Progesterone for perimenopause: Benefits, safety, and when to start

Signs you may need progesterone

Around age 46, women enter into perimenopause – the life transition where they move away from their reproductive years toward menopause. Thankfully, for most women, this change starts slowly as estrogen and progesterone levels start to drop.

While the symptoms of low estrogen are often familiar, including mood swings, breast tenderness, vaginal dryness, and night sweats, symptoms of low progesterone may be a bit harder to recognize. We often attribute them to other factors like stress. You may be feeling tired but wired or not like yourself, or have additional symptoms like:

• Insomnia
• Shorter cycles
• Heavy bleeding

Since identifying low progesterone can be challenging, many women suffer longer than they have to. One way you can avoid this situation is by using a hormone tracker like the Hormona App to track your cycle.

With the app, you can log your mood, sleep patterns, and symptoms for a full month, making it easier to visualize your unique patterns. With this information, you can “build your case” for your doctor and help ensure you get the right support. Hormona is also introducing at-home testing, which lets you monitor your hormones with lab-grade data so you can take control of your hormonal health.

The “progesterone cliff” phenomenon explained

Throughout your menstrual cycle, it’s normal to experience hormonal fluctuations. However, during the perimenopause transition, your hormones start acting more erratically. Estrogen fluctuations increase toward late perimenopause, as ovulation becomes less consistent.

Without ovulation, your body doesn’t form a corpus luteum, the structure that produces progesterone in the luteal phase of the menstrual cycle. Without progesterone, estrogen goes unopposed, causing symptoms like heavy menstrual bleeding.

The benefits of progesterone therapy

For many women, menopause hormone therapy (MHT) can improve their quality of life and make symptoms more manageable. The North American Menopause Society (NAMS), now named the Menopause Society, recognizes MHT as one of the most effective treatments for perimenopause and menopause symptoms.

Additionally, many prominent professionals, including Dr. Jerilyn Prior, acknowledge the impact progesterone has during the menopausal transition.

Progesterone is not only a sex hormone, it is also a neurosteroid, meaning it is produced by the neuro system and acts directly on the brain. Let’s explore some of the top benefits of progesterone therapy for perimenopause.

Protecting uterine lining

When it comes to MHT, there are two common types: estrogen and progesterone therapy. Estrogen therapy is often prescribed to help manage symptoms, and it’s very effective, while progesterone therapy is used to protect the uterus. In cyclic and non-cyclic women, progesterone is used with estrogen to prevent cancer.

Restoring sleep and fighting insomnia

While rare, progesterone can be given to help restore healthy sleep patterns after months of disruption. This therapy works because progesterone is a neurosteroid and interacts with GABA receptors acting like a natural sedative or sleep aid.

Reducing anxiety and mood swings

Progesterone is not primarily prescribed for anxiety relief and mood swings since estrogen therapy is effective, but when taken as part of a combined MHT, it can be helpful. Although progesterone is often calming, it can cause some women to feel depressed as a side effect.

Managing weight management expectations

Progesterone is NOT known to have an impact on weight – it’s estrogen that has some beneficial effect.

Bioidentical progesterone vs. synthetic progestins

Now that we’ve covered why progesterone is an effective treatment for many perimenopause symptoms, it’s time to talk about the different kinds that are available. There are two different types of progesterone for MHT: micronised progesterone and synthetic progestins.

Micronized progesterone is derived from natural sources like urine of plant compounds, is chemically identical to the progesterone your body creates, and is referred to by some sources as ‘bioidentical’ progesterone. Because its molecular structure is the same as natural progesterone, it’s easier for your body to recognize and absorb, making it highly effective.

Micronized progesterone is an FDA-approved and commonly prescribed MHT as many women prefer using natural progesterone for perimenopause since it has fewer side effects and a better safety profile.

Synthetic progestins are lab-made hormones that are designed to mimic your body’s natural progesterone. The most common types of synthetic progestin for MHT are medroxyprogesterone acetate, levonorgestrel, norethisterone acetate, and norgestrel, which are used for endometrial protection to prevent uterine lining overgrowth.

