How to Survive the Great Progesterone Crash of Perimenopause

perimenopause and stressIn your forties, you may find you don’t cope as well with stress. It happens because losing progesterone during perimenopause can destabilize the HPA (adrenal) axis or stress response system.

This recalibration of the nervous system is why perimenopause is associated with an increased risk of anxiety, depression, and insomnia.

 👉🏽 Tip: HPA axis dysregulation is the medical term for “adrenal fatigue.”

Progesterone is a “stress-buffering” hormone 

By converting to the beneficial neurosteroid allopregnanolone (ALLO), progesterone calms GABA receptors and stabilizes the HPA (adrenal) axis. It also promotes neurogenesis (new nerve growth) in the hippocampus which further supports a healthy HPA (adrenal) axis.

Progesterone drops in perimenopause

With perimenopause, progesterone drops before estrogen.

adapted from Prof Jerilynn Prior’s “Perimenopause lost—reframing the end of menstruation.”

In a fascinating new study called “Estradiol and progesterone as resilience markers,” researchers found that a lower level of progesterone in perimenopause is associated with lower life satisfaction, higher perceived stress, and an increased risk of depression and anxiety. The same was not true for lower estrogen.

How to support your nervous system during perimenopause

More rest and self-care. You’re in a vulnerable time but it won’t last forever. You have permission to slow down and look after yourself until you achieve menopause. One easy way to promote relaxation is to activate the vagus nerve and parasympathetic nervous system.

Magnesium is a powerful stress-reliever. It boosts GABA, blocks glutamate, reduces adrenaline, regulates cortisol, and promotes sleep. If you take one supplement during perimenopause, let it be magnesium. (See 8 ways magnesium rescues hormones.) Magnesium glycinate is the best type because the amino acid glycine has its own calming effects.

Taurine is an amino acid and neurotransmitter that calms the brain by boosting GABA and blocking glutamate and adrenaline. Taurine is depleted by estrogen, so women have a higher requirement for taurine than men. I commonly prescribe a combination of magnesium and taurine for my perimenopausal patients.

Reduce histamine and mast cell activation by avoiding cow’s dairy and alcohol and maybe taking an anti-histamine on bad mood days. Read The role of mast cells and histamine in PMS and PMDD.

Ashwagandha (also called Withania somnifera) is an “adaptogen” that reduces neuroinflammation in the hippocampus and stabilizes the HPA axis. It also reduces anxiety and promotes sleep (hence the Latin name somnifera or “sleep-inducing”).

Progesterone. Finally, oral micronized progesterone capsules are an effective treatment for many symptoms of perimenopause including anxiety and insomnia. See The guide to using progesterone for women’s health.

163 thoughts on “How to Survive the Great Progesterone Crash of Perimenopause”

  1. I would love to hear more about ashwaganda! I see that it can boost testosterone and thyroid function. Is it appropriate for people who have some signs of androgen excess? Or for someone with thyroid labs that are on the high end of normal? The benefits sound great but I worry I would be playing with fire.

  2. I’m 56yrs on estrodiol 50mg twice a week
    Had to stop prescribed progesterone from 100mg 21 days a month to 200mg 10 days every 12 weeks because I was absolutely wrecked with anxiety
    I had a terrible time with depression and anxiety before Hrt
    It had helped me greatly
    I’ve also done a huge amount of lifestyle alterations – exercise meditation beta wave training etc diet & no alcohol

  3. Hi Dr Laura! I have both of your books and they have been so helpful! Thanks you! However, I do have a question. I recently had to have a hysterectomy, however before the surgery I was on prometrium and since the surgery they told stop taking since I no longer have a uterus. I still have my ovaries though. I feel that prometrium would with sleeping, which has now gotten worse and my anxiety in the luteal phase has also gotten worse. What are your thoughts on taking prometrium after a hysterectomy

  4. Hi Lara,
    What kind of Antihistamine do you suggest for the bad PMS days as mentioned in your article? Could you please recommend? I have both books but reading them on my iphone has given me a migraine so cant check them.
    Thanks 🙂

  5. Hi Lara I have brought your book Hormone repair manual, which is so good really learnt a lot.
    The only issue is I brought this through my kindle and your resource section at the end about the brands of supplements in NZ and Au I can’t read because it’s small and blurry! can you please let me know the brands of magnesium that you recommend? Thank you

  6. What if you CANNOT take magnesium? Like magnesium is touted any and everywhere for everything BUT there are those of use who have adverse or paradoxical reactions to it. For example, in pregnancy when I was given it at the “typical” doses via IV to stop labor? I had 6 people racing to my IV pole because my contractions had not decreased but increased.. a lot. I now have myofascial pain syndrome from perimenopause (seems to be a hereditary thing.. both sides… hormone imbalances trigger autoimmune issues, particularly MPS.. polymyalgia rheumatica.. I was just formerly diagnosed limited CREST in year 5 of peri, never had any issues my entire life until age 46.. healthy as a horse). Anyway, if I want to ensure I do not move? Body totally cramps up? Give me magnesium. I’ve tried it all. Epsom salt baths, magnesium chloride lotions and creams. Malate, taurate, glycinate, oxide, citrate.. You name it I’ve taken it. Nope. And my blood serum is low end of normal but the needle never moves (like it’s been the exact same blood serum amount of 6 years.. 1.9). I’ve even made magahol. So what does one substitute for magnesium? Another brand, volume, dosage.. isn’t going to do it. Again, for example, when I had my pregnancy issue, I was on IV magnesium for a total of 16 days. My blood serum was close to 11 and I did another 3 days on it. Mild side effects (slightly blurred vision, overheated face) but nothing drastic AND.. it never did fully stop contractions and I had my daughter 3 months prematurely (I had placenta previa.. hemorragher).

    Also, what does one do if one doesn’t tolerate progesterone? I’ve managed an oil at VERY low dose (9mg) and even that leaves me feeling like I have a terrible flu. And can never take at night.. I won’t be able to function the next morning I’m so fatigued.

  7. Im perimenopausal (49.5 yo) and having periods still regularly between 29-35 days. Last 2 cycles i have spotting, following my 1-2 days period, that would last up to 10+ days (when im wiping after bowel movement/urinated). Would love to know what you think!

