Progesterone – Everything You Need To Know

If you want a helpful guide to using progesterone therapy well, Lara Briden is an expert in this area. I follow her work and am delighted to share her ideas with you on getting the most from this key hormone.

Progesterone is an interesting hormone. It calms, shields, affects body processes, and reacts to its surroundings, especially oestrogen and the brain.

When used correctly, it can greatly improve sleep, mood, heavy periods, and perimenopause signs. When used not quite right (like with very high oestrogen or swelling), progesterone may feel odd or uneasy, mostly at the start.

How is progesterone not like progestins?

Body-made progesterone is exactly the same as what your own ovaries naturally produce. The synthetic Progestins are different structures that mimic the natural hormone but without the benefits and have their own side effects.

Sarah E Hill is an award-winning research psychologist with 100+ research publications and two books to her name.

Her view? “Progestins and progesterone are not the same. Not relatives. Not twins. Not even similar looking.”

That structure difference leads to real body differences.

Progesterone usually helps heart and body process health, while some progestins can make blood pressure, sugar issues, and fats worse. Progesterone tends to help head hair grow and may lower breast cancer risk, while progestins can do the opposite.

What can progesterone help treat?

Progesterone is known for helping heavy monthly periods by making the womb lining thinner and constant. But that’s just the start. Real progesterone (not progestins) changes into the brain chemical allopregnanolone (ALLO), which works with GABA-A brain spots to boost sleep, calm worry, and help headaches.

These brain benefits can be very useful in the first years of perimenopause, when oestrogen often goes higher than normal.

Progesterone can also help control brain-ovary signals, which is why timed progesterone use can help PCOS, and, of course, progesterone is commonly used in fertility to help to support embryo growth and early pregnancy.

Can progesterone be taken without oestrogen?

Yes, progesterone works well on its own, especially when oestrogen levels are high. This is common in the early to mid phases of perimenopause.

During this time, progesterone can help reduce breast tenderness, heavy bleeding, and sleep issues.

As oestrogen levels eventually drop later in the transition to menopause, progesterone alone might not help with hot flushes or memory problems.

At that point, adding oestrogen can be beneficial so it is important to match treatment to your body’s needs.

Do you still need progesterone if you don’t have a uterus?

If you do not have a uterus, progesterone is no longer necessary for protecting the lining . However, many women still use it to help with sleep, mood, and breast health. Wherever oestrogen works, progesterone also has an effect.

Can progesterone be used with a progestin?

For example, someone using a levonorgestrel IUD for birth control or to manage bleeding can also take body-identical progesterone for its benefits on mood and breast health.

However, do be aware that the bio identical progesterone and the synthetic progestins compete for the same receptor sites in the body and this can make both of them less effective.

Wellsprings recommends if you are using hormonal birth control you need to be aware of this fact and to take additional precautions.

What is the difference between oral micronised progesterone and compounded progesterone?

Both are body-identical progesterone and are micronised for better absorption.

Oral micronised progesterone (OMP) usually means standard commercial products like Prometrium and Utrogestan.

Compounded progesterone is the same micronised hormone such as in Wellsprings creams, or made to an individual prescription by a compounding pharmacist. This can be a specific capsule, cream, or other form, often to adjust the dose or avoid certain fillers.

Which form is best: oral, vaginal, or cream?

The best type of progesterone depends on why you are using it.

Oral progesterone goes through the liver so is normally in higher doses as some is lost in this process. It also increases the neurosteroid ALLO. This is why oral progesterone can be better at calming the brain, making it good for sleep, anxiety, and migraines.

Vaginal progesterone sends more medicine directly to the uterus with less conversion to ALLO. This makes it suitable for treating adenomyosis, helping with fertility, and managing heavy bleeding. It is also a good choice for those who do not react well to the neurosteroid.

Oral progesterone is usually taken at night in doses of 100–300 mg and vaginal or topical forms deliver more progesterone to the body without first going through the liver, so they generally require lower doses, like 20–100 mg, and can be taken any time of day.

The exact dose should depend on your situation and symptoms, not on blood or urine tests.

If you have a luteal phase, take the dose during that time. If your cycles are irregular, following a pattern of two weeks on and two weeks off can mimic a luteal phase and help with ovulation. This can be useful for managing PCOS and early perimenopause when ovulation might still happen or when a withdrawal bleed is needed.

Later in perimenopause, when ovulation is infrequent or absent, taking progesterone every night often works best. Bleeding may still be unpredictable, but the total flow usually decreases because progesterone lightens periods.

If you are using oestrogen therapy after menopause, you will typically take progesterone every night, however, it can be helpful to take breaks, like stopping for three to five nights each month, to maintain its calming and sleep-promoting effects.

Always consult with your healthcare provider.

