Menopause Spotlight

Progesterone is a steroid hormone that plays a central role in reproduction, menstrual health, and overall hormonal balance. Although often overshadowed by estrogen, progesterone is just as important, especially during the menopause transition.

It regulates the menstrual cycle, prepares the uterus for pregnancy, supports fetal development, influences mood and sleep, and helps protect the uterine lining. While primarily produced in the ovaries after ovulation, progesterone is also made in small amounts by the adrenal glands and, during pregnancy, by the placenta.

Although progesterone levels drop significantly after menopause, the adrenal glands and peripheral tissues continue to produce small amounts. When progesterone declines faster than estrogen, women may experience relative estrogen dominance, which can cause symptoms like mood swings, anxiety, and irregular bleeding.

How Progesterone Levels Change Through Life

Reproductive Years: Cyclical rises after ovulation (luteal phase) prepare the uterus for pregnancy.
Pregnancy: The placenta becomes the main source, producing high levels to support the developing baby.
Perimenopause: Progesterone declines earlier and more sharply than estrogen, creating hormonal imbalance.
Postmenopause: Levels remain consistently low (typically 1 ng/mL or less), produced only in small amounts by the adrenal glands and peripheral nerves.

Why Progesterone Matters

Progesterone’s influence extends far beyond reproduction. It plays multiple roles throughout the body:

Balances Estrogen: Helps prevent estrogen dominance, reducing risk of uterine overgrowth, mood swings, and bloating.
Regulates the Menstrual Cycle: Prepares the uterine lining for implantation.
Supports Pregnancy: Maintains early pregnancy until the placenta takes over.
Protects Uterine Health: Essential with estrogen therapy to prevent endometrial hyperplasia.
Acts as a Neurosteroid: Promotes calmness, better sleep, and mood stability through effects on GABA in the brain.
Supports Bone Health: Helps maintain bone density and reduces risk of osteoporosis.
Contributes to Skin and Hair Health: Influences sebum production, elasticity, and scalp health.

Progesterone and Menopause

Progesterone is a key reproductive hormone that works alongside estrogen to regulate menstrual cycles, support pregnancy, and balance many of estrogen’s effects. During the reproductive years, progesterone is produced after ovulation each month, preparing the uterine lining for a potential pregnancy.

As women approach menopause, ovulation becomes less frequent, leading to a natural decline in progesterone. By the time menopause is reached, progesterone production has dropped significantly, since the ovaries are no longer releasing eggs.

Signs of Low Progesterone in Menopause

Falling progesterone levels can contribute to many of the symptom's women notice during perimenopause and menopause, including:

Irregular or heavy menstrual bleeding (before menopause is complete)
Mood swings, anxiety, or irritability
Sleep disturbances, particularly difficulty falling or staying asleep
Breast tenderness
Headaches or migraines
Weight changes and bloating

Because progesterone has a calming effect on the brain and nervous system, its decline can also worsen sleep and mood challenges that often accompany estrogen changes. In postmenopause, progesterone levels remain very low, and while bleeding issues typically resolve, mood and sleep effects may persist for some women.

Broader Health Effects of Progesterone

Progesterone does more than regulate cycles and support pregnancy. It also:

Supports the brain and mood by enhancing calming neurotransmitters, improving sleep, and easing anxiety.
Protects bones by stimulating bone-building cells and working with estrogen to maintain density.
Regulates immunity and inflammation, helping balance the body’s defenses.
Maintains breast and skin health by balancing estrogen’s effects and supporting skin hydration.
May aid cardiovascular health, with emerging research showing protective effects on blood vessels.

Clinical Considerations

Endometrial Protection
Women with a uterus who take systemic estrogen must also take a progestogen (natural progesterone or synthetic progestin) to reduce the risk of endometrial hyperplasia and uterine cancer.

Formulation Differences

Micronized progesterone (bioidentical) is generally well tolerated, supports sleep, and provides endometrial protection.

Synthetic progestins (e.g., medroxyprogesterone acetate) can mimic progesterone’s effects but may differ in mood, metabolic, or cardiovascular impact.

Delivery Methods
Options include oral tablets, vaginal preparations, transdermal creams, intrauterine devices (IUDs), and injections. Choice depends on whether the goal is endometrial protection, contraception, or symptom relief.

Side Effects
Some women may experience breast tenderness, bloating, dizziness, mood changes, or fatigue. Progestins may carry more side effects than natural progesterone.

Contraindications
Use with caution in women with a history of breast cancer, unexplained vaginal bleeding, liver disease, or certain clotting disorders (though risks are generally lower compared with estrogen).

Combination Therapy
Progesterone is rarely prescribed alone in menopause. It is typically combined with estrogen in menopausal hormone therapy (MHT) to balance benefits and minimize risks.

Treatment & Support Options

Medical (MHT/HRT):

Progesterone Therapy (oral, vaginal, or other delivery methods) is most often prescribed together with systemic estrogen therapy for women who still have a uterus. Its main purpose is to:

Protect the uterine lining by counteracting estrogen’s stimulatory effects, lowering the risk of endometrial hyperplasia and cancer
Stabilize menstrual cycles during perimenopause
Support sleep and mood, thanks to progesterone’s natural calming effects on the brain
Balance hormones, helping to reduce symptoms of relative estrogen dominance such as bloating, breast tenderness, and mood changes

Important Note: Women with a uterus must take a progestogen with systemic estrogen therapy to protect the endometrium and reduce cancer risk.

Supplements & Botanicals:

Wild Yam: Contains diosgenin, used in labs to synthesize hormones, but not converted to progesterone in the human body.
Chaste Tree Berry (Vitex agnus-castus): May regulate prolactin and support progesterone rhythms, with possible benefits for PMS and menopausal symptoms.

Evidence is limited, but some women find symptom relief with these options.

Progesterone