23 Apr 2014

The Power of Progesterone

7MenopausalDwarfs_300Let’s talk about progesterone. This magical hormone is keeps the 7 Dwarves of Menopause (Itchy, Bitchy, Bloaty, Sleepy, Sweaty, Forgetful, and Psycho) cool, calm and collected.

Progesterone is the hormone that a woman’s ovaries produce in the second half of her menstrual cycle. In the first 14 days of the cycle, estrogen is in charge. Estrogen’s job is to grow the cells of the uterus to prepare it for implementation of a fertilized egg. At day 14, presumably when ovulation occurs, estrogen production slows down as progesterone ramps up. Progesterone’s job is to slow down the growth of the endometrial cells and to develop their function. If you become pregnant and a fertilized egg implants itself, progesterone levels will continue to rise. If not, progesterone drops, signaling the end of the cycle, and the whole process starts over again.

But that’s not progesterone’s only job. Progesterone receptors are located in the blood vessels, the liver, breast tissue, the bone, and the brain, and the hormone has an important influence in the functioning of all those parts of the body.

Most of your progesterone is produced by ripened eggs. That means when your ovaries slowly wind down their function and you stop ovulating, progesterone production slows down.

Estrogen, however, can be produced by other cells in the body besides the ovaries, namely fat cells that convert testosterone into estrogens. Plus, we are all exposed to compounds in the environment that act like estrogen in our bodies (xenoestrogens).

So, during perimenopause, progesterone is dropping, but estrogens may not be, leading to a situation called estrogen dominance. This basically means that you don’t have enough progesterone to balance out the activity of the estrogens still circulating in the blood stream. Estrogen dominance causes all kinds of symptoms such as:

  • Depression
  • Anxiety
  • Panic attacks
  • Aching body and joints
  • Fatigue
  • Breast tenderness
  • Decreased sex drive
  • Mood swings
  • Allergy symptoms
  • Insomnia
  • Weight gain
  • Water retention
  • Hair loss
  • Migraines
  • Heavy periods and bad cramps

Does any of this sound familiar? Welcome to perimenopause!

And the irony is that doctors have been prescribing estrogen, synthetic progestins and antidepressants to women who complain of these symptoms since the 1950’s! This makes no sense. They likely need natural progesterone.

I have worked with dozens of women with perimenopausal and postmenopausal symptoms and 90% of them have some level of estrogen dominance on their hormone tests. So progesterone is an important part of their personalized hormone management plan. Bioidentical progesterone is safe, easy to use, and often resolves symptoms without the need for other hormones.

Dr. Anna Garrett


  1. Hi Dr. Garrett, I was wondering what your perspective is of a woman who has had a hysterectomy with regard to taking progesterone? Do you think it is good to take it for two or three weeks out of the month? Or the entire time…

    Thank you for your article, it is very informative!


    • Hi Rhonda,

      I generally recommend that clients who have had hysterectomies use it Mon-Sat and skip Sun…or you can use it 3 weeks of month and stop for a week. This helps keep receptors responsive to it.

  2. Bobbie Grant Says: May 11, 2014 at 8:57 am

    what about someone who is 60 yrs old and postmenopause and having difficulty sleeping would progesterone cream help them ?

    • Hi Bobbie…it’s worth a try. Post-menopausal women can have hormone imbalance problems. If the problem is your cortisol levels it may not help, but try it for 8 weeks or so and see if it helps.

  3. Dr. Anna, so good to make your acquaintance! I followed your post from the Menopause Professionals group on LinkedIn. I have question of my own, as I continue searching for a midlife specialist GYN who is friendly towards the idea of herbal and bio-identicals and have no one here yet to ask. After every month regularity my whole life, I abruptly stopped having periods for five months, and just started again last month (on my birthday – surprise!). I had two periods that month, spaced two weeks apart (very abnormal for me). I’m having a period again at a slightly irregular space of time this month. For this kind of “funky spacing” era of menopause, what is your suggestion on application of progesterone cream? I’m using Ann Louise Gittelman’s brand from UniKey, but with the serious irregulariy, haven’t the first clue what schedule to be on. Thank you for any clues you can provide and thank you for such informative blog posts – I am going to read them all. Cheers!

    • Hi Maryam,

      Likewise! I ran into this myself and just started taking every night (I have oral caps)…it was too hard to guess and the worst that happens is that your period stops. I recommend taking a 4-5 day break a month to keep you receptors responsive.

  4. Thank you Dr. Anna! So you take it whether you’re bleeding or not. I wouldn’t mind if it all just stopped though. 🙂 One more question – is there any difference to the capsules or cream qualitatively? My cream is bioidentical.

