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

Dr. DeRosa • June 23, 2025

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. 


***

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!

By Dr. Angela DeRosa July 3, 2025
I recently read an article about how a man in a 27-year marriage to the same woman was contemplating divorce because the woman he married was a “completely different person” now that she was in her 50s and postmenopausal. In the article, this man went on to say their sex life was nonexistent, and his wife was “moody and mean” all the time. In fact, this husband seemed to be blaming his failing marriage wholly on his wife and menopause. Could there be any truth to this? Or is the man just complaining because his wife has gotten older? With little insight into the rest of their relationship, it’s hard to know what else may be a factor in this particular situation. But, what I do know is that when women attempt to ignore symptoms of perimenopause and menopause (or perhaps even be somewhat in denial of how their psyches and bodies have betrayed them in this natural stage of life), it could wreak havoc on any relationship. There’s a physiological reason for all of this, though. These symptoms occur because your hormones – estrogen, progesterone, and testosterone in particular – begin a natural decline sometime in your 30s. Left untreated or ignored, the physical and emotional changes you go through in perimenopause and menopause could potentially have long-term effects on your marriage. In fact, recent research indicates that more couples over the age of 50 are divorcing than ever before. Research also suggests that couples who have a mutually satisfying sex life are happier overall. Whether you’re married, in a relationship, or single, perimenopause and menopause symptoms are real , even if your doctor has told you otherwise. (If that’s the case, find a new provider!) Ignoring the Symptoms of Perimenopause and Menopause Won’t Make Them Go Away In perimenopause – the years leading up to menopause – you may begin to experience miserable symptoms, like hot flashes, low libido, vaginal dryness, and mood swings as a result of declining hormones. Imagine how ignoring these symptoms not only affects your health and well-being in the moment, but also how it affects your significant other. “I honestly believe that many couples break up when women start going through perimenopause and it’s largely due to testosterone deficiency.” – From A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You I mean, can you even slightly ignore a hot flash or night sweats? If you share a bed with your husband, he’s going to notice that you’re no longer snuggling up to him for warmth and intimacy, but now sleeping with the fan on high and the thermostat on 62 in the middle of winter. And, he might also notice that you toss and turn because you aren’t sleeping well. Then he might notice that you struggle to get out of bed in the morning because you’ve barely slept, yet you still have personal and professional obligations to meet. Is it surprising that you’re in a bad mood as you trudge through your day wishing you could remember how great you used to feel when you could sleep for 7-8 hours a night? Beyond all of this, your partner surely will notice when you’re no longer interested in sex because 1) you have ZERO desire or energy, and 2) you’re suffering from vaginal dryness, so sex is now really painful instead of really pleasurable. If you’re having trouble getting through a week of your life during “the change” – the menopausal transition – then I imagine after months or even years of these experiences, it’s bound to put a strain on your relationship! Beyond emotional strain, untreated hormone deficiencies and imbalances can have long-term physical effects on your brain, heart, and bones, too. Let me be clear here: You are the one going through the rollercoaster ride of perimenopause and menopause – not your husband. You owe it first to yourself to address your symptoms with bioidentical hormone replacement therapy (BHRT), not only for the short-term relief, but for the long-term health benefits. And, a bonus “side effect” of you taking care of your own health as you get older is that perhaps your marriage, other relationships, and even your professional life won’t be caught in the middle of it all. Why Choose to Replenish Your Hormones with BHRT? As I mentioned, there are many reasons to replenish your hormones as you get older. The short-term relief of symptoms seems like an obvious one, including getting your libido back and overcoming vaginal dryness so sex isn’t painful. But, the long-term health benefits often go unconsidered, simply because most people aren’t educated about how an estrogen deficiency increases your risk for osteoporosis, high blood pressure, and heart disease. Or, that years of low testosterone can also affect your brain health, and increase insulin resistance, which often leads to pre-diabetes. The bottom line is that, as a woman, you need balanced levels of estrogen, progesterone, and testosterone to keep yourself healthy and your relationships – especially the intimate ones – thriving, too. *** 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 hormone and intimacy success stories in Chapter 10.
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