The role of natural progesterone creams is one of the many controversial topics in menopause management. Among the most controversial questions about these popular products is whether they can improve bone density.
Most women who use progesterone creams, typically containing naturally occurring progesterones derived from Wild Yam, are using them in conjunction with conventional or natural estrogen replacement. For the products that do contain what they say they do, transdermal delivery in a cream vehicle is a highly effective way of getting progesterone into circulation. That fact is not lost on the pharmaceutical companies that have developed transdermal patches for delivery of their synthetic progestins. Most menopause experts agree that a woman with an intact uterus on estrogen will need some form of progesterone replacement to prevent endometrial hyperplasia.
Several physicians who recommend natural progesterone creams report that many of their patients have marked improvement in bone mineral density (BMD) with long-term use of these creams. According to C. W. “Randy” Randolph, MD, an ob.gyn. in Jacksonville, FL, some of his patients have gained 10%–20% in spine and hip BMD after a year on progesterone cream. “I had a lady who has been on my regimen for a year and she went from a –3.6 on her spine to a –2.5. The hip was a little bit less, from –2.7 to –1.8. I continually see results like that.”
Dr. Randolph added that the progesterone-associated improvement is most pronounced in women with the lowest baseline BMDs. Those who have normal BMDs at baseline tend not to see increases.
So far, the BMD claim has not been fully evaluated in controlled studies. The only existing study, by Helen Leonetti, MD, tested BMD in perimenopausal women using progesterone creams versus those who did not, and found no significant difference between them. Dr. Randolph said that he was not surprised by the absense of effect, since most of the subjects in Dr. Leonetti’s trial had normal baseline BMDs. “We need a study done with progesterone cream on women who do have measurable bone loss.”
