I often read statements from other physicians making sweeping – and erroneous – generalizations that all progestins should be avoided, and women should use only bioidentical natural progesterone.
I frequently prescribe FDA-approved bioidentical progesterone (brands available are Prometrium, Prochieve, Endometrin), but there are certain medical situations in which progestins are actually safer and more appropriate for an individual woman than natural progesterone. Many perimenopausal women I see are worried about getting pregnant as their cycles become more erratic closer to menopause. They ask about the contraceptive vaginal ring, NuvaRing, and want to know “Is this safe for me to use?”
Let’s look at NuvaRing’s safety and effectiveness aspects, from the perspective of a woman specialist who has been treating complex hormone problems in women from puberty to menopause for the last 25-plus years.
NuvaRing is a soft, flexible open ring, smaller than a diaphragm, that is inserted in the vagina once a month. It is removed after three weeks to have a period, and then a new ring inserted. I have prescribed this option for hundreds of women – from adolescence to perimenopause. My patients really like the convenience of not having to remember to take a pill every day.
There are a variety of reasons NuvaRing is a safe and effective option for women I treat who are in those turbulent hormone years leading up to menopause:
1. NuvaRing contains both estrogen and progestin. Both hormones are present in lower doses than oral contraceptive pills, but the potency of the synthetic hormones reliably prevents ovulation to work as an FDA-approved contraceptive. Clinical studies showed clearly that NuvaRing was both safe and effective to prevent pregnancy. Bioidentical estradiol and progesterone, on the other hand, are not potent enough to suppress ovulation and provide reliable contraception. Women who don’t want a late-life baby need reliable contraception – they cannot safely use bioidentical hormones (estradiol and progesterone). I recently saw a new patient who had been put on bioidentical hormones without the practitioner telling her that this regimen might actually enhance fertility. Her bioidentical hormones were “natural” all right – so natural that after three months on her cyclic hormone therapy, she had quite a shock – an unplanned and unwanted pregnancy at age 49! This is one situation in which using a progestin is definitely the safest and best course of action – late-life pregnancies carry a great deal more risk for women than using the low dose synthetic progestin and estrogen in NuvaRing.
2. It is primarily the progestin in NuvaRing that provides contraceptive effectiveness. Bioidentical progesterone is not contraceptive. In fact, natural progesterone is often used by fertility specialists to help improve fertility by enhancing conception and helping prevent early miscarriage. This is an example of how progestins can be not only safe but also beneficial.
3. NuvaRing delivers hormones non-orally, which means it uses lower doses than oral birth control pills. Non-oral hormones have lower risks than oral pills for blood clots, gallstones, and elevated triglycerides. Non-oral NuvaRing is less likely to increase blood pressure than oral contraceptive pills. All of these are important benefits of NuvaRing, especially for older perimenopausal women who want to safely prevent pregnancy.
4. There are other benefits of the progestin in NuvaRing. Several common problems tend to increase in frequency in the perimenopausal years: fibroids, erratic and heavy bleeding, ovarian cysts, and flare-up of endometriosis. Women I treat with NuvaRing find that the low dose daily progestin in NuvaRing successfully reduces these problems and relieves painful, heavy periods. Recent research presented at the International Society of Gynecological Endocrinology found that bioidentical progesterone actually makes fibroids grow in size and have more blood vessels, thereby contributing to increase in bleeding problems rather than the decrease in bleeding with progestins.
One important concern for me is to see that women get individualized hormone approaches tailored to their particular needs. Natural progesterone has a role for some women, while other women need the particular benefits that progestins offer. Unpleasant side effects such as low sex drive, weight gain, headaches, feeling sluggish or irritable or depressed can occur with natural progesterone as well as progestins. In fact, some women I have treated have been quite ill from the progesterone they were given by other doctors, and felt markedly better when I changed their prescription to a low dose progestin.
Whether it is progesterone or progestin, side effects depend on your individual make-up, dose, route of delivery, and type of progestin. The key point is that natural progesterone doesn’t work for all women. Some women do better on progestins. There is no single right way for all women.
It doesn’t serve women well when doctors or writers throw the baby out with the bath water and condemn all progestins as “bad.” Women deserve better – they deserve to be given medically sound information, to be respected and treated as individuals, and to have medical therapies tailored to their specific health goals, medical needs, and desires.
You may want to read more about all these options and ways to individualize your treatment by checking out my various books and my website, www.herplace.com. There are many ways to achieve your health goals and feel well!
© 2010 Newsmax. All rights reserved. “The Savvy Woman’s Guide” is a registered trademark of Dr. Elizabeth Lee Vliet and Savvy Woman's Guide Publishing, Inc. Used with permission.
