Gail Sheehy reports in her book, THE SILENT PASSAGE, that many doctors hear common complaints about progestin: "Whenever I take Provera, I have migraines, bloating, breast tenderness, the blues: I feel awful and want to die."

Dr. Prior does not believe Provera causes these side effects. She points to two double blind studies which showed no increase in PMS symptoms with the addition of Provera to estrogen.

The Benefits Of Natural Progesterones

Provera is a synthetic or man-made form of progesterone. Natural progesterone has the same structure as the one normally found in the female body. Natural progesterone appears to be safe and have far fewer effects than its distant synthetic relative.

Since natural progesterone taken by mouth is broken down in the stomach, it has to be taken in special micronized oral form or by rectal or vaginal suppository or skin cream.

According to Gail Sheehy, some experts believe "that oral micronized progesterone (OMP) is the wave of the future." Dr. Joel Hargrove did a small study on the effect of taking a daily combination of natural oral micronized progesterone (200 to 300mg per day) and natural estrogen in the form of estriol. Women on this regimen felt well, had a better blood lipid readings and the uterus was still protected.

Dr. Malcolm Whitehead, Chairperson of the British Menopause Council, says that OMP in adequate doses causes sleepiness and drowsiness. He says he would recommend taking the natural progesterone by vaginal or rectal suppository instead. Natural progesterone is better absorbed through this route, thus lower doses can be used.

Through his research, Dr. Whitehead has found that at least 300mg of Utrogestan (a type of OMP made by a French company and soon to be marketed in Canada as prometrium) for 10 to 14 days a month is necessary to fully protect the uterus. Dr. Whitehead also uses Duphaston (another form of natural progesterone that is made in Holland but not available in North America).

Dr. Don Gambrell, Professor of Gynecology, Physiology and Endocrinology in Atlanta, recommends 25 to 50mg of natural progesterone twice daily in a vaginal suppository form; or in a capsule form taken by mouth: 100mg in the morning and 200mg at bedtime. All these doses will protect the uterus from cancer.

OMP is currently available through specialized pharmacies by prescription only.

Dr. John Lee believes that most menopausal symptoms, including prevention of bone loss, can be best handled through a natural progesterone cream that is applied to the skin. One to one half jars of the progesterone cream is used per month and each two ounce jar contains 900mg of natural progesterone. The chapter on osteoporosis gives details on how the cream is applied.

Hormones And The Heart: The Pros

Although well designed studies have yet to be done, experts point out that the studies to date, although of mixed quality, show a positive effect of estrogen on the heart and perhaps as high as a 50 percent reduction in the rate of heart disease.

The protective effect of estrogen was originally thought to be due to its favourable effect on cholesterol levels in the blood.

Estrogens decrease total cholesterol, increasing the good cholesterol (HDL) and decreasing the bad cholesterol (LDL). They also increase levels of one of the "bad fats" in the blood, known as triglycerides. When estrogen skin patches are used, HDL levels do not increase. Some forms of synthetic progestin may cancel out many of the beneficial effects of the estrogen. In contrast, natural progesterone has a positive effect on HDL.

According to Dr. Pierre Fugere, from the University of Montreal Menopause Clinic, "This action [of estrogen] on the lipid profile would explain between 25 percent and 50 percent of the reduction of risks. Thus 50 to 75 percent of the risks must be explained by a direct action of estrogen on the coronary blood vessels."