Treatment protocols: Forms and dosing

When it comes to symptomatic perimenopause treatment, there are different methods and dosing depending on how far into perimenopause you are and your unique needs.

Oral vs. vaginal: Which is better?

There are two main forms of progesterone MHT: oral capsules and vaginal gels, suppositories and capsules. Oral micronized progesterone is generally preferred by some professionals because it offers greater sleep benefits.

Please note that there are pills and transdermal patches containing both estrogen and synthetic progestin, which can make taking the medication more convenient.

Cyclic vs. continuous: When to take

Menopausal hormone therapy can be taken in cyclic dosing or continuous dosing. Women who are still cycling receive dosing that generally runs 14 to 28 days to mimic the natural luteal phase of the menstrual cycle. For non-cycling women, continuous dosing is taken daily. It’s recommended that postmenopausal women over 54 years old or who have used cyclical dosing for over one year switch to continuous dosing.

Can you take progesterone without estrogen?

Yes, there are times you can take progestins without estrogen as a perimenopause treatment, as they are frequently used to treat heavy menstrual bleeding, most commonly via a hormonal IUD.

Progesterone alone has been used in some clinical trials to treat hot flashes and insomnia. However, it is not typically prescribed this way in standard clinical settings. If your doctor advises against taking progesterone alone for hot flashes or other perimenopause related symptoms treatment and recommends combining it with estrogen, please note that they are following established high standards of healthcare.

While estrogen can be an effective treatment during perimenopause, unopposed estrogen, or estrogen therapy without enough progesterone, can cause unregulated stimulation of the endometrium. In women with a uterus, it can cause an increased risk of excessive growth of the uterine lining, leading to heavier bleeding, and increased risk of cancer.

How to talk to your doctor about progesterone

When it comes to perimenopause, no two women are alike. Getting treatment for your symptoms can sometimes be an uphill battle, where you’re dismissed or even told you’re too young for menopause. It’s crucial that you advocate for yourself and speak up about what’s happening to your body. This step-by-step advocacy guide will help you get the care you deserve.

1. Track data – When it comes to getting treatment for perimenopause symptoms, it’s not enough to just describe what you’re feeling – you need to also show data. Hormona App’s export your data feature creates reports from your logged symptoms so you can provide your doctor with comprehensive information on what is happening to your body.
2. Ask specifically – Using the correct terms when speaking with your doctor helps them view you as an authority that has done the research and understands the perimenopause transition. Instead of saying a generic phrase like, “I want something to help make me feel better,” state, “I’m interested in oral micronized progesterone for symptom management” or “Is a hormonal IUD right for me even if I no longer need contraception?”
3. Consider testing – Hormone testing is NOT required before starting MHT when perimenopause is diagnosed clinically. However, you may still want to understand your body’s fluctuations before deciding whether or when to begin treatment. Baseline testing helps you and your doctor determine whether you are in perimenopause and your symptoms aren’t related to another condition like thyroid dysfunction.

FAQs

Does progesterone cause weight gain?

Progesterone is not known to cause weight gain.

Is wild yam cream the same as progesterone?

No, wild yam cream isn’t the same as progesterone. It’s often confused since the diosgenin in the plant can be converted to progesterone in a lab, but the human body can’t do that conversion on its own.

What are the side effects of progesterone?

The side effects of progesterone supplement include:

• Drowsiness
• Bloating, constipation
• Breast tenderness
• Vaginal bleeding

Will I get a period on progesterone?

Whether you continue to have a period while on hormone therapy depends entirely on the specific regimen your doctor prescribes. If you are in early perimenopause and follow a cyclic MHT plan – where you take progesterone for only a portion of your cycle – you will typically continue to have regular withdrawal bleeds. However, if you are prescribed continuous MHT, which involves taking both estrogen and progesterone every day, you shouldn’t be bleeding.