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Thinking about using progesterone cream to manage symptoms of perimenopause or menopause? Progesterone is a necessary part of a hormone replacement therapy (HRT) strategy for midlife women who choose to do HRT,  but is rarely successful as a standalone treatment for any length of time. Perimenopause, also called the menopausal transition, typically commences in a woman’s forties and often comes with symptoms. Menopause is defined simply as 12 months without a menstrual cycle.

Progesterone and estrogen are the two primary female sex hormones. Most women make progesterone and estrogen in reliable monthly amounts throughout their 20s and 30s and into their early 40s. Progesterone is made only when we ovulate. At some point, usually in the 40s, ovulation sputters (meaning, it doesn’t happen at reliable monthly intervals) which causes progesterone levels to drop sharply and the transition towards menopause begins.

Some of the symptoms of perimenopause and menopause are:

Weight gain

Anxiety (that worsens or appears out of nowhere)

Low libido

Brain fog

Worsening PMS

Breast tenderness


Trouble sleeping

Vaginal dryness

Progesterone is sold over the counter, so it’s safe and effective, right?

Progesterone cream to the rescue, right? It’s available everywhere (from Amazon to your local health food store) and recommended by large swaths of women in online support groups claiming that it fixed all of their issues, so why not, right? 

Progesterone only treatment for perimenopausal women (whether done as a DIY project, something I don’t recommend, or prescribed by your doctor) can work for some women initially but it usually stops working and can cause unwelcome consequences. 

While progesterone has its place in an HRT regimen for midlife women, it is over-hyped, over-used and poorly understood. 

Before we explore the reason why progesterone only as a treatment for the symptoms of perimenopause and menopause is faulty,  we first need to understand the role it plays in a pregnancy. 

Stay with me….this is going to make a LOT of sense.

Progesterone is a key part of the menstrual cycle and helps maintain pregnancy (pro-gestation, get it?). Because the prime directive of life is reproduction (whether you ever have a baby or not, this is how the species continues!), the successful maintenance of a pregnancy requires several metabolic and physiological changes that prepare a woman to nurture a growing baby inside of her body. During pregnancy, the level of progesterone is about 10 times higher than during the menstrual cycle. 

Let’s consider some of these changes that progesterone induces during pregnancy and consider if this is what we are going for as we move towards menopause:

  1. Progesterone stimulates appetite. That growing baby needs food, so progesterone causes a pregnant woman to eat. This has an obvious effect for the survival of her baby. The problem is, when you are perimenopausal, not pregnant and your appetite is being overly stimulated by an excess use of progesterone causing you to eat. And let’s face it, those cravings are not for a big arugula salad, they are for sugary carbohydrates. 
  2. In pregnant women, progesterone relaxes the smooth muscles of the intestinal tract. This can cause constipation due to slow transit time of food. It can also cause bloating. The purpose of slowed down transit time in a pregnant woman is to allow for the high absorption of nutrients for the survival of her baby. If you’ve been pregnant, you’ve more than likely had occasional bouts of constipation and bloating. When midlife women slather on copious amounts of progesterone cream as a hormone balance strategy, they can experience some of these gastrointestinal pregnancy related effects. Not fun. 
  3. The immune system is suppressed during ovulation and pregnancy. During ovulation, this happens in order to prevent the immune system from attacking the fertilized egg and from preventing implantation. Once pregnant, the immune system remains somewhat suppressed to prevent the the unborn baby (which has foreign protein of the father’s genetics) as something to be destroyed. This is great in pregnancy but we don’t want this immune suppression when not pregnant. Your immune system is the basis of your health. Many immune regulating chemical messengers are also involved in regulating metabolism. If you are trying to lose weight, excess progesterone affecting your immune system can thwart your best efforts.
  4. Progesterone increases insulin resistance. First, let’s establish what insulin resistance is, because it’s a very big deal for midlife women. In a nutshell, insulin resistance is when cells in your muscles, fat and liver don’t respond well to insulin (a hormone produced by your pancreas) and can’t extract the glucose from your blood for energy. To make up for it, your pancreas makes more insulin. Over time, your blood glucose levels go up and so does your weight. Insulin resistance is a common issue in midlife women (especially in those who eat too many carbohydrates) and is a major contributor not only to weight gain, but almost all of the diseases that we associate with aging, such as heart disease, cognitive decline and diabetes. Maternal insulin resistance is crucial for efficient provision of glucose to a growing baby. However, for vibrant health and hormone balance, we want to be insulin sensitive as we age, not insulin resistant. Using progesterone for long periods of time, without also using estrogen, might make you insulin resistant.

Why does progesterone cream stop working?

Progesterone absolutely has its place in a midlife woman’s hormone balance strategy, but first a little bit about how hormones work in concert with each other: Hormones work like a lock and key system. The hormone is the key and the receptor is the lock. Hormones are created in glands and swim in the bloodstream to target tissues which have receptors for hormones all over them. Simply put, in order for progesterone to work, it needs a dock into a progesterone receptor.  

Want to know what creates receptors for progesterone?

It’s estrogen!

Which means you need to have an adequate level of estradiol (the primary estrogen in premenopausal women)  for progesterone to have the correct effects in the body. 

For women that have estradiol in decline (which happens at some point in the menopausal transition, though it tends to decline after progesterone drops), the benefits of progesterone are limited at best or wholly useless. The benefits of using progesterone simply aren’t available without receptors for progesterone.

This is why progesterone may work initially for some women. It’s because they have enough estradiol in the body to create receptors for progesterone. When this estradiol level drops out, as it will do in ALL women at some point, progesterone cream as a standalone strategy is more problematic than helpful. It may actually feed into bloat, weight gain,  cause an increase in cortisol and thus feelings of stress and overwhelm and low mood. The very things that midlife women tend to struggle with.

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