When I think about progesterone, I think of it as the calming hormone. Anxiety during perimenopause is a very common problem. As I have stated before, I was guilty of prescribing antidepressants for the 35-45-year-old woman coming in complaining of anxiety or depressive symptoms. You know, I always got the question, “Why me? My life is just fine. I have nothing to be anxious about.” My typical answers were, “We don’t know,” or, “It just happens.” Good scientific explanations, right? I now think completely differently when I look at symptoms having a better armamentarium and knowledge of the physiology and functions of hormones other than making babies! I think: does this woman have a hormone imbalance? Is there a deficiency of nutrients causing a lack of neurotransmitters? More often than not, this is a progesterone deficiency. Without progesterone, women may feel more overwhelmed and easily stressed. In many women this leads to anxiety issues, including tension headaches, palpitations, digestive symptoms and more. In some cases, this can lead even to full-blown panic disorder.

When the body is stressed, it produces more of the stress hormone cortisol. Progesterone is an important precursor to cortisol and in times of stress, when the body is making more of this, progesterone levels may suffer.

Again, we get back to the issue of estrogen dominance. The imbalance of estrogen and progesterone is the basic issue; but, again, we have to remember that there are numerous xenoestrogens in our environment such as plastics, pesticides, household products, as well as foods containing hormones, like what is injected into cows and chickens. So instead of just getting progesterone prescribed, ideally we need to address those issues related to cortisol in addition to environmental influences.

Insomnia can become a big issue for some women in their 30’s and 40’s. Many times in my practice, a little progesterone orally will help sleep patterns tremendously. This is because oral progesterone is broken down into allopregnanolone which potentiates the GABA receptors in the brain, thereby helping with insomnia.

Progesterone is important in the prevention of bone loss (osteoporosis). As referenced in the Journal of Osteoporosis 2010, P4 (progesterone) prevents bone loss in pre and possibly postmenopausal women. Progesterone co-therapy with antiresorptives may increase bone formation and BMD. Not that I, in general, am in favor of antiresorptives. This is a personal bias.

Progesterone can have a marked effect on pain and inflammation. Frequently, I will have a woman come back to the office stating that the pain in her muscles and joints has significantly improved since the addition of progesterone. And typically, this is just progesterone that has been added as these patients are usually in the pre-menopause phase.

Especially in conjunction with estrogen replacement, progesterone can have a nice effect on your HDL cholesterol. Remember, the HDL cholesterol is the “good” cholesterol. And thereby, beneficial effects can occur on the heart.

Do you have problems with heavy menstrual cycles? Many times in premenopausal woman, this is simply a problem of not enough progesterone or estrogen dominance. I cannot tell you how many times I have seen women who have had an endometrial ablation when simply a little progesterone possibly may have helped this. Again, this is not the only reason for heavy menstrual cycles, but it is an important and many times unrecognized one.

Hair loss is something I see frequently. This is not usually due to an isolated progesterone deficiency. However, progesterone is part of the recipe for healthy hair. Other things I tend to look for with this problem include thyroid problems, autoimmune disease, iron deficiency, B vitamins, especially biotin and of course, stress!

So, are there any ways to naturally improve your progesterone levels? A few thoughts about this: The precursor of progesterone is cholesterol. In fact, cholesterol is the precursor of all of our steroid hormones. You actually need a cholesterol level of around 140-150 in order to make adequate levels of hormones. And in this society, some people think that the lower the cholesterol, the better. I will leave it at that. Cholesterol is also very important for brain health. So, if you are on a cholesterol-lowering medicine, keep in mind that stress was alluded to earlier. Consider ways to help you de-stress. Excessive sugar, excessive saturated fat, deficiencies of vitamins A, B6, C, zinc as well as low thyroid hormone can cause low progesterone. Another very important cause of low progesterone I see all of the time in my practice is oral contraceptives.

Progesterone has so many wonderful and beneficial effects in the body. This is not a complete list of all of its beneficial effects, but I hope it is a good start for you. In traditional medicine, it is the “forgotten hormone,” or at a neglected one. But, as importantly, doctors tend to think of it just as they do synthetic progestins. Many times in the literature, you really have to read the actual study since the topic of the article may say progesterone when actually the discussion is on synthetic progestins. Many, many authors do not differentiate between the two; and hence, the harmful side effects that are associated with synthetic progestins are attributed to natural progesterone as well.

I shall end with a short patient’s story. A 47-year-old nurse came to me because she had become gloomy. She no longer enjoyed being with her grandchildren who were the delight of her life. She was irritable. She wanted to be alone and not with other people. All of these were out of character for her. She had developed low progesterone and estrogen dominance. She was started on progesterone and three weeks later she told me her life had changed back to what it was before. She was ecstatic. I jokingly said that if she had come to me 10 years earlier with this complaint, I would have put her on an antidepressant. Her response was that one of her friends did have the same symptoms and went to her physician and, indeed, was placed on Zoloft. This is your choice.

John B. Abell M.D.