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 helps the brain cope with stress 

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, further supporting a healthy HPA (adrenal) axis.

Progesterone is good for the brain.

Progesterone drops in perimenopause

With perimenopause, progesterone drops before estrogen.

estrogen and progesterone across the lifespan
Adapted from Prof Jerilynn Prior’s “Perimenopause lost—reframing the end of menstruation.”

In a fascinating study called “Estradiol and progesterone as resilience markers,” researchers found that lower progesterone during perimenopause is associated with lower life satisfaction, higher perceived stress, and increased risk of depression and anxiety. The same is 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. Estrogen depletes Taurine, 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 perhaps 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 night sweats and insomnia. See The guide to using progesterone for women’s health.

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