There has been a lot of discussion and excitement about the prospect of being able to buy a bespoke 50 mg progesterone lozenge as part of cBHRT (ref stellajane's post giving the acronyms and what they stand for).
However
not all progesterones are created equal and in particular each formulation will be absorbed in its own particular way to give a different systemic level and time-curve of absorption. It is just not possible to say that such a 50 mg progesterone (that you are using Mary G) is necessarily what we?re looking for because there is nothing to compare it with.
Just to emphasise ? just because it contains 50 mg of progesterone does not mean it will be equivalent to half the dose of Utrogestan given vaginal or orally (each of which behaves differently). It is all extremely complex.
So ? if we were being offered a 50 mg capsule of Utrogestan (or similar micronized progesterone in soft capsule) then we'd be talking.
. We would all know ( and of course there would be trials to measure its effects) that we should experience fewer side effects with this than with the 100 mg version and be able to guage the effects (backed up by the trials).
When this was brought up on westie's thread on the other board, I pointed out that actually, even though the liver first pass effect is avoided through buccal or vaginal dosing (ie progesterone is absorbed straight into the bloodstream), I imagine buccal delivery is still less effective at a given dose for example than vaginal delivery ( but better than oral ingestion) because systemic concentrations must still be high enough for sufficient to reach the endometrium. With vaginal delivery (in my view the best option currently available) the progesterone is transported and absorbed directly through the cervix to the uterine tissues. One paper I read suggested it was held there for longer than any other method. Buccal delivery also produces a rapid rise in serum concentration within about 80 mins (according to paper I read) and has metabolised quickly in the body which might be unacceptable for some women even if taken twice a day and even though the dose is lower ? due to greater fluctuations.
Even so unless a commercically available preparation of 50 mcg buccal lozenge is being used ( eg possibly from another country?) we still can't even compare one (lozenge) with another produced at a different clinic - as that is the whole point. They make their own, with whatever ingredients they decide, will be absorbed in their own way, and only trial and error will determine efficacy ( in endometrial protection which is the aim).
In addition I read that systemic levels of progesterone were actually more stable when taken vaginally ? for the reasons given above even sometimes over 48 hours. Everything I've read says to me that vaginal delivery is the best and most effective way of getting progesterone to the uterus and maintaining stable levels in the body, and therefore reducing side effects.
In any case - a 50 mg dose even used vaginally would only be beneficial for women on low doses of oestrogen due to the need for endometrial protection. Studies show that even the current licensed doses work best at low and medium oestrogen doses - and tend to cause more bleeding at higher oestrogen doses (can't recall the papers that looked at higher doses).
In my view what we need ? is not expensive unregulated compounded hormones, but more evidence based information disseminated from the menopause specialists as to how current regulated products can be used to tweak the different regimes to suit many more of us. This is of course only with respect to the endometrium ? the breast cancer and progesterone is a whole separate issue.
Hurdity x
Author
Topic: Is this the right place to discuss compounded hormones? (Read 110959 times)