Benefits of Taking Progesterone After Menopause

Like estrogen, progesterone is a hormone that your ovaries produce. These hormones work together to regulate sexual health and reproductive function — in particular, high progesterone and estrogen levels are essential in preparing the body for possible pregnancy.

Estrogen plays an important role in a woman's life. During puberty, it helps with breast growth and triggers the start of the menstrual cycle. Throughout your reproductive years, estrogen helps regulate the menstrual cycle and makes childbearing possible. This hormone also plays a role in controlling cholesterol, helping with mood, and protecting bone and heart health.

Progesterone helps prepare the endometrium (uterine lining) for a potential pregnancy after ovulation (the release of an egg). This hormone also stops the uterus from contracting, which could cause the body to reject a fertilized egg. During pregnancy, progesterone encourages the body to support the endometrium that nourishes the growing baby. This hormone also helps the body start producing breast milk.

After menopause, when progesterone levels fall significantly, supplementing with progesterone therapy can restore several of these protective effects. The benefits of progesterone after menopause include:

• Sleep quality: Oral micronized progesterone taken at bedtime has been shown to improve deep sleep quality and reduce the severity of night sweats. [8]
• Bone health: Progesterone works alongside estrogen to support bone density and reduce the risk of osteoporosis-related fractures. [6]
• Mood and cognition: Progesterone has a natural calming effect on the nervous system and may support verbal memory in menopausal women. [9]
• Uterine protection: Progesterone thins the uterine lining, reducing the risk of endometrial hyperplasia and uterine cancer in women taking estrogen. [6]
• Hot flash and night sweat relief: Hormone therapy that includes progesterone helps reduce these vasomotor symptoms. [6,8]
• Cardiovascular and colorectal support: Taking estrogen and progesterone together may reduce the risk of heart disease and colorectal cancer. [5]

Some women also find that progesterone causes fatigue, particularly at higher doses. If you're wondering whether progesterone makes you tired, that's a side effect worth discussing with your doctor when evaluating dosage.

During perimenopause, the phase leading up to menopause, hormonal fluctuations are common. Typically, estrogen levels rise and fall, while progesterone production may start to decrease. These changes mark the onset of the menopause transition, leading to various physical and emotional symptoms. It's possible for elevated progesterone levels to occur during this phase.

Once you reach menopause, both estrogen and progesterone levels decrease. This results in estrogen and progesterone deficiency, which can cause a variety of menopausal symptoms. Some of the most common are vasomotor symptoms, such as hot flashes and night sweats. A low progesterone level can also cause abnormal uterine bleeding.

Low progesterone and low estrogen levels both during and after menopause can increase the risk of developing heart disease and osteoporosis. Thankfully, one of the benefits of progesterone after menopause is that it can help improve many menopause symptoms, stabilize a hormone imbalance, and reduce certain health risks, such as abnormal bleeding after menopause.

If you have low progesterone after menopause and want to improve your hormone levels, therapy may be able to help. There are two main categories to understand before getting started: the source of the progesterone (natural vs. synthetic) and the method of delivery (oral, topical, injectable, or implanted). Understanding both helps you have a more informed conversation with your healthcare provider about which option is right for you.

You may have heard the term "progestins" and wondered if it is the same thing as progesterone. Progesterone is the hormone that your body makes, while progestin refers to progesterone-like products that scientists have created to act like natural progesterone in the body. This means that progestin is synthetic, or manmade.

Man-made progesterone, also known as bioidentical progesterone, is designed to help treat a hormonal imbalance or low progesterone levels. These products have become quite popular over the years, as many people view them as safer alternatives to taking synthetic progestins.

There are different forms of bioidentical progesterone. Some are premade by a drug company and others are custom-made at a pharmacy through a process called compounding. The benefit of premade drugs is that many have been approved by the US Food and Drug Administration (FDA). This means they have been through safety and purity testing. As a result, many medical societies recommend using premade drugs over custom-compounded hormone therapy for menopause management.

Micronized progesterone vs. synthetic progestins

Not all progestogens behave the same way in the body, and the differences matter clinically. Oral micronized progesterone — the bioidentical form — is structurally identical to the progesterone your body produces naturally. Synthetic progestins are chemically modified and can behave differently in body tissues.

Key differences include:

• Breast cancer risk: Combined HRT using micronized progesterone is not associated with an increased risk of breast cancer for the first five years of use. For women using HRT for longer than five years, risk appears lower with micronized progesterone than with synthetic progestins.
• Blood clot risk: Oral micronized progesterone does not appear to increase the risk of venous thromboembolism (VTE), unlike some synthetic progestins.
• Side effects: Women taking micronized progesterone typically report fewer side effects — such as mood changes, bloating, and irregular spotting — compared to those taking synthetic progestins.
• Cardiovascular effects: Micronized progesterone does not appear to negate the cardiovascular benefits of estrogen, while some synthetic progestins may.

If you're concerned about these differences, discuss them with your healthcare provider, who can recommend the formulation best suited to your health history and risk profile.

Every woman is different, so progesterone therapy comes in a wide variety of doses and delivery methods.

