Hi I’m Dr. Jared Nielsen. I’d like to talk to you about hormone replacement therapy for females and particularly, the utilization of progesterone. A lot of books have been written. A lot of studies have been promoted about the use of progesterone for the post‑menopausal female.
The interesting thing though, when we think about progesterone utilization, is the natural function of progesterone, and a correlation to thyroid hormones be in the body. Let me say it this way. When a young woman, a young expecting, or potentially pre‑expecting mother is trying to regulate her cycle, and observe when it is that she ovulates, she’ll often use her temperature as that indicator.
The temperature spike in the female body is associated with progesterone elevations that cause then, an activation of a thyroid peroxidase enzyme, which actually binds tyrosine to iodine to form thyroid hormone, or T4.
What’s important of this to know is that the progesterone in in the mid‑cycle actually then stimulates this TPO, which then allows an increase in the T4, which is measured in the body as an increase in body, or basal metabolic temperature. Your body temperature will actually increase due to this increased production of thyroid hormone during an ovulation cycle.
The interesting thing about this correlation to note then is, if a female actually has an antibody that attacks her thyroid peroxidase, then she actually experiences something that’s actually suppressing this normal, productive activity.
Let’s look at it this way now. Let’s say that a woman with hormone replacement therapy has thyroid peroxidase antibody that’s already elevated in her system. When we offer more exogenous progesterone we actually up regulate this TPO antibody therefore, suppressing our T4 total and now manifesting more of a hypothyroid symptomatology, or in this case a Hashimoto’s hypothyroid endocrinology case.
This person now will feel the more progesterone they take, the less metabolically active, or the less energy, the more slow they feel. Their hair may start to thin. They may notice that their digestive system is slow or becomes constipated. Their skin may become dry and again, more and more of the hypothyroid symptoms.
The other interesting thing about this is, as the progesterone levels are sustained high, this suppressed thyroid output by activating auto‑immune antibodies will then manifest more and more their symptomatology when this may be what they’re trying to address.
When we look at this again, measuring progesterone is not alone adequate for us to determine, “Are you a candidate for hormone replacement therapy?” We actually need to determine, “Do you have TPO antibodies?” If you do, caution you to use, or excessively use that type of a hormone replacement because of the response that occurs here.
If we also look at hormone replacement and its companion of estrogen, excessive estrogens have also a potential hypothyroid response in that the estrogens can suppress thyroid receptor sensitivity downstream.
When you’re considering hormone replacement therapy it’s not enough just to measure your estrogen/progesterone levels. Also you need to measure thyroid function and see if there’s an antibody present, if you have adequate T4 thyroid stimulating hormone, and the antibodies including TPO antibody, and thyroglobulin antibodies.
An accurate measurement of this profile will give us a better window into your likelihood for a positive outcome of utilizing these hormones, if they’re necessary. Again though, these hormones actually are better and more strategically activated by looking at adrenal function and allowing the body’s adrenal system to kick into gear to sustain those hormones prior to hormone replacement therapy.
Remember, a lot of women experience hormone replacement therapy and need for it because of a total hysterectomy. Prior to that hysterectomy, thyroid evaluation and adrenal evaluation should be considered because already the dysregulation of the antibodies, or excuse me, of the hormones estrogen/progesterone may have caused or proliferated the need for this surgery to actually occur, a hysterectomy.
When we’re thinking of that then, if we can consider if the hysterectomy was necessary, and that has already been performed, evaluate all of these components rather than just jumping to the conclusion, “A young woman needs estrogen, she should also have progesterone.”
I hope this is a help for you as you contemplate your health questions and you’re trying to get on your road to wellness. Thanks for watching.