    • The capsules are best for sleep. All forms are bioidentical whether cream or capsule. It’s important to make sure the cream says USP micronized progesterone on the label. I stop when bleeding starts.

  5. […] Use progesterone cream or capsules to help balance estrogen and improve symptoms. Progesterone cream is available over-the-counter, but capsules require a prescription. Progesterone also helps with bloating and many of the mood-related symptoms of perimenopause. You can read more about the power of progesterone here. […]

  6. HI Dr Anna. I was on estrogen gel (daily) and progesterone (two weeks of 4) for hot flushes. I had experienced them for about 4 – 5 months. I had skin breakout and other symptoms (headaches) so stopped the estrogen and went on the bio identical progesterone each night without a break. The flushes and acne stopped almost immediately – but 4 – 5 weeks later my breasts, hips, stomach are all swollen (I am usually very slim and fit). I have no idea where I am in my cycle (have not bled for about 4- 5 months) so not sure whether to stop the progesterone for two weeks and see what happens? can I go off the progesterone and see what happens. Jennifer

  7. Dear Dr Anna

    I had a hysterectomy some 10 years ago and believe now in menopause. Was inserted estrogen and testosterone pellets 3 months ago. I take DHEA capsules and progesterone every night. This month of December my breasts are so huge and the left one is sore.
    The pain extends to the chest and left arm. As I cannot reverse the pellets, what should I do with the DHEA and progesterone cream?

  8. Hi I am in perimenopause and experiencing headaches, weight gain, low sex drive, irregular periods, body aches and moodiness. I want to try the essential oil blend of clary sage and thyme, is this something you would recommend? I can’t seem to lose weight to save my life, and I’m tired of just feeling blah. I’d appreciate any peri tips you can offer, thanks!

    • Hi Jennifer! Yes, that blend can be helpful for hormone balance. The best first step is to get your lifestyle squeaky-clean. This means eating whole foods, avoiding alcohol and caffeine, making sure you exercise and take time out for yourself. I’d be happy to have a consult with you if that would be helpful. You can find that info on my web site, http://www.drannagarrett.com, under the Work with Me tab.

  9. Lorie Etta Says: October 26, 2017 at 6:08 pm

    I am also going through premenapause. I haven’t had my period since July. I just stopped having hot flashes and now my breasts are huge and sore. I want to get that progesterone cream. Do I rub it directly on my breasts?

  10. Gina Lowery Says: January 25, 2018 at 12:05 pm

    Hello! Do you prefer oral as opposed to cream bio identical progesterone? And are you partial to specific brands?

    • Hi…oral works best for sleep issues. Otherwise, cream in fine. Any brand that says USP progesterone on the label is fine. It really boils down to the consistency of the cream and how easy it is to rub in.

  11. Leslie strong Says: March 13, 2018 at 6:50 pm

    Hi… I have been experiencing migraines, breasts are sore, crawling skin, no period since December and before this October. But, I have a family history of breast cancer can I take progesterone?


  12. Sherri Boles Says: April 14, 2018 at 10:55 am

    Dr. Anna,
    Hello. Have you heard women complain of increased tinnitus during perimenopause? It seems to get worse at the same time that my breasts become swollen and sore. Also, I swear things worsen after an intense workout or after taking a sauna. Any thoughts on that? Thank you.

  13. I am 72 years old and had a complete hysterectomy when I was 47. 16 years ago I was prescribed a topical progesterone cream. Testosterone injection of 1/2 ml once a month (I give myself the injections) and Estroil vaginally once a month for dryness. I quit the estroil because it was too messy.
    At my last Medicare checkup the doctor refused to refill these prescriptions especially the testosterone until I get my hormones checked by a gyro doctor. I did this and was told not to take the progesterone anymore but did say the testerone was ok. My hubby likes me taking the testosterone. Do I need the progesterone cream?
    I’ve felt good for all these years and hate to change things up for fear of feeling bad. Opinion?

  14. Barbara Millard Says: September 2, 2018 at 4:47 pm

    I am 67 yeas and postmenopause for 12 years! I am interested in progesterone and if it helps with high blood pressure, cholesterol, insomnia and vaginal dryness! Had none of these until menopause. Am I to old now. What would you suggest?

  15. Hi Dr. Anna,

    Is it OK to take just the bio-identical progesterone? I have been prescribed Tri-est and Progesterone in troche form (2 different troches)…but, when I take the Tri-est…my breasts hurt and my vaginal fluids smell a bit fishy…I have VERY high stress so I am thinking of just taking the progesterone to counter-act the high cortisol???

    • Hi, I have many clients that use progesterone alone. I can’t tell you specifically what to do without knowing more about you and your situation (feel free to schedule a consultation), but breast tenderness is often a sign of too much estrogen.

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