Kathy’s Question: I tried progesterone 100 mg pill. I felt dizzy and felt like I could not stand upright. Does a cream have the same side effect? I was also prescribed an estrogen patch.

Short Question: It is certainly possible that progesterone can cause someone to feel dizzy. It is often prescribed to help with sleep issues and anxiety, but some women claim to feel dizzy or “weird” after taking it. In our experience, this is more common with Prometrium, which is an instant-release form of progesterone. Bioidentical, sustained-release progesterone can still cause some of the same side effects but is typically much better tolerated. Progesterone cream usually does not cause some of the same side effects but is not effective for insomnia or anxiety. There is some research to suggest that progesterone is a vasodilator. This effect could lower blood pressure, which could make someone feel dizzy after taking.

PYHP 113 Full Transcript: 

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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progressional Podcast. I’m Dr. Maki.

Dr. Davidson: And I’m Dr. Davidson.

Dr. Maki: So, again, we have another question. This one’s from Kathy. So, again, in the future, for those of you that are new to the podcast, hopefully we’re getting lots of new listeners all the time. If you are an avid listener, you like what we have to say, please give us a review on whatever platform. We are on all the major platforms. I still haven’t added our podcast yet, or I have had it added to an Audible or Amazon Music, but that’s on the list which I think is cool. But we’re on iTunes. We’re on Stitcher. We’re on Spotify. We’re on iHeartRadio. We’re on all those different podcast platforms. So, please give us a review. That’d be really nice. So, this question is from Kathy. Once you dive in and give it a whirl.

Dr. Davidson: Sure. We always change everybody’s name. We always say that on every podcast too. And these questions come from podcast listeners, and also from our website, from our blogs too. Kathy doesn’t say on here whether she got this from the podcaster or from reading one of the articles or one of the blog’s. So, this is from “Kathy”. I tried progesterone 100mg pill. I felt dizzy and felt like I could not stand upright. Does a cream have the same side effect? I was also prescribed in estrogen patch.

Dr. Maki: Yeah, so there’s a lot. This is a really simple question, which is nice. Right? It’s just a couple of questions and it’s fairly similar. We’ve done a bunch on progesterone. But this one adds a little bit of a different element with the progesterone patch or the estrogen patch. She doesn’t specify, but I would assume that if she’s getting the estrogen patch, that means she’s getting prometrium. We could probably make that as… Would that be a fair assumption to make?

Dr. Davidson: Yes, like you said, this is a short question. It seems simple, but it I like it because we can really extrapolate on it to help other people that might be in a similar situation, because this is really common. The estrogen patch is a very conventional type of hormone replacement. So we know she’s on an estrogen patch. She’s either menopausal, and she’s also on the progesterone. She’s probably gone through menopause and she has a uterus.

Dr. Maki: Yeah. So, we can assume at that point that she’s probably in her early to mid-50s, something like that. She’s probably having the classic hot flashes, night sweats, insomnia, all those…

Dr. Davidson: Brain fog memory, waking.

Dr. Maki: If she’s still menstruating, she’s not a candidate for the estrogen patch. That would not be good. It would just probably cause a lot of frequent bleeding. That’s one of the ways that you determine if someone’s a candidate or not, is their menstrual history. If they still have one, then progesterone is fine. You could do progesterone. Sometimes that’s very necessary. That’s kind of the more the perimenopausal window. But if they are menstruating, they are not really candidates for estrogen necessarily. So, the feeling dizzy and could not stand upright, a fairly a recent episode – I think it was the last one we did – was talking about someone not being able to wake up in the morning, right? These are fairly common side effects, would you say?

Dr. Davidson: Yes, because progesterone is very relaxing. You don’t want to take it in the morning. Although I will have to say, I have two patients that love taking their progesterone in the morning and they feel no grogginess or tired or anything. They are just like unicorns. But for most of us, myself included, if you take progesterone, it’s going to make you a little relaxed, a little tired. So it’s perfect to take it at night to help you sleep. And then progesterone is needed for anyone taking estrogen. They’ve got to take some to take some progesterone because you don’t want to give unopposed estrogen, especially if they have that uterus because that progesterone, I’ve said it probably a billion times, that progesterone is going to help protect that uterine lining when someone’s taking estrogen replacement therapy. But 100mg is pretty much an average dose for somebody with the uterus on menopausal taking hormone replacement with estrogen. So I wouldn’t say that we’d want to go lower because then that would just leave her uterus unprotected. And then at the same time, we wouldn’t want to switch to a cream. And maybe every practitioner knows this is a dance, this is an art doing hormones, but I’ve always found the cream is just not strong enough to protect that uterine lining.

Dr. Maki: Yeah. Right. And the progesterone cream doesn’t have that mental-emotional plane level of relief that the oral capsule does. So yeah, we don’t grant it. We contradict ourselves because we do use progesterone cream with rhythmic dosing. That’s quite something common. But in that case, if a woman has her uterus, now granted we’re really complicating things now, but in that case with the rhythmic dosing and progesterone cream, we want the women to have a period, which kind of goes against the gradual.

Dr. Davidson: It’s like one different kind of therapy. Exactly.

