Paradoxical Progesterone

Human as defined in one paragraph by is “of, pertaining to, or having the nature of people: human frailty”. I can relate to that definition especially “human frailty” more days than I care to even acknowledge but when you take on “Heal Thyself” as your badge of identity you face those days with a sense of purpose.

There have been many of those frail human moments in the past few years since I took on my foe, Hashimoto’s Dis-ease. Why? You ask. Because to “heal thyself” is often a daunting task and you need lots of support from the medical community, friends and even strangers who become friends through one commonality: human frailty. Mine just happens to be a thyroid that resists normal treatment and time and again I find myself faced with something new and unusual to find an answer to.

If your thyroid doesn’t run on all pistons at all times it seems like one hormone or another is always in need of tweaking. This past weekend it seemed to be my sex hormones that were slightly wacky but that was not clear from the onset. It was only after some introspective time that the light finally dawned that what I have and did experience might be what Uzzi Reiss describes as a “paradoxical” response to taking bio-identical Progesterone.

The paradox, you see, is that Progesterone is supposed to be a calming hormone, one I often rightly or wrongly liken to Melatonin, but in some human females it can react in quite the opposite way leaving you feeling quite stimulated. If Uzzi Reiss is correct, and I have no reason to doubt him, in some women who take Progesterone with bio-identical Estrogens the Progesterone actually affects the way your body absorbs and utilizes the Estrogen.

Youthful Aging Center has this to say about progesterone it “is the balancing act for all of the estrogens within the body. It is also very important for normal reproduction and for menstrual function. Bioequivalent progesterone influences the health of your bones, blood vessels, heart, brain, skin, and many other tissues and organs.

As a precursor, progesterone is used by the body to make all of the other steroid hormones, including DHEA, cortisol, estrogen, and testosterone. In addition, progesterone plays an important role in mood, blood sugar balance, libido and thyroid function, as well as in the health of your adrenal glands.”

Yes, progesterone is vital to the female body and our bodies need it to run efficiently and to avoid the pitfalls of the aging process BUT if you experience the paradoxically stimulating effects of progesterone it is most disturbing and perplexing. It is possible, no it is probable that balancing all your hormones may be necessary before you can successfully add progesterone, yet progesterone is often the first thing doctors prescribe even before testing your progesterone levels.

I think, based on personal experience and clinical studies, there truly are three paradoxical reactions to progesterone and three different reasons. Paradox #1 may be due to progesterone’s affect on your cortisol levels. Apparently the progesterone can convert to cortisol and if you already have high cortisol it is going to make things worse. Or you might  experience hot flashes and some depression, we will call this Paradox #2. It is due to the down regulation or overloading of estrogen receptor sites. Another negative reaction to progesterone when you aren’t used to it might be an increase in your appetite and subsequent weight gain, there you have it, Paradox #3.

If you suffer from the second paradoxical response this could be due to low estrogen levels. If you are menopausal and your doctor has foolishly put you on a low dose of  BHRT (aka E1 and E2) taking progesterone will clog the estrogen receptor sites and now with your low dose of estrogen you will have hot flashes like you haven’t had in years.

Take it from me it has happened. If your levels of E1(Estrone), E2 (Estradiol), and E3 (Estrone) are not correct optimizing your estrogen levels especially E1 and E2  may take care of the paradox and allow your body to react correctly to Progesterone.

I also believe I have experienced Paradox #1. I have challenged adrenals according to my ZRT saliva cortisol tests I have taken twice in the past year. I am not in full blown adrenal fatigue (not yet anyway) but I can see that my cortisol levels are affected negatively by any progesterone intake. So dramatic is this effect that I see a rise in my temperatures, both basal and daytime, within a day of progesterone intake or using it on my skin.

The temperatures are a remarkable indication of its power but the paradoxical effect is worse. I will awaken around midnight (but sometimes 3 or 4) with a racing heart. This is usually precipitated by a vivid and disturbing dream and when I awaken I am hot and sweaty and have a distinct need to get up.

At that point I have no choice but to lumber out to my cold (we turn the heat down to 55 at night) and dark kitchen and prepare my special elixir, filtered water and a full teaspoon of sea salt. It is the only thing that will calm my racing heart and thankfully it works every time. (I have this love/hate relationship with salted water. I need it but I hate it and I am tired of my unquenchable need for it but  that is off the topic.) The elixir cures what ails me but, more to the point, the entire episode is likely caused by an adrenaline surge because the progesterone is converting to cortisol and my nighttime cortisol is already high.

