Chapter 6 - Progesterone Matters More

Perimenopause can feel like your body is changing the rules overnight: sleep falls apart, anxiety ramps up, bleeding gets heavier, migraines appear, and you’re left wondering why no one can join the dots. We’re going to gently disrupt the standard “it’s all about oestrogen” narrative, because the pattern we see again and again is progesterone dropping first, sometimes from your mid 30s, while oestrogen swings wildly in the background. When progesterone is missing, the whole system loses its steadying influence, and symptoms can escalate fast.

We break down what progesterone actually does in the body: supporting deep sleep, easing anxiety, acting as a natural diuretic, protecting bones, and modulating immune function and inflammation. Then we walk through Kate’s story, where severe PMDD-like symptoms, haemorrhagic bleeding and iron deficiency, insulin resistance, thyroid slowdown, weight gain, and gut inflammation all point to a bigger hormonal picture that was initially dismissed. Her progress highlights a clear hierarchy of healing: repair the gut, reduce triggers and inflammation, then rebalance hormones using the right tools.

We also tackle the confusion between bioidentical progesterone and synthetic progestins, why the Women’s Health Initiative left lasting fear, and why asking “what exactly am I being prescribed?” is a non-negotiable. Finally, we connect progesterone with MCAS and histamine issues, and discuss how perimenopause can mimic fibromyalgia and overlap with hypothyroidism or Hashimoto’s, making thorough testing essential.

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Transcript

Progesterone Takes Centre Stage

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Chapter six. Progesterone Matters More. We don't just survive perimenopause, we rise through it.

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I'm going to begin with something you may never hear from your GP. And yes, my intention here is to gently disrupt the dominant narrative. In perimenopause, progesterone matters more than estrogen. Yes, estrogen matters too, and for reasons we will discuss, she seems to get all of the attention. However, because estrogen levels roller coaster in perimenopause, it's progesterone that becomes vital. More specifically, adequate levels of progesterone can consistently support your body's unique biochemistry. In perimenopause, the first hormone to go missing is progesterone. Her levels can begin to decrease as early as 35. That early decline is precisely why progesterone takes center stage in this chapter, as we delve deep into her critical role in supporting your body and easing your transition.

Meet Progesterone And The Estrogen Diva

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Meet the goddess. First, I want to properly introduce you to progesterone. She sleeps beautifully.

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No hot flushes or night sweats. She's calm. She's anti-anxiety, so you wake up feeling cool and collected. She modulates your immune system, keeping chronic autoimmune diseases at bay. She protects your bones, reducing risk of osteoporosis, loss of bone mass. In the throes of perimenopause, think of progesterone as the goddess. She is graceful and supportive. Then there's estrogen who is the diva, the party girl, who is unpredictable and prone to throwing tantrums. Progesterone is the behind the scenes, cool, calm, and collected one, whose job is to keep the diva in check when estrogen misbehaves as her levels soar. Simply said, progesterone modulates estrogen. So when progesterone leaves the scene, the diva is left to her own devices. And when she's in excess and progesterone is deficient, imagine that estrogen becomes a bit bitchy, self-centered and moody. She's responsible for headaches, migraines, hot flushes, night sweats, and heart palpitations. But when progesterone is on board, all of these symptoms can dissipate. Progesterone is the goddess who keeps the diva estrogen in line. I often say to patients when progesterone goes missing, it's similar to leaving a five-year-old at home alone, completely unsupervised, with your lipstick, toilet paper, and matches at hand. A recipe for disaster and a huge mess to clean up. But with proper progesterone levels restored and your estrogen levels modulated, you can feel like the goddess you are meant to be and deserve to be.

