Body-identical or bioidentical progesterone is a viable treatment for women’s health conditions such as PCOS, PMDD, migraines, endometriosis, adenomyosis, and perimenopause.
Progesterone is called oral micronized progesterone and requires a doctor’s prescription. Brand names include PrometriumⓇ, UtrogestanⓇ, TevaⓇ, and FamenitaⓇ, depending on your country. Alternatively, progesterone cream is available over-the-counter in some countries and can help with mild symptoms but is generally not as effective as capsules.
Here’s what you need to know.
First, progesterone is different from progestins such as norethisterone, levonorgestrel, and drospirenone. Progestins are sometimes referred to as progesterone, but they shouldn’t be because progestins are not progesterone and have their own set of drug side effects. For example, levonorgestrel is quite testosterone-like and so can cause androgen side effects such as weight gain. If you’re not sure if you’ve been prescribed progesterone or a progestin, read the ingredient label and consult this chart.
Second, progesterone might be worth trying, even if you have “progesterone sensitivity.” It’s all about the dose. Because of the bimodal association between serum allopregnanolone and adverse mood, you might feel better on a 200 mg capsule compared to a cream. In other words, anxiety can be relieved by moderate dose progesterone but worsened by low or high dose.
👉🏽 Tip: If you consistently experience anxiety from progesterone capsules at any dose, consider switching to a vaginal progesterone pessary.
Third, understand that your doctor may, unfortunately, be reluctant to prescribe real progesterone because it is currently approved only for menopausal hormone therapy and not for conditions such as heavy bleeding, endometriosis, or adenomyosis. Yet, the consensus from gynecologists to whom I’ve spoken is that progesterone can be used for those conditions, with a few caveats:
- real progesterone is gentler than a progestin so needs to be used at a higher dose to have the same period-lightening effect
- real progesterone may not be strong enough for certain conditions, such as endometrial hyperplasia
- real progesterone is more expensive than a progestin. (Depending on the pharmacist, it costs 30-50 cents per day.)
Conditions that benefit from progesterone
Menopause (either progesterone-alone or with estrogen as part of menopause therapy). Progesterone can be helpful even if you’re sensitive to progesterone and even if you don’t have a uterus. Your doctor may think that progesterone’s only job is to protect the uterus, but it has many other benefits, including promoting sleep, strengthening bones, and protecting the breasts. Progesterone-alone has a few advantages over estrogen: 1) it’s better for sleep and migraines, 2) it’s safer for breasts, and 3) it’s easier to stop because it’s not addictive like estrogen.
If you would like to try progesterone-alone for menopause, try saying:
“According to Canadian endocrinology professor Jerilynn Prior, micronized progesterone alone can relieve menopausal symptoms.” Print out the following study and take it to your appointment: Oral micronized progesterone for vasomotor symptoms—a placebo-controlled randomized trial in healthy postmenopausal women. Or simply accept the script for both estradiol and progesterone but start by taking only the progesterone.
“According to Canadian endocrinology professor Jerilynn Prior, micronized progesterone can be helpful for perimenopausal symptoms.” Print out the following study and take it to your appointment: Oral micronized progesterone beneficial for perimenopausal hot flushes/flashes and night sweats.
Heavy periods as described in my books and blog post How to treat heavy periods with diet and natural progesterone. If you need help obtaining the script, try saying:
“Could I try a few months of Prometrium or Utrogestan for heavy bleeding (or pain)? I understand it can work as well as a progestin to lighten flow (or help pain) but without the side effects. See this protocol by Canadian endocrinology professor Jerilynn Prior.” Print out the following document and take it to your appointment: For Healthcare providers: managing menorrhagia without surgery. Draw your doctor’s attention to the paragraph that states: “For heavy flow in a woman who already has anemia or who is in Very Early Perimenopause with regular cycles or in the Early Menopause Transition Phase with irregular cycles plus typical perimenopause experiences such as night sweats, new sleep problems, and increased premenstrual concerns, full-dose oral micronized progesterone (OMP, 300 mg at bedtime) must be given daily for a full three months.”
Endometriosis and adenomyosis as described in my books, particularly Hannah’s endometriosis patient story in Period Repair Manual and Francine’s adenomyosis patient story in Hormone Repair Manual. Progesterone helps to suppress the growth of endometrial tissue and regulate the immune system—therefore, potentially also addressing the immune dysfunction that lies at the heart of both conditions. See also my blog post Immune treatment for endometriosis. Progesterone can be used in addition to a hormonal IUD.
Migraines as described in my new book and blog post Natural treatment of menstrual or hormonal migraines. It works by reducing histamine and glutamate and calming the brain. Progesterone capsules are usually the best treatment, but progesterone cream is also an option.
Perimenopausal and premenstrual mood symptoms (PMDD) as described in my new book and my PMDD-progesterone blog post. See also my blog posts about PMDD and histamine, PMDD and prolactin, and PMDD and iodine.
PCOS as described in my new peer-reviewed paper, Professor Prior’s protocol for cyclic progesterone therapy, and my blog post Cyclic progesterone therapy for PCOS. Progesterone works for PCOS because it lowers androgens and helps to restore ovulation.
Of course, progesterone is only one aspect of treatment for all these conditions. It combines well with other treatments such as magnesium for migraines, inositol for PCOS, and immune treatment for endometriosis.