This stuff is not licensed in the UK and thus is not available on the NHS.
It claims to be a "natural progesterone" and is surrounded by the kind of
marketing hype that most such alternative and complementary therapies are.
It seems to be derived from Yams, or something similar, so while the
progesterone maybe natural, one would have to ask, natural to what? Yams,
presumably.
Fairinuff. But some sensible people have looked at it:
(http://www.thelancet.com/newlancet/reg/issues/vol351no9111/research1255_2.h
tml)
(you need to have registered with the Lancet Interactive 1st)
and found that although it does raise progesterone levels a bit, it probably
doesn't do so enough to prevent either bone loss or endometrial hyperplasia.
Is it any use in simple menopausal symptoms? I remember in the dim and
distant past that progesterones and their derivatives could be used for
menoopausal symptoms on their own, where oestrogens were contraindicated.
So, the alternative to this Pro-gest stuff would be the much more
biologically active progesterones like crinone.
So, to prescribe it I would have to issue a private prescription (because
topical progesterones creams are not available without a prescription in the
UK, unlike in the USA apparantly) and thus take full responsibility for it
if it kills my patient. Although the chances of it killing anyone are slim,
as it is not particularly well absorbed.
So, what to do? My patient has vague "menopausal" symptoms which may or may
not be menopausal. She is convinced that topical progesterone crm would
help, so there is a very good chance that it would. She felt mucosal
progesterone helped. Pro-gest is probably relatively benign. But not
licensed. And not therefore subject to the regulatory bodies that be, and
there has been some debate elsewhere about the actual percentage of active
ingredient in the stuff.
What would you do?
Paul Miller
GP
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