It has been my experience in counseling women on hormone therapy, many if not most, suffer from insomnia in some way, whether it be difficulty falling asleep, staying asleep, or both. Many physicians, even physicians treating hormonal imbalances in women, will be quick to prescribe a “sleeping pill”. I learned in my training as a hormone specialist by Dr. Pam Jones with A4M that women are not deficient in Temazepam (Restoril) or Zolpidem (Ambien), which are prescription drugs for insomnia and can be addicting. The question we need to ask is if women are not deficient of Ambien, then what are they deficient in?
Most do not realize that progesterone helps with sleep. Most women I counsel also have low levels of progesterone and can contribute to many symptoms such as insomnia. Estrogens and progesterone have opposite effects on the body and must be balanced for optimum health. Too much estrogen in relation to progesterone, even if progesterone is in the normal range, can have terrible consequences to how a female will feel. What is recommended concerning progesterone in helping with sleep?
There is a definite distinction between oral progesterone and topical progesterone. Let me explain. Topical progesterone is great for increasing blood levels of progesterone for optimum health. It is 80% to 90% bioavailable when given topically. That means that 100mg of progesterone applied topically, 80mg to 90mg will be absorbed into the blood stream to be used for its biological functions. The liver metabolizes 10% to 20%. However, oral progesterone is only 10% to 20% bioavailable, where 80% to 90% is metabolized in the liver. Likewise, that means that a 100 mg capsule given orally, 10mg to 20mg will be absorbed to be used for the biological functions that progesterone provides. With that said, why give progesterone orally?
There is a twist to oral progesterone giving it the perfect solution to women’s problems of insomnia. Most drugs are metabolized to an inactive form without any biological use and then excreted from the body. This is true to most drugs, but not all and progesterone when taken orally is a perfect example. Progesterone when taken orally is metabolized by the liver to an active metabolite. This means the product produced from metabolism has an active function on the body outside from what the parent drug does.
Progesterone when given orally is 80% to 90% metabolized in the liver to allopregnenolone, which has a biological function on the body. I am sure everyone has heard of allopregnenolone, right? Allopregnenolone works on the GABA receptors, which we will not dive into that! Let us make it simple and just understand that allopregnenolone working at the GABA receptor site in the brain helps with sleep! Therefore, oral progesterone enhances the ability to fall asleep and stay asleep. Now you know that women are not deficient in Ambien, but deficient in allopregnenolone!
There is another twist to giving oral progesterone to enhance sleep. Topical progesterone takes two to three months to reach the peak therapeutic effect. However, oral progesterone’s effect on sleep is very quick, within 30 to 60 minutes. This helps us to determine the right dose for each individual woman. It is always best to start low and slow when it comes to hormone therapy. With oral progesterone, it is no different, for each person is unique and will require different doses depending on each person’s needs. I mentioned Dr. Pam Jones above and I can remember her teaching that due to progesterone’s quick effects on sleep, it makes a perfect drug to titrate up and without too much time to get to the effective dose. Dr. Jones also made it clear that helping a female sleep is a priority and can be a quick fix. So, how is the titration done?
It is recommended to start at a low dose, Dr. Jones recommends progesterone 12.5mg slow release capsule to be given before bedtime for 2 nights. Remember the low and slow strategy. If a person falls asleep and stays asleep those two nights, then 12.5mg is the effective dose. However, if not, it is recommended to increase by 12.5mg every two nights until able to fall asleep and stay asleep. One’s effective dose may be 50mg, 100mg, or even 200mg. Each person will be different. Once the effective dose is found, we can compound that dose into one capsule and with refills if the doctor okays it.
I have used 25mg titration with effective results. I believe 25mg is not going to make that much difference, plus, most women are deficient in progesterone and even though little is absorbed to raise progesterone levels, there is still some being absorbed. We can help females find the ability to fall asleep and stay asleep in a very short amount of time, which is a huge benefit to one’s overall wellbeing. Most of the time, women are needing topical progesterone as well.
Progesterone may be just what you need if you have insomnia. Please contact us if you are having difficulty sleeping by clicking the “learn more” button below for Consultation Calls for Medical Providers and Patients. I would love to hear from you.
C. Craig Wells, RPh