  8. Dr Lara, I am 51 and have been taking Tibolone for about 11 months, although I still have periods (some full, some very light) every few months. It has helped a lot with my perimenopause symptoms. However, throughout my life I’ve experienced depressive episodes, especially before and/or during and right after my periods, and these still occur sometimes. Since I started going through perimenopause, the episodes are more random, but I believe they are still connected to hormonal fluctuations because I tend to experience a return of mild hot flushes and insomnia around the same time, and they are sometimes followed or accompanied by bleeding.
    Incidentally, there are several brands of Tibolone available here (I live in Costa Rica), and I usually take the lowest-priced one (a generic called Tinox). When that was not available during these past few months, I switched to a different generic brand called Climabel, and one or two months I had to buy the full-priced Livial brand. Ironically, I felt my symptoms were worst on the higher-priced brands(!) though it may have been sheer coincidence and due to other factors.
    I talked to my doctor about other options for HRT and he said I might have better relief by taking estriadol and oral progesterone. I happened to read that oral progesterone can make depression worse. I’m hesitant to try it, and fear that I might be working with too many variables, with all the different forms of estrogen and progesterone available.
    One specific question would be, do you think progesterone cream is as effective as the oral? And do you think I would experience better relief by using HRT instead of Tibolone?
    I’ve also heard conflicting things about how exercise affects hormone levels. I exercise moderately about six days a week, alternating cardio and strength training. Do you have any thoughts on this?
    Thank you so much for your help!

    • In general, my top choice for hormone therapy is an estradiol patch (like Estradot) combined with Prometrium or Utrogestan (progesterone) capsule. Although some women experience mood side effects from progesterone, my experience is that most women experience mood BENEFITS. I take progesterone myself and love it for sleep and mood.

      Also, I’m not a fan of tibolone. I address it in my new book coming in March 2021.

  9. I am 51 years old and have a question regarding uterine polyps, heavy periods and progesterone. My dr has indicated that, due to an imbalance of estrogen and progesterone, the uterine lining is very thick which leads to polyps. I will have surgery to remove the polyp, during which she will insert a progesterone-treated IUD to prevent the growth of more polyps. In the meantime, I tried 100 mg Prometrium but stopped due to side effects (bleeding, racing heart, increased anxiety, headache, etc.) Given my reaction to the Prometrium, I am nervous about the progesterone- treated IUD. Is Wild Yam a better option for me? What are the benefits and downsides of using a Wild Yam
    cream or oil?

  10. Hi, please could you let me know how much taurine is a good starting point? Plus, hadn’t thought of how much magnesium to take, just taking one a day atm, but my peri symptoms have taken an upswing in the past fortnight! Thank you x

  11. Hi Lara.
    Please ,would you have some recommendations for Hormonal Migraines . I had a low part has been removed in 2012 but now ok without treatment.
    I am now in Perimenopause stage almost menopause. I suffer from debilitating big migraines once or twice a month since 15 years.(that obliges me to stay in the dark with no noise until I vomit and fall asleep).
    Would you recommend some progesterone?
    Is it ok with vitex and ashwagandha?
    Thanks for your answer.😊

  12. I’m taking calcium d-glucurate after several months of “flooding” and the result is that my flooding ended. I’m been taking one 500 mg capsule per day. Is it safe for me to stay on long term? Best to cycle it like I would progesterone (second half of my cycle?)

  13. I love your blog! I’ve started using Taurine and magnesium to help with a monthly end of period migraine and it really helps. Thank you! Thank you Dr. Briden.

    I’m curious, where can I get capsule progesterone? My GYN won’t go there…Do I need a script?

  14. Hi Lara

    Thank you for all the resources and super information. Is there any risk in taking such a high B6/Taurine dose of one is in perimenopause but still trying for a baby.



  15. I’m 34. I’ve been on hormonal birth control pills for 18 years with only 2 breaks to have children for about a year each. I take them continously to not have a bleed and have my hormones dip and elevate. I have such bad migraines due to hormone upa and downs that my doctor didn’t wait the 6 weeks post partum to put me back on them bc they were so bad I couldn’t take care of my baby. Literally any advice/tips help at this point. I’ve read your amazing book. Take all the supplements you suggest as well as butterbur. Can you help? I might be starting perimenopause bc I have an increase in migraines now as well as insomnia and hot flashes. Please guide me in the right direction.

  16. Love your articles! I’ve learned so much. Can you dedicate a list to clotting in your period (normal and not normal) and what could be the cause and how to manage?

  17. Dear Dr. Briden, I am in mid seventies. Do any of your patients who are my age use progesterone cream? For purposes of general health, I have been using Emerita ProGest twice a day from Day 8 through end of month for about three months now and I can’t tell any difference in the way I feel or look. Should I abandon this or what should I expect if I keep using it? One thing I was hoping for is for my hair to thicken a little. It has gotten very thin following a period of prolonged stress and I don’t see any improvement. My PCP is useless with any hormonal questions. Thank you for a reply and thank you for your emails.

  18. I’m using 75 mg of compounded progesterone cream two weeks out of the month to assist with my estrogen dominance and symptoms associated to it. Is it normal for the progesterone to cause major bloating? I feel really great while taking it and sleep very sound, but the bloat is quite awful.

  19. I just tried to post reply to Karen from June 3. In case that doesn’t post, try me on Instagram at HistamineHacker. I have answers that worked for me!

  20. I have a history of histamine intolerance. I have many resources and personal experience with this. You can contact me through Instagram @HistamineHacker. I haven’t been active there but if you want to send me a direct message or reply to something I will try to check it and respond. I have resolved my own histamine problems and do not consider myself to have PMDD. I resolved inflammation (which showed up as a swelling knee which immediately stopped swelling when I stopped eating grains and xanthan and guar gum and carageenan. But, I would also like to explain much more in detail so that you can see how I understand the histamine intolerance.) There is a worse version of histamine intolerance which is Mast Cell Activation Syndrome, but I do not have that. I believe that you have to rule out simple histamine intolerance FIRST with dietary and gut microbiome modifications. If you cannot get relief with the list of things that worked for me, then go to a specialist who understands the difference between gut-mediated histamine intolerance (that’s what I have and I just made up the term) and MCAS (which I don’t have and cannot advise on at all). Alison Vickery is a good resource but is possibly not good as a beginner guide.

