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Katharina Dorothea Dalton

BMJ 2004; 329 doi: (Published 28 October 2004) Cite this as: BMJ 2004;329:1048

Rapid Response:

Katharina Dalton and progesterone dangers

Editor –“Women are indebted to Dr Greene and Dr Dalton for so clearly
describing their problems in the premenstrual syndrome.” So began my BMJ
review of Katharina Dalton's book, “The Premenstrual Syndrome and
Progesterone Therapy” in 1978.1,2 Dalton’s personal charm, energy,
enthusiasm and dedication to her patients, were beyond question to all of
us who knew and were inspired by her.

Unfortunately, I failed to persuade her against the use of
progesterone as a “therapy” for premenstrual symptoms. Dalton’s belief
that only synthetic progesterones caused side-effects has achieved “cult”
status with the sale of progesterone cream and promotion of progesterone
“therapy” by the late Dr John Lee.

Progesterone induces secretory changes in endometrial glands which
increases endometrial and platelet monoamine oxidase activities (MAO)
dramatically, increases vascular development and causes irregular bleeding
and headaches, and also induces proliferation in breast tissues. Removal
of the ovaries has long been used to prevent endogenous progesterone
production as a treatment for breast cancer. Recent studies confirm that
progesterones cause more breast cancer than oestrogens. Progesterone is
also potentially teratogenic.

Progesterone-induced high MAO activities match depressive mood
changes in untreated or in treated cycles, whether symptoms last for a few
days premenstrually or continuously as adverse effects of progesterone
use.3 Steroid sex hormones may suppress symptoms in some women by a stress
-modulating effect but their mental adverse effects are often dismissed as
“psychological” by hormone prescribing enthusiasts.

Ivan Oransky’s Lancet obituary points out that the Daltons' vitamin
B6 study was questioned by the Lancet and other researchers but was
influential in the 1997 UK Committee on Toxicity restriction of the sale
of vitamin B6 to 10 mg per day.4 Severe functional deficiencies of B
vitamins are common, especially because oral contraceptives cause vitamin
B 6 deficiency, and 50 mg doses of vitamin B6, along with other B
vitamins, are needed for repletion. Toxic metals such as cadmium from
smoking and mercury form dental amalgams are an overlooked cause of
peripheral neuropathy.

Dalton’s advice to eat small frequent starch meals could cause fluid
retention, weight gain and migraine, especially when combined with
progesterone “therapy”. Wheat and corn are common food allergens, which
can be unmasked by exclusion dieting.5

Stewart and Howard reported magnesium and potassium deficiencies in
women with PMS in 1986.6 Also common are marked deficiencies of essential
enzymes co-factors like zinc, copper, magnesium and B vitamins and lack of
essential fatty acids.7 These basic deficiencies can impair hormone
production, receptor activities and alter amine pathways. Such impairments
of homeostatic mechanisms unmask symptoms when hormone levels fall, even
if these levels are already abnormally high, as HRT tachyphylaxsis

1 Dalton K. The Premenstrual Syndrome and Progesterone Therapy.
William Heinemann Books. London 1977

2 Grant ECG. Creatures of the moon. BMJ 1978; 1: 165.

3 Grant ECG, Pryce Davies J. Effect of oral contraceptives on
depressive mood changes and on endometrial monoamine oxidase and
phosphatases. BMJ 1968; 3: 777-80.

4 Oransky I. Obituary. Katharina Dorothea Dalton. Lancet 2004; 364

5 Grant ECG .Food allergy and migraine. Lancet 1979; 2: 358-59.

6 Stewart A, Howard JMH. Magnesium and potassium deficiencies in
women with pre-menstrual syndrome. Mag Bull 1986; 8: 314-316.

7 Grant ECG. The pill, hormone replacement therapy, vascular and
mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998; 8:

Competing interests:
None declared

Competing interests: No competing interests

01 November 2004
Ellen C G Grant
physician and medical gynaecologist
20 Coombe Ridings, Kingston-upon-Thames, KT2 7JU