What Estrogen Does in Your 40s (and How Progesterone Can Help)

Estrogen rollercoaster of perimenopause Hot flashes, sleep problems, mood swings, and crazy heavy periods. Is this menopause already? And you’re only 42? No, menopause may still be a decade away. This is perimenopause, which is the two to ten years of hormonal change before periods stop.

Perimenopause can be a tricky time and causes more symptoms than menopause itself. Conventional medicine has surprisingly little to offer. Your doctor will say you’re too young for hormone replacement, so she will likely prescribe the pill or an antidepressant, or tell you just to ride it out.

“There has to be a better way!” you say. And fortunately, there is. It all starts with understanding what estrogen is really up to.

Estrogen goes on a roller coaster ride

Contrary to current medical belief, your estrogen is probably not on a slow, gradual decline in your forties. In fact, it would be a lot nicer if it was (see “Low-estrogen type of perimenopause” below). Instead, it’s fluctuating wildly. It’s soaring to levels that are almost twice what you had you were younger—only to crash down again to almost nothing. (And then to do it all over again the very next month.) I call this the estrogen roller coaster of perimenopause, and it’s very unpleasant.

High estrogen causes breast pain, heavy periods, fluid retention, and irritable mood. Crashes to low estrogen cause depression, hot flashes, and night sweats. (Hot flashes are not caused by low estrogen per se, but rather by a rapid rate of decline from high to low.)

Low estrogen type of perimenopause

The estrogen roller coaster is the most common type of perimenopause, but another type is a slow and steady decline in estrogen. With low-estrogen perimenopause, there are no heavy periods or intense PMS. Instead, periods become lighter and lighter and fade away. Low-estrogen perimenopause can cause mild sleep disturbance, but generally, it’s a much easier road. For treatment ideas, read How to increase estrogen.

Progesterone becomes seriously deficient

Your estrogen is crashing up and down, so some progesterone would be nice. Why? Because progesterone counterbalances estrogen. For example, progesterone calms your nervous system, while estrogen stimulates it. Progesterone boosts your thyroid, while estrogen suppresses it. Progesterone thins your uterine lining, while estrogen thickens it. And finally, progesterone prevents breast cancer, while estrogen promotes it.

And just when you need progesterone more than ever, it is quietly exiting the scene. As I say in my book Period Repair Manual, progesterone is like a beloved friend who never stays long. Progesterone was hard enough to make in your twenties and thirties. As you move into your forties, you will ovulate less frequently, and therefore make less and less progesterone. See Road map to progesterone.

👉 Tip: Magnesium plus the amino acid taurine is incredibly soothing for flashes, sleep disturbance, and other symptoms of perimenopause.

Natural treatment of perimenopause

Two key strategies:

  1. Prevent estrogen from spiking too high by supporting its healthy detoxification. That means reducing alcohol and maintaining healthy intestinal bacteria. You can also consider supplementing iodine (see my iodine post), and calcium-d-glucarate, which promotes estrogen clearance. For more information and treatment ideas, read How to lower estrogen.
  2. Consider taking natural progesterone, which is almost the perfect treatment for perimenopause because it relieves symptoms of both estrogen excess and estrogen deficiency. It also stabilizes the HPA (adrenal) axis and supports thyroid function, which further benefits mood and wellness. Natural progesterone is available as a capsule (Prometrium) or a topical cream, and it’s safe as long as you stay around a dose of 20 mg in a cream, or 50-100 mg in a capsule. Natural progesterone does not promote breast cancer, and according to new research, it may even be effective for treating breast cancer.

Natural progesterone is also called body-identical progesterone or micronized progesterone, which is the term your doctor prefers. Don’t use the word “natural” when speaking with your doctor.

Natural progesterone is completely different from the progestins of birth control and conventional HRT. Read The crucial difference between progesterone and progestins.

Finally, progesterone lightens periods. For treatment for the heavy, flooding periods of perimenopause, please see my heavy period post.

The good news

If you work now to reduce estrogen spikes, then your estrogen receptors can more easily adapt to the permanent decline in estrogen that’s coming in your fifties. In other words, if you treat perimenopause now, you’ll have an easier menopause transition later.

Ask me in the comments.

Dr Lara Briden

243 thoughts on “What Estrogen Does in Your 40s (and How Progesterone Can Help)”

  1. Dr. Briden, I found your book very insightful, but need some help. I am 49 and my cycles have shortened to 21 days, with a few longer at 32 days. I have incredibly sore breasts for most of the moth and my flow is very heavy. Over the last year I have have developed lower abd pain (pain to the touch) during my flow. OB says it may be new onset endometriosis. My pelvic ultrasound showed thick lining, but my ovaries looked fine. As all symptoms point to high estrogen, I started taking a estrogen reducing supplement (dim and calcium glucarate) and progesterone cream. The first month, was great – I felt amazingly better (especially the breast pain) and my cycle was 26 days. The next cycle was back to 20 days and since then my breasts have been hard and sore and my pelvis feels heavy (going on 3 weeks). Any thoughts on why my symptoms improved one month on supplements but then returned with a vengeance the next? Am I missing something? I already take magnesium, iodine, zinc, evening primrose oil, and vitamin e, d, and c.

    It’s so hard to get doctors to pay attention to menopausal/hormone problems. Most just brush you off, explaining that this is what happens during menopausal transition. I even see a breast surgeon for my cysts and have a family history of breast (and other) cancers – even she did not seem remotely interested in helping me.

    Hoping you can help!

    Reply
    • Perimenopausal symptoms can vary greatly month to month so it might just be that, rather than the situation where the treatment worked and then stopped working. Did any other factors change? Such as diet? A dairy-free diet is one of my favourite prescriptions for this sort of thing. Also, how much iodine are you taking? Look at the information on the Violet site.

      Reply
  2. I have suffered severe pms symptoms for a few years and intense nausea around ovulation for the last 10 months. I am now the last 2 months getting a really bad anxious stomach feeling that I can’t shake after my period for about a week. So all month there is something. I am 46. Would prometrium help?
    I am taking magnesium taurine Quercetin and bromelin plus b vitamins. Really struggling at the minute

    Reply
  3. Hello, I am 46 years old and have been diagnosed with Hashimoto’s disease but at the moment the endocrinologist says I do not need to go on a pill. My periods are normal in frequency (every 28 days and very rarely have a minor delay of 1-2days) and it has always been like that at least in the past 15 years that I have s clear memory of. The thing that puzzles me though is that over the past 6 years I have noticed a gradual decrease in the flow that in the last few months has deteriorated. Does it mean that menopause is approaching or could it be a sign that something more should be don e about my thyroid and how can I find out about it? Is there an extra test I should ask my doctor to do? Here I should note that my thyroid hormones appear to be normal so far and have only had high antibodies in the past but the ultrasound shows the thyroid tho be uneven and swollen in certain points.
    Also, in the last gyn check up that I have had in May my doctor said that I still have ovulation but endometrial was slightly thinner than what it was in the past.
    Thank you in advance.

    Reply
  4. I have been suffering terrible pmdd for a while now. I’m 46. I tried a natural progesterone called progest e and it made me so nauseous I had to start ametryptaline to cope with the intense nausea I was getting. I have tried SAMe which made me feel very strange in my head. I’ve tried 5htp and DAO and stopped the 5htp last week as after my period came I have had the worst anxiety in my stomach for a week for no real reason. Now I’m thinking maybe I didn’t ovulate and so no progesterone?
    Would the micronised progesterone make me nauseous as I couldn’t cope with that again?
    Starting to feel like nothing is going to take this away.

    Reply
  5. Dr Briden
    If i can’t obtain Promentrium through a doctor, I saw availability online to buy without prescription
    should i trust that?
    thank you

    Reply
  6. Thank you Dr Briden for replying regarding my question about testing progesterone
    I use progesterone cream for now instead of prometrium, because i don’t have a gynecologist or another doctor who i can trust with giving me prescription for prometrium, they won’t give it to me, they push their own things.
    Unfortunately there is a lot of stuff that a patient in USA needs to go through to get what will benefit them and not what doctor learned in medical school and doesn’t work

    I appreciate your work and your wonderful book!

    Reply
  7. Thank you for all the great work you do Lara! I’d be interested to learn more about androgen decline in women who are in their forties. Could you please do a post re drivers for low testosterone in women and best ways to support.

    Reply
  8. Dear dr.Briden
    please advice, i have been asking questions but didn’t get a response from you 🙂
    I am so grateful to you and your work and the book!
    It’s my savior! i recommend to all my female friends !
    My period cycle became longer 32-33 days, i am in my late forties (46) and feel like i have entered perimenopause. I want to check my progesterone and other hormones so i can make a decision regarding Prometrium!
    I don’t have heavy bleeding but i have other symptoms such as depression, fatigue and insomnia, and i already take suggested by you in the book, minerals and supplements!

    I am not sure with my long cycle when shall i check my progesterone and other hormones via blood test!?

    Thank you

    Reply
    • In truth, you probably don’t need to test progesterone in that situation. Prometrium can be helpful for the symptoms of perimenopause, regardless of blood levels.

      Reply
  9. If i have low estrogen and very light periods should I avoid utrogestan capsules? I’m 43. When I use utrogestan caps I get a migraine, cystic acne which I don’t like, but it makes me very sleepy which I like. Only on 100mg utrogestan caps.

    Reply
  10. Hi Dr. Briden
    i am 45 yrs old, suspecting that i have entered perimenopause. My periods were 21-22-28 days. Now it’s more like 30-32 days, with moodiest crying time ever. I have your book and take all recommended supplements based on my symptoms.
    What is the cause of my period being delayed…? I don’t go to the doctor because they won’t take my blood test the right way, since hormones fluctuate, and it’s challenging to guess, and medical insurance only covers blood tests once a month

    Reply
    • prescription progesterone such as Prometrium or Utrogestan IS natural progesterone. It’s usually one of the easiest ways to obtain a natural progesterone capsule.