  21. I’m 47 years old. What is the difference between micronized progesterone, and the bio identical progesterone mixed with coco butter from my compounding pharmacy?

    (My Dr said she doesn’t want me using the micronized version and wanted me to use the troque vaginally. Weirdly though it doesn’t seem to do anything vaginally so I resolve it under my tongue and the hot flashes have disappeared, mostly, once I added taurine, magnesium, and Vitex)

  22. Hi Lara, I’m 45 and have been covered in hives every day for 15 months now. Immunologist can’t find a cause. I’m currently on xolair plus am taking large doses of antihistamines. I’ve had some improvement in the past but have just had a bad relapse for the past two weeks. When I get a period it seems to ‘fire up’ and is bad for weeks. My gp recently put me on the pill so that I’m having a period less often as I also get terrible headaches during my period that last for 5plus days that are only relived by sumatriptan. Do you have any insights for me? Could this be perimenopause?

    • Hi Karen, I saw your post. Did you fix your hives? I had a similar thing and I fixed it by having a tsp of honey every three hours for a couple of days. It was so bad and I was having so many antihistamines and truly miserable. I was desperately looking for a solution when I found a reddit thread about someone else using honey. It worked it 24 hours…after suffering with the hives for about 6 months . I’m not sure why or how but I have recommended this to others and it worked

    • 38 here. Found out I’m really low progesterone via testing. I had all these symptoms along with pmdd. Mum went through menopause at 42 so I may very well be headed or in perimeno.

  23. My 17 year old daughter is having insomnia I believe a week or so before her period. She’s been through a lot of stress with my hysterectomy it has affected my whole family really but she is my concern. Nobody has any help. She also gets heart palpitations that bother her. She’s been using remag in her water and that helps the heart palps but no the sleep so much. I’m desperate for any advice

    • Hi, has she had her thyroid full profile done? I used to get insomnia and heart palpitations and since being diagnosed with thyroid disorder and in awhile thyroid medication no probs now…. maybe good to check?

  24. Aina, if you will look at this post, you may find the answer:

    “4 Things to Know About Menopausal Hormone Therapy” which is at this URL:

    She mentions Professor Prior. Prof Jerilynn Prior. So, if you want hunt around, you can do a site search on for “Prior’s” and see various places where Lara has linked to articles by Professor Prior.

    The one that I looked at today was from “4 Things to Know About Menopausal Hormone Therapy” and it linked to this, where she said, “A doctor can prescribe Prometrium without doing a hormone test. See Professor Prior’s paper: Progesterone for Symptomatic Perimenopause Treatment.” Lara Briden.

    This NCBI.NLM.NIH.GOV article has a list of 9 symptoms–if you have 3 of the 9, then you are in perimenopause. This seemed like a simple way to diagnose.

    By the way, the progesterone test that I know of, your doctor can order the lab. You want to be in the luteal phase where your progesterone is supposed to be high. And, the lab will show the “normal” range for luteal phase. Your doctor can interpret the results. But, it seems to me, as I am trying to keep up with Dr. Lara Briden here on her site, that it’s not just a lab number for progesterone that will tell you. It is multi-factor to say whether you are in perimenopause, or not.

    • Yes she says to do the progesterone test on day 21 when it’s at it’s highest. My progesterone increased to 44 (despite being 44) which is great – I increased it by eating the gentle carbs she talks about – google “Lara Briden Gentle Carbs”

      I THINK the other test is FSH /LH. (follicle stimulating hormone /Luteinizing Hormone – or something like that) . I’m not sleeping and waking up with heat sweats at night. I feel like I’m going mad

      Bought all the herbs above including the MagTaur concoction. I’m want to avoid the SSRI’s.

  25. Hello Lara!!! And thank you for all the info you share. As I am feeling most of the symptoms you describe in the post…. How can i know if I am in perimenopause?? Blood test?? What day of the month is better?? I have heard about the test of the third day .Thank you very much.

  26. You said… Progesterone also converts to a neurosteroid called allopregnanolone (ALLO), which acts like the soothing neurotransmitter GABA and is your “hormonal valium.”

    A capsule works better than a cream because oral progesterone converts to allopregnanolone (ALLO).

    But, I’m not sure I’m understanding PMDD, and whether for those of us with predictable dysphoria (on days when Estrogen drops after ovulation and again before bleeding), 1). Is allopregnanalone NOT soothing? 2) would we avoid oral progesterone so as to NOT get more allopregnanalone?

    Could you write more specifically to those of us on the PMDD spectrum? Could you interpret the medical literature in re: allopregnanalone, PMDD, gaba receptors?

    Thank you!


    • Perfect timing with your question because I’m about to write a new blog post on allopregnanolone and PMDD. Stay tuned!

  27. Hello Dr. Lara ,

    I am asking this question for a friend who is suffering a lot since a long time . She is 42 years old and have been experiencing symptoms of anxiety accompanied by increasing heart palpitations and burning hands since 2 years. The episode is often followed by increased blood pressure. She has been to several doctors , even a psychologist but nothing has helped . Recently , due to heavy menstruation , she was diagnosed with fibroids and underwent hysterectomy. Following the surgery , her anxiety has worsened keep her up many nights. She is supplementing with 0.3 mg Conjugated Estrogen and has been advised to supplement with vitamin D too . Her anxiety and high bp episodes are such a mystery. Do you have any ideas of the possible causes? And potential treatment ideas ? As you can imagine this is greatly impacting the quality of life and any suggestions will be welcome .
    Thank you for your time !


  28. Every time I try any kind of progesterone or progestin (I know they’re not the same) to help with the perimenopausal insomnia, I get even worse insomnia – I mean raging insane insomnia where I hardly sleep for days. The worst bout was with the natural micronized progesterone.capsules. It didn’t go away until I stopped them. Tried again later and same thing. If I take something that even enhances progesterone I get the same reaction (vitex for example). It’s very frustrating and weird that an insufficiency of something can cause you to sleep badly, but ingesting that same thing also causes you to sleep even worse. I don’t understand it. (Oh, and BP pills also made me crazy with insomnia, as did a progestin aimed at my endometriosis. Sigh.)

