Progesterone Changes in Perimenopause

Apr 01, 2024
The words Progesterone and Perimenopause along with TārāMD Icon in shades of pink.
Progesterone changes in perimenopause affect women profoundly. Understanding its decline is crucial for managing symptoms and maintaining well-being.

In perimenopause, estrogen gets a lot of attention. Its wild fluctuations and eventual decline are responsible for many uncomfortable symptoms. However, progesterone is equally important. For many women, progesterone decline contributes to the first perimenopause changes, even before you experience changes in estrogen levels.

We live in an exciting time, with more information and research on perimenopause than ever before. The conversation is coming to the forefront, and women need trusted information, resources, and solutions to navigate health in midlife.

We can’t talk about perimenopause without a deep understanding of the progesterone hormone, and that’s exactly what today’s article will do. Keep reading to learn more about:

  • What is progesterone?
  • Progesterone benefits
  • Progesterone decline in perimenopause
  • Low progesterone symptoms
  • Progesterone support for perimenopause

What is Progesterone?

Progesterone is a steroid hormone produced by the ovaries (the corpus luteum) during the second half of the menstrual cycle (the luteal phase). In a healthy menstrual cycle, progesterone rises after ovulation (when the egg is released) to balance estrogen, thicken the uterine lining, and prepare the uterus for pregnancy. Without ovulation, there is no progesterone.

When implantation doesn’t occur, progesterone levels fall, and your period comes. If pregnancy occurs, the corpus luteum increases and maintains progesterone production for the first 10 weeks. Then, the placenta takes over progesterone duties.

Your body relies heavily on progesterone with progesterone receptors and signaling pathways throughout the body. Progesterone benefits go far beyond reproduction. In fact, you make much higher levels of progesterone than estrogen.

Health Benefits of Progesterone

In addition to its critical role in reproduction, progesterone also:

  • Calms the brain and nervous system
  • Reduces anxiety
  • Promotes sleep
  • Reduces inflammation
  • Supports immune balance
  • Protects the heart
  • Increase body temperature and metabolic rate
  • Protects breast health
  • Has anti-androgen properties
  • Builds bone

Given all these roles, it’s beneficial for overall health and disease prevention to have ovulatory menstrual cycles and progesterone production for as long as possible. Note that birth control methods that suppress ovulation, such as oral contraceptives, don’t allow for the body’s natural progesterone production.

How Progesterone Changes in Perimenopause

Perimenopause is a significant biological change that occurs gradually over many years, leading to loss of ovarian function and the menstrual cycle. During perimenopause, progesterone and estrogen levels decline. Even though estrogen levels fluctuate, especially in early perimenopause, the overall trend is down.

Given how these sex hormones benefit tissues throughout the body, it’s no surprise that declining hormones lead to perimenopausal symptoms.

As you move into perimenopause, the corpus luteum pumps out less progesterone after ovulation. You may experience cycles with a shorter luteal phase, meaning less progesterone production. Eventually, you’ll have anovulatory cycles (when ovulation doesn’t occur), and no progesterone.

Symptoms of Low Progesterone

In perimenopause, progesterone levels can be the first to decline, which can lead to symptoms of progesterone deficiency. Low progesterone also causes an imbalance between estrogen and progesterone, so it may present similar to high estrogen.

In the early stage of perimenopause, it’s common to experience low progesterone symptoms while the menstrual cycle is still regular. In late perimenopause, when you begin skipping periods, symptoms of low progesterone may be more pronounced.

Symptoms of low progesterone include:

  • Short luteal phase of menstrual cycle
  • Cervical mucus (fertile mucus) at the wrong time of the month (you should see it for about 5 days before ovulation)
  • Spotting before your period
  • Prolonged period bleeding
  • Heavy periods
  • PMS (pre-menstrual syndrome)
  • New or worsening migraines
  • Decreased fertility and miscarriages
  • Trouble sleeping, especially in the luteal phase
  • Increased anxiety or depression
  • Decreased resilience to stress

One of the most interesting roles of progesterone is how it directly interacts with GABA receptors. GABA (gamma-aminobutyric acid) is the body’s main calming neurotransmitter. Progesterone stimulates the GABA receptors, producing an anti-depressant, stress-reducing, and slightly sedative effect. With declining progesterone in perimenopause, sleep disturbance, mood changes, and decreased resilience to stress are common.

Progesterone levels in women at all stages of life correspond with:

  • Psychosocial resilience
  • Well-being
  • Favorable mental health
  • Lower levels of perceived stress
  • Life satisfaction
  • Better mood

So, it’s not hard to see how declining progesterone in perimenopause makes you more sensitive to stress and everyday life more challenging. While your life and habits may not have changed, you may not feel as positive, energetic, and vital as you once did. Many women get brushed aside by the medical system in perimenopause because these initial changes are hard to measure. In actuality, symptoms are very real and related to hormonal changes.

