Should I Take Progesterone?

Hi, I'm Dr. Tabitha, the gutsy gynecologist. I'm a triple board certified, OB GYN and Functional Medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyne health and your overall health. And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more band aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. Hey, hey, hey. Oh my goodness, I'm so excited to be back. We're just going to do a quick episode today because I keep getting asked on Instagram and Facebook, do I need progesterone? Yeah, you probably do. That's the short answer, but let me just break that down for you a little bit. And I want to preface this by explaining what progesterone is and what it isn't because there is still way too much misinformation about there out there about it, even from the societies who make the decisions about how doctors, gynecologists especially, practice medicine. So OBGYN follow their standard of care, meaning how they practice medicine, how they base their decisions, the algorithms that they follow to treat patients based on the recommendations of a couple main bodies. The American, American College of OB GYNs, or ACOG. If there are DOs like me, the American College of Osteopathic OBGYN, a COUG, and then NAMS, the North American Menopause Society. Those are the three big societies that govern how OBGYNs practice. So I want you to understand that and it's a very kind of small group of board of trustees who kind of make these decisions. They follow the research, they update it on an ongoing basis, and they change their position statements, meaning what they believe as a society is best practice for obgyn. And I'm just going to be honest that some of the information is slow to change, slow to progress. And it doesn't take into account all of the studies and the information being put out by the world of health and wellness. It does not take into account the research being done in the functional medicine space in the anti Aging space of like a 4M. And so it's very much steeped in traditional culture of conventional medicine, of a disease based model, like here's your disease and here is your prescription medication, treatment or surgical treatment. OB GYNs are surgeons. Okay? I spent four years in a surgical residency learning how to become a surgeon. So that was the main tool in my toolbox to treat things was prescription medications and surgeries. So I just want you to know where they're coming from. And I'm not saying anything about that other than that is the truth. That is how conventional obgyns operate. And so if you are talking about diet and lifestyle impacting GYN conditions and you are using what they call alternative medicine or integrative medicine, with herbs, with diet change, with lifestyle changes, then you're practicing outside the scope of standard of care. Sometimes I'm okay with that because I know that it's the right thing to do. I know it's what actually moves the needle and returns you to wellness. I'm not about trying to get rid of symptoms and manage disease. I'm about reversing disease, getting rid of diagnoses, and getting you back to a state of thriving and well being. So I just want to put that out there because a lot of the information that you all are conflicted about is because it's coming from two different worlds, coming from a world of sickness and disease, and the other is coming from the world of health and wellness. And so I feel like a little bit of a unicorn because I have, you know, a foot in both worlds. So I can bridge the gap and help you understand why this side is saying this and this side is saying this, and where's the happy medium? And where can I feel amazing and really figure this out without going to one extreme or the other? Because I understand a lot of you. I want you to see your OB GYNs, you need your exams, you need your pap smears, you need to have that relationship. Yet you might be confused by some of the recommendations they're putting out there, the information they're giving you. And progesterone is one of the big hot topics that really separates conventional medicine from functional medicine. Progesterone, that is the hormone that naturally gets produced in our bodies, in our ovaries, when we ovulate, and a little bit from our adrenal glands. Progesterone, I think of it like keeping estrogen in check. Estrogen is a growth hormone. It helps the lining inside your uterus grow every month in case you fertilize an egg and want that egg to implant in the uterus, you need the growth in that lining from the estrogen. Estrogen grows your breast tissue, it grows your the fat on your hips. It's a growth hormone. Progesterone keeps that growth in check, it prevents it from over growing. So it's kind of like the estrogen is the fertilizer that makes the grass grow. The progesterone is the lawnmower that keeps it from overgrowing. It keeps a level, even playing field. When we naturally go into our 40s, and some of you earlier in your 30s, you get this premature ovarian insufficiency where you're not ovulating every month either. From pcos, over exercising, nutrient deficiencies, toxin overload. There's multiple reasons you aren't going to make progesterone the way that you would if you ovulate. Because there's actually a place in the ovary called the corpus luteum that is a leftover area where the egg left the ovary. You, you popped the egg off, it, released the fallopian tube, grabbed it, took it down to be fertilized or not. That space in your ovary produces progesterone during the luteal phase after ovulation. So if you're not ovulating, you're not going to make progesterone that typically shows up as irregular periods, no periods, bleeding every couple weeks, that type of thing. But if you are on oral birth control or you are on a hormonal IUD like Mirena, if you're on a depo shot anuvaring an explanon rod, those all interfere with your progesterone production. Please check out my podcast episodes about birth control so that you can understand this relationship with hormones even more. But just understand that you're not necessarily making the progesterone that you should be making. The main thing that OB GYNs are concerned about is that if you're not getting enough progesterone, that lining inside the uterus is overgrowing from too much estrogen, from chronic estrogen exposure. In the functional space, we call that estrogen dominance. In the conventional space, we just say unopposed estrogen. So it's a little bit different terminology. But either way, you need progesterone because we also have progesterone receptors throughout the rest of our body, not just in our uterus. So it balances the estrogen in our breast tissue. We need progesterone for healthy breasts. We need it for Healthy brains, we, part