Progesterone and Perimenopause: What You Need to Know

Night sweats. Hot flashes. Vaginal dryness. Swollen breasts. Mood swings. All of these are the classic signs that we associate with a very specific time in a woman’s life: menopause. 

But it’s not just menopausal women who experience these (and other) symptoms. Because these symptoms can actually begin years before menopause, during a phase known as perimenopause. In fact, when you combine perimenopause and menopause, some women can experience “change of life” symptoms on and off for over a decade! 

These menopause/perimenopause symptoms can range from a minor inconvenience to downright painful or disruptive. And some can even interfere with your life to the point where medical treatments become necessary. 

Luckily, researchers have found proven options that offer some relief if you’re close to or going through menopause. One of these is progesterone. 

Let’s take a closer look at what to expect during perimenopause and menopause and how progesterone can help relieve some of the struggle. 

What is Menopause?

Menopause is diagnosed based on its symptoms. You’ll be “officially” considered to have reached menopause when you’ve gone one full year without a menstrual cycle. It marks the transition between your childbearing years and non-childbearing years.

Most women experience menopause in their midlife years, usually between the ages of 45 and 55, with an average age of 51. 

If you’re over 45 and have stopped having your menstrual period, your healthcare provider will inquire about some of your other symptoms. Most likely, they will make a presumptive diagnosis of menopause. After a year without menstruation, the diagnosis is confirmed. 

If you’re under 45 and have stopped menstruating, you may want to see your physician. It could be early menopause, but it could also be something else that has halted your reproductive cycle. High-performing female athletes, for example, often go through phases where they stop having a period. 

What is Perimenopause?

Perimenopause (or pre-menopause) is the period of time during which your body is making its menopausal transition. It’s very name says so; it comes from the words “peri” (Greek for “around” or “near”) and menopause.

During perimenopause, you’ll experience some of the changes associated with menopause. These changes come courtesy of the erratic levels of estrogen (a female sex hormone), which is a natural part of aging. 

For example, you may notice that your periods have become quite irregular. How irregular? It can range from more frequent to less frequent to completely unpredictable. They may also become noticeably heavier or lighter. 

Perimenopause vs. Menopause

Surprisingly, most of the symptoms that come to mind with the word “menopause” are actually symptoms of perimenopause! 

Some of the most common symptoms of perimenopause include: 

• Irregular periods: As we mentioned above, your periods will likely become hit or miss. Lighter, heavier, varying lengths of cycles, everything except predictability will be on the table. You might even skip a period here and there during perimenopause. 
• Hot flashes: Be ready for unexpected heat! Hot flushes , usually lasting between 30 seconds and five minutes, can range from mild to volcanic
• Sleep disturbances: Even the soundest sleeper might have trouble making it through the night uninterrupted. The cause is usually a nighttime hot flash, waking you up in a pool of sweat. 
• Changing moods: The fluctuating hormone levels combined with the discomfort of hot flashes and lower-quality sleep can leave you stressed and irritable. 
• Vaginal dryness: When your hormone levels drop off, your vaginal tissues lose lubrication and elasticity. This can make sex painful. It can also make you more susceptible to vaginal infections. 
• Bladder issues: You may also experience urinary incontinence, due to the diminished tissue tone in your bladder. 
• Bone loss : As your estrogen level drops, you also lose bone. Left unchecked, this can lead to osteoporosis. 

As perimenopause progresses, your periods will be less and less frequent. You might go a few months without menstruating, only to have it pick back up. Again, once you have gone 12 consecutive months without a period, you are considered to have reached menopause. 

Believe it or not, most of the symptoms you’ve been experiencing will actually get better when you hit menopause! This is due to the leveling off of your estrogen levels. Although they’re lower than they were during your twenties and thirties, they won’t have the wild fluctuations of the perimenopausal phase. 

There are very few actual symptoms of menopause. These include:

• Loss of fertility: Since you are no longer ovulating, your body is no longer able to bear children naturally. However, you can still get pregnant with donor eggs. 
• Cognitive issues: Minor memory loss and difficulty concentrating often accompany menopause. These sometimes go hand in hand with anxiety and depression, both of which are common during perimenopause. 
• Emotional changes: With all of the changes going on in your body, it’s not surprising that you may have some emotional changes, as well. Irritability, anxiety, loss of energy, aggressiveness, tension, and depression are all common. 

