Progesterone: The Unsung Hero of Menopause Care

When we talk about hormone replacement therapy (HRT), estrogen usually gets all the credit. It’s often thought of as the “worker bee” hormone—the one doing all the heavy lifting. But there’s another hormone quietly working in the background that deserves just as much respect: progesterone.

I tell my patients all the time—progesterone doesn’t get enough love, but it should. Especially the bio-identical form, which is very different from the synthetic progestins used in many birth control pills.

What Does Progesterone Do?

Progesterone works hand in hand with estrogen, creating balance in your hormone system. But it’s not just a sidekick—it brings its own unique benefits:

• Calms the brain and eases anxiety

  Progesterone has a naturally calming effect and can help reduce mood swings and irritability.

• Improves sleep

  In oral form, bio-identical progesterone is one of my favorite natural sleep aids. Many women finally get the deep, restful sleep they’ve been missing once we add it in.

• Supports heart health

  It helps relax blood vessels, which can positively impact blood pressure.

• Acts as a natural diuretic

  Progesterone reduces fluid retention and that uncomfortable "puffy" feeling.

• Protects the breasts

  Progesterone helps breast cells complete their normal life cycle and die off when they should—one of the body’s natural defenses against breast cancer.

• Protects the uterus

  Unopposed estrogen (estrogen without progesterone) can cause overgrowth of the uterine lining, increasing the risk of uterine cancer. This is why every woman with a uterus who takes estrogen for HRT must also take progesterone.

  
  

Progesterone and Your Adrenal Hormones: Cortisol & DHEA

What many women don’t realize is that progesterone is also deeply connected to your adrenal system—especially two key adrenal hormones: cortisol and DHEA.

• Cortisol is your “get up and go” hormone, responsible for energy, stress response, and inflammation regulation.

• DHEA is a precursor to other hormones, including estrogen and testosterone, and it supports mood, immunity, and vitality.

  
  

When you’re under chronic stress, your body ramps up cortisol production, often at the expense of other hormones—including progesterone. This imbalance can lead to symptoms like anxiety, poor sleep, fatigue, and irritability.

Progesterone has a regulating effect on the HPA (hypothalamic-pituitary-adrenal) axis. It can help:

• Soften the effects of cortisol overproduction

• Support adrenal recovery in states of chronic stress

• Restore balance between cortisol and DHEA, which is often disrupted during perimenopause and menopause

  
  

This is one of the reasons why some women report feeling calmer, more energized, and more emotionally stable once we introduce progesterone into their care plan—even when they don’t “need” it for uterine protection.

Beyond the Basics: Hair and Bone Health

Newer research and clinical experience are showing that progesterone may also play supportive roles in hair and bone health—two areas that matter deeply to many midlife women.

• Hair support

  Progesterone may help slow hair thinning by decreasing activity of 5-alpha-reductase—an enzyme that converts testosterone to DHT, a major player in female hair loss. While large studies are still lacking, many women report less hair shedding and improved scalp health when their hormones are well balanced.

• Bone building

  Estrogen remains the MVP of bone protection, but progesterone stimulates osteoblasts, the bone-building cells. There’s growing evidence that progesterone may help maintain bone density, especially in perimenopause when bone loss can begin before estrogen drops significantly. Used together, estrogen and progesterone may support bone health more effectively than estrogen alone.

What If I Have an IUD or No Uterus? Should I Still Consider Progesterone?

Absolutely—and this is a conversation I love having with my patients.

If you have a progesterone-containing IUD (like a Mirena), you’re already receiving localized progesterone to protect the uterine lining. And if you’ve had a hysterectomy, you technically don’t need progesterone (for uterine protection).

But here’s the thing: progesterone does so much more than protect the uterus.It improves sleep, calms the brain, helps manage cortisol, supports adrenal health, and may even benefit bones and hair. I often encourage my patients—even those without a uterus—to consider bio-identical progesterone simply because of how many women feel noticeably better with it on board.

That said, not every woman feels great on it. Some don’t tolerate it well—and that’s completely okay. If uterine protection is still needed and you don’t tolerate oral progesterone, we can get creative with alternatives, like vaginal forms or different dosing strategies. That’s the beauty of individualized care. There's always a solution that prioritizes your well-being.

Why I Generally Avoid Synthetic Progestins

Not all “progesterones” are created equal. Synthetic progestins, such as those found in many birth control pills or older hormone therapies, don’t act the same as natural progesterone.

In fact, they can block your own progesterone receptors, leading to frustrating side effects like:

• Increased appetite

• Fluid retention

• Breast tenderness

• Low libido

• Hair loss

• Depression

  
  

Whenever possible, I use bio-identical progesterone, which exactly matches the progesterone your body used to make. It’s better tolerated, works beautifully with estrogen, and avoids the side effects seen with synthetic versions. Still, in rare cases, a synthetic progestin might be necessary when bio-identical options aren’t tolerated and uterine protection is essential—and that’s okay too. We’ll make it work for you.

Bottom Line

Progesterone is far more than just a supporting player in HRT. It’s a calming, protective, adrenal-friendly, potentially bone- and hair-supportive hormone that deserves far more attention and appreciation than it typically gets.

At Dragonfly Menopause Care, I’m here to help you feel heard, understood, and supported. That includes giving progesterone the respect it deserves, and finding the best version of hormone therapy that works for your body, your life, and your goals.

Dragonfly Menopause Care Your Best Years Start Now

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