Role of Progesterone in Perimenopause and Menopause
By Andrea Donsky | Fact Checked | Sources
Estrogen gets most of the attention when people talk about perimenopause and menopause. Progesterone deserves some too. Here’s what it does, what happens to it in these years, and what the research says about taking it.
What is progesterone?
Progesterone is a sex hormone. In women it’s made mainly by the ovaries, with a smaller amount from the adrenal glands. After you ovulate, the part of the ovary that released the egg (the corpus luteum) makes progesterone to prepare the lining of your uterus for a possible pregnancy. If you don’t get pregnant, progesterone drops and your period starts.
What happens to progesterone in perimenopause?
As you get closer to menopause, you ovulate less often, and a cycle without ovulation makes very little progesterone. Estrogen, meanwhile, can swing high and low. That mismatch can be part of why periods get heavier or less predictable, and why sleep and mood can feel off in these years.
Read about menopause and depression
And after menopause?
Once your periods have stopped for good, your ovaries make very little estrogen or progesterone. It’s mainly the drop in estrogen that speeds up bone loss and changes heart health after menopause.
Read about menopause and osteoporosis
Why progesterone matters if you take estrogen
This is the most important thing on this page. If you still have your uterus and you take estrogen as a pill, patch, gel or spray, you also need a progestogen, meaning progesterone or a progestin. Estrogen on its own makes the lining of the uterus grow, and the progestogen protects it. The Menopause Society’s 2022 position statement says the right formulation, dose and route of progestogen is needed to counter that effect of estrogen.
A progesterone cream is not enough to protect your uterus. The British Menopause Society says progesterone put on the skin is absorbed unpredictably and is unlikely to give enough protection, so it shouldn’t be used that way alongside estrogen. If you’re using an over-the-counter or compounded cream with your estrogen, please talk to your doctor.
Can progesterone help with hot flashes and sleep?
There’s real research here. In a trial by Dr. Christine Hitchcock and Dr. Jerilynn Prior, published in Menopause in 2012, 133 women aged 44 to 62 took either 300 mg of oral micronized progesterone at bedtime or a placebo for 12 weeks. Hot flashes and night sweats dropped more in the progesterone group.
A later trial led by Dr. Prior in perimenopausal women, published in Scientific Reports in 2023, couldn’t show a clear difference in hot flashes overall. But the women taking progesterone reported fewer night sweats and better sleep, and it didn’t increase depression.
Oral micronized progesterone is a prescription medicine, so this is a conversation to have with your doctor.
Here’s an interview I did with Dr. Chris Shade on my podcast about bio-identical hormones, including topical progesterone (he even offered listeners 10% off his products).
And here’s an interview I did with Dr. Lara Briden, a naturopathic doctor, on bio-identical hormones as well.
Our Top Picks for Hormone Support
What about the risks?
Hormone therapy has real risks, and they depend on your age, how long it’s been since your last period, the type, dose and route of what you take, and your own health history. The Menopause Society’s 2022 position statement says that for women younger than 60, or within 10 years of menopause, with no reason they shouldn’t take it, the benefits outweigh the risks for treating hot flashes and preventing bone loss. It also says hormone therapy doesn’t need to be stopped automatically at 60 or 65, and that compounded bioidentical hormones raise safety concerns because they’re lightly regulated and haven’t been tested the way approved products have.
If vaginal dryness is what’s bothering you, that has its own treatment options.
Read about menopause and vaginal dryness
What about wild yam and soy?
Wild yam (Dioscorea villosa) and soybeans contain a plant compound called diosgenin that has to be changed in a laboratory before it becomes progesterone. Wild yam and soy on their own don’t contain progesterone.
What we changed on this page
An earlier version of this article listed the risks of estrogen and combined hormone therapy, including dementia, stroke, heart attack and blood clots, with nothing to put them in context, and said to take the lowest dose for the shortest time possible. That was out of date, and we’ve replaced it with what the Menopause Society said in 2022.
It also said that a low-fat or low-cholesterol diet stops your body making enough progesterone, that certain foods, nutrients and chasteberry can raise or rebalance progesterone, and that progesterone may help vaginal dryness. We couldn’t find good human research for any of those, so they’re gone. We also removed a link that no longer worked.
Bottom line
Progesterone is the “other” hormone in these years. It drops as you ovulate less, it may help night sweats and sleep, and if you take estrogen and still have your uterus, you need it to protect your uterine lining. That last part is not something to handle with a cream from the drugstore, so talk it through with your doctor.