Why Progesterone Drops First

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Why progesterone goes missing? In perimenopause you're actually progesterone deficient, not estrogen deficient. In the current orthodox medical model, this fact often goes unspoken and untreated, which then risks inadequate care. Why are you progesterone deficient? From 35 and beyond, even if your menstrual cycles are regular in frequency and in length, it becomes more difficult to produce progesterone. In perimenopause, you may have a less robust ovulation or anovulatory cycles, no ovulation. You only produce progesterone or more specifically the corpus luteum does, after you've successfully ovulated. The job of the corpus luteum, this beautiful organ that only forms after ovulation, is to produce progesterone to prepare your uterus should you fall pregnant. As you progress in perimenopause and your anovulatory cycles increase, your body produces less progesterone overall. According to Professor Gerald and Pryor's research, conditions you may experience with low levels of progesterone include the following insomnia anxiety heavy periods frequent migraines autoimmune disease MCAS or mast cell activation syndrome, which can cause systemic inflammation in your body, including your gastrointestinal tract, which we will discuss at length in chapter nine, PMDD like symptoms or premenstrual dysphoric disorder, what can feel like a severe extension of your PMS, premenstrual syndrome. Hopefully now you know the most likely reason why your progesterone levels may be low.

Kate’s Symptoms And The Missed Clues

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Kate's Journey. Meet Kate, a young woman who presented with many of these same conditions and symptoms. Her healing journey will show clearly what can unfold when a woman's progesterone deficiency is ignored or left untreated. In later chapters, you will continue to meet other women I've treated. I share their stories because I believe their healing journeys, the challenges they've faced, and the way those challenges were alleviated or resolved, are the most powerful teaching tools. Kate is a lovely woman in her late 30s who was intensely progesterone deficient. Due to her young age, her GP initially dismissed the possibility that hormonal imbalance might be at the core of her issues. Kate presented with the following symptoms Extreme PMDD, a severe form of premenstrual syndrome, PMS, to the point of aggro and experiencing dark thoughts, extreme fatigue due to her blood deficiency, extremely low iron, insulin resistance, meaning she was not using glucose properly, creating an energy crisis in her body, hemorrhagic bleeding, excessive bleeding resulting in a severe iron deficiency, thyroid issues affecting her metabolism, basically shutting it down, and resulting in the mysterious weight gain. Issues in her gastrointestinal tract due to systemic inflammation triggered by a higher estrogen state. This is merely her list of physical symptoms. Now let's really meet Kate, a beautiful young woman who came to me desperate for answers to why she was feeling this way, why she felt her body was betraying her. Due to my training in Chinese medicine, I could tell by simply observing her that her estrogen levels were high, and she was deficient in progesterone. She described her weight gain as constantly feeling bloated, almost puffy underneath her skin. When she pushed on her skin, it felt squishy and soft, puffed up like a balloon. I recognized this was due to her fluid retention, which indicated she was progesterone deficient, because progesterone is a diuretic. A higher estrogen state can also exacerbate MCAS, which can trigger systemic inflammation throughout the body. This also accounts for her puffiness. However, the first issue I wanted to address with Kate was her excessive bleeding. Again, her higher levels of estrogen and lower levels of progesterone were driving the strain, severely affecting Kate's health and disrupting her life. To give you an idea of the severity of her bleeding, you should only lose up to 80 milliliters maximum per bleed. When we did the math, Kate was losing an average of 500 milliliters per bleed, creating a massive iron deficiency. This blood deficiency can lead to a feeling of psychosis and aggro, as well as severe feelings of depression, doom, and gloom. When I explained the effects of her heavy bleeding, she added, sort of kidding. Maybe that's why once a month I want to end my relationship with the man of my dreams. With insufficient iron combined with insulin resistance and low progesterone, Kate suffered from an energy crisis in her body, accounting for her extreme fatigue. To complicate issues, we also discovered Kate's hypothyroidism, which in essence shut her metabolism down. This is one of the trifectors I see in women in perimenopause. Iron deficiency, progesterone deficiency, and hypothyroidism. If you were to ask Kate, she would tell you that this is a bad mocktail. As I took Kate's medical history and looked at the labs her GP had ordered, I assured her that not only was she not psychotic, so please stay with your wonderful partner, but we would get her joie de vivre back and her weight back to where she wanted it.

