Progesterone Therapy: What It Does and Why Type Matters
Progesterone is not just an endometrial protector — the right form, at the right time, improves sleep and mood in many perimenopausal women.
Progesterone's role in HRT
In women with a uterus, progesterone is added to estrogen to prevent endometrial hyperplasia and cancer. Beyond that protective role, progesterone has direct effects on GABA-A receptors, which is why oral micronized progesterone at bedtime often improves sleep and reduces anxiety.
Micronized progesterone vs synthetic progestins
Micronized progesterone (Prometrium) is chemically identical to what the ovaries produce and has a more favourable metabolic and breast cancer risk profile than older synthetic progestins (medroxyprogesterone acetate). It is the first choice in modern menopausal hormone therapy.
Synthetic progestins are still useful in specific situations: continuous combined regimens delivered as a fixed-dose patch, contraception, and management of heavy bleeding.
Cyclic vs continuous regimens
Continuous combined therapy (daily estrogen + daily progesterone) aims for amenorrhea and is preferred more than a year after final menstrual period. Cyclic therapy (progesterone for 12 days per month) mimics a cycle and may be better tolerated in early perimenopause.
Discuss the right regimen
Ready to discuss hormone therapy? Book an initial hormone therapy consultation or a perimenopause / menopause appointment, or contact us via our booking page.
Frequently asked questions
Why take progesterone at bedtime?+
Oral micronized progesterone is sedating for most women — bedtime dosing turns this into a benefit for sleep.
Do I need progesterone if I had a hysterectomy?+
Usually no — estrogen alone is safe when there is no endometrium to protect.