It’s Not Just Oestrogen: Why Progesterone Matters More Than You Think
- Feb 15
- 2 min read
When we talk about hormones in perimenopause and menopause, most of the focus is on oestrogen.
But there’s another hormone that often shifts first — and quietly.
Progesterone.
And understanding it can completely change how you view symptoms like anxiety, poor sleep, and that “wired but exhausted” feeling so many women describe.
Progesterone Is Often the First Hormone to Drop
In perimenopause, ovulation becomes irregular. Here’s something many women aren’t told:
Progesterone is only produced after ovulation.
So when ovulation becomes inconsistent - or doesn’t happen at all, progesterone levels fall. Meanwhile, oestrogen may still be fluctuating (and sometimes even high).
This imbalance can show up as:
Heightened anxiety
Broken sleep or 3am wake-ups
Feeling emotionally overwhelmed
Worse PMS
Breast tenderness
Shorter or heavier cycles
For many women, this is why perimenopause can feel so destabilising - even before periods stop.
Isn’t Progesterone Just for Protecting the Womb?
Progesterone’s primary medical role in HRT is to protect the uterine lining from thickening when taking oestrogen.
Under guidance commonly followed in the UK (including the NHS), women who have had a hysterectomy are usually prescribed oestrogen-only HRT, because there is no womb lining to protect.
And medically, that is correct.
But progesterone does more than protect the womb. It is a neuroactive hormone.
Progesterone crosses the blood–brain barrier and is converted into a compound called allopregnanolone, which interacts with GABA receptors — the calming pathway in the brain.
This is why progesterone may:
Support deeper sleep
Reduce night waking
Calm anxious feelings
Help with that “wired but tired” state
For some women, particularly those in perimenopause or surgical menopause, this brain effect can be significant.
What If You’ve Had a Hysterectomy?
If you’ve had a hysterectomy but still have your ovaries, you may still produce progesterone naturally - though levels can still decline in perimenopause.
If you’ve had your ovaries removed (surgical menopause), both oestrogen and progesterone drop suddenly and significantly.
In both cases, progesterone isn’t automatically prescribed because its licensed role in HRT is endometrial protection.
However, some menopause specialists may consider micronised progesterone (often prescribed as Utrogestan) for women experiencing sleep disruption or anxiety - even without a uterus.
This isn’t a blanket solution. It isn’t right for everyone, and not everyone tolerates progesterone well.
Some women can feel:
Low mood
Fatigue
Irritability
Emotional flatness
Hormones are individual and affect everyone differently.
Why I’m Talking About This
So many women are told: “You don’t need progesterone - you don’t have a uterus.” Technically, that’s correct for endometrial protection against cancer. But the conversation often stops there, and it shouldn't. This isn't about self-prescribing, it's about learning more about your hormones, making informed decisions about YOUR health.
Women deserve to understand what their hormones are doing - and why they feel the way they do.
That’s why I’m starting this conversation. Continue this conversation by coming to an event or contacting me to find out more information about 1:1 Coaching. I'd love to hear from you!
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