It has become fashionable to say that PDD and PMS should be treated with synthetic pharmaceutical antidepressent medications. These medications have excellent uses, especially for severe depression, but are not as effective for PDD and PMD as natural bio-identical hormones in the experience of thousands of physicians and compounding pharmacists throughout the country.
It is also a clique to say there is "no research on natural progesterone." Absurd. Prometrium is an FDA approved medication which is a bio-identical natural progesterone. The FDA does not approve medications with "no research." Many physicians merely feel that there are better delivery forms of USP approved natural progesterone powder, e.g., capsules individualized to each person, rapid absorption creams or lozenges.
Natural Progesterone Organogel for Treating Adolescent Premenstrual Dysphoric Disorder
We report two sample cases using natural progesterone in the successful treatment of premenstrual dysphoric disorder (PDD) in adolescents. Natural progesterone is physiologically milder than potent synthetic progestins in birth control pills (Lachelin, 1991). The only low dose patented natural progesterone is Prometrium's oral 100-mg. capsule. Its dose size, potential for peanut oil allergy, along with potential concerns with absorption speed and fluctuating bioavailability, have caused us to utilize organogels (Willimann et al.) for adolescent PDD.
Patient one is a 16 y/o female with menarche at 13, and a normal body size, with cycles ranging from 28-30 days. Regularly, three days prior to menses she met the diagnostic criteria for PDD: irritability, felt "on edge," affective lability, lethargy, sleep and appetite changes, bloating and migraines. 25 mg. of natural progesterone organogel (.05 ml of 50mg/.1 ml) applied bid to the dorsal hand caused prompt and complete reversal of symptoms, including her migraines.
Patient two is a thin adolescent with only 15% body fat whose menarche was at age 14 1/2. She menstruates every two to three months, most likely due to her insufficient fat estrogen (estrone or E1). Presently she uses the 25-mg. progesterone organogel each am and evening "when she feels her symptoms worsening." She starts the organogel 5-7 days before her menses. She meets full PDD criteria during any month she has a period and has clear resolution of these criteria with this treatment. She also benefits from the smallest bio-identical patch for the first three days of her period, presumably, because she has insufficient fat estrogen to "cushion" the fall of her estrogen. Such a sudden decrease of estrogen triggers menses, but in thin women can make them uncomfortable due to minimal fat estrogen (E1).
The etiology of PDD is complex, in part because of the interconnection of hormones, neurotransmitters, carrier proteins, stress and nutrition. Like other neuronal agents, progesterone's effects are not simple, and include influencing both the Serotonin and GABA systems (Yen, 1999). Further, some progesterone research has been further clouded by the false assumption that natural progesterone and synthetic progestins are similar in function. An example of their contrast would be their different effects on blood HDL-the synthetic lowers it in varying amounts depending on the progestin while the natural does not increase HDL (Ottosson et al.).
We report the successful use of a rapid absorption progesterone organogel in reversing the symptoms of PDD in two of our patients. It is worthy of consideration as a mild and useful treatment. Properly designed forms of natural progesterone can be obtained through referrals from the International Society of Compounding Pharmacists (800) 927- 4227.
James L. Schaller, M.D., M.A.R.
Chester County Research Center, PA
Ben Briggs, R.Ph., Lionville, PA
Michael Briggs, Pharm.D., Lionville, PA
- Dickey RP (1998), Managing Contraceptive Pill Patients, Durant, OK: EMIS, pp 8-9
- Lachelin GC (1991), Introduction to Clinical Reproductive Endocrinology, Cambridge: Butterworth-Heinemann, pp 182-183
- Yen SSC (1999), Chronic anovulation due to cns-hypothalamic-pituitary dysfunction. In: Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management, Samuel SC, Jaffe RB, Barbieri RL, eds. Philadelphia, PA: Saunders, pp 553-554
- Ottosson UB, Johansson BG, von Schoultz B (1985), Subfractions of high-density lipoprotein cholesterol during estrogen replacement therapy: A comparison between progestogens and natural progesterone. Am J Obstet Gynecol 151:746-750.
- Willimann H, Walde P, Luisi PL, Gazzaniga A, Stroppolo F (1992), Lecithin organogel as matrix for transdermal transport of drugs. J Pharm Sci 81:871-874
Published in the Journal of the American Academy of Child and Adolescent Psychiatry.
Reprinted with permission from Lippincott Williams & Wilkins Publishers.