      Reply
  11. Hi Lara, I get migraines that tend to be worse a few days before my period. I’ve read blogs about the links between migraines and periods as well as about perimenopause as I am 42. I then printed everything out and went to my doctors. She did blood tests to check my hormone levels at the start of my period. Everything was ‘normal’ but she thought my Estrogen levels were significantly low (168) and that could be a cause of my migraines. I thought I would get some progesterone but she has suggested Estrogen patches for three days prior to my period. My question is would you recommend doing this or would progesterone beca better option.
    Thanks
    Rachel

    Reply
  12. I am 49 and had a partial hysterectomy at age 40 due to adenomyosis. I kept my ovaries (they had been “tied” in 2008). Symptoms have led me to believe I have been in perimenopause for at least a year already. Recently, my right ovary in particular has been making functional little cysts multiple follicles as though it’s hanging on dear life! It has caused heart palpitations, skin peeling anxiety, insomnia and mood changes (I slept 3 nights out of 30 in September and was crawling the walls). My gynecologist prescribed bioidentical progesterone cream, 50mg at night for sleep and anxiety and to calm the ovaries down. I am to apply it daily as there is no way to know where I am in a cycle except via bloating and tender breasts. It has helped me sleep and when I wake in the night, I’m not stricken with palpitations and anxiety so I am happy…but is it okay to use it daily? For how long? I use less than prescribed (it’s supposed to be one gram of the cream, I use about 2/3 of that) because I’m so confused about everything I read. No one talks about those of us with crazy estrogen levels and no uterus trying desperately to manage our symptoms…

    Reply
  13. I have been on eastrodil 5mg for the past 10 years after having a hysterectomy at the age of 40 I recently am finding it hard to sleep and feel anixious and feel like im swelling up is there somethink I can take to help with these symptoms I would love to here your suggestions

    Reply
  14. I am 42 and my periods are irregular. My Dr prescribed progesterone to take from ovulation to the day my period starts. But how can I know when to take it if I am irregular? Therefore, I have not been able to start taking it. Any suggestions?

    Reply
  15. Hi! I am 42 and was experiencing heavy periods. My Dr prescribed progesterone but directed me to take it 7-10 before my period rather than every day. It does not seem to be making a difference. Wondering why he wouldn’t prescribe it daily????

    Reply
  16. Dr. Briden,

    I have very heavy periods from fibroids. I have tried both natural progesterone cream and 200 mg of prometrium before and both made me quickly gain weight, feel very very bloated and dizzy. I simply felt worse on it and I already felt so miserable! I was wondering if this was due to my untreated adrenal fatigue issues? I have read that if the adrenals are not first treated, then adding any hormone can make you feel worse because the exhausted adrenals are not “up to the task” of the added hormone? What are your thoughts? I also suspect I have some gut issues. I am trying to figure out what to treat first and how to avoid feeling worse.

    Thank you!

    Reply
  17. Hi Dr Briden, I have your book & was hoping to clarify something. I’m 43 & been told by my gynae that I’m in ‘very early stages of peri-menopause’. My cycles are irregular now – they can be 26 days one month (with ovulation early in cycle – day 7/8/9) or very long at 60-70 days (with ovulation late in cycle). Luteal phase is always 14 days. I’m guessing from reading your book & posts that my estrodial is crashing up and down. When it’s high it ‘feels’ very high (loads of fertile mucus, no hot flashes, no dryness and loads of energy) then when it’s low, (in the follicular phase only in the cycles which are very long), i get hot flashes, disturbed sleep, irritability & dryness. I have 2 children conceived in my 30s and am trying to conceive again without success which is very upsetting. Would Bio-identical progesterone cream help me to balance my hormones out? And potentially help me to conceive?

    Reply
  18. Hello! You talk about DIM to prevent spike of oestrogen. But since during perimenopause the oestrogene is like a roller coaster, do you take DIM even when you are in the low oestrogene phase ? Because it is hard to know when it will spike or fall… I have the roller coaster oestrogene and I find it hard to know what to do to stabilize this roller coaster. I take progesterone, but it does not a lot for the spike of oestrogene. Can you help ? Thanks!!!!

    Reply
  19. Is it safe to take a very low dose of DHEA without any progesterone? I’m talking like 10 mg or less (if possible) only during luteal phase because of low libido. I just don’t like progesterone very much. Don’t know if dhea is low, but my testosterone was last time I checked. I have a lot of anovulatory cycles as well. I’m 46, no health insurance, in US.

    Reply
  20. Hi there,

    I’m almost 47 and my periods last one day now, but I still get PMS here and there. Since progesterone lightens your period, is it still okay to take since I’m already experiencing light periods? I’d appreciate your answer as my doctor just suggests both control, which is ridiculous to me Thank you!

    Reply
  21. Hello, is the cream as beneficial to taking a bio-identical pill? Also, if I am taking a progestin type of birth control, can I also use bio-identical progesterone cream or pill day 14-28 safely? Thank you!

    Reply
    • a natural micronized progesterone pill is higher dose and converts more to allopregnanolone so it’s better for heavy periods and perimenopausal sleep.

      A cream can work for PMS and migraines.

      What type of progestin birth control are you referring to? Because if you’re on a pill, then you’re probably not ovulating and so probably don’t have a day 14-28…

      Reply
  22. Hi. I’m 49 years old . I’m in the menopause. Is it safe for me to use both estrogen cream & progesterone cream to help with my symptoms?
    Thankyou x

    Reply
  23. Hi Lara, I am in my early forties and my integrative GP suggested I use a low dose 3.2 % biodidentical progesterone.cream. I have found that the base creams are full of chemicals and I am very sensitive to chemical based products so I have been looking for a suitable product. Do you know of a natural base cream option that is natural that I could suggest to a compounding chemist? Thanks

    Reply
  24. I have been taking progesterone cream for a while now (made by Kokora) Have you heard of this brand? I am interested in the capsule type you mentioned (prometrium)….How would I get this or where can I find this? It is bio-identical right? Thank you,
    Kim

    Reply
  25. I believe I am in perimenapause. I use natural progesterone cream but I am very confused when to use it now. I was doing it day 14-26 between my periods. The older I get I am missing periods and they are very irregular. I started my progesterone cream yesterday and got my period today( a month & 1/2 late). Do I continue my progesterone cream or stop it until my cycle is over and then start the progesterone cycle again when it is over? Please let me know.

    Reply
  26. Hi, I am on the rollercoaster!! I have recently had my Estradiol and Progesterone levels checked. First time my FSH was 30 with Estr at 351 Prog at less than 1.5. I had them done again this month and FSH was 18.6 Est 575 and still waiting on Progesterone. I am 50 in 3 weeks and have fairly irregular periods. My doctor is going to start me on Cyclogest (bio-identical progesterone) to see if this helps things as my main symptom is histamine intolerance which I am getting very intolerant of!!

    I am interested in hearing your thoughts on this – do you think this is the right pathway?

    Thanks

    Sinead

    Reply
  27. So I am wondering, does Progesterone also turn off the sex hormone? I have been noticing that as soon as I start with the cream 14 days in, there is zero sex drive which is annoying.

    Reply
  28. Thank you Lara! The advice in these articles is clear and concise without being pandering. I really appreciate that.
    I have been reading a lot about progesterone since I began to experience hormonal changes that were causing me distress. I come from a family of five women. My mom is also from a family of five women and hormonal issues have plagued our family. I believe all to do with estrogen toxicity. Several of my aunts have had early hysterectomies due to endometriosis, also damaging mood changes and heavy painful periods are very common.
    My doctor prescribed me norethindrone after I visited her twice complaining about mood swings, melasma and night sweats. She didn’t do a hormone panel although I requested one. She did prescribe me the medication and it helped!!! I immediately began sleeping my painful breasts subsided as well as mood swings and hot flashes. Here’s the problem. A few months later it wasn’t working as well. Especially the sleep disturbances were making a comeback. I switched to a progesterone cream, but I don’t know how to get the same dose with the cream. So far my symptoms are back and I am miserable. Do you have any advice about this. I was taking a 35 mg tablet of norethindrone and it was working well until it wasn’t. I also stopped taking it because I was concerned about it being synthetic. Sorry for the long comment. I just want to figure out how to take the bio identical progesterone correctly. I love the results with the norethindrone. Just don’t love the synthetic.

    Reply
  29. I was prescribed Prometrium by my obgyn to help with anxiety and other symptoms. She advised to take one at night starting the first day of my cycle lasting 7 days then stop. Everything I read indicates to take during ovulation. Does it make sense to take during the follicular phase rather than literal?

    Reply
  30. Hi Lara, I have read and reread your book. We moved from Alaska 3 years ago to Texas, and have been unable to find a good doctor. My daughter is insulin resistant PCOS(self-diagnosed with blood work and symptoms)which we have been using your natural methods to treat.
    Since last year, I have had crazy hormone issues. I am on many of the supplements you suggest . I have had menstrual migraines which seemed to have increased till I started taking supplements. All my symptoms except insomnia are much better. I fall asleep at about 9 or 10pm then awaken at between 3-5 in the morning and am not able to go back to sleep. I just started the Progestrone cream. I’m exhausted. It seems to be the worst about 14 days before my period. We have had such bad experiences with doctors, I’m kind of afraid to go back. Also, reading some of the comments, wonder if they would even give me a prescription. I know in your book you recommend the ionized oral Progestrone for sleep issues. Do you have any advice?

    Reply
  31. I just started in a natural progesterone do I have to take estrogen with it? I haven’t heard a period in 10 years I am 59 years old what do you suggest?

    Reply
    • Natural progesterone can be taken on its own without estrogen.
      (but estrogen should always be taken with some progesterone to counterbalance it)

      Reply
  32. Natural progesterone saved the day for me. It took some time, but well worth it. I stopped using oral birth control at 39 years of age. Put on it at 16 years of age for pcos. Every attempt to get off of it resulted in dysmenorrhea, the most painful ovarian cysts, and then the lovely cystic acne. After reading more about estrogen dominance, the downside to oral birth control, need I mention Premarin? My views changed dramatically. On many practices. I’m a nurse, so medication administration became questionable to me, along with big pharma etc. My blood work showed low Magnesium. However, I had to find out for myself magnesium oxide isn’t the best choice for bioavailability. I was told go to CVS and get a bottle of Magnesium. After some reading. I ordered a chelated form. Then began 20 mg of progesterone cream. After 3-4 months my periods regulated, no more ovarian cyst pain and the Magnesium is very calming. I really didn’t believe a cream could take away that kind of pain. But it certainly did. This was a great article, and I’m proof. Getting of birth control can be a bit challenging in its own right, but if your goal is to get off it. It’s well worth it.