    • I recently had a patient who reacted with a similar paradoxical response to natural progesterone capsules. She felt over-stimulated.

      In her case, it turns out she had an underlying histamine problem that was worsened by progesterone. I suspect she also has a genetic variant of the progesterone receptor but we haven’t done that test yet. She took steps to reduce histamine and then found she could get a sedating effect from a small dose of progesterone (50 mg oral every third day).

      • Could this genetic variant also cause hyperemesis during the luteal stage and most of my pregnancies? The higher I get my natural progesterone, the worse I feel.

  29. So interesting! I’ve been taking magnesium and recently starting taking a product Happy Hormones as I try to regulate my cycles which have unusual. Does the drop in progesterone account for very long periods as well or mid cycle spotting? My current period has been going on 3 weeks 🙁

  30. Ashwagandha should not be taken by people with autoimmune diseases. Ashwagandha can increase the symptoms of autoimmune disorders because it stimulates the immune system.

  31. Dear Lara
    I appreciate your work, and i have your second edition book.
    Please advise regarding Magnesium Taurine, how much to take?
    Currently I am only taking Magnesium Glycinate 360 mg, i can’t find a clean natural source of Mag taurate, in USA. If i find a separate Taurine capsules, what is the dosage should be?
    Besides i have PMS / Perimenopause symptoms that i try to regulate with your help from the book, so far only headaches that i am suffering from.
    Thank you

  32. Hello, I’m 41 and I’m struggling a bit, because I’m now having a period every two weeks, sometimes 10 days and it’s very heavy the first 2/3days, I’m beyond tired (two small boys running round too) and a lot of stress with family doesn’t help but I’ve not got the best sleep, i went to the doctor with my symptoms and they tested my hormones and said they were normal but I don’t understand how this can be with a period every 10-14 days?! I have painful breasts even though they’re tiny I can’t run, I’m having a lot of headaches my memory feels horrendous and fuzzy it goes on but it’s hard to know where to turn for help or what to do or where to start, I don’t have lots of money to try lots of different things, it’s all a bit overwhelming, especially if you don’t know exactly what’s wrong but know it’s not quite right either if that makes sense?don’t mean to sound defeatist or depressing! But I worry about the menopause and what to do, as I really don’t want to do HRT as my mum had a really bad time on that, I can’t use my mums menopause as an indicator as she had an early hysterectomy due to a hemorrhage. Any starting direction would be a help thanks x

  33. Your post got my attention! I am almost 46 years old. Since a few years I am suffering from severe fatigue ( and other complaints) during ovulation (2 or 3 days) and about 5 days before my period starts. It got worse the last year.
    About 9 years ago I have been diagnosed with CFS/ME chronic fatigue syndrom. I felt a lot better since I started histamine-poor diet and once I stopped hormonal birth control pills. ( with AZO colouring = histamine trigger).

    Unfortunatly now I feel severy fatigued about 8 days out of 22/25days. I have read woman with CFS experience more fatigue in the luteleal phase of their cycle. I also have more histamine-related problems the week before menstruation. So the feamle hormonal cycle seems to affect both CFS and histamine-intolerance. I don’t exactly understand how…
    I take a combination of vitamin C, B6, magnesium, zinc picolinate, chelated copper ( adviced by dietician for HIT/ histamine intolerance). During luteal phase I use Starflower oil, and the John Lee ProgesterAll progesteron cream. I read it could help for PMS. I also take vitamine D.
    ALL OF THIS DOESN’T HELP anymore during ovulation and during the week before my period!
    * Can I use Ashawaganda with my condition of histamine-intolerance ( or histamine-trigger?)
    * Can you recommend progesterone capsules for me?
    *Is natural micromized progesterone the same as bioidentical progesterone?
    I would be happy with a good advice 🙂 Thank you for your time!

    Esther from the Netherlands

  34. Hi Lara:) I’ve been troubled for more than a year, feeling suddenly very tired, and just wanting to lie down. Not having the energi doing anything. With this comes a kind of fatigue / paine in the lower part of my back. This is not muscular, but something else. In addition, I sleep very badly and get up every hour to pee. My eyes are also bothered with dryness, and I’m often very thirsty at nights. I do not have diabetes because this has been thoroughly investigated with many different tests over a long period of time. My blood sugar is nice and stable. The last test was my fasting blood sugar of 4.8 mmol / L, and after drinking sugar and sitting for 120min, the blood sugar was 5.1 mmol / L. What can this be caused by? and what blood tests do you think I should take to investigate further? I have noticed that my prolactin level in blood tests is elevated, and low creatinine levels. I have also been bothered with slow stomach, low iron level, and periodically a little low vitamin D level (but not below the lowest limit. around 70 mmol / L). My thyroid and hormone tests has also been ok. But sometimes my THS levels have been low, (under lowest limit around 0,24), but this was when I was pregnant. My selenium and sink has also been a little low, but not under lowest limit. Could this be an indication of adrenal fatigue? When I took ACTH blood samples it showed 2.1 pmol / L. but the doctor said this was not valid because of the blood sample being taken at. 12 in the morning. Please help guide me somewhere, cause the doctors seems not to be doing anything good or give me any kind of help. I’ve been bothered with this for so long now, and I’m realy tired and frustrated. Thanks in advance! Btw I’m 30 years old.

  35. ps……I take 160 mgs magnesium three times a day I.. love it and at night I take Cal/mag 2×1 ratio…would this be too much magnesium?

  36. I am in my sixties was on Progesterone cream for quite long time….now my hair is falling out dramatically….is it too late to go back on Progesterone cream……I’m desperate……your advice would be greatly appreciated….thanks so much

  37. Hello, do you discuss premature ovarian failure or insufficiency in your book? I haven’t been able to find a reference to it on your blog. I’m 43. I’ve been reading your advice for a while trying to understand and manage what I thought were indications of perimenopause (irregular and absent periods, PMT, weight gain around the stomach, digestive disturbances, extreme energy dips and sugar cravings). I finally went to the doctor and had blood tests and scans after having a period that lasted for 6 weeks. She diagnosed premature ovarian failure (or Insufficiency), or premature menopause (no ovulation) and said I should go on HRT. She said this is recommended even when there are no symptoms or if symptoms have been managed through nutrition or natural remedies because of the risk of osteoporosis of having low estrogen when under 50. In a case like mine where the hormone levels indicate menopause but I’m only 43, do you think HRT is the right thing? Thank you very much for any light you can shed!

