Progesterone

[GemmaJ]

Hello Everyone,

I'm wondering if anyone can offer me some advice. I have just started on BHRT. My hormones are chronically low for someone my age - my fault totally after years of abusing my body through anorexia. I'm APOE 4/4 and have followed a ketogenic diet with a 13/14 hour fast for the last 3.5 years since I discovered my genetic status and my Mum died from Alzheimers at 70 years of age.

My problem is that my BHRT doctor has told me to take progesterone 2-3 hours after evening meal, just before going to bed with fatty food. The actual advice was to take it with a big bowl of full fat yoghurt as apparently the progesterone needs to "sit in fat" to be able to to be properly absorbed. This obviously causes me a few problems - I don't eat dairy for a start and this interrupts my fasting period. Last night I used MCT oil - I was told that if I insisted on doing this I should take 4 "spoonfuls" (I used 2 teaspoonfuls!) but I feel very uncomfortable breaking my fast like this.

Has anyone else heard of these absorption issues or had the same problem?

Any advice would be very welcome.

Thank you everyone!

[circular]

I take my progesterone pill before bed without food and my levels now are in range, so I question your docs advise. Maybe you could try without the food and see where your measurements comes out? I hope others respond who may know more about this.

[GemmaJ]

Thanks circular. That's what I'm thinking too....It's good to hear someone speak your thoughts though. Thank you!

[Stavia]

Hi Gemma
If your absorption of the progesterone is compromised by taking it fasting, here are two options
1. Take it with your dinner. Honestly, there is no science why it needs to be taken ar bedtime. It can be sedating, but if you are at home just chilling, its not a problem.
2. Take it at bedtime fasting, and check blood levels. If they are suboptimal, just increase the dose. Your doc has just made up the 4 spoons rule. There is no evidence here either that I know of.

Good luck.


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[GemmaJ]

Thanks Stavia.

It all sounded bit odd to me and I couldn't find anything about it on the internet. I just needed to hear some other voices of reason. All sensible advice - thank you! Gx

[slacker]

I take my progesterone 200 mg at bedtime with water, approx 3 hours after eating. My levels tend to run low-ish but this dose of progesterone seems to be the maximum recommended. I had been taking the dose at my evening meal without problems for quite a while, but eventually started to feel off balance and incredibly fatigued about 2 hours later. Once I change to taking the progesterone at bedtime, the fatigue and off balance sensation resolved. My blood levels are similar taking with food and at bedtime. N=1!

[maddanwill]

I take my progesterone 200 mg at bedtime with water, approx 3 hours after eating. My levels tend to run low-ish but this dose of progesterone seems to be the maximum recommended.

Slacker, I am taking 400 mg of progesterone as prescribed by my doc. She said my progesterone/estrogen ratio was off. I do carry a gene that predisposes me to estrogen dominance. I read your post and was wondering who recommends 200 mg as being the max recommended dose? BTW the increase to 400 has helped my sleep. Thanks!

[slacker]

I take my progesterone 200 mg at bedtime with water, approx 3 hours after eating. My levels tend to run low-ish but this dose of progesterone seems to be the maximum recommended.

Slacker, I am taking 400 mg of progesterone as prescribed by my doc. She said my progesterone/estrogen ratio was off. I do carry a gene that predisposes me to estrogen dominance. I read your post and was wondering who recommends 200 mg as being the max recommended dose? BTW the increase to 400 has helped my sleep. Thanks!

Hi Madd;

According to the package insert, the 400 mg dose is FDA indicated for treatment of secondary amenorrhea for 10 days only. You have to scroll past all the black box warnings about provera and progestin, as well as possible side effects of prometrium (brand name progesterone) to get to the approved dosing.

The FDA approved use of prometrium covers "endometrial hyperplasia prevention, postmenopausal" using 200 mg at bedtime 12 days out of 28. Any other use of the drug is off label. That being said, prescribers use medicines off label all the time.

I've been taking 200 mg at bedtime every day (off label!) I'm scheduled to see a new FM MD later in the month, and will see what she suggests for dosing. Higher dosing for me will be a cost issue. My insurance does not cover transdermal estradiol or progesterone. I'm currently paying approx $36/month for progesterone 200 mg #30 using Good Rx. Not sure I can swing $72/month without cutting back on an equivalent monthly cost of supplements.

[Plumster]

My problem is that my BHRT doctor has told me to take progesterone 2-3 hours after evening meal, just before going to bed with fatty food. The actual advice was to take it with a big bowl of full fat yoghurt as apparently the progesterone needs to "sit in fat" to be able to to be properly absorbed.

