A Transcript     Contents     Introduction: Dr Goodman     Dr Bond (Intro)     Dr Lee

Dr Bond     Q&A: Drs Lee and Bond     Dr Smallbone     Dr Griffin     Beth MacEoin

Q&A: Smallbone, Griffin & MacEoin     Leslie Kenton     Q&A: All     Exhibitors & Speakers

 

 

Question & Answer

Dr Shirley Bond, Dr John Lee and AnnA Rushton field questions from the audience.

Goodman: It has been a pleasure to hear that everyone is individual and there isn't a magic formula that is going to work for everyone, and I hope we all take this away with us. AnnA Rushton who is the Head of the Natural Progesterone Information Service has joined the podium and I am going to invite Kate Neil as well, so we can have the next 35 minutes for, what I am sure is going to be a roaring question and answer session. We have 2 stewards and 2 radio microphones, and the way I propose to deal with this is that when someone has a question please raise your hand and one of the 2 stewards will point at you and you will get your microphone.

 

Audience: I have 2 questions, one is for Dr Bond. I want to know about people who have had ovarian removal, if the dosage of progesterone has been higher than if it has just been the natural menopause?
Bond: I am just going to repeat your question, are you asking if you had a ovarian removal do you need to take a greater quantity of progesterone than a woman who is going through a normal menopause?
Audience: Yes.
Bond: No, you would probably need to take about the same because after the menopause the ovaries don't in fact make very much progesterone at all, because you are not ovulating.


Audience: Dr Lee this is nothing to do with the progesterone but I just want to know about the role of DHEA in the menopause.
Lee: We know that DHEA falls with age. It's a marker for ageing. We do not know that supplementing it for any woman provides any benefit whatsoever. At this stage of medical science I see no reason for it to be given to anyone.


Audience: Dr Lee, thank you very much for all you've done for us, we have really appreciated it. I run little groups for women now and again. I show a video of you and in the last few times some men have crept into the group and they get very excited at the end. It's the New Ways video, you mention about progesterone for prostate and also wonder about osteoporosis in men. Should they have progesterone too?
Lee: Very good questions. The men continue to make testosterone usually till they are in their late sixties, mid seventies. Their osteoporosis shows up when their testosterone falls, so testosterone and progesterone do much the same thing in promoting new bone formation, so that I have used progesterone instead of testosterone for men where their urologist thinks that their prostrate cancer originated from testosterone. He wouldn't like it if I gave the patients testosterone for their bones so I give progesterone. However, the urologist is mistaken. New studies, two sets of scientists now, in papers that will be published in the next month or two, have found that prostrate cancer cells are killed in the presence of real testosterone but as men age the testosterone changes to dihydrotestosterone, becomes something other than real testosterone, and that is what allows cancer cells to grow.
     This change occurs because their progesterone fell and they have a rise, even though they are males, they have a rise of oestradiol and you will see these in golfers that you watch on Sunday television on the senior golf circuit, you will see breasts bobbing under the tee shirts of the older male golfers, and that is their oestradiol. When progesterone falls their testosterone changes into dihydro-testosterone. So you get this combination that occurs in men who are over sixty five. Progesterone falls, oestradiol rises, testosterone change and prostrate cancer is the result. This is now confirmed beyond dispute. Two studies show the same thing and these will be published. Now the question is what to do. I think the time will come when we will recognise that progesterone deficiency exists in men and that supplementing it will protect them from cancer. The male prostrate is the male equivalent of the woman's uterus, it has the same genetic structure. So therefore the same gene controllers work.

Goodman: I would like to at this point, invite AnnA Rushton to provide us with an update of the legal status of obtaining natural progesterone, I am sure this a subject we all want to hear. So if you don't mind AnnA?

