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When a doctor suggests progesterone treatment, a woman should make sure that he is talking about giving her natural progesterone and not synthetic progesterones, called progestogens (or progestogens). Only natural progesterone is effective in combating premenstrual syndrome. Progestogens do not diminish PMS and may even worsen a woman’s symptoms, although a couple of my patients have found relief on synthetic progestogens (Provera).

Researchers wanted to create a synthetic form of progesterone because natural progesterone was very expensive to produce. Furthermore, natural progesterone could not be taken in pill form, since it is not absorbed into the bloodstream as an oral medication. A natural progesterone pill disintegrates in the stomach and gastrointestinal tract and never enters a woman’s system. Synthetic progestogens were designed to simplify any treatment that called for progesterone, and the differences between progestogens and natural progesterone were never especially significant to doctors. Most physicians believed that one could replace the other. Although natural progesterone and synthetic progestogens are interchangeable in many instances, the treatment of PMS is not one of them.

Natural progesterone, a cholesterol derivative, is made from Mexican yam, soybean products, and occasionally from animal sources. Progestogens are chemically formulated from progesterone, but rather than duplicating the properties of progesterone, these synthetic hormones react differently. In addition to exhibiting the progesterone effect, some have estrogenic effects, some have very progesterone like effects, and some also react like male hormones. Birth control pills contain synthetic progestogens, which is why women with PMS may feel debilitated when they’re on the pill.

Both a synthetic progestogen, such as Provera, and natural progesterone can trigger uterine bleeding similar to menstrual flow. However, one of the problems with the synthetic progestogens is that they inhibit a woman’s concentration of natural progesterone in the blood and, in fact, worsen the imbalance of the female hormones and intensify the symptoms of PMS. Some progestogens are actually 2,000 times more potent than progesterone, which is why certain progestogens can make women feel more out of sorts than others.

Also, the synthetic progestogens that have testosterone activity, such as norethynodrel, esthisterone, dimesthisterone, and norethisterone, can have masculinizing effects on a woman, while the synthetic progestogens with estrogen activity bring on symptoms such as fluid retention and edema, which are related to estrogen excess. Natural progesterone, on the other hand, does not cause masculinization and is known to reduce sodium and fluid retention.

Synthetic progestogens, in addition, are unable to function as progesterone substitutes in an essential biological conversion process that involves progesterone and the adrenal glands. In the body, natural progesterone is converted into hormones called corticosteroids by the adrenal glands. These corticosteroids aid in transporting glucocorticoids through the bloodstream. Glucocorticoids regulate the body’s blood sugar metabolism. If progesterone is low and the adrenal conversion does not occur, a woman may experience a drop in blood sugar that brings on a hypoglycemic like episode. If she is taking synthetic progestogens, they may be responsible for this episode because, first, progestogens do not convert into corticosteroids and, second, they serve to lower progesterone levels. However, this temporary hypoglycemia may be corrected with progesterone supplementation.

Both natural progesterone and synthetic progestogens may be helpful in maintaining pregnancy, although synthetic progestogens should not be used because they might harm fetal development. This adverse effect on the fetus has not been reported when natural progesterone has been used during pregnancy. In fact, studies of the offspring of women who took natural progesterone during their pregnancies have revealed that these children are especially intelligent and well adjusted. Among the adverse effects that have been observed when certain progestogens have been taken during pregnancy is that the sex organs of the female babies have become somewhat masculinized.

Progesterone is not believed to be cancer causing. No human cancer has been reported during progesterone treatment; quite the reverse, progesterone has been used in treating specific uterine cancers.

As mentioned earlier, when a woman is treated with synthetic progestogens, her body becomes confused and produces less natural progesterone. When natural progesterone drops, the hormonal conversion by the adrenal glands can not take place, salt may build up, fluid may be retained, and hypoglycemia may ensue. Synthetic progestogens generally make PMS symptoms worse, so, if a woman is about to be treated with progesterone, she should be sure that it is natural progesterone.

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Last modified: March 15, 2009