    • Hi Rachael, I briefly mention early menopause in my book, although technically, early menopause is younger than 40. The normal age of menopause is anywhere from 45-55.

      What is your FSH reading? You need at least two FSH readings over 40 IU/L to be seriously thinking it’s menopause.

      • Thank you very much for the reply. Yes, I do have two FSH readings that the doctor said were well into the menopause zone. I can ask her for the exact figures. I just wondered whether you see this situation as one that does need the intervention of HRT because of the osteoporosis risk, or if I should try other things first.

        • In short, Yes, I think HRT can be helpful. BUT, the best kind is a low-dose estradiol patch (like Estraderm) together with micronized progesterone (like Prometrium). They are both natural, bioidentical hormones which are safer and nicer to take.

          • This is in part in reference to the poster’s question. I’ve been doing a lot of thinking about bhrt lately, as my perimenopausal symptoms continue to bother me. However, I’ve been wondering if it isn’t possible simply to deal with the symptoms and just try to mitigate the risk of heart disease, osteoporosis, etc. with diet, supplements, and healthy living? I’m not judging the person who posted, or anyone else who decides bhrt is the way to go. I would love to take bhrt to help with my perimenopausal symptoms, but I can’t help but question if taking hormones is really necessary for a natural physical process. Also, I wonder how long I could reasonably financially afford such measures, but that’s another story. I understand this is just my case, only my personal opinions. I am curious what Dr.Briden has to say about this. I’m 45 and not so young that I’m concerned with early menopause.

          • Yes, that’s what I wondered too, particularly as I don’t really have menopause symptoms yet, more perimenopause. Also taking shatavari has helped me a lot re energy levels. But my doctor said that in fact having such low estrogen at my age is not a ‘natural’ state of affairs for the body, and can’t be remedied through diet…

          • I need to clarify my above statement by saying that I would only ever recommend estrogen after periods have stopped and there are clear symptoms of estrogen deficiency such as vaginal dryness and hot flushes. In that case, I think low-dose estradiol can be helpful for symptoms. (But always given in combination with natural progesterone)

            I do not recommend estrogen be taken during perimenopause. In fact, Professor Prior (who helped me with my book) strongly recommends against estrogen during perimenopause. She recommends progesterone if there are symptoms. Otherwise, she recommends lifestyle and nutrition. And I agree. So, in your case, you don’t need to worry about estrogen while you’re still having the occasional period. And in menopause, it’s probably worth having a bone density before you commit to using hormone replacement. Please have a read of Chapter 10 of my new book where I provide details for the different hormonal and non-hormonal treatments. I also discuss bone density.

          • Hi Med, you raise a good point about the cost of bhrt. And the short answer is that Yes, nutritional and lifestyle treatments are sufficient for the majority of women. Natural hormone replacement is the backup plan if symptoms are severe. I discuss both hormonal and non-hormonal treatment options in Chapter 10 of my new book.

        • With FSH readings like that, you probably won’t have many more periods. And yes, the natural estrogen + progesterone I mentioned earlier would relieve any symptoms you may start to develop (hot flashes or sleep disturbance). But even if you don’t have symptoms, the hormones could still be helpful for your bone health. But, it’s a conversation to have with your doctor.

          • Thank you for your reply, Dr. Briden. I found your responses to my comments, as well as Racheal’s, very helpful.

          • Just to update on this. Far from not having many more periods, I went back to having completely normal periods the month after this and have had normal periods for the last nine months. The PMT and energy issues have also gone. I put this restored hormone balance down to the shatavari, which I’m still taking. I’m not sure what else it could be. The digestive symptoms turned out to be lactose intolerance. I’m glad I ignored my doctor’s advice and didn’t go on any hormones…

  38. I’m not in my 40s;-) but just turned 30. I’m pregnant and have adrenal fatigue. After stopping all supplements because of the baby my health has gone south, and I’m back with all of my bad symptoms 🙁 What are safe supplements for my adrenal fatigue now that I’m pregnant?

    • First of all, it’s pretty normal to be fatigued early in pregnancy. Your energy should pick up after the 3rd month.
      Zinc and magnesium are safe to take during pregnancy, but please check with your doctor or dietitian.
      You might want to also check your iron and thyroid to see if they are contributing to your fatigue.

      • I’m in week 32 now. My last blood tests showed
        iron 12.0
        transferrin 3.0
        transferrin saturation 16
        ferritin 21
        hemoglobin 11.8
        folate 7
        tsh 0.24
        t4 12.7
        t3 3.9.
        do you have any comments on these blood tests? Is there something I should talk to my doctor about. He simply says that these results are normal. At the beginning of my pregnancy (the first 4 months), I had a overactive thyroid and was treated for this. These results I refer to here are after the treatment is ended. I’ve been to a specialist, and they say my thyroid and thyroid tests are fine now.

  39. Great article, Lara! Should a woman in perimenopause use progesterone cream throughout the entire month since progesterone levels are falling, or is it still important for her to take the follicular phase break?

    • I generally recommend a break in the follicular phase for 2 reasons. 1) to permit ovulation (if possible), and 2) to clear progesterone from the body and not super-saturate the receptors.

  40. What are the dosages of the magnesium, taurine, ashwagandha and progesterone? What is the first line treatment? What can be used together (other than magnesium and taurine, as outlined in the article)?
    Thank you very much!

  41. So fascinating to read this, I am pretty sure my progesterone level is reducing (brown mensus not red) and have some more reading to do, thanks so much!

  42. Hi Dr. Briden,
    I just started Progesterone Capsules (I am 47). I am having horrible vivid dreams/nightmares. I have researched and found other women with the same complaint. Do you have any recommendations to help with this problem? I think the only thing worse than not sleeping, is being scared to go to sleep!
    Thank you.

    • Hi Suzanne, thanks for sharing your story. Actually, I had not encountered the nightmare side effect before but it makes sense because progesterone has a strong effect on the sleep centers in the brain. My first thought is that you could try a lower dose (50 or 100 mg). Or try changing to a cream, which has a nice calming effect, but does not promote/alter sleep like oral progesterone.

