What role does progesterone play in managing menopausal symptoms?

Progesterone is a hormone made by a woman's ovaries, adrenal gland, and, during pregnancy, the placenta. It is the most important of a group of steroid hormones called the progestogens. Menopausal women experience a significant decrease in their progesterone level, which is important since natural progesterone improves pain tolerance, alleviates joint pain, and provides relief from anxiety. Progesterone also plays a crucial role in bone health by reducing the rate of bone absorption and minimizing calcium loss in urine. Additionally, it has a calming effect on the brain, promoting anti-anxiety responses. Menopausal women have a higher risk of ACL and MCL tears in their knees as well as shoulder injuries because progesterone stabilizes tendons and ligaments.

Women with a uterus require a progestogen or a selective estrogen receptor modulator (SERM) to reduce the risk of endometrial cancer that occurs when taking estrogen alone. Both progestogens and SERMs block estrogen from building the uterine lining, which reduces irregular bleeding and risk. Oral (but not transdermal) micronized progesterone provides this endometrial protection. Although some doctors recommend daily progestogen alongside estrogen, it is equally effective to take it only for two weeks each month. However, due to the challenge of remembering specific weeks, many women opt for daily intake. A new drug called Duavee is composed of conjugated estrogen and a SERM (bazedoxifene), which acts as an estrogen antagonist in the uterus, eliminating the need for additional progestogen to protect the uterus during its use. It's important to note that women without a uterus can safely take estrogen without progestogen or a SERM.

Micronized progesterone is also prescribed to menopausal women to help with joint pain, brain fog, anxiety, and disrupted sleep. There is evidence that progesterone alone, without estrogen, can improve symptoms like hot flashes and night sweats. Peri-menopausal women are often prescribed a progestogen-containing birth control pill or a progesterone IUD to manage the irregular bleeding common to peri-menopause.

The decrease in progesterone during menopause can cause unwanted symptoms that can be mitigated by taking progesterone alone or with estrogen as part of MHT. Menopausal women usually can take progestogens safely. Women with a uterus taking estrogen must take enough progestogen or a SERM like the one found in Duavee to protect their uterus from endometrial cancer. If you have a uterus and are taking estrogen but not a progestogen or Duavee, see your doctor at once. If you are not using MHT because you should not (or don't want to) use estrogen, you can talk to your doctor about using a progestogen alone to help with irregular menstrual bleeding during perimenopause, as well as hot flashes, night sweats, mood disorders, and/or sleep disruptions.