Progesterone & Hot Flashes

Progesterone & Hot Flashes
March 25, 2018 Writing Department

Hot Flashes

At approximately age 45 to 50 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.

Take a closer look at Hot Flashes, one of the primary symptoms associated with menopause in industrialized countries. Although there is no empirical proof of the cause for hot flashes, the following explanation may have merit.

An area in the brain’s hypothalamus (the GnRH center) monitors estrogen and progesterone levels. When levels of these hormones decline, this triggers the GnRH which, in turn, stimulates the pituitary to make the hormones, follicle stimulating hormone (FSH) and luteinizing hormone (LH). This, then, results in the ovarian production of estrogen and progesterone. The rise in these hormones inhibits further production of GnRH.

At menopause, estrogen levels fall and progesterone levels are usually already low. The ovaries, therefore, no longer respond to the FSH and LH prompt. In addition to hot flashes, 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 hormone levels.

When estrogen is supplemented, FSH levels fall and so does the incidence of hot flushes. The most likely scenario for this phenomenon is that low hormone levels stimulate the hypothalamic centers resulting not only the FSH elevation, but also the activation of nearby hypothalamis controlling vasomotor responses. Although estrogen supplementation is effective in reducing hot flushes, later attempts to reduce estrogen supplementation often results in recurrence of the symptoms.

There are other ways to deal with hot flushes. Experience shows that a diet rich in fresh vegetables and low in sugar and refined carbohydrates, along with vitamin E and aerobic exercise, will often decrease the intensity and frequency of these symptoms. Also, replacement of natural progesterone alone and in sufficient doses, will frequently result in elimination or decreased severity of hot flushes. Since the hypothalamic centers monitor both estrogen and progesterone, it should not be surprising that sufficient natural progesterone will be effective in treating hot flushes. Because of the inherent toxicity of unopposed estrogen, these methods should be thoroughly tried before resorting to estrogen supplements, and, when supplementing with estrogen always supplement with progesterone on the same days of use, so as to avoid “unopposed estrogen”.

Summary

  • The GnRH centers in the brain effectively signal to increase estrogen and progesterone levels.
  • Elevated estrogen and progesterone inhibit GnRH release.
  • After menopause the ovaries no longer make estrogen and progesterone.
  • Lack of estrogen and progesterone response results in increased activity of the GnRH center.
  • Heightened GnRH activity activates the vasomotor center, causing hot flashes and perspiration.
  • Supplementing with topical progesterone alone, will almost always ameliorate hot flashes. (avoid EDC’s}

 

References:

The Midlife Women’s Health Study – a study protocol of a longitudinal prospective study on predictors of menopausal hot flashes. Ayelet Ziv-Gal, Rebecca L. Smith, Lisa Gallicchio, Susan R. Miller, Howard A. Zacur, Jodi A. Flaws. Womens Midlife Health. 2017; 3: 4. Published online 2017 Aug 17. doi: 10.1186/s40695-017-0024-8 PMCID: PMC6300019

Genetic Polymorphisms, Hormone Levels, and Hot Flashes in Midlife Women. Chrissy Schilling, Lisa Gallicchio, Susan R. Miller, Patricia Langenberg, Howard Zacur, Jodi A. Flaws. Maturitas. Author manuscript; available in PMC 2008 Jun 20. Published in final edited form as: Maturitas. 2007 Jun 20; 57(2): 120–131. Published online 2006 Dec 21. doi: 10.1016/j.maturitas.2006.11.009 PMCID: PMC1949021

Longitudinal Changes in Menopausal Symptoms Comparing Women Randomized to Low-Dose Oral Conjugated Estrogens or Transdermal Estradiol Plus Micronized Progesterone Versus Placebo: the Kronos Early Estrogen Prevention Study (KEEPS) Nanette Santoro, Amanda Allshouse, Genevieve Neal-Perry, Lubna Pal, Rogerio A. Lobo, Frederick Naftolin, Dennis M. Black, Eliot A. Brinton, Matthew J. Budoff, Marcelle I. Cedars, N. Maritza Dowling, Mary Dunn, Carey E. Gleason, Howard N. Hodis, Barbara Isaac, Maureen Magnani, JoAnn E. Manson, Virginia M. Miller, Hugh S. Taylor, Whitney Wharton, Erin Wolff, Viola Zepeda, S. Mitchell Harman. Menopause. Author manuscript; available in PMC 2018 Mar 1. Published in final edited form as: Menopause. 2017 Mar; 24(3): 238–246. doi: 10.1097/GME.0000000000000756 PMCID: PMC5323337

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