Rushton: Actually the situation has changed in the last year and some of you may have old information. Currently in this country you can obtain natural progesterone only on prescription from your doctor, either privately or, happily, an increasing number of women are getting their natural progesterone on the NHS. Regrettably it is very much on the whim of your doctor, or maybe not necessarily your doctor but his or her Health Authority. I get letters frequently from women who have been given natural progesterone on the NHS who have had it withdrawn because the Health Authority have changed their minds and I have women who write happily to tell me that they have now got the National Health prescription from their doctors. It is pretty much a lottery.
     So legally you need to have a prescription and this leads to another confusion in this country.
     If you can buy a cream over the counter, by mail order without a prescription within the UK, it cannot by law contain progesterone. I really need to make this clear and I am going to ask Dr Lee to expand on this a little because it is a part of our confusion with the Yam creams. You also do have the right as a citizen of the EEC, if you cannot get a prescription from your doctor, you are allowed to order it from the United States. You can actually bring it back from the United States if you are going on holiday there, it's much cheaper, take an extra suitcase. You can buy it over the counter there. If you are not happy going to the United States for a holiday then there are several agencies who will arrange to import it for you.
     We have a table in the foyer. Our free prescribing leaflet gives the telephone numbers of the people who do that. We always suggest to women that they be in relationship with their doctor because when you undertake anything new your doctor knows your medical history, they can support you. They can tell you whether some symptom you are experiencing may be due to progesterone, a new element or it could be something else.
     Regrettably what many women find is that their doctors are not as open minded as they might be. That is a very polite way of putting it I think. I know a number of you have already experienced this. There are some marvellous doctors out there. I had a telephone call this week from a woman, and I know John will appreciate this one, her doctor has given her natural progesterone on the NHS, she has had wonderful results from it, she is extremely happy on it, and she has given her doctor all the information that we provide, information packs for doctors and Dr Lee's books. Her doctor has read it all, her doctor has seen the results that she has had and on her last checkup she said "Are you going to prescribing it for other women in the practice?" "Oh no" he said. "This is just for you, I don't know that it works, I don't know what it is?"
     The constant debate we have is, but where is the research? Well I haven't got it with me but there is a pack this deep of research that is available. What they mean is they personally don't know about it because the drug rep hasn't called on them with a glossy brochure and a free sample. I am afraid this is one of these areas, I am going to use my favourite Germaine Greer quote here, "The twentieth century will be remembered as the one in which woman's bodies became living laboratories" and that is what we have become and as Dr Lee has always advocated we need to take some responsibility here for our own health care. I am afraid we have to find out the information, we have to give it to our doctors and then we have to be the thing that most doctors hate and dread, a complaining persistent woman. You have to keep going in there. Assertive. Yes that is the key word, assertive. Most doctors don't see it that way but yes we'll call it assertive.


Audience: I am here because I read Dr Lee's book. I am here also because I am taking responsibility for myself. I am a complaining woman who went to my doctor and was told to go on Prozac. Thanks to AnnA's leaflet I met Dr Smallbone and I am on progesterone, but following Dr Lee's talk I am interested to know if any research has been done on our levels of oestrogen falling and why don't the doctors test our oestrogen levels by saliva? We only have blood tests.
Lee: The answer is that the saliva hormone assay is available for any of the oestrogens that you might want to test. It also includes DHEA if you want that, any of the corticosteroids, testosterone and, of course, progesterone and they can separate the progesterone from the synthetic progestins, the progestogens. They are all available and they are less expensive than the plasma test and they are far more relevant because they are measuring the active hormone circulating in your bloodstream.

Goodman: Dr Bond, have you got a comment on that? Why doctors don't test?
Bond: I think it is, one has to admit to a certain extent, I think it is ignorance. Many doctors are not aware that there are saliva tests and because they are not very familiar with them they don't like doing them and they can get very upset when patients come along with them because basically they don't understand them. There is no reason why they shouldn't.
Goodman: Why do you think it is, that this research from twenty-five years has never been reported to the general public?
Rushton: The answer to that is the same as for all the research that Dr Lee talked about. It doesn't profit anybody. That is why I myself was horrified in the same week Dr Lee talked about these wonderful cancer results which would hearten every woman and breast cancer is such a major issue. What hit the newspapers was Tamoxifen – it was in every single newspaper. Where was the reporting? I suspect that the answer to your question is simply, who profits?


