Hot Flashes of Menopause Treatment with Progesterone

Hot Flashes of Menopause

The following excerpt is from "What Your Doctor May Not Tell You About Menopause" by John Lee, MD pg 153:

"Around age 45 to 50, sometimes a little earlier or later, 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.

Let's zero in and take a closer look at hot flashes, the hallmark of menopausal symptoms. The prevailing explanation for hot flashes is follows: Recall that an area (which we'll call the GnRH, which stimulates the pituitary to make hormones (FSH and LH), which in turn result in 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 no longer respond to the FSH and LH prompt.

When a woman's ovaries don't respond to FSH and LH signals by ovulating, the hormone signaling system can go awry. In effect, the hypothalamus begins "shouting", trying to tell the pituitary to tell the ovaries to ovulate. The inability of the ovaries to respond is most likely due to a final depletion of eggs and their surrounding follicle cells. This over activity of the hypothalamus and pituitary signal begins affecting adjacent areas of the brain, which we'll call the vasomotor center (specifically the arcuate nucleus of the hypothalamus that controls capillary dilation and sweating mechanisms), and these are the women who get hot flashes and night sweats. 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.

In a nutshell:

1. Then GnRH center effectively signals to increase estrogen and progesterone synthesis.

2. Elevated estrogen and progesterone inhibit GnRH and release.

3. After menopause, the ovaries no longer make estrogen and progesterone.

4. Lack of estrogen and progesterone response results in increased activity of the GnRH center.

5. Heightened GnRH activity activates te vasomotor center, causing hot flashes and perspiration.

It is important to recognize that the GnRH center monitors both estrogen and progesterone. Thus, since the post menopausal woman continues to make estrogen in respectable levels and makes little or no progesterone, hot flashes may well respond to progesterone supplementation alone. Hot flashes will also respond to much smaller doses of supplemental estrogen when Provera (medroxyprogesterone acetate) or Megace (megestrol acetate) have been found effective in treating hot flashes, further indicating that estrogen per se is not the only factor in hot flashes.

The truth is that estrogen is only one part of the menopausal picture and is certainly not a cure-all. In fact, these days I hear more complaints about the side effects of taking estrogen than I do about menopausal symptoms."

Emotional State

Some how the emotional state of the woman also affects hormones and hot flashes. Back in 1999, when I first started to treat my patients with natural bioidentical progesterone, I would have never believed this. I was ten years out of Medical School and thought that I was very well versed in the use of Natural Progesterone. However, in truth, I didn't know much. Now hopefully, I am smarter, humbler, and wiser in 2009 after listening carefully to some of my 10,000 patients with female problems.

A woman at church, a personal acquaintance, complained that she could not sleep because she was having hot flashes. So I gave her a bottle of Progestelle for free. I instructed her how to use it.

The next time I saw her was a month later at church. I asked her how the insomnia and hot flashes were. She said the hot flashes and insomnia had disappeared. "How did you like the Progestelle?" I asked.

"I never used it," she answered. "My husband and I took a 2 week vacation in Maui, and all the hot flashes and insomnia went away!" she exclaimed.

After talking to other patients, I am beginning to realize that the way you think affects brain chemistry. And brain chemistry affects body chemistry. And body chemistry affects insomnia and hot flashes.

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