What is Progesterone?

What exactly is progesterone, and how is it released? Progesterone is one of the two main female reproductive hormones (the other one being estrogen) secreted by the ovaries. Its main role is to prepare your body for pregnancy if your egg is fertilized. 

Progesterone’s job is to thicken the endometrium , allowing the fertilized egg to implant. It also stimulates the secretion of nutrients that nourish the newly fertilized egg. During pregnancy, your progesterone levels will continue to rise, until the baby is born. At that point, the progesterone levels will drop back to their pre-pregnancy averages. 

Progesterone is released mid-menstrual cycle, during ovulation, when an egg is released from the ovary. This happens during a phase of your menstrual cycle known as the luteal phase. 

• At around day 14 of your cycle (the count begins the day you begin your period), the egg bursts from its follicle. 
• The follicle, which stays on the ovary’s surface, transforms into the corpus luteum. 
• The corpus luteum begins releasing progesterone. 
• If the egg is fertilized, the corpus luteum continues to produce progesterone to support the development of the fetus. 
• If the egg is not fertilized, the corpus luteum dies, around day 22 of your cycle. Progesterone levels drop and the uterine lining  falls away, resulting in menstruation. 

Progesterone During Perimenopause

Progesterone is a reproductive hormone, released by your body during its menstrual cycle. As you enter perimenopause, your periods will become more sporadic and less frequent. As a result, your body will slow down and then eventually cease its production of natural progesterone. 

This reduced level of progesterone is what triggers many of your symptoms during menopause. But because your progesterone levels fluctuate, with skipped and irregular periods, your symptoms will typically be erratic during perimenopause. Think of a few nights of great sleep, followed by a couple of nights waking up in sweat-soaked pajamas! 

Since your symptoms are traced back to the lower levels of progesterone, your physician may prescribe hormone replacement therapy (HRT), with lab-created progesterone to reduce or eliminate them. 

Progesterone Therapy

Progesterone as a medication is in a class known as progestins: female hormone replacements. In oral or topical forms, it mimics the functions of progesterone that is naturally made in the ovaries. 

Progesterone Benefits

Progesterone therapy is an effective treatment for  reducing or even eliminating some of the most disruptive symptoms of perimenopause. 

• One study showed that taking a daily oral dose of micronized progesterone decreased the  frequency of vasomotor symptoms such as hot flashes and night sweats. Those that did occur were less intense. 
• Another study showed that progesterone therapy improved sleep for perimenopausal women. In fact, lab-created progesterone is so effective at improving sleep that it’s usually recommended for nighttime! 
• Still other studies show that progesterone may also help with some of the cognitive issues associated with perimenopause, improving visual and verbal memory. 

Progesterone Side Effects

Progesterone therapy is usually considered safe. The FDA has approved many prescription progesterone products. However, like all medications, there are possible side effects. 

These include: 

• Upset stomach
• Changes in appetite
• Weight gain
• Fluid retention/swelling
• Fatigue
• Acne
• Sleep problems  (drowsiness or insomnia)
• Skin conditions (rashes or hives)
• Fever
• Headaches
• Depression
• Breast tenderness/soreness 
• Decreased blood pressure
• And others 

Who shouldn’t take progesterone? 

Despite the relative mildness of its side effects, progesterone therapy isn’t recommended for everyone. Your physician may not prescribe progesterone if you: 

• Are over 60 years of age
• Have been experiencing menopause symptoms for over 10 years
• Have a personal or family history of breast cancer
• Are in a high-risk group for dementia, heart attack, stroke, blood clots, osteoporosis, or liver disease
• Have had your uterus removed (a hysterectomy)

Final Thoughts

The onset of menopausal symptoms marks a big transition for most women. While some changes are welcome (no more periods!), others can be uncomfortable and disruptive to your lifestyle. Those hot flashes can come at the most inopportune moments! 

Luckily, many of the most unwanted symptoms can be handled through progesterone therapy. Prescription progesterone, in oral or topical form, can replace the progesterone that had been previously released by your body. 

Thanks to progesterone therapy, your most bothersome perimenopausal symptoms could be a thing of the past! 

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