Can progesterone cause irregular bleeding?

When oestrogen is high (like early in perimenopause or with some PCOS), starting progesterone can briefly upset a too-excited lining and cause bleeding. This bleeding can show that oestrogen was high.

Later, progesterone usually makes periods lighter and, with PCOS, can help periods return monthly.

What is progesterone intolerance or sensitivity?

“Progesterone intolerance” is often used for any bad reaction to a progestin, natural progesterone, or the natural late cycle phase. But these are not the same.

Reactions to progestins happen differently than to real progesterone.

Though late-cycle symptoms can be caused by progesterone (and how it makes the body need more salt, protein, rest, and nearly everything; see below), other causes can include dropping progesterone, rising histamine, blood sugar changes, prolactin, falling oestrogen, and being low iron or iodine.

To learn more, see my article/podcast/YouTube video on treating mood symptoms before your period.

For natural progesterone treatment, possible reactions can include mood changes, breast swelling, looser joints, bloating, acne, and feeling heavier. Below are main issues and fixes, but remember, most women feel good on progesterone.

Negative mood symptoms

Temporary mood changes are usual in the first few days, especially if oestrogen is high. This is because oestrogen boosts the enzymes that change progesterone to ALLO and the GABA receptors that react to it. This can cause a stronger neurosteroid signal than expected, which may feel like worry, distance, or short temper.

For many, these feelings ease within three to seven days as receptors adjust, but if bad mood feelings last longer than seven days, it might be from other causes, like:

– Sodium loss. Progesterone causes sodium loss, which can start fast heartbeats and worry in some women. Try adding more salts or an electrolyte drink.

– Blood sugar swings. A short drop in insulin action can cause low sugar signs like short temper or fear. Try more protein and steady meals.

– More need for food and rest. Progesterone takes a lot from the body, needing more sodium, magnesium, protein, food energy, deep calm, and sleep. When these needs are not met, the nerves can feel weaker, causing mood issues.

– Gut inflammation or permeability. Progesterone can temporarily slow down the movement in the intestines and relax the intestinal barrier.

This can lead to an increase in toxins from gut bacteria, which may worsen anxiety or mood symptoms, especially if there are gut problems like dysbiosis or SIBO so It is important to address any underlying gut issues.

– Sleep disruption. Progesterone can change how we sleep, leading to disturbances and so to improve sleep, it helps to practice good sleep habits. Get bright light exposure in the morning, and avoid alcohol or screens in the evening.

– Paradoxical neurosteroid response. ALLO usually calms GABA receptors, but in some women, especially when oestrogen or inflammation is high, it can lead to agitation or low mood.

Other factors include genetic differences in GABA receptor subunits, high histamine, mast-cell activation, ADHD-like neurobiology, and a nervous system that is sensitized from past trauma.

To manage this, it can be helpful to reduce inflammation, histamine, or oestrogen, switch to vaginal or topical progesterone (which has less neurosteroid effect), or, paradoxically, try a higher dose under medical guidance.

This is because ALLO has a “Goldilocks” effect on GABA receptors: too little can irritate them, while the right amount calms them.

Breast swelling

When oestrogen is high, progesterone can initially trigger the breast tissue that oestrogen has readied, causing swelling or soreness. After a few days, progesterone’s actions that stop growth and remove fluid should begin and lower swelling.

Magnesium and iodine can help with soreness. Importantly, progesterone that is the same as the body’s, such as Wellsprings Serenity cream, is seen as safe for breasts in most cases. And might even shield them.

Ligament looseness

Progesterone can affect collagen and linking tissue in a way that can make ligament looseness, joint over-flexibility, and histamine release worse in people with existing over-flexibility or mast-cell sensitivity.

Ways to manage this include strength building, good sleep, and minerals. Lowering the amount or changing to a vaginal dose can sometimes help.

Stomach bloating

Progesterone slows the gut’s movement and can loosen linking tissue in the gut wall, which can cause being unable to go to the bathroom or bloating.

Try fixing any deep gut problems and supporting healthy linking tissue.

Skin spots

Progesterone is usually good for skin, but in some people, its changed forms can raise skin oil. Lowering the amount or changing to a vaginal application can help.

Also, think about acne treatments such as zinc and pantothenic acid (vitamin B5).

Weight increase

The hormones most likely to lead to weight increase are male hormones like testosterone and excess oestrogen. That said, some women say they gain weight from progesterone, maybe because it can raise hunger and change how insulin works. So far, the weight increase effect has not been found in studies.

In fact, many of my patients say they lose weight with progesterone, and its ability to boost metabolism (help with weight loss) is part of why it’s useful for PCOS. See my metabolism book for weight-loss plans and metabolic problem-solving.

When should progesterone be paused or reconsidered?