Progesterone in Menopause: Its Role, Symptoms and Treatment Options

Progesterone is a hormone made by the ovaries after an egg is released each month. Its best-known job is to prepare and then balance the lining of the womb. At midlife it matters for two reasons: it is often the first hormone to fall in perimenopause, and if you take estrogen as part of HRT and still have your womb, you will need a progestogen to keep the womb lining safe.

This page explains what progesterone does, how it changes around menopause, and the different types of progestogen a doctor may suggest. You may also want to read our pages on estrogen, testosterone and hormone replacement therapy (HRT).

A quick word on names

Progesterone is the natural hormone your body makes. Progestogen is the umbrella word for any medicine that acts like progesterone. This includes micronised progesterone (which is the same as the body's own hormone) and synthetic progestogens (sometimes called progestins), such as dydrogesterone, medroxyprogesterone, norethisterone and levonorgestrel.

What progesterone does in a woman's body

• The womb lining: in the second half of each menstrual cycle, after ovulation (the release of an egg), progesterone changes the lining so that it is ready for a possible pregnancy. If there is no pregnancy, progesterone falls and the lining is shed as a period.
• Balancing estrogen: estrogen makes the womb lining grow; progesterone keeps that growth in check.
• Pregnancy: it helps support a pregnancy in its early stages.
• Other effects: progesterone also acts on the brain and body temperature. Many women notice changes in breasts, mood, bloating or sleep in the days before a period, partly because of these hormone shifts.

What happens to progesterone in perimenopause and menopause

Progesterone is only made in good amounts after ovulation. In perimenopause, ovulation becomes less regular, and some cycles happen without an egg being released. In those cycles, very little progesterone is made.

Meanwhile, estrogen can still be high at times. This mismatch, with estrogen not balanced by progesterone, is one reason why periods can become irregular, heavier or longer in the years before menopause. After menopause, ovulation stops and progesterone levels stay very low.

Symptoms that can be linked to low progesterone

Research on symptoms caused by low progesterone alone is more limited than for estrogen, because the two hormones change together. Changes women often notice in perimenopause, where shifting progesterone may play a part, include:

• Irregular, heavy or prolonged periods
• Spotting between periods
• Worse premenstrual symptoms, such as breast tenderness, bloating and irritability
• Sleep problems
• Mood changes and anxiety

Please note: these symptoms are not proof of low progesterone. Heavy or irregular bleeding can also be caused by fibroids, polyps, thyroid problems, and occasionally by thickening of the womb lining or cancer. Heavy periods can also lead to anaemia, which causes tiredness and breathlessness. Any bleeding after menopause, or a big change in your bleeding pattern, should always be checked by a doctor. See our full list of menopause symptoms.

Do you need a progesterone blood test?

Usually not. Progesterone goes up and down across every cycle, and in perimenopause cycles are unpredictable. A single result tells you little about your symptoms or treatment.

NICE advises that in otherwise healthy women aged 45 or over, perimenopause and menopause should be identified from symptoms and periods, without laboratory tests. The Indian Menopause Society also says menopause is diagnosed from your history, with hormone tests such as FSH kept for special situations, like women under 40 or women who have had a hysterectomy. Progesterone levels are not used to diagnose menopause or to decide your HRT dose.

If you have heavy or unusual bleeding, your doctor may instead suggest a blood count (to check for anaemia), a thyroid test and an ultrasound scan of the womb.

Treatment options with progestogens

For most women at midlife, a progestogen is prescribed for one main reason: to protect the womb lining when estrogen is taken as HRT. Estrogen alone makes the lining grow, which over time raises the risk of thickening of the lining (endometrial hyperplasia) and womb cancer. The Indian Menopause Society notes that unopposed estrogen in women with a womb increases this cancer risk, and that adding a progestogen reduces it. Women who have had a full hysterectomy usually do not need a progestogen.

Types of progestogen

Type	How it is taken	Points to know
Micronised progesterone	Capsule by mouth, usually at bedtime	"Body-identical" to natural progesterone. Some women feel drowsy after taking it.
Levonorgestrel intrauterine system (hormonal coil)	Small device placed in the womb by a doctor	The 52 mg device protects the womb lining for up to 5 years within HRT, and also provides contraception. Can reduce heavy periods.
Synthetic progestogen tablets	Tablet, on its own or combined with estrogen in one pill or patch	Includes dydrogesterone, medroxyprogesterone acetate and norethisterone. Combined products can be convenient.

Sequential or continuous?

There are two main ways to take a progestogen with estrogen:

• Sequential (cyclical): the progestogen is taken for 12 to 14 days each month. You will usually have a monthly bleed. This is often used if you are still having periods or your last period was recent.
• Continuous combined: the progestogen is taken every day. The aim is no bleeding. It is usually used once you are past menopause. Some irregular bleeding is common in the first few months.

