Why Your Progesterone Cream is Not Working
Thinking about using progesterone cream to manage symptoms of perimenopause or menopause? Progesterone is a necessary part of a hormone replacement therapy (HRT) strategy for midlife women who choose to do HRT, but is rarely successful as a standalone treatment for any length of time. Perimenopause, also called the menopausal transition, typically commences in a woman’s forties and often comes with symptoms. Menopause is defined simply as 12 months without a menstrual cycle.
Progesterone and estrogen are the two primary female sex hormones. Most women make progesterone and estrogen in reliable monthly amounts throughout their 20s and 30s and into their early 40s. Progesterone is made only when we ovulate. At some point, usually in the 40s, ovulation sputters (meaning, it doesn’t happen at reliable monthly intervals) which causes progesterone levels to drop sharply and the transition towards menopause begins.
Some of the symptoms of perimenopause and menopause are:
Anxiety (that worsens or appears out of nowhere)
Progesterone cream to the rescue, right? It’s available everywhere (from Amazon to your local health food store) and recommended by large swaths of women in online support groups claiming that it fixed all of their issues, so why not, right?
Progesterone only treatment for perimenopausal women (whether done as a DIY project, something I don’t recommend, or prescribed by your doctor) can work for some women initially but it usually stops working and can cause unwelcome consequences.
While progesterone has its place in an HRT regimen for midlife women, it is over-hyped, over-used and poorly understood.
Before we explore the reason why progesterone only as a treatment for the symptoms of perimenopause and menopause is faulty, we first need to understand the role it plays in a pregnancy.
Stay with me….this is going to make a LOT of sense.
Progesterone is a key part of the menstrual cycle and helps maintain pregnancy (pro-gestation, get it?). Because the prime directive of life is reproduction (whether you ever have a baby or not, this is how the species continues!), the successful maintenance of a pregnancy requires several metabolic and physiological changes that prepare a woman to nurture a growing baby inside of her body. During pregnancy, the level of progesterone is about 10 times higher than during the menstrual cycle.
Let’s consider some of these changes that progesterone induces during pregnancy and consider if this is what we are going for as we move towards menopause:
Why does progesterone cream stop working?
Progesterone absolutely has its place in a midlife woman’s hormone balance strategy, but first a little bit about how hormones work in concert with each other: Hormones work like a lock and key system. The hormone is the key and the receptor is the lock. Hormones are created in glands and swim in the bloodstream to target tissues which have receptors for hormones all over them. Simply put, in order for progesterone to work, it needs a dock into a progesterone receptor.
Want to know what creates receptors for progesterone?
Which means you need to have an adequate level of estradiol (the primary estrogen in premenopausal women) for progesterone to have the correct effects in the body.
For women that have estradiol in decline (which happens at some point in the menopausal transition, though it tends to decline after progesterone drops), the benefits of progesterone are limited at best or wholly useless. The benefits of using progesterone simply aren’t available without receptors for progesterone.
This is why progesterone may work initially for some women. It’s because they have enough estradiol in the body to create receptors for progesterone. When this estradiol level drops out, as it will do in ALL women at some point, progesterone cream as a standalone strategy is more problematic than helpful. It may actually feed into bloat, weight gain, cause an increase in cortisol and thus feelings of stress and overwhelm and low mood. The very things that midlife women tend to struggle with.
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