Audience: I have a question for Dr Lee. I was originally introduced to Pro-Gest cream through my sister because we were concerned about menopause symptoms. Despite having a long history of healthy living, good diet, exercise etc. and breast feeding four children, I have produced a cancerous breast lump. I discovered this in October last year and decided to refuse surgery. I have been using Pro-Gest since and I am wondering whether there are any more studies that have been done on its use with cancerous tumours, since November 1997. And also whether you could comment on the application, whether it's different when you are thinking about treating cancer rather than menopause alone?
Lee: Another good question. The problem is that for the cancer to become evident it has been growing silently for eight to twelve years and once it reaches the stage at which it's palpable and can be found by mammogram the doubling time becomes about every three to four months. So it becomes more aggressive as it goes along but it often takes eight years and people will tend to think that perhaps the progesterone had something to do with developing the cancer, but it did not. There is study after study since the middle seventies showing that it protects against the breast cancer.
     The problem with the conventional medical journals reporting it, is that they would search for proof that it was absorbed by using the plasma test or the serum test and they would miss it and it wasn't until we had the appearance of the saliva assays now becoming accurate and easily done that we know that the progesterone is well absorbed. The dose is interesting, the experience that I have had over twenty years of using it, I have aimed at a dose that would be physiological, fifteen to twenty mg a day at most. Possibly less for a post-menopausal person, you are not preparing a uterus to carry a baby. You are supplying the progesterone that the cells of your body need.
     There are progesterone receptors in brain cells, bone cells, white blood cells, red blood cells, there are progesterone receptors in the mucosal lining of your sinuses, they are all over your body. It is not just a hormone for creating a baby, it is an essential hormone for the entire body but the dose the entire body needs is considerably less than it needs to carry a baby so that I think that fifteen mg a day is probably an optimal dose and if you double the dose or triple the dose you will lose effectiveness. These hormones work by combining with receptors and you can overwhelm the receptors and cause them to down regulate. Also it is excreted to the liver and these high doses of, hundred, three hundred, four hundred mg a day that doctors are giving patients will cause a high amount of the metabolites.
     One of the metabolites of progesterone made in the liver normally in excreting it, happens to be a very powerful brain cell anaesthetic and if, in fact, you isolate it you could use it for an anaesthetic for surgery. This has been known for years. When you use smaller doses like fifteen mg or twenty mg a day, you do not achieve any significant doses of these metabolites that might not be good for you, so fifteen mg a day, is what I tell people or twenty mg a day. It's easy to create with the creams, the cream that has 960 mg in a 2oz jar, would have 480 mg in a 1oz portion, 320mg in a third of a jar. If 320 mg is used up over 21 days out of the month, you are getting 15 mg a day.

Audience: Presumably there is no benefit from applying it directly to the lump.
Lee: There might be an emotional benefit because we all retain our primitive instincts, but no. For instance the heart patches with the nitroglycerine, they all show them over the left chest but the nitroglycerine doesn't penetrate through the skin, the fat, the fascia, the bone, the pleura, lungs, the pericardium into the heart, no it gets into the blood stream and gets to the heart, you could put the patch anywhere. Now we have been doing research on sites of skin, where absorption is best and we find absorption is best where the capillary bed is richer and closer to the surface. That happens to be all the areas where we blush. So the face, the neck, the chest, the back, the ears, the palms of the hands. If you look at the palm of your hand it is pinker than the rest of your arm, so the palms of the hand, soles of the feet all the places where we blush, you get maximum absorption.
Audience: I would like to say that I wasn't suggesting the Pro-Gest cream was involved. Going back to something you said in your talk, my mother was injected with stilboestrol through two pregnancies before me and throughout my gestation and I think that definitely was a factor.
Lee: Fine, I just didn't want people to make the connection that taking the progesterone cream brought on the breast cancer.
Audience: No, I wasn't suggesting that and the work I have been doing since October and investigating this with AnnA's help, I would say that time and time again I come up against not just lack of information but deliberate misinformation that has been put out by people who are profiting and I think we have to make a stand.
Lee: Me too.