NICE says that continuous combined HRT lowers the risk of womb cancer, while sequential HRT may slightly increase it, more so with longer use or fewer days of progestogen. Your doctor will help you choose and may switch you over time. Bleeding that is heavy, keeps going beyond the first few months, or starts again after a bleed-free time should be checked.

Possible side effects

Some women feel well on progestogens; others notice side effects that feel similar to premenstrual symptoms, such as breast tenderness, bloating, low mood or irritability. Changing the type, dose or route (for example, to the hormonal coil) often helps. Do not stop taking your progestogen on your own while still taking estrogen, because the womb lining would then be unprotected. Talk to your doctor first.

Progestogens and breast cancer risk

NICE says breast cancer risk rises with combined HRT (estrogen plus progestogen), and that the increase is greater the longer it is used. It is lower with estrogen-only HRT, which women without a womb can take. You may read that micronised progesterone or dydrogesterone carries a lower breast cancer risk than other progestogens. NICE's 2024 review concluded that there is not enough evidence yet to say whether this is true. We think it is important to be honest about that uncertainty.

Progestogens and blood clots

Blood clot risk with HRT is mainly linked to estrogen taken as tablets. A large UK study found that estradiol combined with dydrogesterone had the lowest clot risk of the tablet combinations studied, and that estrogen through the skin was not linked with higher risk. Your doctor will consider this when choosing your HRT.

Who should take extra care

Progestogens are usually avoided or used only with specialist advice in women with certain hormone-sensitive cancers, unexplained vaginal bleeding that has not been checked, active liver disease, or a history of blood clots (depending on the product). Your doctor will review your history before prescribing.

Body-identical vs "bioidentical" compounded hormones

Micronised progesterone is a regulated, "body-identical" medicine. It has the same structure as your own progesterone, and it has been tested for protecting the womb lining when used at the right dose.

This is different from "bioidentical" compounded hormones, which are mixed by a pharmacy in custom doses. Some of these are progesterone creams. The British Menopause Society says compounded products are not recommended and are not evidence based for effectiveness and safety. It also notes that progesterone absorbed through the skin varies, and is unlikely to protect the womb lining well enough. The North American Menopause Society raises similar concerns. Read more on our BHRT page.

Questions women often ask

I have had a hysterectomy. Do I need progesterone?

Usually not. If your womb has been fully removed, estrogen-only HRT is normally advised. There are some exceptions, for example after surgery for endometriosis, so check with your doctor.

Can I use a progesterone cream instead of tablets?

Progesterone creams and gels rubbed on the skin are not considered reliable for protecting the womb lining when you take estrogen. Use the progestogen your doctor prescribes.

Will I have periods again on HRT?

With sequential HRT, you will usually have a monthly bleed. With continuous combined HRT or the hormonal coil, many women have no bleeding after the first few months.

Does progesterone help with sleep?

Some women find micronised progesterone makes them drowsy, which is why it is often taken at bedtime. It is not prescribed as a sleeping pill, and sleep problems at midlife have many causes.

Is the hormonal coil a good option at my age?

For many women in their 40s and 50s, the levonorgestrel coil can protect the womb lining as part of HRT, help heavy periods, and provide contraception, which is still needed in perimenopause. It is not suitable for everyone, so discuss it with your doctor.

Talk to a NuHer doctor

Whether you are dealing with changing periods or trying to choose the right HRT, a doctor can help you weigh up your options. NuHer is a doctor-led menopause clinic. We see women in person at Nariman Point, Mumbai, and by video across India, Monday to Saturday, 10 am to 7 pm. A good first step is to take the free menopause assessment. You can also book a consultation with one of our doctors.

References

1. National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). Published 2015, updated 2024. https://www.nice.org.uk/guidance/ng23
2. Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical practice guidelines on menopause: an executive summary and recommendations: Indian Menopause Society 2019–2020. J Midlife Health. 2020;11(2):55–95. https://pmc.ncbi.nlm.nih.gov/articles/PMC7688016/
3. British Menopause Society. Tool for clinicians: Progestogens and endometrial protection (May 2026). https://thebms.org.uk/wp-content/uploads/2026/05/14-NEW-BMS-TfC-Progestogens-and-endometrial-protection-MAY2026-A.pdf
4. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. https://pubmed.ncbi.nlm.nih.gov/35797481/
5. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810. https://pmc.ncbi.nlm.nih.gov/articles/PMC6326068/
6. British Menopause Society. Consensus statement: Bioidentical HRT. https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/