If menopause had a group chat, progesterone would be the friend who keeps getting blamed for everything.
Can’t sleep? “It’s progesterone.”
Gained five pounds? “Definitely progesterone.”
Cried at a dog food commercial? “Progesterone did it.”
Feel bloated? “Progesterone is the devil.”
Meanwhile, progesterone is over in the corner like, “I literally came here to protect your uterus, keep you calm, and help you sleep, but OK.”
Let’s clear the air.
Progesterone is not magic. It is not poison. It is not a “cute little add-on” you take only if you are trying to get pregnant. It is a powerful hormone with real jobs, real benefits, and yes, real side effects for some women.
And in perimenopause, when hormones are doing the cha-cha while your nervous system is begging for mercy, progesterone myths spread faster than a hot flash in a wool sweater.
So here we go: the most common myths about progesterone, what’s actually true, and how to use this information to advocate for yourself.
Progesterone 101 (The Quick Version)
Progesterone is one of your main sex hormones. It rises after ovulation each cycle and helps balance the effects of estrogen on the uterine lining. It also has effects in the brain, which is one reason it can influence sleep and mood.
In perimenopause, ovulation becomes less consistent. Translation: progesterone often drops earlier than estrogen does. That can lead to heavier or irregular periods, breast tenderness, mood changes, and sleep issues for many women. Then in menopause, both estrogen and progesterone are low, but it still continues to help with sleep, moods, bone health, breast protection and uterine protection.
Now, let’s bust some myths.
Myth #1: “Progesterone is only for pregnancy.”
Nope.
Progesterone’s job is not limited to baby-making. In midlife, it can play a role in:
- Regulating bleeding patterns (especially when cycles get unpredictable)
- Protecting the uterine lining if you use systemic estrogen therapy and you still have a uterus
- Supporting sleep for some women (especially when taken at bedtime)
- Keeping us cool, calm, and collected
- Helping bones remain “bendy and resilient”
Pregnancy may be progesterone’s most famous gig, but it has plenty of work experience outside that role.
Myth #2: “If my labs are ‘normal,’ I don’t need progesterone.”
First, let’s talk about what “normal” even means.
In perimenopause, hormones can swing dramatically day to day and week to week. One progesterone level on one random Tuesday does not necessarily reflect what’s happening across your whole cycle, but suffice it to say that if you ovulate, progesterone is highest in the second half of your cycle. That’s why we test on day 19-21.
Second, treatment decisions should be based on the whole picture: symptoms, cycle patterns, medical history, and goals, not one lab value that your body may change its mind about by dinner. If you ARE going to have labs (and I do check them), progesterone is best assessed on day 19-21 of your cycle, assuming it’s 28 days. A level less than 10 means you probably didn’t ovulate. If your cycles are irregular and you’re in your early 40’s I will often have a client use an ovulation predictor kit, looking for an LH surge, then testing about 5 days later.
If someone dismisses you with “your progesterone is normal,” you are allowed to ask: normal for where I am in my cycle, and normal for whom?
Myth #3: “Progesterone is the same as progestin.”
This one matters.
“Progestogen” is the umbrella term. Under that umbrella:
- Progesterone is the hormone your body makes (often prescribed as oral micronized progesterone and called bioidentical).
- Progestins are synthetic versions used in various medications including ALL birth control and hormonal IUDs
They can act differently in the body. Some women tolerate one type well and struggle with another. This is one reason blanket statements like “progesterone causes breast cancer” or “progesterone always causes mood problems” can be misleading. We have to talk about which type, which dose, which route, and which person.
Myth #4: “Progesterone is optional if you still have a uterus and you take estrogen.”
If you are using systemic estrogen therapy (like a patch, pill, gel, spray) and you have a uterus, you typically need uterine lining protection from the proliferative effects of estrogen. That protection may come from a progestogen (progesterone or a progestin) or from a medication combination designed to protect the uterus in a different way.
Why? Estrogen can stimulate the uterine lining. Without protection, the lining can overgrow, which raises risk for endometrial hyperplasia and, over time, endometrial cancer.
This is not a “maybe.” You must have it.
Myth #5: “Over-the-counter progesterone cream is enough to protect my uterus.”
I know the appeal. It’s easy. It’s “natural.” It’s sold with soft lighting and promises and without a prescription.
But “available” does not automatically mean “effective for your specific goal.”
If your goal is endometrial protection while using systemic estrogen, you need a regimen that has evidence behind it and a clinician who understands dosing, absorption, and monitoring.
OTC creams can vary in strength and absorption, and they are not a reliable stand-alone strategy for uterine protection. This is one of those areas where DIY can get risky, even if it feels empowering.
Empowering is great. Safe and effective is better.
Having said this, if you are NOT on estrogen and you don’t need help with sleep, progesterone cream may be fine. I have helped a number of women lighten their crime scene periods using high doses of progesterone cream. Need help? Let’s talk.
Want to create a custom longevity health plan?
You’re in the right place.
I can help you with a functional approach to midlife women’s health including hormone balance, gut health, autoimmune issues, bone health, heart health and more!
Myth #6: “Progesterone will fix all my perimenopause symptoms.”
Let’s be honest: I wish it did.
Progesterone can be helpful for specific issues, especially sleep disruption and cycle-related symptoms in some women. There is also research on oral micronized progesterone for perimenopausal night sweats and hot flashes. And cream can help with these too.
But perimenopause symptoms are not caused by one hormone doing one thing wrong.
Your symptoms can involve:
- Estrogen fluctuations
- Progesterone decline
- Stress hormones and nervous system dysregulation
- Thyroid changes
- Blood sugar swings
- Sleep debt
- Alcohol sensitivity
- Medications
- Life load (and yes, the mental load is real)
Progesterone can be part of a plan, but not the whole plan.