    Reply
  33. I just got my month long saliva Hormone panel back. Total output of Estrogen for the month was only around 20 pg/ml It ranged from 1.1 to pre-ovulation peak 1.7 . My progesterone was in normal levels most the month and my symptoms…anxiety/panic attacks/low mood/insomnia/constant hot flush coincided with days my Estrogen fell or Prog was raising. You said if a woman is cycling she doesn’t need Estrogen? I’m 43 and period is 28-29 days and I have Ovulation pain every month around day 14, but my symptoms are pretty severe. I have adverse reactions to anything that promotes GABA and progesterone creams have not worked for me in the past. Is it possible some women cannot tolerate Progesterone or just may need to add Estrogen cream the first part of cycle even if they’re cycling?

    Reply
  34. I am 42 and recently had a hormone blood test done due to multiple symptoms and other blood work coming back normal. My testosterone is 35, progesterone is 0.5 and estradiol is 79. Doctor said my progesterone is too low and is what is causing my symptoms. She prescribed 200mg of progesterone which I will start on Sunday when I begin taking my active birth control pill. I haven’t had a period since the end of July and just started again yesterday for the first time in 3 months. I am also on Blisovi FE 1-20. She only has me taking the progesterone for 21 days at a time over the next three months. My symptoms are extreme fatigue, night sweats, weight gain (feeling bloated), difficulty staying asleep (tired all of the time), mood swings, anxiety, foggy memory, heart palpitations, numbness in my toes, frequent headaches etc. TSH and Free T4 are in normal range. She also mentioned that I will most likely be going through perimenopause within the next year. I can’t rely on my mom because she had a hysterectomy when I was 12. I will definitely be checking out your book! Glad to stumble across your website while googling all of this. Thanks!

    Reply
  35. I’m 43. My naturopathic Dr prescribed Progesterone for me. I haven’t started taking it yet. He told me the same things your article says. But I’m wondering why my periods have become more frequent in the past year, rather than dwindling ?

    Reply
  36. Hi Dr Briden: I am 48 years old and have been taking low dose (25 mg) of oral micronized progesterone for a year. I cannot tolerate a higher oral dose. Last month my progesterone and estrogen dropped dramatically compared with previous roller coaster months and I am suffering from migraines, hot flashes and hair loss. Based on your experience, is it safe to combine low dose oral progesterone with low dose progesterone cream and to be on such a regimen daily (with a 5 day break/month) versus cyclically to help with migraines? Many thanks for your advice. I find your blogs super-helpful!

    Reply
    • There should be no reason why you can’t take both oral and transdermal progesterone at the same time. It increases the total dose, but you’re on a fairly low dose anyway. But please do check with your doctor.

      Reply
  37. Are there any side effects of taking Dim or Dhea? I’m periomenopausal and was just prescribed progesterone and dim and dhea. I’ve tried progesterone 3 times without the dim and dhea and anxiety went through the roof. I’m terrified dim or dhea may do the same or cause insomnia. I’m supposed to try the progesterone again next week.

    Reply
  38. Hi Lara,
    I am 40 and endometriosis and migrianes. I have symptoms of high and low oestrogen. DUTCH test shows all oestrogens to be veryt high end of range on day 21 of cycle. Further tests show I have MTHFR and COMP gene mutations and therefore poor methylation oestrogen detoxification. Is this something you have experience with? I have tried activated b complex and calcium d gucarate 1500mg daily but still get symtoms of huge oestrogen fluctuations. Irritable, sore boobs one day then night sweat and tearful the next. Rollacoatster is definietly a good way to explain it. Anything you have found to help with COMP activity??
    Thanks

    Reply
  39. Hi

    I have breast pain and lumpy and symptoms at 10 days of cycle .have all kind of symptoms lack of sleep,pimples,breastpain,heavy bleeding
    Used natural progesterone cream but it gave me cysts and bad insomnia.can you guide me what ican try other than cream for my symptoms

    Reply
  40. Hi there, your post has been super helpful for me. I am 37 and starting to have low progesterone and high estradiol. I am trying to get pregnant but my periods are so irregular ( and the last one was insanely heavy) and sounds like I am perimenopausal. My dr is starting me on prometrium 100mg for 14 days on 14 off to try and help regulate my cycles. My FSH is slightly high, 12.9. I understand my ovarian reserve is low and this may not work, I don’t think I have been ovulating. My plan is try for 6 months and then close the door of having another babe. Question, at that point should I be on progesterone every day to help balance the high estradiol? Do women who take progesterone remain in perimenopause longer than those who don’t take it?

    Reply
    • It’s unusual to be in perimenopause so young. (it is possible, but not common). Are you sure there’s not something else affecting your ovulation? Such as insulin resistance, or PCOS, or coming off hormonal birth control? Have you read my book Period Repair Manual? If not, I recommend you start with that.

      You’re trying to ovulate so you don’t want to be on progesterone every day or it could impair ovulation. Best to take it only during your luteal phase.

      And your question “Do women who take progesterone remain in perimenopause longer than those who don’t take it?” I’m not sure what you mean? Do you mean can progesterone delay menopause? No. But, like I said, I doubt you’re already in perimenopause.

      Reply
    • There is no test to determine if progesterone supplementation will be helpful in perimenopause. The standard approach is to just try it and see.

      Reply
      • Hi Lara,

        My naturopathic doctor prescribed 100mg of bio identical progesterone for heavy periods, vaginal dryness, low libido. I had a terrible reaction to just one pill- insomnia and horrid anxiety- all the opposite of what was supposed to happen. They now recommend trying to cream but I’m afraid I’m so sensitive that what is a low dose for most women 20mg is too much for me. I had 5mg natural progesterone cream compounded at the pharmacy but I’m still nervous to give it a go after such a bad experience with oral. Any thoughts on the difference cream over oral would make on women who don’t handle oral progesterone well?

        Reply
  41. Hi Dr Briden
    Just wondering what strategy you would recommend for a 42 yr old woman who has low estrogen?I have started estradiol patches – is excess now a potential concern? Estrogen range in the last 4 weeks 130-650 pmol/L. Would natural progestrone also be helpful? I am still having insomnia and night sweats even with the patches.
    Thanks you so much for sharing your knowledge – this site is amazing.

    Reply
    • are you still having periods? If you’re cycling, you shouldn’t need estrogen, but natural progesterone can be very helpful. That’s the order I recommend: first natural progesterone and then natural estradiol (but only if symptoms are not completely resolved). Read Rescue Prescription for Perimenopause.

      Reply
      • Thank you for the reply – yes still having periods. I will definitely give those steps a try. I use magnesium oil – but will switch to the glycinate and add taurine. The estradot patches don’t seem to be worth the side effects and no one can tell me why my estrogen levels would be so low – they just want to treat the symptoms.

        Reply
        • Your estrogen level is not low. 650 pmol/L is normal to high depending on what day that was in your cycle.
          Remember, it’s normal for estrogen to be VERY low (menopausal levels) during the period and then climb up.

          Reply
          • Wow, my gynecologist said the range should be 350-850. She said I’d feel better after it got above 350 – I don’t.

  42. Finally! Real answers …perimenopausal @ 40. Thank you , Lara! Was trying to get some straight answers about using a progesterone cream if I have low estrogen (right now). Roller coaster is right , looks like I’m strapped in for this crazy ride.
    Stephanie

    Reply
  43. Hi Dr Briden,

    I seem to be in perimenopause (symptoms started at age 33 after coming off of birth control. I am age 37 now. My mom completed menopause at age 40). Anyways, I have been taking a very small dose (7.5 mg days 13-26) of micronized progesterone to help manage my spotting, heavy bleeding, night sweats w/anxiety, and hair loss. It has managed my spotting very well, and sometimes my heavy bleeding, but I still struggle with cyclical night sweats/anxiety and hair loss. I have had my thyroid heavily tested (TSH, T4, FT4, T3, FT3, TBI, and thyroid antibodies) and it is in the functional range of normal. I also have a healthy diet (no dairy, sugar, eggs, limit gluten, and eat starch/grains) and take the main supps that you recommend (Thorne zinc, B6, magnesium, and tumeric). Prior to birth control and in between my pregnancies, my period was always very predictable, albeit heavy, so the craziness after coming off birth control that has persisted for 3 years is different for me.

    My question: I have read through Dr Prior’s website and her guidance on cyclic progesterone therapy. She typically recommends a 300mg dose of Prometrium, while it seems you often recommend a 50-100mg dose of Prometrium. I was just curious about the differing thoughts on dosing? I was particularly interested in her treatment for high androgen symptoms: 300mg Prometrium cyclic therapy + 100mg Spiro. I’ve read your thoughts on Spiro, so again, I’m just curious about the difference in viewpoints. Thank you!

    Reply
    • Thanks for your question. Since speaking with Professor Prior about her cyclic progesterone treatment, I have been recommending it for more patients (albeit at a lower dose), and getting good results even without the spironolactone.

      Reply
  44. I have been on the pill (diane) for 30 years, I started it in an effort clear acne and excess facial hair. It worked like a miracle. I have stopped twice for 2 pregnancies. I am now 46 and have been suffering from intermittent visual disturbance migraines (minus the headaches, just followed by exhaustion). I am otherwise very fit, weigh 53kg, skin is great and loving life. I am afraid to stop the pill, but I am concerned for my health (stroke etc) by staying on it! Do you think I should start taking DIM, magnesium and some of the other supplements now, before I stop the pill to make the transition a bit easier? Last time I went off it for 3 months, I had migraines ever other day, my skin was like and oil slick and I felt awful. Help please!! Amy

    Reply
    • Hi Amy, It can be hard to get off Diane, as it has one of the worst “withdrawal” syndromes, which can involve a big surge in androgens, skin oil, and estrogen. Please start by reading my book Period Repair Manual or my blog post How to Prevent Post-Pill Acne.

      Reply
  45. I am in perimenopause and I have been taking DIM for a couple of years. Can I continue to take it without a break or should I stop for a while?

    Reply
  46. Is it possible to have low-level estrogen type of peri-menopause at 35? Because the description of it fits me perfectly. Only difference being, my periods both come early and late with each cycle.

    Reply
  47. I’m so grateful for your website…I’m 42 and almost 2 years post hysterectomy minus mt ovaries. My life has still been effected by depleting at least 7-10 days prior to my cycle. (Without bleeding). Honestly, I probably didn’t need a hysterectomy but I can’t look backwards. I started my period at 9 and my mother went through menepause in her early 40’s. I’m grateful that another doctor is trying an alternative approach prior to removing my ovaries.

