I recommend natural progesterone for women who have moderate to severe PMS that doesn’t respond to simple lifestyle changes and who often describe a Jekyll-and-Hyde personality change premenstrually. Natural progesterone also works well for women whose major premenstrual symptom is a migraine-type headache. These headaches often start with the gradual change in estrogen and progesterone levels that tends to occur in the years leading up to the menopause.

Natural progesterone is not the same thing as the synthetic progesterones (progestins), such as medroxyprogesterone acetate (Provera—see Appendix for chart listing other synthetic progestins). There are no serious side effects with natural progesterone at the usual doses. Sometimes it might cause intermenstrual spotting or delay the period. This usually resolves itself in one to two months. Extremely high doses—much higher than I recommend—have been associated with euphoria and occasional dizziness in rare cases. Natural progesterone is available by prescription from your doctor. 

 Note that while natural progesterone is synthesized from wild Mexican yams or from the soy plant, creams that contain only yam extract, though helpful for some women, are not the same as those that contain adequate amounts of natural progesterone. For application to the skin, you can use natural progesterone cream by having your doctoryour doctor prescribe one for you from our compounding pharmacy. I have recommended a 2% progesterone cream…for many years.  These 2% creams contain 20mg of progesterone per gram. One gram applied to the skin once or twice per day has been shown to result in physiological levels of progesterone that match those found in the normal luteal phase.

General instructions are to apply 1 gram (approximately 20 mg) on the soft areas of skin (breasts, abdomen, neck, face, inner arms, or hands) in the morning and again in the evening. Alternate the sites with each application; apply on days fourteen through twenty-eight of your menstrual cycle for at least three months. The precise timing and dosage will vary from woman to woman, however. It is important to get the progesterone into your system before you normally experience your mood change. You need to apply the cream a day or two before ovulation or a day or two before your symptoms usually start. For some women, this will be on day twenty-one; for others, day twelve or thirteen. Continue through the first day of menstrual bleeding (day one of the cycle). This will often prevent symptoms or greatly alleviate them. Waiting until you are symptomatic to start treatment often doesn’t work. Increase or decrease the dosage depending on the severity of the symptoms; most women have to experiment to find a level that works for them. You may safely use natural progesterone for more than two weeks of your cycle provided that you interrupt use in each cycle for at least twelve hours.

Synthetic progestins, as opposed to natural progesterone, have many known side effects, such as bloating, headache, and weight gain. Unfortunately, many women are told that synthetic progestin is the same as natural progesterone. But synthetic progestins can actually increase PMS symptoms, because taking a synthetic progestin decreases the body’s natural progesterone levels.

Women who do well on progesterone are often those who experience a rapid change in mood that begins after ovulation and ends just as the menstrual flow starts. They describe feeling fine and then within several hours having a “black cloud” come over them. When their periods start, they feel as though “a light has gone on.” These women are describing a biochemical change in their body that is very real and not just “in their heads.”
 

"Women's Bodies, Women's Wisdom", page 138 & 139