Perimenopause and Progesterone

What is perimenopause? Perimenopause is a decline in ovarian function that precedes menopause, with menopause being defined as not having a period for at least 12 months. The perimenopausal transition may take several years and during this time, ovarian function can go up and down. Because of this many women feel like they are “going crazy”: their emotions are all over the place even though nothing different is happening in their life. Often the periods aren’t that irregular, and symptoms may come and go, making things more challenging to understand.

What is happening? The ovaries make estrogen, which produces an egg. In turn, the. egg makes progesterone, and it is the rise and fall of these hormones that creates the menstrual cycle. As the ovaries age, egg production is reduced, causing continued production of estrogen, but low progesterone. This is often referred to as “estrogen excess” because progesterone balances estrogen. If progesterone is low, the body feels like there is too much estrogen. This may result in chronic premenstrual type symptoms (PMS), as well as breast tenderness, excess menstrual bleeding, and fibroids.

Progesterone’s role in pregnancy is to promote the growth of the embryo and calm the nervous system to provide an optimal environment for the baby to grow. When progesterone levels go down, it can cause anxiety, agitation, sleep problems, heavy bleeding, and PMS symptoms. There is especially a feeling of anxiety in the body, an uncomfortable restlessness. When the calming effect of progesterone is lost, any usual symptoms of insomnia, underlying stress and anxiety tend to be much worse. Women feel that menopause brings on anxiety, but in reality, it simply exposes it.

How can progesterone help? Progesterone is produced in the second half of the cycle, so it is best to support it during that time. Progesterone comes in two forms: transdermal (cream or lozenge) and oral capsule. Cream is available over the counter at natural food stores, or by a doctor’s prescription at a compounding pharmacy. Capsules are available by prescription only. All progesterone discussed here is natural or bioavailable progesterone. Synthetic progestins are not generally used for relief of menopausal symptoms. Also of note, wild yam creams, while popular, do not contain any available progesterone.

There’s a big difference between over-the-counter progesterone cream and prescription capsule. The first difference is dosing: cream that is available at the health food store is 20 milligrams per quarter teaspoon. Capsules can be made in any amount from a compounding pharmacy, but conventional prescriptions start at 100 milligrams per capsule.

The second difference between cream and capsule involves symptom effectiveness. Both types will help with general symptoms of progesterone deficiency, but oral progesterone is metabolized to favor brain calming and sleep, which is what a lot of women are having the most problems with. Additionally, higher doses may be needed if heavy bleeding is the problem. DUTCH urinary hormone testing can tell you if you would benefit more from capsule than cream for sleep and stress issues.

Natural progesterone is safe to use and is not associated with increased risk of breast cancer. Due to its benefit for sleep and relaxation, progesterone is generally given before bed. However, some women find the lower dose cream used twice a day to be most helpful. The vast majority of women don’t have side effects from progesterone. If side effects are experienced, it would most frequently be a feeling of excessive grogginess. If you have a history of breast cancer, you would want to consult with a doctor before using hormones of any kind, including progesterone.

There are some herbs which have been known to support progesterone levels. Chaste Tree Berry (Vitex agnus-castus) particularly comes to mind. CTB can be especially helpful when the period has become irregular and you want to normalize it. CTB regulates the ovarian-brain connection and helps to restore ovulation. Chaste tree berry is completely safe and can be taken by anyone without side effects or contraindications.White peony (Paeonia lactiflora) raises progesterone levels and helps to balance the menstrual cycle. Herbs that improve cortisol levels may also be useful during perimenopause. Cortisol from the adrenal glands is needed to make progesterone and adrenal depletion (and therefore low cortisol) is very common amongst women, especially in perimenopause. Herbs that can improve cortisol levels are bupleurum, rhodiola, ashwaganda, and schisandra. Licorice root is also very good, but care needs to be taken when using licorice as it may have and effect on blood pressure.

Lastly, eating a diet high in whole foods, colors, and fiber is extremely helpful in balancing perimenopausal symptoms. Reducing alcohol, as well as high sugar foods and simple carbohydrates like pastries, cookies, and pasta will go a long way towards making perimenopause a much smoother transition.