    Reply
  48. Hi is it ok to take prog and DIM to help lower we and help the balance between prog and E? My Dr has me on both is it ok to do together?

    Reply
  49. I just went to gyno today, I am 50 and have signs/ symptoms of menopause (no period for 4 mos, hot flashes etc) but nothing that is beyond what i can deal with. New Gyn immediately handed me a script for progesterone and said I should take for 10 days “just to see if you are really reaching menopause. I am really leery of taking a prescription when I don’t have any real concerns. Am wondering if this is something I NEED to do, or can I just deal with menopause as it comes and skip the Rx.
    **I have strong family history of breast cancer, and personal history of endometriosis and hypothyroid / parathyroid nodules. And severe fish / seafood/iodine allergy (epi-pen worthy, not just itchy ) so I am pretty leery of adding anything to my system which will mess up the balance I have.

    Reply
      • She did say something about causing a bleed; since I don’t know exact date of last stop date. (It was mid October, but not sure of exact date) and since electronically transmitted Rx to pharmacy directly, I have no idea name of medicine until /unless I fill it and read the label when they hand it to me. (US, a weird system and it limits your knowledge unless you just do as Doctor says)

        Reply
        • It sounds like she’s prescribing a progestin such as Provera–not natural progesterone. So, it’s acting more as a test to see why your periods have stopped. Progestins have side effects and provide none of the benefits discussed in this post.

          Reply
  50. Hello, thank you for this information! Since I turned46, I’m experiencing anxiety and crazy heavy periods and am thinking of supplementing with the progesterone cream. Should I take it daily or only certain times of the month. I am menstruating every 28 days still. Thanks!

    Reply
  51. Hello,
    Im feeling totally overwhelmed with knowing what to do for the best. I am pre menopausal at 41 and have very low estrogen <50 but still have periods with mood swings, hot flushes ect. I have decided to go down the Bio identical hormone route and my doctor has started off by prescribing me a Troche Prog 350mg Bi Est 2mg. Is this necessary or could I use a cream to get both of these into my system to start off with?
    Any advice would be appreciated thanks

    Reply
  52. Hello. I have been using progesterone cream for 5 years and it has helped my peri symptoms tremendously until recently. Ive noticed 2weeks out of the month I’m bloated, depressed, eating everything, crying and tired. I have been on Prednisone for the last 3 years and am wondering if this has messed up my hormones. I was looking to try Vitex, B6 and magnesium. Do you think this is what I should do? I already take an adrenal supplement, fish oil & b-complex. thanks!

    Reply
    • Prednisone will most definitely affect your hormones. And it won’t be easy to relieve those side effects with natural treatments.
      Are you going to have to stay on the steroid?

      Reply
      • Yes I could be on it a while longer for a lung infection ive had the last 3 years. Also, I don’t eat any junk food, I been eating a Paleo diet for the last few months.

        Reply
  53. Hello Lara, nice to find your blog as I’ve been struggling to know what to do about my perimenopausal issues which are depression, mood swings, irritability, bad nausea (like morning sickness) a few days before P and night time waking. Im a fit 45 year old who lives a natural and healthy lifestyle (I work in fitness and Wellness). I’m loathe to take HRT but mentally I can’t go on, this P was so bad that after trying natural remedies I caved in and I’m on day 3 of HRT. Could the natural progesterone you speak about help alleviate my symptoms? I’m so unsure what to do, would love some advice. Thanks

    Reply
    • I just want to say that I am a 48 year old who has led a healthy lifestyle since my early 20’s, and started experiencing perimenopausal symptoms about a year and a half ago. I visited a medical doctor, and he recommended I go on a birth control pill, which there was no way I was going to do. After doing some research I decided to start using a natural progesterone cream and I feel it has alleviated all the symptoms I had. My period returned to normal: predictable cycle, short duration, normal flow. Sleeping improved, mood stabilized, hair stopped falling out, skin didn’t feel as dry. I could not find a local store that sold it, so I bought it online.

      Reply
  54. Dear Dr. Briden,

    Thank you for all this amazing information! I will be buying your book now 😉 I am 44 and have been having relatively light and short, but regular periods since my daughter was born 10 years ago. It sounds great in theory, but when I have done acupuncture, or am treating my gut issues (more below), they tend to be heavier and longer (which I feel like is better bc it is actually getting everything out that needs to get out?). My issue is mainly that around ovulation (although I have yet to get a truly positive ovulation test – they tend to be very faint lines when I feel like I am ovulating around Day 12-14 b/c of excess discharge etc), I gain weight and get very puffy and heavy, and even more so before my period. Basically, from Day 10/11 until Day 28, I no longer resemble myself! I have been using natural progesterone, usually one pump from day 14-21ish and two pumps after that. The problem is, I cannot tell if it is working, meaning it doesn’t help tremendously, and sometimes I cannot tell if it is making me more bloated or if it would be significantly worse if I don’t take it. I therefore am not consistent. Also, my face gets very puffy around ovulation, as if I am allergic to something. I do have histamine issues and just read your blog about Estrogen and histamine and will pay close attention to my levels from here on in. I also know that SIBO and a parasite I had must trigger something hormonally b/c when I take an antibiotic for them, i start spotting, or just recently, got a full blown period on day 8 of my cycle. Any advice is appreciated and thank you for helping women with this truly significant health issue! My mother-in-law had 10 children and I cannot even imagine how her body was functioning seeing this is me after only 2!

    Reply
  55. Wow thank you so much from the bottom of my heart for this article… I was literally at the end of my line as I had no idea why I was feeling all of the symptoms described above.

    Thank you for giving me the answer as to why, now I just need to work out all the fixes that work for me 🙏🏼😊

    Reply
  56. Thanks to your book I have learned a lot, even if I am in menopause.

    I remember reading that you do not suggest high intake of melatonin because it could lower estrogens.

    My estrogens (estradiol) are already quiet low, I am using progesterone cream (so no problem with progesterone), but my question now is: can I raise melatonin to 3 mg (I am now taking 1 mg) and be sure to do no harm?

    I went on menoupase at 42 I am 63 (no problem with menopause).

    Thanks in advance for your suggestion.

    Reply
    • The theoretical estrogen-lowering effect of melatonin would only be before menopause. It should be fine after menopause.

      Reply
      • Thank you so much for your reply, I will now raise my melatonin to 2mg.

        I wonder if you could give me one more suggestion. I use maca powder and flax seeds to try to raise my estrogens (estradiol). I already take 50 mcg of vaginal estriol once a week.

        What do you think of these supplements , are there some better natural supplements for women in menopause?

        As said I am already taking progesterone cream and make two cycles of Dhea 10mg a year. Do not need testosterone cream because it is good.

        Only my estradiols are very low, Look forward to knowing your point of view and thank you very much in advance.

        Reply
  57. Hi Lara,

    I’m 49 and I’ve been taking DIM for over a year for what I thought was estrogen dominance and it helped clear my face, reduce tender breasts and lumps and seemed to level out my moods. I was having very heavy periods that would sometimes last more than 30 days. I did take Vitex on and off during that time, then started taking it only for a few days when I was bleeding heavily to help it stop. For the last six months or longer, I have hardly had a period and when I do, it is scant and brown. I continue to take the DIM almost daily because if I don’t, the terrible breast lumps and tenderness return and I seem to get moody. The problem I’m having now is weight gain and though I’ve reduced my calorie intake to too around 300 calories less than my TEE and started lifting weights and doing cardio, I can’t seem to lose weight. I’m not ready for menopause yet. Would Vitex help to regulate me and possible bring on a period and help with the weight loss? I know it sounds strange but I want to have a regular period if possible for as long as I can. Has that ship sailed lol!?! I also feel that low progesterone is part of the problem but would rather try to raise it with Vitex if I can. Thanks in advance!

    Reply
  58. Hi Dr Briden,

    Can supplementing with progesterone cause pre-menstrual spotting and breast tenderness? I’ve read on other Naturopathic sites that sometimes progesterone supplementation “wakes up” estrogen hormone receptors in those who have been progesterone deficient for a long time – could this be true?

    I was already spotting 3-5 days before my period prior to starting progesterone cream, but now I pretty much spot the whole time I use it :-/

    Background:
    I am 36 years old and on month two of supplementing with micronized progesterone (15-25mg day 15-25). I was given the prescription after a progesterone serum test of 2.6ng/ml 5 days before my period. I also have the following symptoms: hair loss, scalp issues, awful hot flashes and night sweats, spotting 3-5 days before every period (which only started after stopping Ortho-Tri-Cyclen Lo almost two years ago), pre-menstrual anxiety, increased reactions to foods and products, etc. My mom completed menopause at age 40, so I’m guessing I’m riding the estrogen rollercoaster. This is so unpleasant!

    Reply
  59. Thank you for this article. I am 47 and just started Dim can I take the progesterone with that or should it be one or the other. I still have regular periods heavy for three days but am watching my friends who are older and in menopause and going I need to work on this now thank you

    Reply
    • It should be fine to take both DIM and progesterone.
      My triad of treatment for heavy menstrual bleeding is: 1) dairy-free diet, 2) turmeric, 3) progesterone. And then possibly calcium d-glucarate.

      Reply
      • Thank you, i use Tumeric already too, but will look into the dairy free – i only have a wee bit in cup of tea, I have had issues with facial hair for the last 18 years which i have treated with removal no medication, can this be helped with the DIM or Progesterone I read an article on your site but now can’t find it about antrogens?? but wasnt sure how to work with that thank you so much x

        Reply
  60. My Endocrinologist prescribed 100mg Prometrium capsules to be punctured, squeezed out and used transdermally. I tried this for several cycles, but now understand I was using entirely too much per his instruction. I would like to try this again, but would love to get your thoughts on this method. I assume I would need to use less than one capsule per day to stay around 20 mg, which could prove difficult to be consistent. Do you strictly prescribe Prometrium to be taken orally? Thank you so much for your time. Your book and blog posts have been invaluable to me as I navigate this perimenopausal stage. Thankfully, I am still ovulating regularly and the only symptom I have been unable to improve is hair loss, which I can only assume at this point is due to progesterone deficiency. Yes I have scoured your hair loss posts and implemented your suggestions. I have recently corrected a carb restricted diet (3+months) and have been off Spironolactone (prescribed for acne, hair loss began while I was still on it) for 9 months now.