The Healing Plan And Fast Wins

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The solution was to stop her excessive blood loss. Kate's protocol began with repairing her gut, changing her diet, and eliminating food triggers to reverse her severe inflammation. Then we brought her progesterone levels up by prescribing bioidentical progesterone to modulate her estrogen levels and reduce the roller coastering. Within four weeks of implementing the hierarchy of healing, repairing her gut, rebalancing her hormones, and reclaiming her metabolic flexibility, Kate's gut symptoms disappeared. Bringing her estrogen and progesterone levels back into balance was particularly important. She was sleeping deeply, her anxiety lessened, and her bleeding moderated. For Kate and for so many women in the throes of perimenopause, progesterone matters more.

Progesterone Vs Progestins Explained

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Progesterone versus progestin. Why progesterone gets a bad name? Progesterone gets a bad name because it's often confused with progesterins and other respective side effects, especially concerning cancer. Some of the literature and research out there failed to differentiate between bioidentical progesterone and progestin, which is a synthetic compound intended to mimic progesterone. This confusion started with the Women's Health Initiative, the WHI, in the early 2000s, which linked progestins to a possible increase in the risk of breast cancer. Today we know that some progestins behave like androgens, which are often called male hormones, like testosterone. When a woman's androgen levels are too high, the result can be the production of more estrogen, which is not a good thing for a perimenopausal woman like Kate. Progestins can be like adding fuel to the already burning perimenopausal fire. However, since the WHI findings were published in the early 2000s, subsequent research has shown that bioidentical progesterone, unlike progesterine, does not carry the same risks and may even have protective effects against some cancers. The molecule of bioidentical or body-identical progesterone looks exactly the same as the one your body naturally produces. So your body recognizes it for what it is and has the same properties. But bioidentical progesterone is the true goddess your body needs. Your body is incredibly intelligent. When you give it bioidentical progesterone that is molecularly identical to what your body makes, it recognizes and responds to it as the calming, protective, anti-inflammatory hormone it's meant to be. But when you give it a synthetic progesterone like levinor gesterol, your body responds to its testosterone-like structure, often triggering effects that you never bargained for. This is why asking, what exactly am I being prescribed matters? Not all progesterone are progesterone. And now you can see why.

MCAS Histamine And Hormone Swings

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Progesterone and MCAS. Although Kate experienced some gastrointestinal challenges, they were easily corrected. But I want to take a moment to address the connection between a progesterone deficiency and MCAS, which we mentioned earlier. MCAS can trigger excess histamines. Mast cells are found throughout your body. They play a key role in the immune system and fight potential threats and infections. When the histamines released are in excess, they can result in systemic inflammation throughout the body, often in the gut and the brain, brain fog and that headache behind the eyes. Think of the mast cell as the alarm system for the body. So, with perceived threat, mast cells release histamine, increasing blood flow and triggering inflammation, which helps the immune system respond. However, in excess, you will see systemic inflammation and the issues it can cause.

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Dr.

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Tanya Dempsey is a leading researcher and practitioner in MCAS. She refers to perimenopause as the closing of one era and the beginning of another. If we look specifically at the perimenopausal state, MCAS is activated for specific reasons.

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Dr.

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Dempsey's work shows that for perimenopausal women, estrogen in her roller coastering levels can stimulate mast cell activation. When this activation becomes too intense, so does the histamine production.

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Dr.

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Dempsey's work has demonstrated that higher levels of progesterone can help stabilize not only higher estrogen levels but also mast cell activation, which can modulate and control histamine levels and the resulting inflammation.

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Dr.

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Dempsey's research also indicates a possible connection between MCAS and polycystic ovarian syndrome, PICOS, whose name can be misleading as it implies that it is caused by cysts on the ovaries. As noted earlier, more often than not, PICOS is caused by insulin resistance, something Kate struggled with. Common issues faced by women with both conditions include irregular periods, metabolic changes, hot flushes and night sweats, anxiety and depression. MCAS is something I routinely look for in my patients, as it can be the root cause of many symptoms and chronic issues they face, because it can play such a big role in many women's healing journeys. Progesterone is truly the great modulator, not only of estrogen, but also indirectly of the mast cells. Progesterone is anti-inflammatory. Progesterone, your first line of defense.