• Oral progesterone: One popular form is oral micronized progesterone, which comes in pill form. Taking it at bedtime may improve sleep quality.
• Transdermal progesterone cream: This type of cream gets absorbed through the skin. Progesterone gels, patches, and sprays are also available.
• Injectable progesterone: This type of progesterone is often available as medroxyprogesterone acetate, more commonly known as Depo-Provera.
• Implanted pellets: You can get progesterone pellets placed under the skin, and they will continue to release this hormone over time.

It's important to note that some people claim that you can get progesterone from natural sources like soybeans and yams. However, these foods need to be altered in a laboratory so that your body can use them as progesterone. As a result, the soybeans and yams on the market as progesterone therapy aren't natural and are not recommended for treating a hormonal imbalance.

Hormone replacement therapy with progesterone can be a great option to address common postmenopausal symptoms, such as hot flashes and night sweats. Symptoms of low progesterone after menopause can be addressed with hormone therapy, including:

• Vaginal symptoms, including dryness, itching, burning, and painful intercourse
• Bone loss and fracture due to osteoporosis
• Heart disease and stroke
• Mood swings and mental health disorders like depression and anxiety

Researchers have also found several other possible benefits of progesterone after menopause.

• In one study, taking progesterone at bedtime was associated with a higher quality of deep sleep and less severe night sweats. [8]
• Another study found that taking progesterone may improve visual and verbal memory in menopausal women. However, other studies didn't find these same cognitive benefits. [9]

While estrogen is often the primary ingredient in many forms of hormone replacement, you'll also want to consider including progesterone to reduce menopausal and postmenopausal symptoms.

This is especially true if you still have your uterus. Progesterone helps thin the uterine lining and prevents endometrial hyperplasia (a uterine lining that's too thick). Doing so helps reduce the risk of developing endometrial, or uterine, cancer. Women who have had a hysterectomy may not need progesterone since there is no uterine lining to protect — your doctor can advise whether estrogen-only therapy is appropriate for you. There's also evidence that taking estrogen and progesterone together may reduce the risk of getting colorectal cancer. For those at higher risk of colorectal cancer, particularly those aged 45 and up, consider taking an at-home FIT test to screen for early signs.

The best way to determine your dose is to speak with your doctor. Your healthcare provider can review your health history and symptoms to determine the best progesterone dose for your unique concerns and needs.

That said, common dosages for oral micronized progesterone (such as Prometrium) used in HRT typically range from 100 mg to 200 mg taken once daily, usually at bedtime. The lower 100 mg dose is often used for continuous uterine protection alongside estrogen, while 200 mg may be prescribed cyclically. Topical progesterone creams and other delivery methods have different dosage ranges depending on the product and formulation.

In general, with hormones like estrogen and progesterone, the goal is to address your symptoms by taking the lowest dosage for the shortest amount of time possible. Most guidelines recommend reassessing your need for hormone therapy at regular intervals — typically annually — in consultation with your doctor.

Yes, it is generally safe to take progesterone after menopause. However, as with any medication, some women may experience certain side effects.

• Stomach pain and bloating
• Breakthrough bleeding in newly menopausal women
• Breast tenderness
• Headaches
• Mood changes

Your likelihood of experiencing these side effects, as well as the type and intensity, vary depending on several factors. The dosage is the biggest factor. However, how progesterone interacts with your hormone receptors and how your body processes it can also influence whether you have side effects.

In addition to these side effects, estrogen and progesterone therapy — as well as estrogen therapy on its own — can increase the risk of certain health issues.

• Much like the birth control pill, patch, and ring, hormone replacement therapy can increase the risk of developing blood clots in the legs and lungs. It can also increase the risk of stroke. This risk appears to be the lowest among women between the ages of 50 and 59.
• The risk of developing breast cancer also increases when continuously taking estrogen and progesterone therapy. This risk appears to decrease after discontinuing hormone therapy. If you have had breast cancer, you should talk to your doctor before considering hormone therapy as a menopause treatment.

Who should not take progesterone?

Progesterone therapy is not appropriate for everyone. Talk to your doctor before starting, especially if you have or have had:

• Unexplained vaginal bleeding
• A history of breast cancer, uterine cancer, or other hormone-sensitive cancers
• Active or recent blood clots in your legs or lungs
• Active liver disease
• A history of stroke or heart attack

Your doctor can help you weigh the benefits and risks based on your individual health profile.

For many women, the benefits of progesterone after menopause outweigh the risks of taking it. Additionally, you can take several steps to reduce your risk of experiencing side effects and health risks from taking progesterone for menopause.

Talk to your doctor to find the best progesterone product and delivery method for you. For example, if you're only looking for relief from vaginal symptoms related to menopause, your doctor might recommend a low-dose vaginal cream instead of an oral pill or skin patch.

Take the least amount of medication necessary. As mentioned earlier, you should strive to take the lowest dose for the shortest amount of time to treat your menopausal concerns. This is true for most medications.

Keep following up with your doctor. While you're taking progesterone and/or estrogen for menopause management, be sure to regularly visit your doctor. He or she can provide important screenings and help you determine whether the benefits of progesterone after menopause continue to outweigh any risks.

Finally, making healthy lifestyle choices in other areas can also help decrease the likelihood of experiencing adverse health consequences. This means making time for regular physical activity and eating a nutritious and balanced diet to maintain a healthy weight. You should also avoid drinking and cigarette smoking, manage stress, and seek treatment for any chronic health conditions.