    Reply
    • I can’t any reason why Prometrium could not be used that way. And the higher dose might be okay. I know I say 20 mg progesterone in my book, but there are times when a clinician needs to give more.

      Reply
  61. Hi!
    I am 53 years old, and in menopause. My period stopped in 2011. I would like to know if biodentical progesterone is still beneficial for me at this stage in my life? My energy levels are low, sexual desire is gone, feel depressed, was diagnosed with hypothyroidism last year, on 25mg of levothyroxine, which doesn’t seem to be doing anything for me. I’m at the end of my rope, and don’t know where else to turn.

    Ruth

    Reply
    • The short answer is yes; progesterone can be helpful after menopause. But you may also want to look at a tiny dose of bioidentical estradiol (estrogen), as well as fully supporting your thyroid, and assessing for DHEA deficiency.

      Reply
  62. I love using natural remedies and treating thinga from the inside out. I regularly use essential oils in my healthy regimen.

    I have 2 questions.
    1) I am 37. 6 years ago I had a tubal ligation after my last baby. Does the tubal ligation affect the hormones that would be released without it?

    2) I decided to exclusively use Young Living’s essential oils for various reasons. They have one blend called ‘Progessence Plus’. It has many ingredients…but the one I’m asking about is USP-grade progesterone from wild yam extract. What are your thoughts on the application of this to balance the hormones?

    2 more things to add.
    1) Both my maternal grandma and mother had hysterectomies due to pre-cancerous cysts etc.
    2) I often have very heavy and painful cycles. (Sorry if that is TMI! 🙂 ) I had it checked out and the found nothing. Would this Progessence Plus regimen be beneficial for me since I’m approaching 40?
    Thank you for your time and thoughts!

    Reply
    • Officially, tubal ligation does not affect hormone levels. But some women do report reduced levels of progesterone.
      USP progesterone is the natural micronised progesterone I discuss in this post.

      Reply
  63. Hello Dr Lara, I have a question in regards to estrogen cream please. I am 55 (separated) and had a pap smear done which my doctor advised was positive but could not be confirmed 100% due to not having enough cells due to lack of estrogen. She recommended me to use estrogen cream internally every second day for 2 weeks and then twice weekly for 4 weeks and repeat the pap for an overall better result.
    But after reading the enclosed instructions from the cream and the side effects I do not feel comfortable to do this treatment.
    I have fibroids (which I know were because of too much estrogen) which previously caused heavy bleeding but are not an issue any more since my periods stopped over two years ago.
    Is there some way I can get a better reading with another product without having to use estrogen cream please because I really do not wish to use this cream (Oestriol 0.1%). Thank you.

    Reply
  64. today I asked for progesterone, micronised or bio identical and the Dr had no idea, he sent me off with the mini pill microlut.
    I literally was googling at his request a name to give for the script, so if your article could be improved..or anyone’s infact, recommendations and names of what to get would be awesome. Thanks for all the other info though, i’m getting there, just can’t get a good Dr at all 🙁

    Reply
    • Microlut is levonorgestrel — not progesterone.

      The only brand name of progesterone is Prometrium (which I say in the article). Or micronised progesterone can be dispensed by a compounding pharmacist. Do you have a “compounding pharmacy” in your local area?

      Reply
      • Apologies, now I see the name, it took a few reads tbh. Truthfully, today I didn’t have your article open in the Dr’s. I actually went to 2 Dr’s, the first refused anything asking for a name and dosage when she somehow decided I’d had it before, i couldn’t correct her on anything prior to that so figured another Dr would know it, and I could just get a script because there is so much variation in Dr’s, who knows. I have seen so many, I’m tired of hearing it’s middle age spread without asking anything else when I mention weight gain. I know my body and this is horrible.

        I will try a 3rd time, but first, this is a script right? So I just say I need Prometrium [50mg capsule to start perhaps?] I don’t know how you measure cream etc..second thing if I can’t get that is to ask for a script to a compound chemist for micronised progesterone?
        Sorry to spell that out but simple theory’s turn to mud with some Dr’s and I want to be clear with them and not be accused of Dr shopping either.

        Thanks

        Reply
        • I know this is an older post, but…Google a compounding pharmacy near you & ask them for recommended names of bio-identical hormone replacement doctors near you (they are likely filling scripts for them already). Bio progesterone comes from yams or soy & is not patented by big pharma, hence why your mainstream docs are struggling for a ‘brand’ name (they are educated by the PDR full of drugs). Most mainstream docs are not comfortable w/natural or bioidentical & many just lump natural along with synthetic and have no comprehension that synthetic causes cancer, etc. and bioidentical reduces cancer. Natural, homeopath doctors & some main stream doctors (who step outside the four walls of the various dictating agencies & do not take samples or kickbacks from big pharma) can help and will know how to prescribe and regulate your hormones naturally. It’s not just progesterone that you should have assessed, but it’s testosterone, DHEA, thyroid (T3/T4), estrogen & your adrenal hormones (cortisol, etc.) – all can be balanced naturally or bioidentically. Hormones work in synergy and can affect and be effected by organs and other chemicals (natural or foreign) in your body. A liver detox may be needed, your iron & other vitamin levels may need to be checked & adjusted (through diet or supplementation), in combination with using bioidentical hormone replacement (BHrT). Find someone experienced in this, be an advocate for yourself, your body & your health, but reconsider going rogue on this one or be discouraged, have faith you can find a skilled doc. If you live in a rural area, look for a virtual doc: some docs will request an imperson the first visit & skype all subsequent visits & some can do it all over Skype (they will order bloodwork for you to take at a local facility & then manage you through Skype sessions). Good luck.

          Reply
  65. Is it possible to go theough this when only 25 years old? I’ve had all this since the birth of my children. Severe depression during follicular phase, water retention, irritabilitt, sleep problems and hot flashes … I ovulate and have a 14 day lutealphase.

    Reply
      • Yea Lara, My thyroid is healthy, although my practitioner (functional medicine) says my t3 is a bit low due to problems converting t4 to t3.. But he doesnt know what to do about me anymore.. Its not like I am very tired though. My problems are more typically cycle related. I have been using vitex since reading your book this summer and it worked great right from the start. Before vitex i ovulated day 21 and I had a 10 day luteal phase and e2-deficiency synptoms day 1-10. With vitex I ovulate day 14 and have a 14 day lutealphase. Symptoms of low estradiol dissapears when using vitex but my estrogen excess symptoms Stays. That includes anger / irritability and water retention (worst the days before ovulation and best during menses and the days/week right after ovulation). what I simply cant understand is that I have a 14 day lutealphase so my progesterone must be good? And I am on the lower side of estradiol so how on earth can I suffer from estrogen “excess” at the same time? Or do you think my extreme PMS and water retention doesnt have anything to do with estrogen at all?

        I am so scaired about discontinuing Vitex As symptoms of e2 deficiency comes back when i try. For how long can I take it?

        Reply
  66. Hello (again) Lara,
    Your book and this blog have helped me tremendously! I wish you were in the U.S., I would love to meet you in person just to thank you. I have a question about calcium g glucarate. Should I take it all month or only during my luteal phase? I’m 44 and perimenopausal.

    Reply
  67. I am currently taking bio-identical hormones for menopause, including micronised progesterone (100mg 2xdaily), as prescribed by a GP. At a recent appointment to discuss test results I was advised my levels remain low and to increase frequency of dose i.e. split pills and take 4 times per day rather than 2.

    Do you have any suggestions to enhance/assist with absorption of micronised progesterone.

    Could you also confirm if your Sydney CBD office is still open – yr website makes reference to a CBD practice however only details of a Nth Sydney address are available.

    Many thanks in advance for your assitance.

    Reply
    • As I discuss in my latest progesterone testing post, we don’t expect to see progesterone rise substantially with post-menopausal supplementation. If it’s anything above baseline follicular phase levels, then I consider that over-dose. Yes, I see patients in Sydney CBD.

      Reply
  68. Is it safe for a woman aged 53 in remission from invasive ductal carcinoma, ER+, PR+ take bio-identical progesterone to prevent estrogen from attaching to the estrogen receptors? Woman is currently having a lupron shot monthly and aromasin pill daily. I have seen research from AU in 2015 indicating progesterone “blocks” estrogen.

    Reply
  69. Hi, loved your book and have read many blog posts!
    I am 44, still regular periods, normal thyroid and no pms or menopause signs. I have taken DIM for a couple of months to clear estrogen excess but that extended my cycle with 1 whole week. Thought of Vitex to up progesterone and coq10 to enhance egg quality. I drink raw milk and eat liver regularly. Healthy diet. Take prenatal supplements, and ionic vitamins incl magnesium, fatty acids, etc.
    I want to get pregnant. Does DIM affect chances of pregnancy? Anything else I should do? to conceive?
    Thanks, Christine

    Reply
  70. I’m 49 never been on the pill and had my last child at age 44. Usually the week before my period I know about it because I wet myself more easily,my legs feel like butterflies are let loose underneath them and I can’t sleep or get any life into my hair. My periods are not overly heavy nor last more than 5 days. My moods are horrendous. I’ve tried natural bioidebtical progesterone but then forget to take it so not taken it for any length of time really. However in the last 12 months my hair is a lot lot thinner and I am shedding more. Could this be the progesterone cream I took in the past. I also have a nodule and cyst I’m my thyroid. My day is normal the Dr says. My vitamin d level was 56 after supplementing on and off for several years. Please help, what supplements should I take?

    Reply
  71. Hi Lara, I’ve been in touch with you before, I Iove your blog and just saw you recommend Natural Progesterone…I was on the cream for a long time….then stopped it because I read something bad about it . I’m way past menopause…..(started at 42), prior to using the Progesterone I was on birth control pills, hormone therapy (not natural). ….do you think stopping Progesterone could cause my hair’s falling out like crazy?…..ps …..in my last comment I had said my Dr. told me I had Insulinemia and that was causing hair loss, he put me on Metformin once a day, (I don’t have Diabetis) and I still have hair loss….also I’ve been using Viviscal for 6 months now. Should I go on Progesterone Cream again ? I hope you can make some sense of this. Any info. you can give me would be greatly appreciated…..Sincerely, Sandra

    Reply
  72. Hi Lara just adding to my last comment today. I also feel I retain fluid and thinking maybe I have adrenal fatigue. Could that have anything to do with low Estrogen or Progestrone? I also have mild Osteopenia. So yes not wanting that to worsen. If you could let me no what your suggestions are.

