What Every Woman Needs to Know About Progesterone

Hi friends! In this issue of “Ask Andi Anything,” we’re covering the controversial topic of progesterone. Why is progesterone controversial, you’re wondering? Because so many providers don’t fully understand how to appropriately prescribe this hormone. I realize that’s a bold statement, but you’re going to want to hear me out on this one.  

I recently presented a webinar with Belmar Pharma Solution’s Medical Director, Angela DeRosa, DO, MBA, CPE, called, “Progesterone & Women’s Health Part 2,” in which we answered more than 20 questions from providers about progesterone. This webinar was the follow-up to our first one on this hot topic, titled, “Women’s Health and Progesterone: The Most Inappropriately Prescribed Hormone.” 

Dr. DeRosa and I kicked off this webinar with the top mistakes many providers make when prescribing progesterone to their patients: 

  1. Prescribing too high of a dose when progesterone may not even be needed (or when a lower dose would be sufficient) 
  1. Misunderstanding the progesterone needs of perimenopausal women 
  1. Using doses or certain dosage forms that may not provide adequate protection against endometrial hyperplasia (irregular thickening of the uterine lining due to increased cell production) 
  1. Blaming other hormones for progesterone side effects 

I thought that if providers had so many questions and concerns about prescribing progesterone, then you, as a patient, may also want to better understand this hormone – especially if you’re taking it as part of your bioidentical hormone replacement (BHRT) therapy. 

So, here are a few of the questions that are important to know about progesterone therapy. 

Q: Is it a bad thing to use progesterone regularly before perimenopause, and does that interrupt regular cycles?
A: First off, if you’re having regular cycles, you don’t need to worry about taking progesterone to prevent endometrial hyperplasia (irregular thickening of the uterine lining due to increased cell production that could lead to cancerous cells). If you’re making your own progesterone, as you typically do during regular monthly cycles, then taking “extra” progesterone could lead to undesirable side effects, like weight gain, bloating, and depression. However, if you suffer from anxiety, sleep disturbances, and even polycystic ovary syndrome (PCOS), the right dose of progesterone may help. This is where providers often make mistakes, because too much progesterone could lead to irregular periods and breakthrough bleeding.  

Q: If I’ve had a hysterectomy and no longer have a uterus, do I still need progesterone? 
A: It depends. In combination with estrogen, progesterone may help with symptoms, such as anxiety, sleep issues, and hot flashes. It may also help reduce brain fog and support cognitive function. However, one of the main reasons women take progesterone as part of their BHRT is to help protect the uterine lining against endometrial hyperplasia – cells that could become the precursor to cancer.  

If you no longer have a uterus, you no longer need progesterone to protect the uterine lining. A lower dose of progesterone may be enough to help you manage menopausal symptoms. 

Q: Should my doctor check my progesterone levels on a regular basis? 
A: This is a tricky question! If you are still having regular periods and your doctor checks your progesterone level during a particular phase of your cycle, it will likely be too low. It’s normal for your body to produce low levels of progesterone during part of your cycle. So, if your doctor checks your progesterone level during this time, and prescribes a high dose of progesterone, you may end up experiencing the unpleasant side effects of too much progesterone (weight gain, fatigue) as your body increases production later in the month. 

Now, if you’re already in menopause or are postmenopausal, taking estrogen replacement, and still have a uterus, your doctor should be prescribing progesterone to help protect your uterine lining. And there’s no need to test for that. Your provider should know the typical progesterone dosage to protect against endometrial hyperplasia.  

Q: I’ve gained 10 lbs. since starting progesterone. Is there any way to avoid weight gain, cravings, and other progesterone side effects? 
A: That’s a common complaint, but sometimes weight gain isn’t just from progesterone. In some cases, it’s unbalanced hormones that contribute to weight gain. Once your hormones are more harmonious, you should experience less fluctuations in your weight. I think it’s important to note that one of the jobs of progesterone is “progestation” – preparing the body for pregnancy. Trying to save energy and store sugar may contribute to that initial weight gain, even when you’re not pregnant. 

Additionally, if your progesterone dose is too high, you might experience weight gain and other side effects. Bioidentical progesterone typically leads to less weight gain than a synthetic progesterone (progestin).

Q: Does progesterone help with polycystic ovary syndrome (PCOS)? 
A: Progesterone can help women with PCOS ovulate more regularly, have regular periods, and may also help relieve some severe PMS symptoms associated with PCOS. Polycystic ovary syndrome is a hormone-related condition that can affect women during their reproductive years. Symptoms may include irregular periods, difficulty becoming pregnant, weight gain, high levels of androgen hormones (which may cause an increase in acne, oily skin, and body/facial hair), and cysts around the ovaries. Progesterone may be beneficial in alleviating anxiety and sleeplessness (often accompanying symptoms of PCOS). 

Questions for Andi?  

Email your questions to: askandi@belmarpharmacy.com  

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*The information expressed in this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding any condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read on this site.

Andi Roths