Dr. Reiss suggests a way to possibly cope with the paradox until you get everything in equilibrium. Apparently we absorb far less progesterone through the skin, so he suggests applying progesterone to the breasts, so that they get the benefit of progesterone. His dosing schedule is a bit difficult to decipher, so it might be better if you either worked with a knowledgeable physician (good luck with that one) or experimented on your own.

The answer to all three reactions is to either reduce or discontinue your intake of progesterone until things are in balance. If you need to lower your progesterone dosage trying an over the counter (OTC) cream might be just the trick.I have tried the Emerita brand because it has no parabens and other ingredients that I abhor. Also NOW brand has a fairly natural list of ingredients and they are both USP progesterone creams which are the only effective progesterone creams sold over the counter.

There are interesting discussions about the paradoxical effects of progesterone on several websites and I find the sharing of knowledge encouraging. You see it is only with the discussion that we learn, if we close ourselves off to the experiences of others we lose a very important resource. Some find the sharing of knowledge threatening, I find it invigorating and edifying.

I cannot tell you many times something has happened to me that seems totally out of the parameters of the “norm”. My reaction is to start researching and with that I find there are many souls like me out there. I hope if you glean nothing else from your time on KrisInsight you will find one morsel of tantalizing information that you never considered before. You don’t have to agree but if it sparks a thought that will make my day.

Have a wonderful Thanksgiving and see you next Monday,


13 responses to this post.

  1. Dear Kris:

    I have not read all the responses here but I will when I have time.

    I found what you wrote very interesting because everyone is talking about how fabulous progesterone is and how dangerous it is to be without it.

    In my case I had severe endometriosis for years (along the way hyper parathyroidism which was corrected surgically 23 years ago) and finally at age 43 threw in the towel and had a complete abdominal hysterctomy, only the cervix left. I HAVE NO UTEROUS OR OVARIES. Please no one question about that, it is healthy and was left in.

    My doctor put me on some kind of hormonal patch but after about two weeks the hot flashes were horrible. I lost my health insurance over the years, almost lost my house and had no money for a doctor so I simply started ordering estradial valerate from overseas. No hot flashes, high sex drive, slim and no vaginal dryness. However, I did start hairloss before the hysterectomy and have had bad insommnia almost all my life. My life has to run very smooth for a long, long time for me to stop having insomnia. I took estriol dial valerate 1mg for 13 years until during another financial crisis I ran out. During this time, the horrible hot flashes started. When I got the money, I ordered progesterone pills and the estriadial valerate because I thought “well it seems like it was something I was suposed to do years ago and my hair falls out unless I rub on rogaine (minodoxil) but I have lots of anxiety and insommnia. So I got the progesterone pills and some progesterone cream and tried to take it all kinds of ways. In fact one web site by a very nice lady insisted I only needed progesterone cream. I tried to and felt so depressed I had to stop.

    the hot flashes are still here, and I am so irritable it is all I can do to stay rational. I had to stop this. . It (the progesterone) does knock me out to sleep for awhile, but I wake up two to six hours later. I had to stop it. yet on other web sites, they say only taking the estradial valerate will kill me. And that I should continue taking the progesterone. I cant do it. Any thoughts on this? Please dont tell me to see a doctor. There is ABSOLUTELY NO MONEY FOR A DOCTOR NOW, There is NO WELFARE FOR me. I just would like to hear some comments on this. I feel so scared, all these years I thought I was doing the right thing with the estradial and now I read I am putting myself in danger. I do bruise earily, have insomnia and can have horrible anxiety. The anxiety is much better now because I am with a very good kind man now and we are planning to marry and am a strong Christian but this progesterone controversy is scary. He is doing his best to care for me, and we are saving up to see a specialist but in the mean time it is difficult. Could I really have had none for over ten years and functioned as well as I did, worked, dated, had a good sex life? I took tons of vitamins, followed a low carb diet and used my treadmill, up to 45 per day a few times week Please do not tell me to get a saliva test, I cannnot afford it and I am not eligible for any medical help. Someday I will be able to get one but not now. Two days ago , I stopped the pro completely and just started to take the estradiol valerate. They are the only thing that ever stopped the hot flashes and gave me a sex drive and no vagnal dryness. I am 56. Sorry so long, thanks for your feedback


    • At first thought I would say your adrenals are not healthy enough to handle the progesterone. As I understand adrenal health if you are in any stage of adrenal fatigue the progesterone will stress your adrenals and cause anxiety, sleeplessness and generally everything “they” say it cures will not work for you. Please feel free to ignore what I say, but it seems to me you don’t need anymore stress and I would quit taking any progesterone and take what makes you feel better.