  43. Hello, my research on insulin resistance brought me here and I find your information about menopause very interesting. I’m 47 and past perimenopause for about 5 years and am just menopausal. Do you still recommend the same supplements for a woman in my situation as for a a perimenopausal woman?

  44. Hi Lara,

    I actually just left a comment on your “What Estrogen Does in Your 40s (and How Progesterone Can Help)” post. I’ve been taking 100 mg. of DIM for over a year with great results (less emotional overall, acne cleared, breast tenderness greatly reduced) and I also take Dr.’s Choice Magnesium almost daily. I recently started taking Bacopa to help me sleep and it seems to be working. If low progesterone (along with high estrogen) creates many problems in a woman’s 40’s, why isn’t it that you’re not recommending Vitex as a natural way to to increase it? Just curious? I do have stress and can always decrease it but my main concern right now is not being able to lose weight at the same level that I used to. Last year around the same time, I was able to lose about 10 lbs. without even trying and I attributed that to the DIM but I was also taking calcium d-glucarate and Vitex (the later of which I only took when I was bleeding heavily to stop it). I’m also wondering if I should switch out the DIM for Calcium d-glucarate? As mentioned in my other comment, I went from having long, heavy periods to not having any period hardly at all anymore. I’m definitely going to add B6 to my list of supplements. per your advice but would appreciate your feedback on my current regimen as well as adding back the Vitex to The weight gain is creating stress on it’s own! Thanks in advance!

    • I also wanted to add that I don’t think I have insulin resistance. I have not had any blood work but my waist measurement is 31 and my hip is 42. I’m definitely a pear and not an apple!

    • I’m just responding so I get follow up comments/ the response.

      Also when’s the best time of the cycle to take DIM and calcium d-glucarate … is it the follicular or luteal phase or continuously?

      • Hi Jestagurl,

        I don’t you have to cycle the DIM and calcium d-glucarate. I took both of them daily for a while and then dropped the calcium d-glucarate and took only the DIM. I just added progesterone cream and now I feel like total crap; no energy, bloated, slight headache, and I can’t stay asleep. I read that symptoms may be get worse before they get better but I also may not need the cream. Since my only real problem was losing weight, I think I’m going to stop using it.

        • Hi Traci, Lara recommends the progesterone capsules (over the cream) because of new research (something to do with the liver conversion). I also read somewhere on this blog that progesterone cream doesn’t contain enough progesterone compared to the micronized progesterone pills. Maybe you dont have to throw out the idea completely but just change the mode??

          I did a hair mineral analysis and apparently my phase II detoxification is slow so calcium d-glucarate is something very important for me. I will take the DIM and CDG around my entire cycle until I hear back from someone, anyone? Bueller?

  45. Hi Lara
    Im nearly 44, pretty sure ive been peri for a few years now. Have had thyroid and hormones tested but doc says all fine? Have developed pmdd and am wondering if there is something natural that would help to stabalise the rollercoaster. My cycle has shortened dramamtically and become erratic can be 14-18 days or 28-30 can go for 2 days or 14…its a lottery! Its extremely light now though, like a tap being turned off. I have been taking 1000mg magnesium for about 6months now for sleep. I take echinacea for chronic sinus. i take coq10, and iron injections for energy. And also b12. Any suggestions?

    • I bought your book after my comment and my question has been answered. I highly recommend the book to anyone here who has a big question!

  46. Hi Dr. Briden….I’ve been told I have high insulin, hair falling out so much also have very low iron count of 32…been taking liquid iron for months then went to gentle iron bysiniglate…last lab work Ferritin was 30….endo. Dr said I have male hormones with hair growing on legs….he said thyroid was ok…but I have nodules on thyroid…I’m in my 60’s and was on Bioidentical Progesterone cream for quite a long time….hair was good then. Stopped it couple of years now hair loss gotten so bad I don’t want to go out….should I start Progesterone again?…I’ve spent so much on Viviscal for 8 mths and now Nutrafol for 4 mths…I’m at a loss, very depressed…I try to eat healthy and gluten free as much as possible…and saw you mentioned gluten free for low Iron…any advice you can give me would be greatly appreciated…..I’m in Dire Straits….so sorry this is so long its more than a comment….Please if you can help me….p.s……I also take Magnesium and I love it….you are an absolute darling with a world of knowledge…..thanks again….Sandra

  47. Dear Lara,

    My Tom’s of Maine Wicked Fresh toothpaste has Licorice extract in it. I have been using it for years. Do you think there is enough licorice in it to cause any problems? Do small amounts daily still cause harm?

  48. Hi Lara! Why is it you only recommend 20mg of Progesterone? Do you have any information supporting this dose I can show my doctor? Also, doesn’t Promrtrium come in standard doses much higher than this? How does one get only 20mg? Thank you for your help!

    • Actually, I like the 100 mg Prometrium capsules. Progesterone needs to be taken at a higher dose when it’s taken orally. I will include this updated dose information in the next edition of my book.

      • Lara why are you not recommending Dr Ray Peat’s progesterone formula called progeste-e? it is easy to use, 100% asborbable, comes in pure vitamin E, which is how progesterone is best absorbed. It is safer and more reliable than ingesting oral capsules. It Works! Have you not studied Dr Peat’s work? Dr John Lee author of” What your doctor may not tell you about perimenopause”, acknowledged Dr Peat for enlightening him about progesterone for women, at a time when estrogen replacement was the thing. Dr Peat’s PhD thesis was in foundational hormones. I have used progesterone for almost 10 years and oral progesterone is the least reliable as it depends on liver conversion. Dr Peat explains it well in many of his interviews and some of them can be heard on the Herb doctors or just google Ray Peat progesterone. In Wellness!

  49. Doctor Briden can you help me understand something? I am taking a “human strain” probiotic with “live bacteria”…since they are from humans and also live, could probiotics pass diseases such as HIV/AIDS? Thank you so much!

    • My understanding it that “human strain” probiotics are still purified and then grown in a lab under controlled conditions.

