Health Watch Q&A

Q: I am a retired RN and would like more info on use of progesterone cream to normalize cycles in teens. One thing I have discovered with both my girls (teens and 20s) is the great benefit progesterone has in the latter half of the cycle to normalize cycles when they are stressed. I see this a lot in girls in their 20s who stress over career, classes, relationships, etc. Many get depressed and it often is responsive to rebalancing estrogen with progesterone. But I see little info on this indication for progesterone use. It would be helpful to have “real” info to share with people. These girls can have migraines with expensive, invasive workups. There is solid physiology to support its use, since if stress is great, I believe ovulation can become “sub-par” and set them up for estrogen dominance.

A: If by “real” you mean double-blind, placebo controlled studies with thousands of subjects alas, it’s not there. In fact it’s not even there for a small group of teens with PMS, half on progesterone cream for the last two weeks of the cycle, half on placebo. But the research is badly needed, since with all the estrogen in the environment teens and young adults are much more likely to be estrogen dominant.

As you say, there is solid physiology to support the use of progesterone for PMS, and there are also numerous studies indirectly supporting its use. One study showed that in the first year after menarche (start of menstruation), 80% of girls did not ovulate, meaning they did not make progesterone. Three years after menarche 50% did not ovulate, and by the sixth year 10% did not ovulate. That represents a lot of girls with premenstrual bloating, weight gain, mood swings, irritability and anxiety.

In a teen the adrenal glands can pick up some of the slack in progesterone production, but in a stressed young adult the adrenals will be busy elsewhere.

A physiologic dose (15 to 20 mg) of progesterone cream during the last week or ten days of the cycle can indeed be enormously helpful. I’ve received hundreds of emails and letters over the years from parents of teens and from doctors treating teens, who swear by progesterone cream for PMS. The caveat is that too high a dose of progesterone cream, or oral (pill) progesterone, can create byproducts such as allopregnanolone. Although progesterone normally hits the GABA receptors in the brain and has anti-anxiety effects, progesterone can spill over into excess allopregnanolone and have a “paradoxical” effect in teens, causing increased sensitivity, anxiety, irritability and aggression.

This article by Dr. David Zava, Teens, Birth Control and Hormone Balance may offer other insights.

References

Andréen L, Nyberg S, Turkmen S et al, “Sex steroid induced negative mood may be explained by the paradoxical effect mediated by GABAA modulators,” Psychoneuroendocrinology. 2009 Sep;34(8):1121-32. Epub 2009 Mar 9.

Bäckström T, Haage D, Löfgren M et al, “Paradoxical effects of GABA-A modulators may explain sex steroid induced negative mood symptoms in some persons,” Neuroscience. 2011 May 13.

Vuorento T, Huhtaniemi I, “Daily levels of salivary progesterone during menstrual cycle in adolescent girls,” Fertil Steril. 1992 Oct;58(4):685-90.

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