Progesterone: Why So Many Providers & Women Don't Fully Understand It
Progesterone: Why So Many Providers & Women Don't Fully Understand It

If you grew up watching The Wizard of Oz (circa 1939) then you probably held a lifelong belief that Glinda was the good witch who helped Dorothy get back to her home in Kansas, while the Wicked Witch of the West tried every possible tactic to defeat Dorothy “and her little dog, too!” It was all very black and white; we knew who was good and who was bad.
This all made perfect sense until the Broadway musical
Wicked
came out in 2003, and then most recently, the 2024 movie version. The backstory of how Glinda and Elphaba (for 64 years we never even knew the Wicked Witch had a name!) turned everything we knew about these opposing forces of good and evil totally upside down. Without totally revealing the plot, we come to realize how Glinda and Elphaba actually complement each other in terms of their character strengths and flaws, and how they need to peacefully coexist, and even maintain a close relationship.
Why am I talking about
Wicked in a progesterone blog? Because, much like we now know that Elphaba is a
completely misunderstood character,
progesterone is also a highly misunderstood hormone when it comes to women in perimenopause, menopause, and hormone replacement therapies.
My hope is that after reading this blog, you’ll have a better understanding of progesterone’s role in optimizing your hormones, and why it needs to peacefully coexist with estrogen and testosterone.
Why Progesterone Matters Even After Reproductive Years
Throughout a large portion of a woman’s life, progesterone plays an important role in preparing for pregnancy. During child-bearing years, each month, your body produces follicle-stimulating hormones (FSH) and luteinizing hormones (LH) which cause a new egg to mature and be released from your ovaries. Estrogen production increases and thickens the uterus lining.
So, ovulation occurs, progesterone levels rise in the second half of your menstrual cycle, and your body continues to produce progesterone. If pregnancy occurs, your body keeps producing progesterone to help nourish the development of a baby. But when pregnancy doesn’t occur, both estrogen and progesterone levels drop, the lining of the uterus breaks down, and you have your period.
So, if you’re in perimenopause or menopause (when you’re no longer capable of having a baby), you no longer need progesterone, right? It’s not that simple. Even though progesterone’s most important function is to prepare your body for pregnancy, your body continues to need a harmonious balance of estrogen, progesterone, and testosterone, so you can feel your best as you transition out of child-bearing years and into menopause.
“Progesterone can be annoying, but like the nagging sibling, you really need her in your life, you just have to find the balance. When she’s not around, you start to notice.”
– Angela DeRosa, DO, MBA, CPE
Like Glinda the Good Witch, estrogen is a “feel good” hormone, but progesterone is like the Wicked Witch of the West. You hate to see her coming because she’s often responsible for symptoms of premenstrual syndrome (PMS), like bloating and mood swings, and she might even set you on fire by making your hot flashes worse! However, we can’t simply blame progesterone as the “bad hormone,” because hot flashes and other perimenopause symptoms are more likely to be the result of unbalanced estrogen and progesterone levels.
See where the misunderstanding happens?
As I talk about in my book,
A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You, the idea is to keep your hormones – particularly estrogen, progesterone, and testosterone – balanced. Estrogen is like Glinda – the beautiful, popular girl, and progesterone is like Elphaba – the ugly, misunderstood, brooding girl. Testosterone is the happy-go-lucky guy who keeps the peace between the two.
Perimenopause and Progesterone Sometimes Don’t Mix
To further confuse things, during perimenopause, testosterone typically declines and drops out of the picture, leading to an imbalance between estrogen (who sometimes likes to dominate) and progesterone, who decides since there probably won’t be any pregnancies in the picture, she’s going to stop doing her job. Progesterone often gets blamed for this imbalance, but
many providers also don’t realize how much to prescribe and what types of dosage forms are optimal. (Hint: if you still have a uterus, oral progesterone helps protect the endometrial lining).
What I often hear from women in perimenopause is that their provider tested their hormone levels at a time during their menstrual cycle when progesterone just happened to be low, which is a normal phase. Based on these snapshot lab results, the provider prescribes what ends up being too high of a dose of progesterone.
As a result, these perimenopausal women who are still having periods, experience the side effects of too much progesterone, such as weight gain and fatigue.
On the other hand, some providers tend to
only prescribe estrogen for women in menopause who are no longer having periods because estrogen can address many of the miserable symptoms of hormone deficiencies, including low libido, painful sex, hot flashes, and irritability. However, if you only increase estrogen
without balancing progesterone (and testosterone, too) you can end up with estrogen dominance. Without the balance of progesterone, too much estrogen can lead to cancerous cell growth and even tumors in your uterine lining.
Balancing hormones is a combination of data, medical expertise, and personalization that finds just the right doses for your particular needs. Every woman is different. You know how you feel and you know when something isn’t quite right. It’s important to find a healthcare practitioner who understands the nuances of how progesterone, estrogen, and testosterone all work together for optimal results – peacefully coexisting like Glinda, Elphaba, and the Wizard of Oz.
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As someone who has treated more than 20 thousand patients in the last 30 years, and written about BHRT, you might find my book,
A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You, a helpful tool in your perimenopause journey and beyond. You can read about progesterone in Chapter 3.
The Doctor is in!