    Reply
  73. Hi Lara Briden I was reading your Blog about what Estrogen can do to you in your 40’s !!! or cannot do. I am in my 50’s I had a Hysterectomy in 2013 and also half my thyroid removed. My ovaries are still intact but I am very bloated all of the time. I did have insomnia earlier this year for about 6 months and hot flushes but that has stopped for awhile. My stamina is not good, Fatigue fast, Not ovulating My FSH was 14 in year 2015 75 in May year 2016 and 45 in Sept 2016 my E2 is 276 it was 963 August 2015 progesterone is 0.6 and my LH level is 17 yeah I need something just not sure what to get. My Endocrinologist said take Estrogen patches.

    Reply
  74. Hi, I’m 38, have Hashimoto’s, and I suspect low progesterone. I spot red for several days before my period really starts. I also gained quite a bit of fat in my thighs more recently, also thanks to an extremely stressful year last year, and I’m still struggling to take it (cortisol is not my friend either). Because of my age, I know I’m slightly young for perimenopause to be in full swing, but given my autoimmune issues, something’s definitely out of whack here. Any ideas?

    Reply
  75. Hi I came across your website about 6 weeks ago in an attempt to find some help! I am 47 years old. I have been experiencing night sweats and hot flashes for almost 3 years. I have taken the pill for different short periods of time during the last 3 years but I don’t like the emotional side effects (and neither does my husband….). The last period I had was in April of this year (2016) and the last one before that was in May of 2015. I started taking the supplements you recommended on a few different post on your website—-magnesium, Calcium d-glucarate, DIM and iodine as well as the progesterone cream. It’s been 4+ weeks since I started and haven’t noticed a huge difference in that time period. If there has been a change, it’s been in the frequency of the hot flashes. By the way, I am also on levoxyl (.15 MG) for low thyroid. I am wondering if it takes time for my body to use the supplements before I notice a decrease in my symptoms. Any help would be appreciated!!

    Reply
  76. This blog is amazing! Thank you for this wonderful resource. Hoping you can answer something for me. I am 47, and my period just returned 4 months ago, after I stopped breastfeeding my second baby, who was born 19 months ago. I had my first baby at 42, got my period 6 months later, and conceived naturally when my first was 18 months old. Both were conceived naturally, and I have had regular, problem-free periods ever since I learned about Vitex in my late 20’s. I also used birth control pills and the nuvaring on and off for about 17 years.
    This ‘new’ period I am having is nothing like I have ever experienced. Much longer, much heavier and irregular timing. Plus, cramping and moodiness I never experienced before. So, even though I just had a baby, I assume I am in perimenopause? Will progesterone cream help me? Someone suggested I get bio-identical hormone replacement. I feel like my body is not my own anymore, and I am starting to see dramatic changes in my skin and hair. Combined with my fatigue, it is all very disheartening. Thank you for your work in this domain.

    Reply
    • Your first step should be to speak to your doctor and hopefully get tested for thyroid (because thyroid problems are common during perimenopause, as I discuss in Chapter 9 of my book). If thyroid normal, then yes you could consider some of the estrogen-detoxifying treatments I discuss here and in my book. And also yes, consider natural progesterone (which, just to clarify, is bio-identical progesterone). There is almost never any need for a perimenopausal woman to have estrogen replacement.

      Reply
  77. Thank you SO MUCH! I have been searching in vain for information and help on perimenopause; my doctor wanted to put me on the pill (why is that the answer to everything when it can ruin some women’s lives?) and basically denied it was even happening to me when I’m 45, and in the prime window for it. Your blog is a godsend and I will share it with all of my friends. Thank you again!

    Reply
  78. Hello! Can you tell me if taking progesterone cream could increase estrogen? I have been doing progesterone cream for 4 months and the last blood tests showed elevated estrodial (273pg) at day 20 of my cycle. I have been under a lot of stress and anxiety as well during this time. I am using 10mg per day in first half of cycle and 20mg the second half. At this point I feel pretty bad and don’t know if the progesterone is making it worse! There is a blog out there (progesterone therapy) that suggests low doses of progesterone just stimulate more estrogen receptors and you get the symptoms of estrogen dominance. That blog suggests 100-200mg of progesterone. I’m now using the DIM/calcium glucarate to help reduce estrogen.

    Reply
    • Short answer: yes, progesterone can stimulate estrogen receptors and at high dose, also yes, potentially convert to estrogen.
      Longer answer: The normal range for mid-luteal estradiol is up to 294 pg/mL, so IF you are cycling normally, and IF day 20 was mid-luteal for you, then that estradiol may simply be your normal peak. I generally do not prescribe progesterone in the follicular (first half) of they cycle because it can potentially prevent ovulation and progesterone production.

      Reply
  79. Hi Lara,
    i tried bioidentical progesteron capsules with three doctors. I had the side effect dizziness even with the lowest dose and the vaginal way caused bad inflammation of the skin because i have dermatitis in this area. The doctors said that the cream doesn’t work because it’s to unsure how much of the progesterone reach the right point in the body. My mother had breast cancer and i read a lot of the important role of progesterone for us women. That makes me very anxious. I took the pill for 17 years (now i’m 36) and with PCOS and irregluar periods (last year no periods after getting off the pill) my progesterone values ever where very low. I fear the consequences and that’s why i tried the bioidentical hormones with no luck. What would you recommend? Normally with 17 years the pill and now the PCOS symptomatic…how can i ease off my anxiety of being on the best way to get breast or other cancer because of my situation? Thank you
    K.

    Reply
    • At 36, you should still be able to make quite a lot of progesterone, as soon as you can establish a more regular ovulation. I discuss strategies in my book Period Repair Manual

      Reply
  80. Hi Laura – Thank you so much for this article! I am 40 and have been having symptoms of high estrogen this cycle for the first time in my life. I scoured the Internet to figure out why I had hot flashes, heavy period, and bloating – I came across estrogen dominance, but no real suggestions on what to do. Then this showed up in my e-mail this morning and I’m so grateful!

    My question is: I am 40 and still trying to conceive my second child (desperately!) and fear I’m in Peri menopause already. In general would iodine, dim, and natural progesterone be helpful to balance hormones and, in theory, support natural conception?

    Thank you!

    Reply
    • Yes, the drug fact sheet for Prometrium still contains a “copy and paste” list of progestin side effects. That’s because neither the drug company nor mainstream writers really yet understand the difference between progesterone and progestin. For example, they are incorrect when they say there are “no studies for pregnant women”. Micronised progesterone is prescribed in early pregnancy all the time (following fertility treatment).
      Progesterone and progestin should have completely different fact sheets, and maybe one day they will.

      Reply
  81. Dear Dr. Briden,

    Could you please tell me if it is ok to take herbs such as Rhodiola, Eleuthero and Schisandra with NAC and L-Theanine? Thank you.

    Reply
  82. Hello Lara,

    For NCAH would 5a-reductase and dheas be elevated in this condition and would insulin resistance be present? I am wondering, because all three of these got me the PCOS diagnosis, but I never had an adrenal scan or any of those stimulation tests to rule out NCAH. I also don’t know if my results are suspicious of NCAH or if they look more PCOS.

    Reply
  83. I am so glad I found you today Lara! Unfortunately, it was after I was prescribed a low dose BCP containing Levonorgestrel for my perimenopause symptoms that include hair loss. Obviously my GYN was not familiar with the effects of the Progestin on my already thinning scalp and my hair loss got very bad and really scared me…hence finding your wonderful blogs!! I only finished one pack – the others are going in the trash!! I have not been on hormones since my 20’s (I am 51) but wanted relief for my sore/full breasts, heavy periods, bloating/water retention, night sweats, irritable moods and mild hot flashes. We have used non hormonal methods for birth control all these years and have been very happy – glad to see your support. Most doctors looked at me like I was crazy!! What do you think I could do for my symptoms? Currently, I take biotin (for the hair loss – doesn’t seem to help), fish oil and a prenatal vitamin (that is what the GYN recommended). I am very healthy and fit for my age and have not missed any periods (menopause) yet. Will natural progesterone be a good option? How long do you think my horrible hair loss will continue? I hope you can help. 🙂

    Reply
    • Forgot to mention that I have been taking 25mcg Synthroid for about a year for hypo symptoms to include the hair loss and fatigue. It has really helped with my afternoon fatigue but not my hair loss. 🙁

      Reply
  84. Hi, I’ve just come across your website.
    I have Crohns related arteritis in my sacroiliac joint. Every month it flares, sometimes calms and sometimes dosn’t, so then becomes very painful all around my hips & legs with I assume inflammation.
    As it historically happens most months just before my period starts, I decided to ask my GP ways of stopping my periods to see if this in turn stops the flares. He has put me on a progesterone mini pill. I’m now on my second month, it’s seems to have calmed the build up pain, but it still hasn’t stopped my periods!! I realise that trying to stop my periods isn’t a natural thing to do, but I’m sure it’s the cycle that’s disrupting the arteritis!
    Any advice would be welcome
    I’m 46, 3 kids, don’t need any more!! I have my colitis under control I think with diet, but it’s the arteritis flares I can’t seem to combat!
    Thank you in advance
    Rebecca

    Reply
    • Yes, normal hormonal fluctuations can aggravate an underlying autoimmune, inflammatory conditions. My first approach would be to work on reducing the underlying inflammation, and also reduce estrogen excess (reduce the amplitude of the roller coaster).
      However, it’s very bad, then yours is situation where I can sometimes see the usefulness of suppressing ovarian function with hormonal birth control.

      Reply
  85. I have been told by two different doctors that I have PCOS. However I have low testosterone, and I am taking testosterone cream. Is it possible to have PCOS and low T?

    Reply
    • I’ll just say that would be a very unusual situation, because by definition, PCOS is condition of elevated androgens (male hormone). You don’t mean that you simply have polycystic ovaries on ultrasound, do you? Because PCOS cannot be diagnosed that way.

      Reply
      • Thank you for your reply. Seven years ago I was having very abnormal periods, cystic acne, and what I thought felt like blood sugar issues. The OBGYN I went to told me I had PCOS from the sonogram and the irregular periods. A few years later I went to a gynecologist that specialized in HRT. She also said I had PCOS based on my sono and irregular periods. My Estrogen was high, progesterone extremely low, and testosterone slightly low. Now I take Progesterone and Testosterone because the Testosterone levels on recent tests were also very low. My Estrogen is still high. I’ve had thyroid and thyroid antibodies tested and everything is fine. I can eat very little sugar or I feel sick, and must eat protein with every meal, A1C 5.6. I do not eat wheat/gluten. Would you recommend I see an endocrinologist?