of progesterone gets metabolized into a. A byproduct that binds to our GABA receptors. Those are the calming neurotransmitter receptors in our brain that prevent us from feeling anxious. They help us sleep. So progesterone is our natural anti anxiety hormone. Estrogen is our natural antidepressant. It gives us energy, it makes us feel good, it, you know, makes us feel happy. And then progesterone makes us feel less anxious, less overwhelmed, and sleep better. So there are something called progestins. These are all the progesterones made in the lab. They are not chemically the same as progesterone. There's different carbons, hydrogens, oxygens in different spots on these chemicals. When you look at it from a chemical standpoint, they are a little bit different. They still work on the uterus in the same way. They will still prevent the lining from overgrowing. They will stop fibroids from growing, they will stop endometriosis from growing. But they don't have the same effect in the rest of your body, particularly your brain. So progestins, which are all of the progesterone category, progestogens we call them, that are found in hormone birth control. So in the pills, the regular pills, the mini pills, the tricyclics, the Mirena, the kyleena, the Skyla, the depo shot, the nexplanon rod, the implanon rods, the Nuvarings, those are all progestins, synthetic progestogens. They're not actually progesterone. So I hope that clears that up, because it's very commonplace for obgyns to prescribe progestins. I never prescribed progesterone prior to studying functional medicine. Not one time, not ever. It was not part of my training. It is only recently been added to ACOG's recommendations that progesterone is probably a better alternative than synthetic progestins. And, like, that's a huge win that ACOG is actually recognizing that. But we still have a long way to go, because the way doctors are trained in medical school and residency is how they practice pretty much until they retire. It takes a lot of effort to get doctors to change how they practice. It just doesn't happen. For the majority of doctors. It took me having my own health crisis and not even being able to function, to be able to leave that conventional space and find out all of this whole world of health and wellness. So the majority of physicians, they practice the way they did as soon as they came out and they practice that way until they retire. So just understand that your, your ob gyn probably has never prescribed progesterone. They probably don't know it's a prescription that you a generic medication that's been around forever. It comes in 100mg and 200mg capsules. So there is not a ton of variety for dosing. That is where we start to use compounded medications, compounded pharmacies to make progesterone in different doses or in different vehicles, like not only capsules, but in creams, which is most often used for smaller doses. We can add a sustained release version of it so that it gets just released slower through the night to keep you asleep longer, all the things. But I will tell you, progesterone can be such a game changer during the perimenopausal transition or if you are have PCOS or you are in premature ovarian insufficiency or failure. This is what I felt when I first started progesterone maybe six years ago. It was a game changer. I was not sleeping at all. I was overwhelmed. I was starting to feel anxious. I had never had anxiety in my life. And when I got on progesterone, everything shifted. I was able to sleep. I felt so happy, so incredibly changed as a person because I was sleeping in like deep restoration restorative sleep. I actually started to have energy through the day. I actually felt like a different human being. So progesterone was a game changer for me. And I thought, okay, there is something to this. Functional medicine knows what they're talking about. And I started using it on my patients instead of the progestins. Game changer. Like I get so many thank yous, so many amazing emails just telling me that I'm giving women their lives back because that is how much you can be affected by sleep deprivation and anxiety and just this feeling of like something is off, right? Or estrogen excess where you're growing fibroids, you're growing endometriosis, causing heavy periods, you're in this state of estrogen dominance, your breasts are painful, they're growing, you're getting cysts. So many things from this estrogen dominant state, which is actually a progesterone deficiency. So it can be a game changer. And you might need to consider that it wasn't until more recently where my estrogen started to decline and I needed to add in estrogen. But for years I just took progesterone and it saved my life. It just helped me so much. So I hope that answers the question for so many of you. I can't even name all the people that have asked me this question because it is a hot topic on social media. But just know that there is a difference in progestins. Progesterone. If you've been given what you thought or was, were told was progesterone and it's 10 milligrams that you take it for a week or a couple weeks, that is not a progesterone. That is a progestin. That is typically called progesterone in the conventional space just to confuse you even more. It's actually Provera. Provera is not bioidentical progesterone. So I hope that clears some things up for you guys. And please let me know what else you want to hear about. I am here for you. I do this to serve you. And I would be so honored if you would take 30 seconds, leave me a five star review. Just write something really quick because it does help other women who are struggling the way you are, the way I was, so that they can see these podcast episodes and they can hear it and go, oh my God. Gosh, that's exactly what I need. So you could affect many women by taking 30 seconds today to leave me a review. How cool is that? Like, that is so powerful and we need to be a sisterhood. This is not a competition. We need to support each other as women. And so go do that today because that would be really a kind thing to do. Like I. This is the golden nugget I got. Keep listening to this podcast because you're going to get so much value, like whatever is on your heart to write just so that they are possibly going to get exposed to it. Because that's how Apple works, that's how Google podcasts works. And Spotify, like, whoever's got the ratings, that's what they push up and then pass it on to a woman that you know or 10 women that you know that want to hear, hear this, that need to hear this. If you are north of 40 or your girlfriend's north of 40, your sister, your mom, whoever, they need to hear this episode. All right, go have an amazing week. I love you so much.