Myth #7: “Progesterone always causes weight gain.”
This myth refuses to die.
Some women feel more hungry, more puffy, or more bloated when starting progesterone, especially at certain doses or routes. But true fat gain is more complex than “I took progesterone and now my jeans hate me.”
In midlife, body composition changes are driven by many factors: sleep disruption, stress, insulin resistance, reduced muscle mass, changing activity, and shifting hormones overall.
Progesterone can cause fluid retention (bloating, puffiness, temporary weight gain) by affecting kidney hormones that manage sodium and water, making the body hold onto more fluids
If progesterone makes you feel more bloated, that matters. But it does not mean progesterone automatically equals weight gain for everyone.
Myth #8: “Progesterone will make me depressed.”
Progesterone can affect mood, but the effect is not universal.
Some women feel calmer and sleepier. Some feel flat or irritable. Some feel anxious. And some feel nothing at all.
Here’s what I want you to take away: if you try progesterone and your mood tanks, that is not you being “difficult.” That is useful information. Dose, timing, formulation, and route can sometimes be adjusted.
Also, perimenopause itself can raise anxiety and worsen mood due to hormone fluctuation and sleep disruption. So if you start progesterone during a season where everything is already on fire, we have to be careful about blaming one match for the whole house.
Myth #9: “If I can’t tolerate progesterone, I’m out of options.”
Nope again.
There are different approaches depending on your needs and medical history, including:
- Different dosing schedules (cyclic vs continuous)
- Different routes of delivery (vaginal)
- Different types of progestogens
- For some women, a levonorgestrel-releasing IUD can be used as the uterine-protective piece with systemic estrogen therapy (commonly used, though approval status varies by country and situation)
And for women who need symptom relief but cannot use estrogen, there are also non-hormonal options for hot flashes, plus targeted support for sleep, mood, and vaginal health.
You have options. You just need someone who knows how to navigate them.
Myth #10: “I had a bad experience, so progesterone is bad.”
This is the myth that keeps women stuck.
A bad experience with one formulation, one dose, one schedule, or one brand is not proof that progesterone is “bad.” It is proof that your body gave feedback.
We do not ignore feedback. We use it.
Midlife medicine should not be “take it or leave it.” It should be shared decision-making, personalized dosing, and ongoing adjustment based on real life.
If your clinician isn’t willing to troubleshoot, it might be time to find one who will.
Bonus Myth: Progesterone MUST be cycled
The decision to cycle or use progesterone continuously depends on various factors, including:
- Age: Younger women may benefit from cycling to mimic natural hormone fluctuations, while older women, especially those postmenopausal, may prefer continuous use for consistent symptom relief.
- Symptoms: The severity and type of symptoms can influence the choice of regimen. For example, women with severe hot flashes or insomnia may benefit from continuous use. If anyone had told me I could only sleep 14 days a month, there would have been a riot!
- Medical History: Underlying health conditions, such as uterine fibroids or endometriosis, may impact the decision.
- Individual Response: Each woman’s body responds differently to progesterone, so it’s important to work with a healthcare provider to determine the best approach.
How to Advocate for Yourself (Use These Words)
If you want to walk into an appointment sounding like the CEO of your own health, try these:
- “What is the goal of progesterone in my plan, symptom relief, uterine protection, or both?”
- “Which type are you prescribing, progesterone or a synthetic progestin, and why?”
- “What schedule are we using, cyclic or continuous, and what should I expect in the first 2 to 6 weeks?”
- “If I have side effects, what are our adjustment options?”
- “How will we monitor bleeding changes and uterine safety over time?”
And my favorite:
- “I’m not looking to suffer through this. I’m looking for a strategy.”
Yes. Say it.
Bottom Line
Progesterone is not the villain of perimenopause and menopause. It is a tool. Sometimes it is the right tool. Sometimes it is the wrong tool. And sometimes it is the right tool, but the wrong dose, the wrong route, or the wrong timing.
The myth-filled internet loves a simple story. Your body is not simple.
You deserve nuanced care, clear explanations, and a plan that treats you like a whole human, not a hormone lab report.
Educational only, not medical advice. Talk with your personal clinician about what is safe for you.
References
- The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794.
- American College of Obstetricians and Gynecologists. (2024). Hormone therapy for menopause (FAQ).
- Prior, J. C., et al. (2023). Oral micronized progesterone for perimenopausal night sweats and hot flushes: A phase III Canada-wide randomized placebo-controlled trial. Scientific Reports, 13, 9082.
- Asi, N., et al. (2016). Progesterone vs. synthetic progestins and the risk of breast cancer: A systematic review and meta-analysis. Systematic Reviews, 5, 121.
- Fournier, A., et al. (2007). Unequal risks for breast cancer associated with different hormone replacement therapies: Results from the E3N cohort study. Breast Cancer Research and Treatment, 107(1), 103–111.
- Depypere, H., et al. (2015). The levonorgestrel-releasing intrauterine system for endometrial protection during estrogen replacement therapy: A clinical review. Climacteric, 18(4), 470–482.
- Clark, K., & colleagues. (2019). Benefits of levonorgestrel intrauterine device use vs. oral progestogens for endometrial protection during estrogen therapy. Cureus, 11(5), e4681.
- U.S. Food and Drug Administration. (2022). DUAVEE (conjugated estrogens/bazedoxifene) prescribing information (Label)
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at www.perimenopausebook.com.
Dr. Anna is available for 1-1 consultations. Find out more at www.drannagarrett.com/lets-
