Body-identical or bioidentical progesterone can treat women’s health conditions such as PCOS, PMDD, migraines, endometriosis, adenomyosis, and perimenopause.
It’s called progesterone oral micronized progesterone and requires a doctor’s prescription. Brand names include PrometriumⓇUtrogestanⓇTevaⓇand FamenitaⓇ, depending on your country. Alternatively, progesterone cream is available over-the-counter in some countries and may help with mild symptoms but is generally not as effective as progesterone capsules.
Here’s what you need to know.
First, progesterone is different from progestins such as norethisterone, levonorgestrel, and drospirenone. Progestins are sometimes referred to as progesterone, but they shouldn’t be because progestins are not progesterone and have their own set of drug side effects. For example, levonorgestrel is quite similar to testosterone (in fact, it is derived from testosterone), so it can cause androgen side effects such as weight gain. If you’re not sure whether you’ve been prescribed progesterone or progestin, read the ingredient label and consult this chart.
Second, progesterone may be worth trying, even if you have “progesterone sensitivity” or premenstrual dysphoric disorder (PMDD). It’s all about the dose. Because of the bimodal relationship between serum allopregnanolone and bad mood, you may do better with a higher dose (eg 200 mg capsule) than with a cream.
👉🏽 Tip: If you consistently experience distress from progesterone capsules at any dose (but you need to take progesterone), consider switching to a vaginal progesterone pessary.
Third, understand that your doctor may, unfortunately, be reluctant to prescribe real progesterone because it is currently only approved for menopausal hormone therapy and not for conditions such as heavy bleeding, endometriosis, or adenomyosis. However, the consensus from the gynecologists I spoke with is that progesterone can be used for those conditions, with a few caveats:
- True progesterone is milder than a progestin, so it needs to be used in higher doses to have the same effect on easing periods.
- True progesterone may not be strong enough for some conditions, such as endometrial hyperplasia
- real progesterone can be more expensive than a progestin. (Depending on the pharmacist, it costs 30-50 cents per day.)
👉🏽 Tip: Oral micronized progesterone does not carry a clotting risk like oral estrogen and some progestins.
Conditions that benefit from progesterone
Menopause (either progesterone-alone or with estrogen as part of menopause therapy). Progesterone may help even if you are sensitive to progesterone and even if you do not have a uterus. Your doctor may think that progesterone’s only job is to protect the uterus, but it has many other benefits, including promoting sleep, bone strengtheningand protects the breasts. Progesterone-alone has several advantages over estrogen: 1) it’s better for sleep and migraines, 2) it’s safer for the breasts, and 3) it’s easier to stop because it’s not as addictive as of estrogen.
If you want to try progesterone-alone for menopause, try saying:
“According to Canadian endocrinology professor Jerilynn Prior, micronized progesterone alone can relieve menopausal symptoms.” Print the following study and bring it to your appointment: Oral micronized progesterone for vasomotor symptoms—a randomized placebo-controlled trial in healthy postmenopausal women. Or just accept the script for both estradiol and progesterone but start by taking only the progesterone.
Perimenopauseas described in my book Handbook of Hormone Regulation and my blog post, Rescue prescription for perimenopause. If you need help getting a prescription, try saying:
“According to Canadian endocrinology professor Jerilynn Prior, micronized progesterone may be helpful for perimenopausal symptoms.” Print the following study and bring it to your appointment: Oral micronized progesterone is useful for perimenopausal hot flushes/flashes and night sweats.
Heavy times, as described in my books and blog post, How to treat heavy periods with diet and natural progesterone. If you need help getting the script, try saying:
“Can I try a few months of Prometrium or Utrogestan for heavy bleeding (or pain)? I understand that it can work as well as a progestin to lighten the flow (or help with pain) but without the side effects. See this protocol by Canadian endocrinology professor Jerilynn Prior. Print the following document and bring it to your appointment: For health care providers: management of menorrhagia without surgery. Draw your doctor’s attention to the paragraph that states: “For heavy flow in a woman who already has anemia or is in Very Early Perimenopause with regular cycles or in the Early Menopause Transition Phase with irregular cycles and typical perimenopause experiences such as night sweats, new sleep problems, and increased premenstrual worries, full-dose oral micronized progesterone (OMP, 300 mg at bedtime) should be given daily for for a full three months.
Endometriosis and adenomyosisas described in my books, particularly the story of Hannah’s endometriosis patient in Weather Adjustment Manual and Francine’s adenomyosis patient story in Handbook of Hormone Regulation. Progesterone helps suppress the growth of endometrial tissue and regulate the immune system—therefore, potentially also addressing the immune dysfunction at the heart of both conditions. See also my blog post Immune treatment for endometriosis. Progesterone can be used Furthermore with a hormonal IUD.
Migraines, as described in my new book and blog post, Natural treatment of menstrual or hormonal migraines. Progesterone may prevent migraines by reducing histamine and glutamate and by calming the brain. Progesterone capsules are usually the best treatment for migraine prevention, but progesterone cream is also an option.
Perimenopausal and premenstrual mood symptoms (PMDD)as described in my blog post Top 6 natural treatments for premenstrual mood symptoms.
PCOS, as described in my peer-reviewed paperProfessor New protocol for cyclic progesterone therapy, and my blog post, Cyclic progesterone therapy for PCOS. Progesterone treats PCOS by lowering androgens and helping to restore ovulation.
Of course, just progesterone an aspect of treatment for all these conditions. It combines well with other treatments, such as magnesium for migraines, inositol for PCOS, and immune treatment for endometriosis.