        Reply
  86. I am using progesterone cream as I have uterine hyperplasia .my consultant wants me to take provera daily for 3 months. I have used agnus castus and the cream daily but despite having always had very regular periods ,this has brought on a second heavy bleed only two weeks after my regular one .should I only use both for14 days ?

    Reply
  87. Lara,

    When DHEA & DHEAS is very elevated and your Insulin & Glucose was abnormal, do you consider this Insulin Resistance PCOS or is this still just Adrenal PCOS? Does the treatment target Insulin Resistance or the Adrenals or both? You don’t hear about Insulin Resistance with Adrenal Androgen Excess, I find this very confusing and don’t know the appropriate action. Thank you for your help!

    Reply
    • It is possible to have both ovarian and adrenal androgen excess. Are your testosterone or androstenedione elevated?
      If you are definitely insulin resistant, than that is a pretty important part of the picture. What is your fasting insulin?

      Reply
      • A1C is 5.4
        Glucose Fasting is 84
        Insulin Fasting is 23
        Glucose Hour One 144
        Glucose Hour Two 83
        Glucose Hour Three 43
        Free Testosterone 3.7
        DHEAS 540 mcg/dL
        Testosterone 29 ng/dL

        It doesn’t say the measurements for the Glucose or the Insulin Resistance, but the reference range measurement for the Glucose is mg/dL and the reference range for the Insulin is mcU/mL

        Reply
          • No, but elevated insulin does increase activation of testosterone to DHT, therefore contributing to androgen excess symptoms. If insulin resistance is present, then I always treat that as the priority.

          • Would using adaptogens be sufficient in treating the adrenal excess as well as the insulin resistance? Or do i need something specifically for the insulin such as Berberine or Inositol? I was under the impression that stress hormones from my adrenals may be causing the insulin resistance therefore correcting my adrenal imbalance would correct my insulin imbalance. Thoughts on this?

  88. Dr. Lara Briden,

    I have seen on your twitter many times links to Calcium supplements increasing disease risks etc. I take Magnesium and D3 as well as a Multi. My Multi has 300 mg of Calcium (I believe) and 200 mg Magnesium Citrate. I am a woman with PCOS and I thought I needed the vitamins. What is your opinion on Calcium supplementation and is the recommendation vs the risk different for women with PCOS? Ie: Do we need it, so we have to accept the risks?

    Reply
    • Calcium competes with magnesium absorption so calcium supplements can aggravate an underlying magnesium deficiency. That’s probably one of the reasons calcium supplements cause harm. It would be interesting to see the same studies done where where participants took both calcium and magnesium. I prescribe magnesium all the time, but I rarely prescribe calcium.

      Reply
  89. I’m 42. I’m on iodine. My periods are regular and last about 5 days but 10 days exactly after they start, I get very dark brown blood that sheds for about 4 days. It does NOT have a smell but it freaks me out each month. It started very slowly (1 day) after taking the iodine.

    I went to my Dr’s and she did a blood test. My TSH came back normal. I asked her for micronized progesterone and she said she has no idea what it is.

    She didn’t know why my body was doing this. I asked if it was the iodine I was taking clearing out some estrogen and she shut me down. I was raised to respect Dr’s and each time I ask if I should see someone she raises her voice so I dont want to upset her more.

    Is this something I should wait out?

    The nascent iodine has really helped with my severe anxiety, breast pain and I’m not freezing cold anymore (I can feel my fingers again).

    Reply
  90. Hi Dr. Briden,

    Forgot to include that I believe I used progesterone cream too early and it impeded ovulation while I was on it. Now, no longer have ovulatory pain mid-cycle and have much lighter periods. Afraid that phytoestrogens like ground flax/primrose may help the hair while using it but not help ovulation or getting body back on track. Not sure anymore if I am too old to get on track.

    Thank you for trying to help.

    Jennifer

    Reply
    • Yes, high-dose phytoestrogens can impair ovulation, and yes, your primary goal is to ovulate, if you still can (at 44, you should be able to). Have you thought about Vitex or tribulus? I should have included them in this post as possible treatment-strategies for low-estrogen perimenopause. They’re not the easiest herbs to use. Do you have a local herbalist or naturopath who could help you?

      Reply
      • Thank you Dr. Briden. Currently, I am working with a nutritionist and acupuncturist/herbalist after trying many a doctor. The nutritionist recommended vitex for the insomnia starting day 12 at 400 mg and also sensitol and either black currant oil or evening primrose (and possibly dong quai for 1st part of cycle). She said if that didn’t work, to try the phytoestrogen and progesterone cream. The herbalist has had me on the same blend for a year with mixed results and it includes dong quai (so I haven’t supplemented additionally) and white peony astragali radix, etc, The vitex has helped with sleep, but my hair loss on this protocol which includes bco not epo or flax, has been horrible. I’ve also lost weight and my mood has been affected. I can tell I’m just not producing enough estrogen as I know how I felt when using flax and epo was more positive and I was able to stabilize weight to a normal level. I live in the Northern Virginia area outside Washington, DC. If you have any recommendations for herbalists/naturopaths, please let me know. I’ve switched to using Vitex at a lower but standardized dose at day 6 as described in your book, but not really sure where to go from here. I appreciate your time and work.

        Jennifer

        Reply
        • Are you definitely ovulating? You can tell by tracking your basal body temperatures.
          Also, just a caution about interpreting hair loss. There is always a time-delay, so the hair loss you noticed while on Vitex may not have been from the Vitex, but from something that happened three months previous.

          Reply
          • Dr. Briden,

            Months that I may have ovulated — I have done so early — around day 9/10. I used vitex after this increase in hair loss happened. Possible triggers for increase include: stopping flax and taking rogaine — but unlikely since I only used for one week and then increase in hair loss happened and has not stopped (has been over two months since use). If one uses phytoestrogen and progesterone cream together do they prevent ovulation just as BCP. This low estrogen is very hard to live with — the hair loss is awful, but so are many of the other symptoms that come with it including insomnia — and I really want my life back. I will use your suggestion and chart my temp more regularly to gather more data. Thank you for your help and your work.

            Jennifer

  91. Hi Dr. Briden,

    I am 44 and have suffered from low estrogen symptoms for over three years after discontinuing progesterone cream (which I used for six months to help cure postpartum anxiety). Some of my worst low estrogen symptoms have included hair loss and insomnia. I’ve tested hormones through blood/saliva and although all are consistently low, estrogens are below normal. The only relief I’ve found for the hair loss is through phytoestrogens like ground flax and evening primrose and chaste berry for the insomnia. I’ve read your book and posts and worked on lowering inflammation through dairy and gluten free diets and general healthy eating and exercise but can’t find the right combination to get myself back on track overall. Are phytoestrogen and progesterone creams a safe alternative for low estrogen for a perimenopausal woman? I’ve tried so many combination of herbs and vitamins and can’t get it right! Thanks for anything you can add to point me in the right direction.

    Reply
  92. I am 43 and have premenstrual migraines and terrible PMS. About 6 months ago I got a CT scan, as I thought I was having a kidney stone, but all it showed was an ovarian cyst. I got my hormones checked and my terrible gynecologist just said “You’re in perimenopause” – no explanation, nothing. Since then I have been trying to shrink the cyst on my own. It causes me pain around ovulation and my period. I suspect that I might have a uterine polyp, also, as I have had those in the past. This last cycle I bled in a way that was reminiscent of my polyps. I love this site and have learned so much from it. I love that you don’t push a specific supplement down our throats or try to convince us that there is only one solution to menstrual complaints. I would love any advice for my situation. I take mag, vit B, black currant oil, try to get all my calcium from diet. Progesterone cream made my breasts sore the last time I used it, but I could have been using too much. Thank you.

    Reply
  93. Hi Lara,

    I am 34 and had my third child 10 months ago. I have post partum anxiety but looking back I think it started in my last month or two of my pregnancy. I was put on an anti depressant but it is not working. I told my doctors that strange things are happening to my body around ovulation and my period (joint pain, exhaustion, anxiety, change of appetite, water retention, night sweats etc.) I finally got my ob gun to check my hormone levels and my progesterone was 3.8 (normal 1.2-15.9) and estradiol was 70 ( normal was 21-312). He said everything was good and gave me the pill to help regulate things. I took it for two months and couldn’t take it anymore. It made me exhausted, lost 10 lbs., eyes dried out, migraines with aura, depressed, shortness of breath, weak in the legs. I have been off 4 months and things are still not better…migraines with aura 3/4 months, tingling, dizzy, anxiety even worse than before, water retention, back aches, joint pain. What do I do? I just started taking cited 3 days ago. I need some relief…my kids need their mommy!

    Reply
    • Chaste berry not cited! Since having my son and being on off the pill I have had night sweats and times I feel hot. Before the pill my periods were very heavy. Since going off they are lighter. My cycle is around 30 days. I have never had so many pms symptoms in my life. Anxiety like this is not normal for me either. Thank you!

      Reply
        • Could the low progesterone be from having the baby and it not getting back to where it needs to be yet? And could the pill have made things worse?

          Reply
          • I know this is an older post…not giving medical advice, but go see a natural practitioner who specializes in BHrT (bioidentical hormone replacement). Blood tests are fairly cookie cutter and have broad ranges (which vary by lab). A progesterone level that is ‘normal’ may not be normal or healthy for you. What you’re describing is low progesterone. Doctors are quick to prescribe from big pharma: BC pill or antidepressants when is really a hormone issue (estrogen dominance or progesterone deficiency). Most (not all) pregnant women glow and, even though they are growing and carrying a watermelon, are in happy mental and physical states while pregnant w/child. The reason: high progesterone levels. Women tend to get ‘postpartum depression’ not because they are depressed, but because they just excreted nearly ALL of their progesterone, that awesome feel good hormone, when they gave birth & their body is not able to quickly regenerate the level needed for their mental health. We are all human, but we are not the same, Google to find a bioidentical doctor near you or a compounding pharmacy near you – call the compounding pharmacy and ask for a name or two of doctors who are prescribing bioidentical progesterone and get an appointment, raise your levels & get your life, health, and happiness back on track.

