Progesterone levels progressively decline over the course of the menopause transition. However, this decline doesn’t follow a steady downward trajectory. Levels fluctuate unpredictably, causing an imbalance between estrogen and progesterone, which triggers a variety of menopausal symptoms.
Low progesterone is a result of natural ovarian aging. When levels are lower than the body’s estrogen levels, symptoms may show up in the form of mood swings, sleep disruptions, or heavy menstrual bleeding.
Because hormone levels fluctuate throughout the day, hormone testing is not recommended as a reliable means of diagnosing low progesterone. Doctors recommend keeping a symptom diary to keep track of the symptom type, severity, and frequency.
Making certain dietary adjustments, getting regular aerobic exercise, and managing stress levels are lifestyle strategies that can help reduce symptoms related to menopausal hormone imbalances.
Progesterone is an essential part of a combined hormone replacement therapy (HRT) treatment regimen. While it may help reduce certain menopausal symptoms, such as sleep disturbances, it’s primarily used for uterine protection. Progesterone balances out estrogen’s stimulating effects on the uterus, including uterine cell growth and thickening of the endometrial tissue, which can increase the risk of certain health conditions.
Low Progesterone During Menopause: Causes, Symptoms & Treatments
Erin Marie McCluskey
Dr. Saranne Perman, MDArticle Content
The Bottom Line:
While estrogen often takes center stage, progesterone is just as important and influences various body functions, including sleep, mood, and bone health. During menopause, progesterone production typically declines, potentially leading to a range of menopausal symptoms.(1)
It’s essential to know that the balance between estrogen and progesterone levels is crucial, often more so than their individual levels. For instance, when there isn't enough progesterone to counterbalance estrogen, elevated estrogen levels can cause a variety of symptoms during this transitional phase.
What causes low progesterone during menopause?
Progesterone is primarily produced by the corpus luteum, a temporary gland created during ovulation. As ovulation slows down and eventually stops with the progression of menopause, progesterone production typically declines. This decline can be influenced by the natural aging of the ovaries and fluctuating hormone signals from the brain.(2) However, the reduction in progesterone levels during menopause is not always steady and can fluctuate throughout the menopausal transition.
At the same time, the body may also produce less estrogen, though not always in the same proportion. This imbalance between estrogen and progesterone, combined with low progesterone levels, can cause various menopausal symptoms.
In addition to the natural reduction in hormone production during menopause, several other factors can contribute to low progesterone levels:(1)(3)(4)
Stress
Thyroid conditions
Certain medications like antidepressants
Extreme dieting
Low Progesterone Symptoms in Females
Most menopausal symptoms stem from an imbalance between estrogen and progesterone levels. While it can be challenging to isolate symptoms caused solely by low progesterone, some signs that may indicate this imbalance include the following:(1)(3)(4)
Mood swings, irritability, or heightened anxiety
Sleep disturbances
Heavy periods
Diagnosing Low Progesterone Levels
A blood test can provide insight into progesterone levels, but it may not always be the most reliable method for diagnosing hormonal imbalances during menopause.
Hormone levels, including progesterone, fluctuate significantly throughout the day and menstrual cycle, which can make test results inconsistent.(5) For this reason, doctors usually recommend maintaining a symptom diary to gain better insight into symptom severity and how they respond to treatments or lifestyle changes.
How to Treat Low Progesterone Naturally
Progesterone levels naturally decrease during menopause, but there are ways to support the body in maintaining balance. Certain lifestyle changes can promote the natural production of progesterone and slow its decline. However, combining these approaches with hormone replacement therapy (HRT) may be a better solution for maintaining hormone levels during this transition. Research highlights several strategies that can help support progesterone levels during menopause.
Lifestyle Modifications
Managing Stress: Excessive stress can raise stress hormone levels, which may influence the ovaries and cause low progesterone levels. Meditation, deep breathing exercises, and journaling can be effective in reducing stress.(6)
Getting Enough Sleep: Poor or insufficient sleep can elevate stress hormone levels and cause hormonal imbalance. Practicing good sleep hygiene supports balanced progesterone levels and improves overall health.(7)
Maintaining a Healthy Weight: Excess weight can contribute to hormonal imbalances and insulin resistance, which can affect ovulation and progesterone production. While maintaining a moderate weight may not directly improve progesterone levels, it can help keep hormone levels balanced within a healthy range.(8)
Dietary Changes and Supplements
Although progesterone isn’t present in food, some foods can support the body’s natural production of progesterone:(9)
Milk
Meat
Yogurt
Potatoes
Soybean
Olive oil
Some women may also consider herbal supplements to boost progesterone levels, like chasteberry and evening primrose oil.(10)(11) However, these supplements don’t undergo the same rigorous testing as prescription medications, and there is limited evidence to support their effectiveness in raising progesterone levels. It’s important for anyone considering these options to consult with a healthcare provider.