Audience: I am a complementary therapist and I am here to hear what all of you got to say, so I can pass it on. I was very concerned to hear Dr Bond say we shouldn't ever have been prescribed unopposed oestrogen. I had an hysterectomy 9 years ago, have one ovary left and have been on oestrogen, that I want to come off. Have I any hope to getting optimum health at this stage after being on it unopposed for so long.
Bond: Oh yes, you most certainly have. What oestrogen are you on, what sort of dosage?
Audience: Climaval – 2 mg.
Bond: A very popular one at the moment. The thing is that what you need to do is gradually reduce your oestrogen, cut your tablet in half, take three quarters, don't rush it. Take it slowly but you must use progesterone with this oestrogen because you are taking unopposed oestrogen. Dr Lee has just explained to us all the problems of unopposed oestrogen and in my view it is a very dangerous thing to do, but certainly you have a chance of getting off it.
Lee: I agree with that, you would be a good candidate to have your saliva progesterone level measured because there is a chance your one remaining ovary is still making it. I doubt it is, but it will be nice for your doctor to know, and for you to know whether you are actually making progesterone or not.


Audience: I am a Health Care Professional with an interest in natural progesterone for the last eighteen months. I've got a young friend, age 34 who's had three benign breast tumours. The last time she was operated on was before Christmas. The nature of the operation was they had to remove the pituitary, both anterior and posterior pituitary, and since then she has been on antidiuretic hormone (ADH) and cortisol and her endocrinologist has been talking to her about the possibility of HRT. I was wondering if Dr Lee could comment on this, the use of natural progesterone for her case and also how it would relate to cortisol and perhaps ADH.
Lee: What prompted them to look at her pituitary in the beginning?
Audience: They removed the tumour.
Lee: What prompted them to look for a tumour?
Audience: She grew a tumour 3 years ago which was removed and then it grew back in the last 3 years. They removed the second tumour but they accessed it through the nose but it wasn't all removed and it grew back within 3 weeks.
Lee: Was this a cortisol, I mean an ACTH producing tumour?
Audience: No, she wasn't on any hormones prior to Christmas this year.
Lee: Was it a prolactinoma? Prolactinomas have become the most common intercranial tumour in women. 15% of all tumours in the brain involves a prolactinoma which is a growth from the pituitary and it customarily will make excess prolactin and cause a discharge in the breast. It's not cancer, there is some underlying metabolic imbalance that leads to the continual development of normal cells into prolactinoma cells. It doesn't have to be a tumour it can just occupy the pituitary.
     So I have been following this, this happened to my wife, as a matter of fact. Hers was totally benign and she did have a transection. Fortunately no tumour has come back. It was not a tumour making any hormone whatsoever and fortunately she doesn't have to take antidiuretic hormone or other functions of the pituitary so everything now seems to be all right.
     In general I have looked into this as you might imagine and I have found good evidence that progesterone deficiency is the underlying metabolic imbalance that leads to too much stimulation of the pituitary trying to resolve some hormone imbalance, and it ends up making tumours. I have, to a doctor's wife, given progesterone for her prolactinoma which was making high levels of prolactin, and within 6 months, her prolactin levels have come down to zero and her tumour has disappeared.
     At the George Washington University Medical School the word is spreading that there must be something to this. If she does need progesterone, I would have no hesitancy at all in adding the progesterone to her HRT if they feel HRT is necessary.
Audience: She has actually started on the progesterone now.
Lee: She started on progesterone, that's fine, she may not need the oestrogen, just as Dr Bond said, some women continue to make enough oestrogen as my wife does. Sufficient body fat to make the oestrone which is fine but she needs the progesterone for balance.


Audience: I would like to ask Dr Lee to answer a question that has been asked several times this morning before we actually began the session. A number of women are still confused about the difference between yam creams and progesterone and this has been going around the merry-go-round for several years and I would really like Dr Lee once more to clarify what the situation is.
Lee: No plant makes human hormones, no plant makes cholesterol, you make the cholesterol from the starch and the sugar and the doughnuts and the cookies and the mush and everything else you eat and from animal fat, and from the cholesterol you make your own hormones. When you can't make the hormones they can be supplied and they can be synthesised from fats in plants. Plants are amazingly complex creatures; a leaf of spinach has over 10,000 different chemical compounds in it. Something as complex as a yam has probably 12 or 15,000 and these can include things that act like aspirin, the salicylates, they can be things like belladonna, can dry your throat to dilate your pupils, constipate you.
     There are things that have male-like effects, female-like effects, there are vital oestrogens, there are literally thousands of these compounds but there is no progesterone in the plant and no amount of wild yam or soya or cactus or sunflower seeds or anything are going to change your progesterone production if your ovaries can't make it. They do not make it from anything in the yam, any different than they would make it from the starch in the doughnut. It's not that. It is not progesterone and your body does not make progesterone from it. Companies that sell ground up wild yam or any extract that wild yam, they are selling things that do have physiological effects but they are not progesterone.

