Progesterone cream works best for most hormone balancing, but the progesterone pill can be more effective for treating insomnia and catamenial epilepsy.

The hormone progesterone can be delivered to the body via a pill, cream, troche (dissolved in the mouth) injection or vaginally. There are advantages and disadvantages to each delivery system, depending on why it’s being used. Although progesterone cream is the superior delivery method for achieving hormone balance, the progesterone pill (Prometrium) can work better for insomnia and seizures.

 Progesterone Pills

Conventional doctors treating hormone imbalances tend to be most comfortable using progesterone in pill form (Prometrium) because they believe they are delivering a standardized dose. However, in truth, it’s a highly unreliable way to deliver progesterone. When progesterone is swallowed, most of it is delivered to the liver, where anywhere from 60 to 80 percent of it is either broken down into metabolites (by-products) and/or eliminated. How much progesterone reaches the tissues depends on individual biochemistry and how hard the liver happens to be working that day. Thus, a doctor will generally prescribe 100 mg, of which 20 to 40 mg is actually delivered.

 Progesterone Pills for Sleep and Epilepsy

Many doctors have found that a progesterone pill can be more effective than the cream for treating insomnia and catamenial epilepsy (seizures related to the menstrual cycle). This is because the metabolite allopregnanolone, created in large amounts when progesterone is processed in the liver, stimulates GABA receptors in the brain, which promotes relaxation and helps balance the nervous system. If insomnia is hormone-related, a 100 mg progesterone pill taken an hour or so before bedtime can make a big difference.

Progesterone is well-established as an effective treatment for most catamenial epilepsy, and for the same reasons it works for insomnia, the progesterone pill works better than the cream to reduce or eliminate these types of seizures.

 For mild insomnia, or the occasional night when it’s hard to drop off to sleep, Dr. John Lee recommended a dab of progesterone cream on the side of the neck where the carotid arteries are located, which he theorized would quickly deliver progesterone to the brain. Judging by the emails we received, his theory was accurate!

 Progesterone Creams and Gels

When progesterone is mixed into a properly made progesterone cream or gel, and then rubbed on the skin, virtually all of it reaches the tissues as progesterone, making it a reliable delivery system. A cream or gel is properly made when the progesterone is evenly distributed throughout the cream, and well dissolved. Progesterone cream that feels grainy has precipitated out of the cream and shouldn’t be used. Most of the progesterone cream sold over-the-counter is made by the same few companies and private-labeled. Progesterone cream from a compounding pharmacy is made by pharmacists trained to properly mix and dissolve it.

Progesterone Cream in Fat Cells

 There are claims that progesterone delivered with a cream sits in the fat cells and accumulates, but this is a theory and there is no evidence to back it up. It’s plausible that using mega-doses of progesterone could cause it to accumulate in fat cells, but laboratory testing has shown that better than 90 percent of the progesterone in a cream enters the bloodstream over an 8-hour period.

Other Progesterone Delivery Systems

 Injections of progesterone are used to treat patients with brain injuries. Because the injections are intra-muscular (IM), the delivery system is essentially the same as with the cream. While injections may be a reasonable delivery system in an emergency room or hospital, they’re obviously not practical for hormone balancing. Progesterone injections also tend to cause a lot of pain at the injection site.

 Progesterone is delivered vaginally with syringes or suppositories. This method is sometimes used by fertility doctors who believe that more of the progesterone will reach the uterus and ovaries, but it’s not preferred by most women because it’s messy. Fertility doctors believe they need to use mega-doses of progesterone to help a woman conceive, but Dr. John Lee and many others found that a physiologic dose of 20 to 30 mg of progesterone cream daily for two weeks after ovulation works very well to enhance fertility for women with luteal insufficiency or other progesterone-related hormone imbalances. It should be noted that this dose is continued at least through the first trimester of pregnancy.

 Progesterone troches are dissolved in the mouth. Because the mucous membranes of the mouth absorb so efficiently and effectively, this delivery system tends to create a steep rise in progesterone, followed by a steep drop—not the best way to achieve hormone balance.