If it seems like estrogen gets top billing when discussing perimenopause and menopause, you may be right. So here we are going to highlight the role of progesterone during these transitional years.

What is progesterone?

Progesterone is a sex hormone and steroid produced primarily by the ovaries in women and in the testes and adrenal glands in men. In women, progesterone plays a critical role in the menstrual cycle, pregnancy, and menopause. Production of progesterone occurs in the corpus luteum, the hormone-secreting structure that develops in an ovary after it releases an egg. 

Progesterone in perimenopause

Several things occur regarding progesterone during perimenopause. As estrogen levels start to decline, it creates an imbalance with progesterone. At the same time, progesterone levels are dropping as well. For example, when women ovulate during perimenopause, their ovaries may not be strong enough to make enough progesterone, so levels decline. It’s also natural for hormone levels to decrease with age. Thus it is common to have a progesterone deficiency during perimenopause. Symptoms of low progesterone levels can include migraine, depression, hot flashes, sore breasts, spotting between periods, and insomnia.

Read about menopause and depression

You may want to consider taking progesterone to help restore hormonal balance and manage symptoms. Use of bioidentical or body-identical progesterone may relieve symptoms of hormone imbalance or low progesterone levels. You can get a prescription for progesterone, which is called oral micronized progesterone, from your physician. Progesterone creams are available in some countries over-the-counter, but it should be used only with your doctor’s guidance. 

Here's interview I did with Dr. Chris Shade my the podcast on bio-identical hormones, including topical progesterone (he even gave us a 10% discount if you want to try any of his products).

And here's an interview I did with Dr. Lara Briden, a Naturopathic Doctor, on bio-identical hormones as well. 

Progesterone in menopause

Once you reach menopause and postmenopause, progesterone levels are very low because the ovaries have shut down production and the adrenal glands produce only a minute amount. Low progesterone and low estrogen during this phase of life are associated with various menopausal symptoms and also increase your risk of osteoporosis and cardiovascular disease.

For these reasons, some women may choose to take progesterone therapy, which should be done under a doctor’s supervision.

Progesterone therapy

In a 2018 review of studies of menopausal women who participated in progesterone therapy, the authors found that:

• A 300-mg dose of progesterone taken at bedtime for three months resulted in significant reductions in hot flashes, night sweats, and sleep disturbances.
• Progesterone therapy was as effective or more effective than estradiol in improving cardiovascular health without any cardiovascular safety concerns.
• An eight-year study involving more than 80,000 menopausal women showed that taking progesterone prevented the development of breast cancer in women treated with estrogen. Use of estrogen treatment alone or combined therapy has been associated with an increased risk of vaginal bleeding, urinary incontinence, dementia, stroke, heart attack, and blood clots. 
• Multiple studies also showed that 300 mg of progesterone at bedtime improves deep sleep and does not cause depression.

Read about menopause and osteoporosis

Other potential benefits from using progesterone therapy after menopause include reduce risk of:

• Bone loss and fracture associated with osteoporosis
• Depression, anxiety, and other mood disorders
• Cardiovascular disease
• Bone loss and fracture associated with osteoporosis
• Sexual symptoms such as vaginal dryness, itching, and burning, as well as painful intercourse

Using progesterone therapy

Progesterone therapy is available in several forms: oral (pill), transdermal (cream, gel, patch, spray), injection, and implanted pellets. You and your doctor can decide on the best form and dose for you. Generally, it is recommended you take the lowest dose that provides relief and take it for the least amount of time possible. 

Progesterone therapy from soybeans and wild yams (Dioscorea villosa), which contain the phytoestrogen diosgenin, requires that these foods be modified in a laboratory before the body can use them as progesterone. Wild yams and soybeans alone do not contain progesterone. These products should be used under the guidance of a knowledgeable professional.

Promoting progesterone from foods and supplements

Progesterone is made from protein, cholesterol, and fat. If you are on a low-fat, low-cholesterol diet, your body likely is not making enough progesterone. Foods that can help promote production of the hormone include healthy fats (from fatty fish, avocado, nuts, coconut and olive oils), oats, dark chocolate, chicken, beans, and cruciferous vegetables.

It’s also helpful to get adequate amounts of several nutrients that support and promote progesterone production. They include zinc, magnesium, and vitamins C and B6. Chasteberry is an herbal supplement that may help rebalance progesterone levels. 

Bottom line

Progesterone is the “other” hormone in the transitional years that women should be aware of for its many roles, how low levels can affect them, and know they have an option to take progesterone if it is indicated for them.