  94. Hi I am 44 and haven’t had a period in 6 months. I experienced a short period of hot flashes, anxiety and heart palpitations. I started vitex, I have absolutely no symptoms now other than constant bloating. Should I carry on with vitex??

    Reply
    • Sorry, I can’t give specific advice about what you should do personally. I can say that at the right dose Vitex shouldn’t cause bloating. If that’s what you’re experiencing, then you might want to consider having a break or dropping the dose.

      Reply
  95. I loved your period repair manual. After 20 years on the pill, I came off at age 35. It took me 9 months to get a period. I now cycle regularly (30-35 days) but my periods are incredibly light. Since my periods have come back my skin has gotten progressively worse (acne, loss of facial fullness) as well as feelings of depression and anxiety around my period. I sometimes experience night sweats, but only the week of my period. I eat dairy free, supplement daily with magnesium, inositol, vit D, probiotic, berberine and multi vitamin. I have a feeling I’m in an early perimenopause, but have no clue what else I can do to help my acne and my low moods. I thought after a year of cycling normally my skin and moods would even out but if anything they only seek to be getting worse! Your thoughts would be greatly appreciated!

    Reply
    • Light periods suggest you’re tending to lower estrogen, which can be a problem for skin. Are you sure you’re ovulating?
      I discuss light periods in low estrogen in Chapter 9 of my book. They can be the result of soy, gluten, smoking, stress, and vegetarian diet. Do any of those apply to you?

      One of the most effective treatments for skin is zinc. Please see my acne post.

      Reply
      • Thank you so much for your reply! Yes, I am ovulating – I do temperature tracking and chart. Typically ovulate around day 20 and period starts around day 30. I also spot for 5 days before my period, too. The only one of those that would apply to me is stress… I did try zinc and while it seemed to help with the cystic acne lesions a little bit i believe it may have caused me to break out in lots of smaller whiteheads all around my mouth, chin and sides of my nose. I got the idea for the berberine from that chapter, and although I don’t have PCOS I thought I’d give it a try

        Reply
        • Stress affects skin and estrogen levels. Have you looked at some of the treatments I discuss in Chapter 6 for regulating the HPA (adrenal) axis? eg. magnesium, rhodiola etc.

          Reply
          • Yes I have – I’m currently on 500mg of magnesium BID and the Cortisol Manager supplement from Integretaive Therapeutics which contains rhodolia and ashgwanda (sp). I do think that my skin is very sensitive to androgens as well. I’ve been taking the cortisol manager for 6 months with no real change. If anything my most current cycle is the most “off” I’ve had – there was a delay between my temperature rising after ovulation with a fallback day, and then my other temps this far have been well below my usual post ovulatory temps. Usually I run 97.7-98.0 after ovulation, and I’m hanging at 95.5 the past few days. I exercise only 3 days a week doing heavy weight lifting. No cardio for me as I have always been thin and had a fast metabolism and struggle to gain weight despite eating around 2500 calories a day. The only herb that I haven’t tried which you mentioned in the low estrogen chapter is shatavari – thoughts on that? It seems that I am deficient in hormones all around: estrogen and progesterone 🙁 Thank you so much for revisiting these comments and taking the time to respond. I’m wondering if I should have my cortisol levels checked again, or just assume that they’re still high…

  96. Hi, I’m 42 and have been having v heavy periods for about 6yrs now. Flooding, changing my tampax 3 times in 1hr it’s a nightmare. I had a scan recently which revealed I had a small fibrod. I tried the mirena coil, but unfortunately bled for 4 months and then had it removed. Where do I turn now? Doctors don’t help. Thanks

    Reply
  97. Good morning Dr. Lara Briden.
    I am 21 years old and have only one ovary. I lost my left ovary last year to a cyst (217cm³) . Yesterday made ​​an ultrasound and showed a cyst (4cm) in the single ovary I have. I’m too afraid of losing it and can no longer get pregnant . What can I do? Please help me!

    Reply
  98. Hello. I am 38 have light, regular periods and minimal breast pain cramps. However I do have terrible mood swings and migraines with aura at ovulation and menstruation. Is this symptomatic of high estrogen?

    Reply
    • The best gauge of estrogen is the amount of menstrual fluid. You say your periods are light, so you’re unlikely to have estrogen excess.
      I discuss a few options for migraines in my book, including progesterone.
      I need to do a post on migraines.

      Reply
      • Thanks so much. A migraine post would be seriously awesome. My cousin had migraines too until the menopause when they ceased.

        Reply
  99. Hi, I’d be very grateful for your advice. I’m 50. 3 years ago I put on 3.5 stones in 6 weeks for no apparent reason and I can’t lose it no matter what I do. My diet is already very healthy and I don’t each much so it isn’t real weight gain.
    I’m totally exhausted, depressed, have crippling lower back pain.
    I’m hot like a radiator, I can’t sleep, my hands are puffy and swollen.
    My periods were getting closer together, shorter but heavier before HRT.
    My mother in law is 83 and is much healthier and mobile than I am.
    My GP has prescribed HRT, I don’t like it but I’m so desperate that I first took combined tablets and am now using patches.
    The oestrogen patch helps, the pain in my back eases dramatically so I can even pick things up off the floor without crying and not being able to get back up.
    I’ve managed to lose half a stone but no more.
    I bleed erratically now.
    The progesterone patch makes no difference at all, the pain etc comes straight back in those 2 weeks.
    Should I just try natural progesterone instead? Oestrogen as well?
    Without HRT (and with the progesterone patches) I’m so exhausted, depressed and in so much pain that I find it very difficult to get up and go to work each day, let alone deal with my family.
    I’ve changed GP once already.
    Please can you give me some advice so I can help myself to feel better because I’ve tried so hard and I just don’t know what else to do.
    Thanks so much.

    Reply
  100. I am 47. I started using Lugol’s iodine about 5 years ago to assist with hypothyroidism. To my surprise, it made my PMS disappear! Maybe that is why I am not suffering from emotional issues with perimenopause. I am dealing with night sweats and sleepless nights. I am taking an Estro-G product along with spraying lavender oil on my pillow and around bedroom at night. Both seem to be working well for me. I can’t seem to tolerate natural progesterone cream. It makes me freezing cold, like it is negatively affecting my thyroid. I’d love to know why it is doing that.

    Reply
    • Thanks for sharing your story. I had not encountered that as a side effect of progesterone. But it sounds like it’s a not a good choice for you.

      Reply
  101. Hi Lara. For estrogen excess, do you recommend tasking the DIM the whole month? And progesterone? The whole month or second half (if still getting regular ish cycles). And can estrogen excess cause shorter cycles?

    Reply
    • Shorter cycles and estrogen excess go hand-in-hand, and are both a common feature of perimenopaue. They both happen because of high FSH, which overstimulates the growing ovarian follicles.
      Generally Yes, DIM can be taken all month, but I usually recommend progesterone only in the luteal phase. See my book for more detail about the safe use of progesterone.

      Reply
  102. Hi Lara,
    I have had huge success with the recommendations in your book for endometriosis.
    I started this year, and for the first time in my life my last period was pain free!
    I am not sure I am in perimenopause yet, but at 43 would you recommend I start progesterone based on my age?
    Thanks so much for all you do, it is life changing.

    Reply
    • Hi Lisa,
      thanks so much for your comment. It’s ok to use progesterone at 43, but you may not need it.
      Please send me a private message.

      Reply
  103. I thought I was going crazy, anxious and depressed. I just couldn’t function and wanted to end it all but couldn’t because I have children. I also thought my heavy periods and sore breasts had nothing to do with my crazy mental issues.

    By some fluke I stumbled upon your website. Your articles gave me some direction (especially when my brain wasn’t functioning very well) as opposed to my female Dr who insisted on a quick fix bandaid solution of drugs. After implementing one change, I realised I’m not depressed or suffering anxiety as my Dr insisted I am and I dont need to start any antidepressants.

    The nascent iodine I got from a chemist in the northern area of Sydney is working. My breasts have reduced in size (I will never complain about my size b breasts again and an augmentation has been scratched off my bucket list), my periods are back to normal and I think I detect happiness. I forgot that I can feel this way. My estrogen levels must have been creeping up for years until it affected my brain in such a negative way which got my attention.

    Thank you to everyone who has ever posted on this blog and thank you Lara. My appreciation is paramount.

    Reply
  104. So my periods are completely normal. My diet is healthy and varied I have always strongly looked after my gut health as such. My moods are incredibly hard and I am incredibly depressed about 10 days before my period. Should I take magnesium and use natural progesterone?

    Reply
    • Since you are so healthy generally, you probably want to start with simple nutritional treatment for PMS before resorting to progesterone. Please see my PMS post for more information.

      Reply
  105. What do you recommend for natural topical progesterone and how much and how often and during what part of the cycle? Thanks so much!

    Reply
  106. A great article, thank you for sharing this info. What are your thoughts on Wild Yam cream as a topical form of natural progesterone?

    Reply
    • Wild yam itself is not progesterone, but it’s confusing because real progesterone cream used to be sold and marketed as wild yam cream.

      These days, progesterone cream is clearly marked as what it is. Most over the counter brands are a 2% cream, providing 20 mg per gram (per 1/4 tsp).

      Reply
  107. Thanks to the Period Repair Manual, at age 46, for the FIRST TIME in my life….I began having regular cycles! What a relief for my body, and my mind! I had been on the pill for years, and last summer endured fibroid removal and a D&C. My period hadn’t returned after two months…that’s when I discovered the Manual. I am so grateful for the book, and for this opportunity for my body – to recover my long-muted libido, and to experience regular periods -I’m now 47, so I know that I won’t be cycling forever!

    Lara, would you please consider writing a guide to peri/menopause? Sort of a sequel to the Manual? I’m wondering which of the supplements/tactics (recommended in your book) that I’m using for PCOS should be continued throughout the years of hormonal fluctuation, and beyond.

    Thank you for offering a wealth of clear and invaluable information. I’m evidence that women of all ages can put it to good use!

    Reply
    • Hi Sally, thanks so much for your feedback. Yes, I do need to write a menopause manual. I will think about it.
      As for PCOS transitioning in to menopause, the priority is to continue to manage insulin resistance (if that’s the type of PCOS you have). Insulin resistance can worsen hot flashes and the menopause transition.

      Reply

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