their partner and their partners are still not happy, they’re not having the cyclic who am I going to be today, who am I going to be tomorrow. But they have this, ‘I don’t need you, why are you still here’, from the no testosterone. And then they go into a shriveled up state, in most cases, not everybody and they’re not interested in anything they lose their energy. So the rest of the guys, unless they’re depressed are like ‘see you’. So I just visualize all these exoduses over time. BRETT: So you’re using a lot of pronouns, they and their, you’re really talking about messages from women to men. KATHY: To their spouse, to their partner. BRETT: I don’t need you, why are you here, I’m not interested in sex, you’re getting on my nerves, leave me alone. KATHY: It doesn’t necessarily have to be men. BRETT: It can be to children too. KATHY: No but my patients that are lesbians do this with their partners and their partners come in and say “what happened?” it’s not just that we start screaming at men. I mean I remember doing this and I remember investigating PMS back in the 80’s that was a lifetime ago. BRETT: Well and they say this is not me, this is not the way I’ve always been, and I still love this person but I don’t have any energy for that. And I don’t want it and I’m not interested. KATHY: I mean I would get to work and I’d know it was going to be one of those days and I’d walk up to the reception and say “oOkay, today is going to be a bad day for me so tread lightly because I don’t want to lose my temper.” BRETT: Didn’t you feel crazy because you know your body was doing something and you don’t have any control over it. KATHY: Yes, I felt crazy. Right I mean that was 1985 after I had had my daughter. It was even worse post-partum and then in 1986 it got worse and worse and my patients started coming in saying the same things. I ended up trying vitamins. BRETT: Oh yeah. You try all that stuff. KATHY: I tried vitamins because there was a psychiatrist in our building who I’m good friends with and he said oh nutrition, nutrition. It helps progesterone, it helps PMS. BRETT: Red die number 2, don’t eat any sugars, yeah you try everything. KATHY: Right, and really the vitamins helped a little. They took a little bit of the edge off. So magnesium was the primary thing in the vitamin, there were some other herbs, and it did work. But then I still got back to the fact that it didn’t work at all for some women. It barely worked for me and I was in my 30’s, I didn’t want to be like that the rest of my life. So I talked to the pharmacist who made my vitamins, these vitamins for PMS. And he said “oh yeah you know, just think about it, it’s progesterone. Why don’t you have your patients try progesterone suppositories?” That’s all they made progesterone, natural progesterone, in. You can’t swallow progesterone and expect it to be progesterone when it hits your body. So it can’t be a pill. BRETT: Because of that first pass effect? KATHY: Right, it goes though your stomach and gets changed. There are two new preps of progesterone that sometimes work. And one is done by a compounding pharmacy in Colorado and one is prometrium which is an Rx which is a natural progesterone that you can get with a prescription. It doesn’t always work this way. But most of the time you have to take progesterone non-orally so you have to take it under the tongue, in the ***, in a cream. BRETT: Non-orally means you don’t swallow it, you can put it under the tongue. KATHY: You don’t swallow it, you can put it under your tongue and let dissolve into your blood stream. It goes directly into your blood stream. BRETT: And that’s called sublingual. KATHY: Sublingual. BRETT: And you did that. KATHY: Buckle, you can have a lozenge. That has progesterone in it. BRETT: You don’t swallow it, you let it dissolve. KATHY: You don’t swallow it, you let it dissolve. You swallow too much of that so I usually don’t write that. And then there are creams but creams have to be applied all day long, basically and it just has a short half life. BRETT: Every so many hours you have to stop every so hours. KATHY: So at that time they had *** suppositories. And that’s what I offered my patients and they used them and they were better. Now they weren’t better with the vitamins but they were better with that. NB: So the absorption that way balances it out over time. So with the creams you’re better for a couple of hours. KATHY: Creams just have a short half life. That means half of its gone in just a few hours. In general not all times, but in general. So you’re going to put it on the inside of your arm or you‘re going to put it on the inside of your thighs because it’s thinner skin. And that has to be applied