      I have no experience with Premarin (something you did not mention) but there was a woman on a forum that I participated in that swore that Premarin was not as harmful as had been stated. She also said that if you are on T3-only (which I am) Premarin was the only hormone replacement that worked because of the increase in the Sex Hormone Binding Globulin (SHBG). She had many tests and found that Premarin, which is much maligned, was doing for her what no other more natural replacement could do. You aren’t talking about Premarin you are talking about Estradiol which is bio-identical and safer in my opinion. If I were you, I would listen to what my body is telling me and stop the progesterone for now and see how you feel. In the future, if you can test your hormone levels, and thus know exactly where you stand, then you can adjust your hormones and see how you feel. I feel it is really important to listen to your body and act accordingly but I am not a medical expert I am just a person who has tried it all and shares what worked for me.

      You didn’t mention your thyroid but as you know that is a big emphasis of my blog. You sound like a person who has undiagnosed thyroid issues (anxiety, sleeplessness, hair loss, etc.). If I were you I would get a full thyroid panel and see how your thyroid is functioning because it is possible that therein lies your problem. When you have the money a sex hormone panel would be useful as excess testosterone can lead to hair loss (as well as your fabulous libido) and sometimes excess estrogen is converted to testosterone. Another possible cause of hair loss is low iron, so see there is no end to the blood draws your future could hold.

      In the meantime, I wish you well in your new relationship, how fortunate you are to have found a man who is kind and caring. Now you just need to listen to your body and act accordingly not react according to what you have read or some expert is saying. I wish you well and let us know how things turn out.


      • Posted by Ceenan on 18:22 at Sunday, October 13, 2013

        Thanks so much for kind words and advice. I will definitely keep saving for those type of tests you mentioned. I had to stop with the progesterone, I am afraid to even use a low dose, I just HATE those horrible feelings. It has been a few days and while I dont feel great, I feel better. It usually takes two to three weeks of just estradiol valerate for the hot flashes to stop. I am going to take myself there and continute until I can get all the tests you recommended.

        Is it possible I have run all these years with NO progesterone or does the adrenal cortex make some and my body existed on that amount? I keep reading you cant survive without it but here I am.

      • I think some of us produce our own hormones. My doctor put me on testosterone because it was good for my bones but he never tested me. When I finally got a blood test my levels were sky high. I was flicking people off on the highway and acting like some young stallion high on his own testosterone. I have to admit I was appalled by my behavior and would never wish to be have a penis again. LOL Anyway it convinced me that testing is necessary and I wouldn’t take hormones again unless I had a blood test to tell me what I needed.
        It is altogether possible that your progesterone levels are normally high which would be cancer protective. When you have a chance get your sex hormones tested, that will make everything really clear for you. BTW, when you test your hormones the day of the test don’t do any hormone replacement that morning to get an accurate result (no matter what your doctor says).
        For now, I wouldn’t take anymore Progesterone and stick to what works. Take care.

  2. Posted by ella on 4:40 at Tuesday, July 23, 2013

    Kris, absolutely true, thank you so much! Your information here is of great value. There are so much ‘halleluja’ about progesterone on the internet, but most often there is a distributor of a progesterone product behind it.
    My adrenals were already depleted before I started prometrium – just 100 mg for 15 days a month vaginally (I could not tolerate it orally at all), but it is already too much for me. The only good results after 1 year are that my average daily cortisol is now within normal range. But these awful peaks at 3-5 a.m disturb my sleep immensely. I am also more aggressive and assertive (my testosterone went up) and prone more to anxiety than depression. My DHEA is also within the normal range. So I guess my body converts progesterone primarily into cortisol and testosterone, and a bit into DHEA.
    I experience NO calming effect from progesterone, and the bleeding is just a bit less.
    I’d hate to increase progesterone to stop the bleeding, so if my uterus lining is still not OK I will have to look into alternatives, cause I don’t want to give up my 0,3 mg estradiol 20 days a month. By the way I started estradiol AFTER I was prescribed progesterone, cause I really could not stand progesterone alone.
    I also doubt the term ‘estrogen dominant’. My estrogen is under 30, am I still supposed to be ‘estrogen dominant’? I don’t think so. So check your blood before you proclaim yourself estrogen dominant.