Progesterone As First Line Defence

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After repairing the gastrointestinal tract, the next step is to rebalance a woman's hormonal levels. In the second phase of the hierarchy of healing, rebalance, progesterone is what I call the first line of defense because it doesn't act as a bandage solution. Instead, progesterone often addresses and resolves the root causes that lie beneath the surface of your symptoms. I want to walk you through some of the ways progesterone counteracts not only perimenopausal symptoms, but also chronic health issues you may be facing that may have been misdiagnosed or missed entirely. One example is fibromyalgia, a chronic pain condition causing widespread body aches, exhaustion, and poor sleep. Too many doctors miss when progesterone levels drop during perimenopause, creating almost identical symptoms, the same widespread pain, the same bone-deep fatigue, and the same brain fog. Progesterone isn't just a reproductive hormone, it's your body's natural anti-inflammatory pain reliever. Without it, your pain threshold plummets, your muscles ache, your joints hurt, and everything feels harder. I see women in their 40s diagnosed with fibromyalgia when really, their bodies are screaming for progesterone. The tragedy is that fibromyalgia is treated with strong medications that target pain processing in your brain. The progesterone deficiency, which is often driving the pain, goes completely unaddressed. Yes, fibromyalgia is real and needs a proper diagnosis. But so is the musculoskeletal syndrome of perimenopause. We need both diagnoses on the table. In my clinical experience, when I optimize progesterone in women who've been labeled with fibromyalgia, many experience dramatic pain relief. Some even find their pain disappears entirely. The key is ensuring your doctor doesn't jump to fibromyalgia without first ruling out or ruling in perimenopause as a contributing factor.

Fibromyalgia And Thyroid Lookalikes

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Another commonly overlooked diagnosis is hypothyroidism, and in particular, Hashimoto's thyroiditis, where your immune system attacks your thyroid gland. The symptoms are almost identical to perimenopause. Crushing fatigue, weight gain you can't shift, feeling cold all the time, brain fog, low mood and aching muscles. These symptoms could be your thyroid failing, your progesterone dropping, or both. Here's what makes it worse. When progesterone declines, it can actually trigger autoimmune conditions like Hashimoto's, because progesterone helps keep your immune system in check. So you can have both a sluggish thyroid and declining progesterone, each one making the other worse. Women with this double hit feel absolutely terrible. The exhaustion is overwhelming, the weight gain feels impossible to control, and the brain fog makes you feel like you're losing yourself. Yet too often doctors test only the thyroid or only the hormones, missing half the picture. A proper assessment needs both. Full thyroid testing, including antibodies for Hashimoto's, and hormonal evaluation for perimenopause. Treating just one, when you have both, will leave you struggling. When we address thyroid function and progesterone deficiency together, that's when women finally start to feel like themselves again. In many cases, in perimenopausal women, progesterone is the first line of defense. It isn't a bandage solution or a quick fix. It works at the root causes beneath the presenting symptoms. It's the reason why progesterone matters more in perimenopause, and the reason why bringing your hormones back online is a critical step to feeling like the most vibrant version of yourself.

Reclaiming Vitality Through Rebalance

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In chapter 10 and 11, we'll move into the second phase of my healing protocol, rebalance. I'll share the journeys of six women who set out to restore hormonal balance in their bodies. In doing so, they not only found relief from troubling symptoms, but also began to regain their energy, their resilience, and their vitality. My intention is for you to carry this thought with you. Just as progesterone is the goddess in this transitional state of perimenopause, there is no reason you can't also feel like a goddess in your own body and your own life. You have the right to rediscover the vibrant woman you know is still within you, the one you so want to return to. There is a pathway to reclaim her.

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Keep listening.