What to Know & What to Ask Your Healthcare Provider

TL;DR (Too Long; Didn't Read)

Progesterone is often the first hormone replacement women begin taking in perimenopause.

WHY

Progesterone is often the first hormone replacement women take in perimenopause. This is likely due to clinical symptoms like a shortened menstrual cycle, spotting, poor recovery from exercise, sleeplessness, and increasing anxiety or depression that is atypical for you.

Progesterone has several roles as it relates to the menstrual cycle, such as:

• Decreasing uterine contractions to allow for implantation.
• Increasing vascularization and blood flow to the uterus.
• Increasing mucosal thickening in the cervix (to prevent more sperm from getting in, as well as serving an immune function to the woman [*]).

Progesterone has many functions in the body beyond regulating the menstrual cycle, too, like:

• Bone formation [*] and prevention of osteoporosis.
• Protection of neurons in both the central and peripheral nervous systems for neurodegenerative diseases.
• It also interacts in the musculoskeletal system with estrogen to help form peak bone mineral density.

Progesterone is not solely for your uterus. It’s a systemic hormone. If you do not have a uterus, you can still benefit from supplementing with this hormone (although this must be discussed with your primary prescribing healthcare provider!).

WHAT

If you’re noticing your menstrual cycle shortening, or you’re noticing spotting a few days before your actual period begins, these are usually telltale signs that your progesterone levels are dropping. Coupling this with changes in mood, affect, sleep, or general recovery from exercise would certainly warrant a conversation with your provider about whether progesterone therapy is right for you.

HOW

There are several ways progesterone is administered. The two most common ways are oral, micronized progesterone and topical progesterone cream.

Prescribed oral micronized progesterone is called Prometrium and is chemically identical to the progesterone we make in our bodies. It’s available in 100mg or 200mg doses and recommended that you take it at night because it can cause drowsiness and even dizziness. Taking it before bed helps to minimize these common side effects.

A few other side effects to note with Prometrium that are true for some but not all women:

• Water retention
• Bloating
• Increased appetite
• Mood changes

While these side effects can be temporary when first starting the drug, it’s important to make sure you keep a log of any symptoms you experience to be able to communicate this with your provider.

In terms of dosing: If you’re still cycling, it’s commonly recommended for you to take the progesterone in the second half of your cycle, from the midpoint (usually day 14) to the first day of your period.

If you are menopausal, or you have no idea where you are in your cycle, there are a few schools of thought on progesterone best practices:

• Take it daily, irrespective of where you are in your cycle.
• Take it for two weeks, and then break for two weeks, mimicking the natural rhythms of progesterone secretion in the fertile years.

There is no “better” one way, so expect a bit of experimentation and dialogue between you and your primary prescribing healthcare provider.

NOW

• If you are not already tracking your cycle–start! Even if it’s irregular. You need some foundational data.
• If you notice changes in the length of your cycle, spotting, or mood and energy changes, it might be worthwhile discussing with your provider what your options are based on your health history.

Question of the Week

Q: As a 45-year-old woman, what are the ideal estrogen/progesterone levels or range to look for?

Gina asks a question that I think is difficult to answer for everybody because it’s only one part of three questions that you must consider. So, I can give you a framework to think about what is optimal for you.

We can look at ratios, but we are looking for 1) both absolute numbers to be optimal, 2) the relative ratios of each to be optimal, and then, 3) symptom management to be on point.

To be direct, you want an estrogen: progesterone ratio to be somewhere between 100 and 500. Anything less than 100 usually indicates that too little progesterone and too much estrogen in the luteal phase of the menstrual cycle.

It’s important to know that you can still experience signs and symptoms of estrogen dominance even if your estrogen and progesterone levels are within the normal range. This is why you and your healthcare provider should always consider ratios, absolute levels, and your menstrual cycle experience.

YOUR TURN!

I’ll be answering your questions every week right here in the Mini Pause! Let me know what’s on your mind. I’ll be checking for both questions and feedback at support@drstephanieestima.com.

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