    • Posted by Kris on 7:33 at Tuesday, July 23, 2013

      I am using an OTC progesterone cream from Emerita right now and that seems to be alright but I am on no other hormones. Do you know if you have cortisol issues Ella? Usually the reason a person can’t stand progesterone is it drains what little cortisol they have and that intensifies adrenal fatigue.
      I know I have adrenal fatigue but it is improving with a technique called CT3M developed by Paul Robinson. I take a dose of thyroid meds at 2 in the morning and feed my adrenals what they need when they need it. I find it very interesting and I am totally hooked. Taking thyroid meds at that hour seems to put me back to sleep almost like a sleep drug but it isn’t.
      Thanks for your comment and please feel free to add your wisdom anytime. It is the only way we all learn and treat our bodies as they deserve.

      Take care,


  3. Thank you so much for responding. Somehow I missed this when you originally responded and luckily I just found it. The problem is I don’t know if you would consider me having Graves still as I had the radioactive treatment done to kill my thyroid when I was 26. Worst mistake of my life! Really didn’t have the Internet back then and was young and dumb and listened to my doc. All down hill since then. Soo, I guess my thyroid or lack of is considered hypo now. I’m on synthroid and cytomel. My SHBG was 86.4 back in jan.(that is high) don’t know what that means. My current total testosterone is 34 and free is 2.6. Estradiol is 19.8 and progesterone is 0.4. My FSH is 106. My thyroid is in normal ranges except for T3 is high. Don’t really know what all of this means. I would never of dreamed menopause would be this brutal. Please keep me in your memory and if you come across a doc that you think could help with the whole picture let me know. I will look into Kara Parker and check out my adrenals. Many, many thanks


    • Posted by Kris on 8:24 at Thursday, May 23, 2013

      Dede, with a high FT3 you will have a high SHBG (sex hormone binding globulin). I had this issue and finally quit taking hormones because I couldn’t take enough to overcome the high SHBG and hormones were making me feel worse. Also the high testosterone is not uncommon but I can’t remember the reason for this but I think we are making estrogen in to Testosterone. My testosterone was so high that when my doc put me on testosterone without testing I got very aggressive and full of angst. It made me appreciate what young men must feel like.
      Since your doc has you on Synthroid and T3 your FT3 should be on the high side to feel well but your adrenals may not be healthy enough to handle this load of extra T3. T3 is hard on adrenal health, so testing that is essential. Are you jumpy? Do you respond negatively to bright light? Does any kind of emotional stress leave you shaky? If you answer is “yes” to any of those questions you should do a diurnal cortisol test which you can order at (I may have mentioned this before I can’t see my reply at the moment). Adrenal fatigue, if only Class 1 or 2, requires lots of Celtic sea salt and adaptogens can be useful but you need to know how serious the issue is before treating.
      I apologize if anything is repetitive but Stop The Thyroid Madness is essential to understanding hypothyroidism and yes, once your thyroid is destroyed you are hypo and I do know lots of folks who are sorry they allowed it to happen, so you have lots of company. Stop The Thyroid Madness has a list of good docs and there might be one in MN now but there weren’t any before (although I may have added Dr. Bruley thinking he was better than nothing which he was but that’s about it).
      Now for a question I can’t seem to answer for myself. Why was my answer hard to find? I am having trouble seeing questions and you mentioned not seeing my response. I would really like to improve this issue, so if you can possibly tell me why it was hard I would be ever so appreciative.
      Take care and let me know how things go. I will send some positive thoughts your way and if you ever want to try some energy medicine I know a great Reiki healer, Donna Murray, and of course my homeopathic doctor, Dr.Kim Lane.