Griffin: Do you have any experience with using progesterone with polycystic ovaries? Women who may have had an hysterectomy or the ovaries removed because of it or still have polycystic ovaries, just for everybody else's knowledge, don't normally do very well on progesterone and that's why I'm asking that question?
Lee: My patients (with polycystic ovaries) generally resolve in about 2-3 months of progesterone therapy. It's due to a failed ovulation and when the progesterone level does not rise, the computers in your hypothalamus do not detect any rise of progesterone and therefore signal the pituitary to increase FSH that stimulates the ovary to keep trying, and thus the cysts develop. Progesterone supplementation restores the progesterone surge that should normally occur each month with ovulation. That is from day 12 or 14 whenever her ovulation should occur, I give them extra progesterone from then until a day or so before her expected period. Within 3 – 4 cycles we will do an ultrasound and we will find that the cysts are gone. I have people whose doctors wouldn't believe it, they went ahead and actually opened up the patient in surgery and they would find the cysts are gone and would end up doing nothing. They would say "Oh it must have been a spontaneous remission." There are other causes, but in general they go away.

Audience: I have been taking HRT for 6 months unhappily and 2 weeks ago I just stopped it dead. What have I done to myself?
Bond: You only took it for 6 months, I don't think you've done yourself any harm at all. Are you feeling well now, you're not having any problems? I wouldn't worry about those 6 months.
Audience: The hot flushes have come back and a few night sweats.
Bond: Well on the whole they are more to do with the changeing levels of hormones than an actual drop. They are also very much related to stress and other things that go on. In my experience the best way of dealing with those first of all, is with things like herbal remedies, homoeopathy and then you can always try progesterone after that. The herbal things are a good idea first but I don't think you need worry about having done yourself any harm in 6 months.
Goodman: We will be addressing herbal and homoeopathic remedies this afternoon.


Audience: There is a practitioner here in London, Marilyn Glenville and having read her book she seems to believe that the creams sold as natural progesterone are in fact powerful drugs which happen to have the same molecular structure as the progesterone produced by humans. Research according to her shows that they tend to accumulate on the skin, produce acne, fluid retention, induce weight gain, change libido, cause breast discomfort and menstrual irregularities.
Bond: Could you just stop for one second. There are a number of questions there. You are saying that your practitioner. . .
Goodman: I think I have understood what the lady has said so far. The lady is referring to Dr Marilyn Glenville, who is saying there are a number of effects, negative effects.
Audience: She says two things, one is that natural progesterone is like a drug and then she lists all the effects they can produce.
Lee: Let me ask you, to think here a moment. Natural progesterone is identical to the progesterone you all make from puberty on. Through all your fertile years you make it in surges of 15 – 20 -24 mg a day for 2 weeks and in pregnancy you make it 300 – 350 mg and I recommend 15 mg a day. There are people out there saying, it might have bad effects. Nonsense! If it had bad effects then everyone who has periods would have bad effects. This is not a drug in any sense foreign to your body, those people who bring this up are thinking of progestins, the progestogens the synthetic look alikes, the wanabes, they are not the same, they are foreign.
     If they are going to use the word 'progesterone' to mean a progestogen, they should use the word 'foreign', foreign to your body. Progestogens do not fit your metabolic pathways and they have side effects not shared by progesterone. It is a semantic problem that whoever put the information on the computer, if you leave out all of the progestogen's side effects, there is nothing left.
Audience: She questions how natural 'natural progesterone' is.
Lee: It is identical. It is as natural as you can get. Doctors don't get their hormones by going out and killing women to take their ovaries, they get their hormones the same way. They get if from the fats in oils and plants, they are converted by synthesis in laboratory until they are identical or they are not identical. The ones that are not identical are then used by the pharmaceutical companies because they can be patented. The ones that are identical to your own are called natural. They are 100% natural, there is no unnatural part of them at all. They are the natural hormone and the question is if you are low in it, then you should have it. If you are low in thyroid you should have real thyroid, if you low in insulin you should have real insulin, if you are low in iron, giving you pretend iron isn't going to do it. It has to be the real. So this is the real hormone, so I don't understand the question, a natural hormone means it is bio-identical.