      • Do you know what the purification method is? I contacted a few companies who would not answer. I asked my pharmacist and he said his understanding was that they are heated. To which I replied “but they are supposed to be live, not heated” and he could not answer. I will continue searching for the answer. Thank you so much Doctor Briden?

  50. Hello Dr. Lara,

    What are your thoughts on the link between mood/stress and poor gut health? Is it the chicken or the egg? Is the stress response perpetually harming the gut, or is the bad gut to blame for mood instability? I’ve been reading the digestion chapter in your book which is consistent with things I’ve been doing for years.

    I’m considering trying “adaptogens” to minimize the negative effects the chronic stress response has on the gut while trying to heal it (for a long time now) but I read your post that chasteberry for example, should not to be used casually.

    I have always, even as a kid, had low iron, poor sleep, chronically tired (whether iron is normal or low), suffer migraines, irritability, anxiety, and what I refer to as “reverse PMS” in that I’m a PMS-y, miserable, irritable &!#@% about 23 days of the month, but for the few days leading up to my period, I’m all happy and chatty and friendly and affectionate instead of wanting to kill people. ha ha!

    As a teen, I couldn’t figure out why the other girls used to hate their periods so much because, although mine were ridiculously heavy, I always felt unusually happy during it! And when I was younger I noticed I had what I called “post-menstrual syndrome” where it was the days following my period that made me want to murder my partner and bury him in a shallow grave in the backyard. (kidding) (not kidding) 😉 I never really liked sweets or chocolate until I started having cravings a few years ago (speaking of needing magnesium in our 40s)

    No MD or ND has ever had any idea why so I’ve tried to manage symptoms on my own, mostly with lots of magnesium, and very high doses of Omegas, as well as taking vitamins C, D, B complex, and iron on top of my high quality multi. I stopped eating wheat and dairy about 12 years ago (30 yrs ago allergy specialist said I was allergic to peanuts and wheat, which I ignored for 18 years since I had no digestive symptoms) and have tried many other things over the years. And sadly, I can’t say that I have ever noticed any change in anything except labs say my ferritin levels improve while I’m taking iron.

    6 months ago I had an endo and colonoscopy to make sure I didn’t have Celiac. The surgeon informed me I didn’t have Celiac, but I do have a lot of inflammation in my gut. He insists food can’t cause inflammation in my gut, only things like smoking and drinking which I don’t do, and that the only food that can damage your gut is gluten but ONLY if you are Celiac, which he says I’m not, judging by scope. (How enlightened) And he just shrugged when I asked why the inflammation then! So I gave up on all my supplements because with the high doses of EPA and DHA not even helping with inflammation, and if I don’t feel any different, what’s the point?

    I always took magnesium because it is supposed to help almost all of my symptoms but I’ve never found any change except that when I STOPPED all supplements, I noticed after a couple of months I no longer craved sugar and chocolate! Like everything else, that’s the OPPOSITE to what should happen!

    I thought maybe adaptogens can help the moods, which can minimize the perpetual attack on the gut while I’m trying to heal it. What do you think of a top down approach (adaptogens), if a bottom up approach hasn’t yielded any results in so many years?

  51. Dear Lara, I would really like to try Curcumin for my PCOS. I see you like the Meriva. I read there is DNA damage after 12g. At the absorption rate of Meriva, isn’t this exceeded?

  52. Dear Lara,

    Is there a rule of thumb to follow in regards to how many “Stimulating” herbs one can take at a time? I found a lot of herbs that suite my needs like Rhodiola, Eleuthero, American Ginseng, Astragalus, Dandelion, but all of these say they are stimulating. I am not sure how many stimulating things is safe to take. Can you offer some wisdom? Thank you so much!

  53. I am new here so I am sorry if you have already touched on this topic – what is your stance on Maca as a supplement to regulate hormones? I have taken BC pills in the past for 4 years (tri cyclen lo, yaz and alesse) and it essentially wreaked havoc on my body and I am now dealing with adult acne and hair loss, I am 26. I was told I should take Spiro but that pill makes me feel like I am going to die (100mg dosage was prescribed). I started to take maca when I researched about natural hormone balancing supplements and I saw that a lot of women use it to increase fertility. Do you have any insight on this root?
    Thanks! 🙂

  54. Hello Lara…is Diatomaceous Earth and Bentonite Clay safe to ingest to rid the body of parasites? Does it work? Thanks

  55. Hi Lara,
    My mother went through menopause at 42, I am 42 now. I’ve never been on the pill and successfully used the ovulation sticks as a contraception and to fall pregnant.
    My periods have always been like clockwork but last month I was a week late and I happened to test my progesterone on day 21 as I have been feeling off. It came back 1.3 doc said menopause on its way. I tested on day 3 of my cycle all the other hormones and they have come back fine for this month. I have been unable to come back with a positive ovulation for the last 4 months but still been regular. Last month before I my period I was waking up sweating. No other symptoms but stages of bouts of anger and crying over the past couple of months. Usually a calm person, thyroid and all others ok. Is this the very beginning of peri maybe? Anyway to delay it. Not ready to give up my regularity…and because I’ve never been on the pill (so happy with that) I feel like I wouldn’t know who I am. Feel like my personality is driven by my cycle. Thoughts? Thank you

    • Hi Kate, if your period was a week late, then the progesterone test is probably not accurate. Did you see my post The Right Way to Test Progesterone?

      But if you’re not picking up ovulation with the test sticks, then yes, it’s possible you’re not ovulating every cycle. At 42, I would say the first thing to do is to test your thyroid if that hasn’t been done already. Under-active thyroid can impair ovulation.

  56. Thanks Lara for your helpful information. I’ve just turned 47; 4 months ago I got a Mirena after the inconvenience of several years of unmanageably heavy periods. It has been a wonderful success for me: now I deal with a trickle rather than a flood, happy days. I have noticed my pre-menstrual “low” can be extraordinarily low recently…. but I recognise it when I’m in it, and I warn my husband when I’m in that place, and he knows to leave me alone.

    Does the Mirena modify or negate my loss of progesterone… I’ve not noticed anything different in regards to any changes (yet) in handling stress.

  57. Hello Lara,

    As Vitex makes ovulation more, would you say that it is not a good supplement when you have Endometriosis, because to help Endometriosis it is better to have no ovulation so as to suppress the growth and the pain of the monthly period inflammation.