There are a few (apparently flawed) studies out there indicating that food helps with absorption of progesterone: https://www.ncbi.nlm.nih.gov/pubmed/8513955

Absorption of micronized P was enhanced twofold in the presence of food.

From Wiki (https://en.wikipedia.org/wiki/Pharmacok ... ogesterone)
In addition to the above study, the Wiki references a few more studies:

Influence of food on bioavailability
When oral progesterone is taken with food instead of taken in a fasting state, it appears that maximal levels of progesterone and its overall bioavailability may be greatly improved.[11][7] Measured with the unreliable method of RIA, peak levels of progesterone were increased by 5-fold and area-under-the-curve levels of progesterone by 2-fold when oral progesterone was taken with food.[11] In this RIA study, a single dose of 200 mg oral progesterone in fasting and fed conditions resulted in peak levels of progesterone of 13.4 ng/mL and 69.5 ng/mL, respectively, and AUC0–24 levels of progesterone of 91.5 ng/mL and 182.5 ng/mL, respectively.[11] Likewise however, a study using the reliable method of HPLC–MS/MS found that peak levels of progesterone were 69.7 to 89.2 ng/mL and AUC0–24 levels of progesterone were 111.6 to 125.9 ng/mL after a single dose of 200 mg oral progesterone with a high-fat, high-calorie meal.[7] These data, which are fairly similar, indicate that the previous findings of the RIA study may not have been fully erroneous and may in considerable part have indeed represented actual levels of progesterone rather than those of its metabolites.[11][7] On the basis of the HPLC–MS/MS study findings and previous studies using reliable methods, peak levels of progesterone when oral progesterone is taken with food may be on the order of 15- to 20-fold greater than when it is taken in a fasting state.[7][1][43]

The apparent substantial improvement in progesterone levels and bioavailability when oral progesterone is taken with food may be due to enhanced lymphatic absorption, allowing oral progesterone to bypass some first-pass metabolism.[11][31][39][40] In accordance, a related steroid medication, oral testosterone undecanoate in oil-filled capsules, is absorbed by the lymphatic system but must be taken with meals that contain at least a moderate or "normal" amount of fat for adequate bioavailability.[52][53] Taking oral testosterone undecanoate with food has been found to increase peak testosterone levels by 16-fold and the overall bioavailability by 11-fold relative to when the medication is taken in a fasting state.[54][55] Although the bioavailability of oral progesterone is greatly increased if it is taken with food, its overall bioavailability is still relatively low, even if measured using RIA.[17]

And then there's anecdotal evidence: I can't sleep if I haven't eaten enough during the day. In fact, I often don't sleep well even if I have eaten enough. Last night, I ended up eating something light (a banana and two handfuls of a chickpea snack) at 10PM and took 200 mg oral progesterone and I slept soundly in a way I very, very rarely do. In fact, considering I generally have sleep issues and that my sleep was so good last night, I may need to incorporate a snack (a few nuts? 1 nut?) with taking progesterone at night. I'm still experimenting, but I will certainly prioritize good sleep over fasting. Has anyone else noticed a difference in sleep when taking progesterone with food?

Edit: Adding here that I've slept soundly without waking up for the last 4 nights, taking 200 mg progesterone with a couple of almonds before bed.

[GemmaJ]

And then there's anecdotal evidence: I can't sleep if I haven't eaten enough during the day. In fact, I often don't sleep well even if I have eaten enough. Last night, I ended up eating something light (a banana and two handfuls of a chickpea snack) at 10PM and took 200 mg oral progesterone and I slept soundly in a way I very, very rarely do. In fact, considering I generally have sleep issues and that my sleep was so good last night, I may need to incorporate a snack (a few nuts? 1 nut?) with taking progesterone at night. I'm still experimenting, but I will certainly prioritize good sleep over fasting. Has anyone else noticed a difference in sleep when taking progesterone with food?

Thanks for this Plumster. Really interesting.

Since writing my original post on this, I have been experimenting a bit and definitely think that the progesterone is absorbed better if I take it with food. Again, it's anecdotal but I notice that, when I take it with my evening meal, three hours or more before bed, I become drunk-tired, which I guess means the hormone is doing its job! But, this effect often wears off by bedtime. If I leave it and take it alone before bed, I don't notice that tiredness and will wake up more often during the night.

My dilemma is - do I break the 14 hour fast I'm so strict about to take the progesterone with a fatty snack or do I adhere to the overnight fast? I'm reluctant to go from three to two meals a day and forego breakfast as I really struggle to keep weight on and am trying to gain 5kg at the moment, which is proving difficult enough on my brain-healthy diet!

Any more advice on this issue is so welcome!

Thank you!