kind of all day long like every 4 hours. BRETT: And it’s not consistent dose absorption? KATHY: Right then you’re like “better-PMS-better-PMS.” That’s not a good thing either. Consistent dose of progesterone is really important. BRETT: What if you’re a working woman, if you’re a classroom teacher and you’ve got hourly classes. KATHY: If you’re a surgeon you don’t go to the bathroom like two times a day. You don’t have any alone time. BRETT: Yes ‘excuse me I have to go to the bathroom so I don’t cut your throat’. KATHY: I wouldn’t say it that way. BRETT: No of course you wouldn’t say it that way. KATHY: But the progesterone has to be delivered in a certain fashion. Well they didn’t have all of these things then, they just had the *** suppositories. And I have to tell you, that would be a hard sell today. But most of my patients were so desperate they were willing to do it. BRETT: They were willing to consider any thing. KATHY: And it made them better. And then I had a n entire hoard of women that went and told everybody that they were better from their PMS. And you didn’t know all these women even had PMS. So they came in to get treated. The other thing it did which was so awesome was that it stopped their weird periods. Because when you don’t have enough progesterone, you bleed all the time. BRETT: Right every two or three days you just start bleeding. Because it’s not like you have a period, it’s like you have a. KATHY: Constant period. So by giving them the progesterone after 3 months, we gave it to them day 14-28, their periods were regular and they were more calm. BRETT: Less painful? KATHY: No, not less painful. Because progesterone often times causes the prostaglands in the lining of the uterus to be activated. So, no, not less painful. BRETT: So it doesn’t address that issue. KATHY: No, it doesn’t but it does address infertility. And I did infertility for a long time and there were many women who, these same women how had PMS couldn’t get pregnant because they couldn’t not develop the lining of the uterus with progesterone. They didn’t have enough. So we had to supplement it. BRETT: So it’s such a individually detailed chemistry question but you can globally say that the reduction is testosterone, the reduction of progesterone and estrogen all have to be balanced within ranges and then the range specifically has to be adapted to the needs of the woman and the lifestyle. So if that is attended to then this cascade of aging issues goes away essentially. KATHY: Right, essentially. BRETT: I mean you get older but all of those breakdown issues go away. So the challenge is to find a physician that is aware of this information and subscribes to the idea whether ACOG puts a causal definition to it or not. KATHY: ACOG approves treatment with progesterone but not specifically for PMS. BRETT: Not specifically for that. So you talk to a physician that will empirically work with you for adjusting your chemistry set with these chemicals, these hormones so that you feel better and so that life is worth living again. KATHY: That’s right and I think that is an important take home message because this is a complicated subject and you can’t talk about it in 20 min. BRETT: And it’s different for every single woman based on her unique chemistry. KATHY: And I’m not trying to teach medicine to our listeners. BRETT: Well no, we don’t want you treating yourself. KATHY: Yeah, we don’t want you to treat yourself. But we do want you to be informed about the things that are causing your problem and it’s not hopeless and you can be treated for it. There is some severe PMS, I just want to make sure we do talk about this, that has to have serotonin additions meaning anti-depressants and progesterone together and so that’s for the severest cases. BRETT: And again that requires a conversation with a physician who is aware. KATHY: Right, that’s right. BRETT: So if you have questions about these issues if what we’re talking about triggers that “ah ha experience” for you “Dagummit! My mother has that”. Then have your mother go to her doctor and sit down and talk about the question of progesterone and the question of serotonin if there are more severe issues. KATHY: And PMS, because people are afraid to say that because their doctors say ‘oh well you’re crazy go see a psychiatrist’ so it’s not always an easy thing to bring up. But if you would like more information you can write us at BioBalanceHealth.com. or yo.u can go to our website at podcast@biobalancehealth.com or you can call my office at 314.993.0963. BRETT: And you can always reach me at Brettnewcomb.com. [music] Copyright © 2011 BioBalance Health | St. Louis, MO 63141 • 314.993.0963 Produced by Davis Interactive.