    I was thinking of taking Vitex as I heard that it helps Endometriosis, but if it causes more ovulation than I would think it would make Endometriosis worse as mentioned above?

    I would really appreciate so much for any comments you may have on this please, thank you

    • Yes, because it stimulates ovarian activity, Vitex can aggravate endometriosis.

      And Yes, the conventional approach to endometriosis is to suppress ovulation. I don’t like that approach because women then lose out on the many benefits of ovulation. A better approach is to reduce the inflammation that causes endometriosis, and then be able to tolerate ovulation and the natural estrogen fluctuation of a healthy cycle.

  58. Hi Dr Lara,
    Can being on the bcp and therefore not producing my own progesterone also impact my ability to cope with stress?I’m 38 and on the bcp for 16 years, is it too late to quit?

    • Yes absolutely. The progesterone deficiency caused by hormonal birth control can impact the ability to cope with stress.
      It would say it’s never too late to quit.

  59. Hi Lara
    You have prescribed the progesterone cream for me in the past. Should I switch to capsules? ( I order it from iherb).
    Many thanks

  60. I started crying while reading this post. I live with mood (and other ) issues immediately prior to and during menstruation, which I’ve been managing with a protocol based on your book, Period Repair. Magnesium, Turmeric, B6, B12, and Zinc appear to have helped with duration of both mental and physical symptoms. I also do my best to avoid all cow dairy. My flow is lighter and shorter, my cramps are less severe, as are my GI symptoms. But I still have rough emotional days and severe cramps at least one day where I have to take 800mgs of NSAIDS every four hours. BUT, I experience lovely days in the second half of my cycle, where I feel calm yet productive, focused but not stressed, which I have come to understand as progesterone. I don’t want it to go away. I so look forward to these lovely days. Anyway, this is just my gut reaction. I’m 36, I guess I have a few more years. And I’ll save this article unitl that time.

  61. is neuroinflammation different from the inflammation we have in endo? or does neuroinflammation mean pertaining to the nervous system only? or would Ashwagandha also be good for endo. Thank you

    • Neuroinflammation can be triggered by things like infection, autoimmunity, and toxins. It’s also driven by too much cortisol and glutamate (an excitatory neurotransmitter).

      So no, it’s different than the inflammation of endometriosis. I don’t use Ashwagandha for endometriosis. I usually choose turmeric and/or berberine. Please see my endometriosis post.

  62. Hi Lara, I’m 37 but since the birth of my second child at 32 my periods became extremely short, 2 days, followed by 2 days of no period and then followed by another 7 days of random spotting. Lately I also started to balloon up immediately after my ovulation. (Tracking app) I started Progest E, natural progesterone, only 20 mg per day vaginally taking it from ovulation to 1st day of my period. It seems to help with the water retention, but I’m hoping it will regulate my cycle as well. I have your book but didn’t find anything reverent to my case in there. Is there anything else I could do? Many thanks!!

  63. I have PCOS low progesterone but any time I take progesterone I swallow like balloon my breast and tummy too much water gain . Also can INOSITOLcause hair lose?

  64. Thanks Lara so much for all your helpful information. I am 46 and take a number of things for perimenopause including DIM, Remifemin, iodine, b vitamins and iron. I also use magnesium cream and Epsom salt baths and exercise quite a lot. These things are all helpful. I would like to try both progesterone and oral magnesium. I had trouble when I tried magnesium glycinate as it made me ‘wired’ and unable to sleep, even when taken in the morning. Magnesium amino acid chelate made me dehydrated. What magnesium type would you suggest given these side effects? When I tried progesterone cream, I found it made me get up to go to the toilet a few times a night. My main concern with perimenopause is sleep, though generally I am doing better on this front than in the past (I have been in perimenopause for 5 years), so if any remedy upsets my sleep I stop using it right away. My periods are heavier than before, but so far not too much of a problem. Thank you again.

    • Do you mean you were up at night to pee? Progesterone is a diuretic so can trigger fluid release in the first few days of use.

      In general. for sleep, progesterone capsule works better than cream.

      Magnesium cream is a reasonable choice but you have to apply quite a lot (at least a tablespoon per day) to come close to the 300 mg therapeutic dose. Does your cream say how much magnesium per volume of cream?

      • I now remember that the progesterone cream gave me a racing heartbeat also. Is this common? I only used about half the recommended dose.

        The magnesium cream is 1g elemental mag per 30ml.

  65. Perimenopause has been extremely hard for me. I haven’t had any hot flashes yet, but my migraines have worsened, I have gained weight for the first time in my life, and my anxiety is through the roof! I’ve also developed seasonal allergies, despite living in a desert, and have been dealing with hair loss. On the bright side, I have started exercising again and clearly see the need for healthy boundary setting. Dr. Briden’s book and website have helped. I have seen a difference in my energy levels when taking B6 (p5p) and zinc. I wish that I could say that magnesium has helped my migraines, but this has not been so in my case.I’ve had them for 20 years, so I don’t expect miracles.

    Thank you, Dr. Briden, for this post. I am going to share it with a family member, as it explains very well why stress seems so physically and emotionally more overwhelming than ever.

    • Thanks so much for sharing your story. This post is my message to 40-something women everywhere that they are not going crazy, and that everything is going to be okay.

      If you can find the right doctor to help you, you might want to think about progesterone for your migraines.

  66. Love your posts Lara! I am a fan of magnesium too. Any concern of taking it regularly without balancing with other minerals?

    • I usually give it in a formula with taurine, vitamin B6 and other factors, but no other minerals. In some situations, I might also give calcium, but rarely.

    • I give the Australian product Orthoplex Mag Taur, which has 300 mg magnesium and 3000 mg taurine (and a few other co-factors)

        • I have another script for more of them so I can send one to you if you can organize the courier.

          Tastes great compared to the other magnesium powders I’ve tried and the taurine has helped with my severe anxiety (just don’t take it during the day or you’ll sleep at work).

          If I can help email me at 1689squared (at)

          • Hi Mandy
            you mentioned above regarding Magnesium Taurine that i can get in usa?
            can you be more specific please ? i tried emailing you but seems your email doesn’t work?

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