      • Yes im very jumpy and very light sensitive- I had a hard time finding your reply because when I got the email alert and I clicked on it …it only showed your old reply to someone else. I just happened to go back to the main site and saw you had replied. Now today, it was no problem at all so not sure what was going on. That concerns me that you had to stop all hormones because I’m miserable on them as well as off of them. ill get my adrenal levels checked soon…Thanks again

  4. I am presently taking progesterone cream and am not reacting well with this drug. I was taking it for 3 weeks before i started reacting. My heart races and I wake up in sweats and also the last time I applied the cream I woke up with my heart racing and my left arm was numb. I am seeing a doctor who is a gynacoligist who has been teaching and practicing bio- identical hormones for over 30 yrs. He tells me it is extremly rare to react and that there may not be any help for me. I live near Toronto Canada. Is there any advice you can share.
    Thank you


    • I can provide information Angie. You can take it from there. Many functional medicine docs are really high on progesterone but it isn’t right for all of us. If you have adrenal fatigue it may be affecting you negatively and you may need to stop using it. Have you tested your sex hormones? Has your doctor tested your adrenals? Both tests are available online in the U.S. The best sex hormone testing panel is available at the adrenal test is available at
      Some of this happened to me as well, so I know the heart racing reaction very well. As I understand it what we folks with adrenal fatigue can tolerate is applying the cream directly on the breast tissue once in awhile but otherwise it is most likely taxing your adrenals. When you put too much strain on the adrenal glands it causes the production of adrenaline, too much adrenaline simulates the heart muscle and thus the racing heart. As for numbness in your arm that almost sounds like a chemical reaction. What are the ingredients in your cream? Make sure there isn’t something you may be allergic to in the cream you are using but you would think if it was an allergic reaction that would happen right away.
      Personally I would stop using it and see if I felt better. You can always start using it again.
      Let me know how it goes and perhaps someone else will chime in with a similar experience.


    • Please, I need your advice. I am on estridiol(like a microdot size) and 2 lines of low dose progesterone (compounded by a pharm). I am having the opposite reaction hence the small doses. I get anxious, heart race, major insomnia every time I try to increase the dose. I am suffering with extreme hormonal imbalance along with Graves’ disease. I also was diagnosed with premature ovarian failure at 37 and am now 45. I have every symptom you can imagine and the hot and cold flashes are unbearable and I am yet to find a doc that can help me. They all say progesterone has a calming effect and they have never seen this. At one point my estrogen was at 433 and I was barely taking any. I live in the Mpls, MN area and I can’t find a good doc. Any suggestions or ideas would make me so happy.


      • Posted by Kris on 5:58 at Thursday, May 2, 2013

        Being in MPLS is a problem as I have had trouble finding a doctor in the Twin Cities who really understands hormone replacement much less thyroid disease. My doctor really didn’t understand my SHBG (sex hormone binding globulin) and wanted to prescribe very low doses of bio-identical estrogen (estradiol, estrone, etc.) and it was horrible. I had night sweats like I have never had before. Then I found out that with weak adrenals progesterone will have this paradoxical effect on you that you seem to be experiencing. Have you tested your adrenal health? It is easy to do and with Graves’ you may be in full blown adrenal fatigue. I would love to recommend the doctor I saw but he was the one who put me on the wrong doses of hormones (even thyroid hormones) and I had to self treat to feel better.
        Many people on discussion forums feel that with ovarian failure you would need Premarin which is a touchy subject for me as I hate the idea of Premarin but perhaps finding a doctor who would try that and take you off progesterone is the answer.
        I wonder if Dr. Kara Parker would be a good choice. Aszani Stoddard is a midwife at Methodist Hospital and she sees people who aren’t pregnant and seems very understanding but I am not sure what she would do with Graves’ as she tends to be very naturopathic. My daughter sees her and really likes her. I am currently seeing a homeopathic doctor whom I really like but homeopathy isn’t for everyone (her name is Dr. Kim Lane and she is in Shoreview).
        Otherwise I would join the Yahoo groups of people who have thyroid problems they are the best help I ever had when I was on the roller coaster that you are. One is called RT3 ( and that reopens on May 4th. There may be such a group for Graves’ and you have to request to join and they will want lots of test results but if you can provide the test results their layperson advice is better than anything I have gotten from a doctor.
        Please feel free to stay in touch and share your experiences someone might see it and be able to offer more helpful advice. I can try to help point you in the right direction but do know that I feel your pain. Incorrect doses of hormones are worse than no hormones and doctors don’t seem to understand that.

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