Exercise
Regular physical activity can help lower stress hormone levels, which may otherwise suppress progesterone production and lead to hormonal imbalances. It's important to note, however, that excessive or intense exercise can increase cortisol levels, potentially affecting ovulation. It’s recommended to focus on moderate-intensity activities and limit vigorous exercise to maintain hormonal balance.(12)
Beneficial forms of exercise include the following:
Walking
Jogging
Yoga
Biking
Swimming
Other Potential Treatments for Low Progesterone During Menopause
HRT supplies hormones externally to help maintain steady levels during menopause. It can be a viable option for managing low progesterone levels during menopause and alleviating symptoms like mood swings, sleep disturbances, hot flashes, and more.
It’s important to note that HRT primarily uses estrogen to help women manage menopausal symptoms. For women with an intact uterus, doctors often prescribe a combination of estrogen and progesterone to prevent the excessive growth of uterine lining cells, known as endometrial hyperplasia. Typically, progesterone is not used alone. However, in cases where estrogen therapy is not an option, some women may benefit from progesterone supplementation alone.
It’s also crucial to recognize that not all HRT options are created equal. Bioidentical hormones, derived from natural sources and chemically identical to those produced by the body, are often considered a better option than synthetic hormones. They provide a more natural approach to hormone therapy and are considered to have fewer side effects and offer better symptom relief.(13)
For women who may benefit from progesterone HRT, doctors often recommend starting with the lowest effective dose.
There are several options available for improving progesterone levels:
Progesterone Creams: Applied directly to the skin, creams allow for easy absorption and targeted relief.
Progesterone Capsules: Pills or capsules are taken orally and offer a simple and effective way to balance hormone levels. Progesterone pills are usually taken along with estrogen pills to promote hormonal balance during menopause.
Combination Creams: These creams combine estrogen and progesterone to address both hormone imbalances simultaneously.
Experiencing hormonal symptoms in menopause? Discover if HRT is right for you.
If you’ve entered menopause and are struggling with symptoms, take our brief menopause quiz to see if HRT is right for you. Start with Winona to feel better.
Frequently Asked Questions (FAQs) About Low Progesterone During Menopause
Yes, low progesterone can contribute to anxiety and panic symptoms during the menopause transition. Progesterone influences the GABA network in the central nervous system, which helps regulate mood and stress responses. As progesterone levels decline, some women may experience increased irritability, worry, or emotional sensitivity.
Yes, progesterone may help improve sleep during menopause by promoting relaxation and supporting the body’s natural sleep cycle, which can enhance overall sleep quality.
Yes. While estrogen decline is the primary driver of vasomotor symptoms, low progesterone can make hot flashes and night sweats worse because the hormone plays a key role in stabilizing the brain’s thermoregulatory system. When progesterone levels drop, the brain becomes hypersensitive to small temperature changes that may trigger hot flashes or night sweats as the body attempts to cool itself.
Progesterone levels often drop before estrogen during perimenopause because ovulation becomes irregular as ovarian function gradually changes with age. Progesterone is produced after ovulation, so fewer ovulatory cycles can cause an earlier decline in progesterone compared to estrogen.
“Estrogen dominance” is not a recognized medical diagnosis and is often used inaccurately to describe high levels of estrogen. What’s really occurring is a relative hormonal imbalance, where progesterone levels fall faster than estrogen levels during perimenopause.
Even if estrogen levels are within a normal range, this lower progesterone-to-estrogen ratio can trigger symptoms such as mood swings, weight gain, reduced sex drive, and changes in menstrual patterns.Bioidentical progesterone is derived from plants and has the same chemical structure as the body’s natural progesterone, making it more compatible. Synthetic progestins are deliberately designed with a slightly different chemical structure to alter how long they remain in the body. Some women report being better able to tolerate bioidentical progesterone.
It’s generally recommended to take progesterone at night because it has a sedative effect that can promote relaxation and improve the quality and duration of sleep during menopause. Taking it in the evening also reduces the likelihood of daytime drowsiness.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
References
Hormone Variability and Hot Flash Experience: Results from the Midlife Women’s Health Study
Interactions Between Sleep, Stress, and Metabolism: From Physiological to Pathological Conditions
Naturally Occurring Hormones in Foods and Potential Health Effects
Evening Primrose (Oenothera biennis) Oil in Management of Female Ailments