Dr. Maki: Yeah. And we’ve talked about the difference and we’ll hash this out again, the difference between static dosing and rhythmic dosing. What she’s doing and what is most common for most women is they’re doing static dosing. Same dose every day. With rhythmic dosing, the whole point of rhythmic dosing is to basically recreate the woman’s female cycle. So, she has a peak of estrogen on day 12. She has a peak of progesterone on day 20. And 8 days later she has a period. Something similar to that. So it’s the rise and fall or the peaks of those two hormones that initiate that process. When a woman is in menopause, all the hormones have kind of flatlined in some respects. All we’re trying to do is just raise the baseline, which does provide some symptom relief. I will now granted that’s not raising them to what a woman was when she’s in her 30s necessarily, but it does help with the hot flashes, it helps with the night sweats, it helps with all those kind of menopausal related symptoms.

Dr. Davidson: And like I’ve always said, not one situation fits all. Not one pill fixes all. So, some women love that rhythmic dosing and I have a lot of women on that. And then some women don’t love the rhythmic dosing. And we have a lot of women on static dosing. So that’s where you have to have that individual treatment plan. So even for our patients, one patient is on one particular type of dosing for her and her goals, and then another one’s on a completely different thing. I even have sisters and they’re on completely different therapies because we have to individualize this. So I feel like for Kathy that this treatment plan that she’s on with that estrogen patch and that 100mg of the progesterone may not be completely individualized to her.

Dr. Maki: Yeah, and we were discussing this before we press the record button. Even the estrogen patch could cause a little bit of dizziness and maybe not being able to stand upright. That’s certainly more on the progesterone side, but the estrogen could make her feel a little woozy at the same time.

Dr. Davidson: And like you were mentioning, she’s probably on a Prometrium, which is progesterone. It’s bioidentical progesterone, but there’s also a lot of fillers and excipients and whatnot in there, but it’s instant release. So, what she might be doing is taking it around dinner time, sitting down to watch some TV or something after dinner, and then, like, whoa, yeah, I’m feeling a little woozy. Like trying to get up and walk to the bathroom or get ready for bed. Or she might be taking it right before she goes to bed, let’s say 10 o’clock at night, then maybe she wakes up at midnight to go to the bathroom and can’t walk to the bathroom because it’s so close to when she’s taking it because an instant release is just like it sounds, it’s going to instantly release into your bloodstream and peak as high as it can as pretty much as soon as you’ve taken it. You know, 45 minutes after you’ve taken it because you’ve digested it.

Dr. Maki: Yeah. Now granted, hopefully she doesn’t mention it. Hopefully, that would help her sleep well.

Dr. Davidson: Hopefully she’s not taking it in the morning. Kathy, don’t take it in the morning.

Dr. Maki: Yeah. Hopefully, you’re not getting behind the wheel of a car. You’re not driving a car. You have to put like a warning label energy, not operate heavy machinery after taking progesterone.

Dr. Davidson: I think maybe no, it doesn’t have that.

Dr. Maki: I don’t think it does. Some of the other anxiety medications and any depressants, they certainly have those warnings on there. But this is a very common thing that we get from patients all the time and questions. This one, I think, has come up probably at least a dozen times, if not more. So we might have answered this in the past. If we have, sorry, but the repetition is good, right, because we’re getting new listeners all the time and these things, in some ways, the same. We’re trying to pick out the questions so we are not repeating ourselves. But there are always little nuances in every little thing that we can tease out a little bit. And hopefully there’s something that you’re learning or you’re pulling from it that is helping your situation in some respects. And that’s why this one is very simple, very straightforward, but at the same time, there’s a lot to tease apart there. Prometrium and the estrogen patch are just something that we would not do. That is just not the route we would take with a patient. We’ve talked about the estrogen patch and the vivelle patch fairly recently on how relatively strong that patch really is. I don’t think even practitioners even realize when you see the milligram amount, there seemed so minuscule as far as the milligram amount, but the effect that has on the woman is pretty significant in some cases.

Dr. Davidson: Yes, the patch is a lot stronger than doing bioidentical creams. So much more. And like you said, I don’t know if I would necessarily use a patch with her. I have a few people on it that they like it, but I probably wouldn’t, especially since it sounds like she might be a little bit sensitive, taking that 100mg of progesterone and not being able to stand upright. I would say for Kathy, you don’t want to go below 100mg of progesterone if you are on an estradiol patch. That just wouldn’t be protective. But what you could do is switch to a compounded sustained release. So, instead of that instant release just popping way up and you can’t even hold yourself steady, is you could take the sustained release and then it just comes up gently and stays up over the night, so that you can still get that dose of progesterone, get that protection, get the positive benefits from progesterone, but at the same time she probably would not feel dizzy and be able to stand up straight.

Dr. Maki: Yeah. She won’t feel punch-drunk from taking the progesterone. She’ll actually have a little bit more of a normal response. Still more of a sedating kind of a sleep-inducing response, but not one that’s going to make her compromise in any way. Certainly, nobody wants to feel like that if they don’t intend to. This one, like I said, was relatively short. Do we want to say anything else about this one? Or did we kind of cover the bases on this one?

Dr. Davidson: No, I liked it.

Dr. Maki: Yeah, so this one’s very short, but still I liked it because it was very short and there are a couple things to tease apart and some assumptions that were making based on her situation. So, until next time. I’m Dr. Maki.

Dr. Davidson: And I’m Dr. Davidson.

Dr. Maki: Take care. Bye-bye.