Bond: The second part of this question was the claim that has come up before, that progesterone gets stored in the skin and doesn't get fully utilised.
Lee: There are many ingredients in the cream. The ingredients in the cream are not absorbed as progesterone is. Progesterone is marvelously well absorbed. There is nothing left, it goes to the body fat under the skin and from there it leads to the blood stream. It is a process that takes 8 – 12 hours, it's gone, it's not there. What might be still on your skin is some of the waxes and the creams that are in the cream. This is why I recommend the next time you apply it, put it on a slightly different spot, move it around because there are these ingredients in the cream that are put in there to give it consistency or make it feel smooth or something like that. That I have no responsibility for but it won't hurt anybody. Anybody could go and buy some nice face cream and add the progesterone to it, and you would have your own progesterone cream. What is in the cream is your part but the progesterone part is well absorbed.


Audience: Could Dr Lee comment on something which, or other people may contradict me, but I get a feeling that there is a difference between experience in Britain and in the United States. I think in Britain conventional HRT is prescribed much more frequently for people who haven't completed the menopause but are still in early perimenopause. I am a case in point in that for 5 years I took conventional HRT, came off and was still menstruating at age 53. I am now on natural progesterone cream, but could Dr Lee comment on this. Is it damaging?
Lee: Everyone who is still having periods regardless of any symptoms, is making a ton of oestrogen. Oestrogen is what builds up the bloody lining and when you do go through menopause, all it means is, it is below the level for enough bloody lining to develop to be shed but you are still making oestrogen. If you are having periods you do not need extra oestrogen.
     This is not peculiar to the UK, this also happens in the United States. I attended my fortieth medical class reunion, got to talk to these people I knew as college coeds, they are now sixty-seven years old, they all had a story to tell. In the 5 – 10 years before menopause, they did have some symptoms, they had the weight gain, they had the occasional hot flush, they had the loss of libido, and their doctors did put them on oestrogen, and here they were, doctors' wives.
     Their husbands went along with it, and they all developed fibrocystic disease. They got bleeding more and they developed, they had biopsies and D&Cs and it led to hyperplasia and led to their hysterectomies and so on and you see down the line it's one bad step after another. They didn't need the oestrogen at all.
     What they do need is care, they have to make changes in their life, that will balance their hormones better. For instance there is a wide range of dietary changes. There is fibre that should be added, fibre will help the balance of your hormones. Exercise will do it; there is stress reduction mechanisms that will help; there are vitamins and mineral supplements that will help; there is homoeopathy that will help; there are all sorts of things that can be changed to help bring about balance in the system and adding oestrogen at this stage in your life is not an appropriate treatment.

Rushton: Part of the British experience as you have described it, what I am finding increasingly from women who write to us, is that HRT is being offered preventatively for menopause, which I think is a scandal but is happening more and more frequently. Women executives in their middle thirties who are going for their annual checkups are having it suggested at the end of the checkup by the consultant, "There is nothing wrong with you my dear, your tests are absolutely fine but you ought to start thinking about HRT"
     I think it is something we should all be aware of.

Sandra Goodman: I think we are going to close the morning session but don't despair because the entire panel will be returning at the end of the day. After lunch we are going to be exploring nutrition, herbal medicine and homoeopathy. Before you all depart, may I call your attention to the table and exhibits and information that is in the foyer, including a new book called Holistic Menopause being launched today by Dr Robert Jacobs and Judy Hall. Also there are Dr Lee's, Beth MacEoin's and Judy Griffin's books and if I've missed out anyone else's books, Leslie Kenton's books, and my own book as well about Nutrition and Cancer. Enjoy your lunch. See you after lunch.

 

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