What (key) role does progesterone play during menopause?

Progesterone is produced in the ovaries, the placenta during pregnancy, and the adrenal glands. During your reproductive years, its primary function is to prepare the uterus for fertilisation and support a healthy pregnancy. However, progesterone also serves other important purposes. It helps stabilise oestrogen levels, supports proper thyroid function, maintains body temperature, has a calming effect, and aids in removing excess fluid from the body.

Progesterone and oestrogen work in tandem throughout your menstrual cycle. Oestrogen stimulates the growth of the uterine lining, while after ovulation, the ovaries produce progesterone to thicken the uterine lining and prepare it for a potential pregnancy. If pregnancy does not occur, progesterone levels drop, leading to menstruation.

Have you experienced PMS during your reproductive years? If so, you may already be familiar with the effects of an imbalance between progesterone and oestrogen. Just before menstruation, progesterone levels drop sharply, which can exacerbate typical PMS symptoms such as mood swings, irritability, and fluid retention. This sudden drop may also cause weight gain or swollen, tender breasts. Read more about the role of oestrogen during menopause.

It is well known that both oestrogen and progesterone levels decrease during menopause. Progesterone may begin to decline as early as your late thirties or early forties. From perimenopause onwards, this decline can result in irregular menstrual cycles.

If it has been twelve months since your last period, you are considered to be in postmenopause. At this stage, the ovaries produce almost no progesterone. Instead, other organs, such as the adrenal glands and fat tissue, take over the reduced production. During this phase, progesterone levels stabilise at a consistently low level. After menopause, women still require progesterone, albeit in smaller amounts than before.

Because progesterone levels drop earlier than oestrogen levels, oestrogen dominance can occur during perimenopause. This can lead to various symptoms, the most common of which include hot flushes, mood swings, and weight gain.

As the ovaries gradually stop producing progesterone, the adrenal glands slowly take over its (reduced) production. However, the adrenal glands also produce other hormones, such as the stress hormone cortisol. From an evolutionary perspective, cortisol production takes precedence over progesterone production. Are you under a lot of stress? If so, your adrenal glands may prioritise cortisol production, leaving less focus on progesterone production, which can exacerbate symptoms.

Progesterone promotes calmness, relaxation, and positive thoughts when present in sufficient amounts. A low progesterone level during menopause can lead to:

• Mood swings
• Shorter menstrual cycles
• Feelings of anxiety
• Night sweats

Menopausal symptoms can be alleviated by making adjustments to your diet, engaging in daily physical activity, and maintaining healthy habits:

• Ensure healthy meals. Incorporate plenty of fruits, vegetables, whole grains, healthy fats (such as avocados, nuts, and seeds), and proteins to support hormonal balance.
• Lower your cortisol levels. Reduce stress so your adrenal glands can focus on producing progesterone. Relaxation techniques such as yoga, meditation, or breathing exercises can help reduce tension, stress, and feelings of anxiety. Taking more breaks and slowing your pace can also be beneficial.
• Exercise daily. Stay active every day, even if it’s just a short walk or bike ride. The recommendation? Exercise for at least 30 minutes a day. This not only helps reduce stress but also stimulates the production of endorphins, often referred to as "happiness hormones."

Hormone therapy is an effective treatment for relieving mild to severe menopausal symptoms. The type of hormone therapy that suits you best depends on your symptoms, the stage of menopause you are in, your preferences, and your medical history.

Hormone therapy with progesterone can help in the following situations:

• In case of a progesterone deficiency. For symptoms such as irregular periods, sleep problems, or mood swings, administering progesterone as a single hormone can be beneficial. This is particularly useful during perimenopause or postmenopause when progesterone levels naturally decline or have already dropped significantly. For sleep problems, it may be helpful to take progesterone about an hour before bedtime.
• If you have an intact uterus. If a woman uses oestrogen and still has a uterus, progesterone is added to reduce the risk of thickening of the uterine lining. Oestrogen stimulates the growth of the lining, while progesterone helps maintain balance.
• To regulate your cycle. For an irregular or absent menstrual cycle, progesterone can help stabilise the cycle.