How to Support Progesterone in Perimenopause

Progesterone support may be the first strategy to implement, especially when you are seeking relief early in perimenopause. Work with a perimenopause expert, ideally a gynecologist certified by the North American Menopause Society like Dr. Fenske.

Here are some strategies to discuss with your healthcare provider:

  • Progesterone testing – If you still have a regular or relatively regular menstrual cycle, you can test progesterone levels 5 to 7 days after ovulation (day 19 to 21 of a 28-day cycle, where day 1 is the first day of your period). You can test blood levels of progesterone or use a dried urine test. Looking at progesterone metabolites can also provide more clues.


  • Support GABA – When experiencing low progesterone and symptoms of low GABA like poor sleep and anxiety, natural GABA support can help calm the nervous system and promote sleep. GABA is available as a supplement directly in a pill or tablet. Many herbs, such as passionflower, hops, skullcap, lemon balm, and valerian are GABA agonists and promote increased GABA levels and function. You’ll find these in sleep and stress formulas.


  • Manage stress – When your body thinks you’re in danger, whether running from a lion or stressing over a work email, the body will deprioritize fertility and ovulation, which can lower progesterone. Managing stress through perimenopause is essential but often challenging given lower resilience. Find supportive people, creative outlets, and self-care tools that work. Meditation can help, too!


  • Get enough sleep – Sleep can be really challenging during perimenopause because declining progesterone impacts sleep. Yet, sleep is so crucial for managing perimenopausal symptoms and supporting a healthy menstrual cycle for as long as possible. Read about holistic sleep support strategies here.


  • Eat phyto-progesterones – Phytoestrogens (plant estrogens) get a lot of attention for benefiting perimenopausal women and have good research to support their efficacy. While we need more research on phyto-progesterones (plant progesterone), it can’t hurt to include some of these good sources as part of a whole foods diet:


    • Watercress
    • Mustard greens
    • Arugula
    • Spinach
    • Parsley
    • Cilantro
    • Celery
    • Citrus fruits


  • Try vitexVitex agnus-castus (chaste tree or chasteberry) is an herbal remedy with a lot of research for women’s health concerns. It may benefit PMS symptoms, luteal phase defects, perimenopausal sleep disturbances, and more, with a strong safety profile. Discuss this herbal remedy with your provider to see if it may be a good fit for you.


  • Consider progesterone replacementHormone replacement therapy (HRT) is not only for menopause; many women will benefit from beginning hormones during perimenopause. Be sure to ask for bio-identical progesterone, typically oral micronized progesterone (a prescription), and not synthetic progestins, which don’t provide the same benefits and carry some risks.


If you’re beginning to experience symptoms of perimenopause, don’t wait to seek support. At TārāMD, you’ll receive personalized perimenopause care, and your symptoms will never be brushed aside. We’ll take the time to listen, order comprehensive testing, and uncover the root causes of your symptoms. You’ll receive an integrative perimenopause plan to support progesterone (and all hormones), help you feel better, and support your health through perimenopause and beyond.



  1. Cable JK, Grider MH. Physiology, Progesterone. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK558960/
  2. Garg, D., Ng, S. S. M., Baig, K. M., Driggers, P., & Segars, J. (2017). Progesterone-Mediated Non-Classical Signaling.Trends in endocrinology and metabolism: TEM28(9), 656–668.
  3. Prior J. C. (2018). Progesterone for the prevention and treatment of osteoporosis in women.Climacteric : the journal of the International Menopause Society21(4), 366–374.
  4. Haufe, A., Baker, F. C., & Leeners, B. (2022). The role of ovarian hormones in the pathophysiology of perimenopausal sleep disturbances: A systematic review.Sleep medicine reviews66, 101710.
  5. Stefaniak, M., Dmoch-Gajzlerska, E., Jankowska, K., Rogowski, A., Kajdy, A., & Maksym, R. B. (2023). Progesterone and Its Metabolites Play a Beneficial Role in Affect Regulation in the Female Brain.Pharmaceuticals (Basel, Switzerland)16(4), 520.
  6. Süss, H., Willi, J., Grub, J., & Ehlert, U. (2021). Estradiol and progesterone as resilience markers? - Findings from the Swiss Perimenopause Study.Psychoneuroendocrinology127, 105177.
  7. Weeks B. S. (2009). Formulations of dietary supplements and herbal extracts for relaxation and anxiolytic action: Relarian.Medical science monitor : international medical journal of experimental and clinical research15(11), RA256–RA262.
  8. van Die, M. D., Burger, H. G., Teede, H. J., & Bone, K. M. (2013). Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials.Planta medica79(7), 562–575.
  9. Hipolito Rodrigues, M. A., & Gompel, A. (2021). Micronized progesterone, progestins, and menopause hormone therapy.Women & health61(1), 3–14.