If you’re in your late 30s or 40s and feeling like your body and mood are shifting, you’re not imagining things. Perimenopause can be a confusing time—one that causes a lot of shifts in how you feel, even when your labs seem “normal.” And the question of when to take progesterone for perimenopause is a common one many women are asking themselves at this stage of life.
Progesterone is often one of the first hormones to take a noticeable dip during perimenopause.
And for many women, taking progesterone in perimenopause can make a huge difference in how they feel, emotionally, physically, and even cognitively. Is progesterone right for you? Let's find out.
In this article:
What Is Progesterone and Why Does It Matter in Perimenopause?
Perimenopause marks the gradual shift leading up to menopause, when your ovaries begin to slow hormone production, especially estrogen and progesterone. This transition often starts with a progesterone decline and ends 12 months after your last period, which is when menopause officially begins.
For some women, perimenopause lasts just a couple of years, while for others, it can stretch over a decade. During this time, symptoms can vary widely from hot flashes, mood swings, and poor sleep to heavier or skipped periods. Some women barely notice any changes, while others find the experience physically and emotionally exhausting. Overall, perimenopause is a highly individual journey.
Related: When Does Perimenopause Start and How Long Does It Last?
How Perimenopause Impacts Progesterone:
Progesterone is a hormone produced primarily in the ovaries after ovulation. During your “reproductive years,” it helps to regulate the second half of your menstrual cycle, known as the luteal phase (the time after ovulation and before your period).
For menopausal women, progesterone continues to have many important roles, even though ovulation has stopped and natural production of the hormone declines.
While estrogen tends to get most of the attention during perimenopause and menopause, progesterone is just as important for keeping your body in balance. Without enough progesterone, as often happens in perimenopause, you may start experiencing symptoms like irritability, anxiety, poor sleep, and fatigue, even if your estrogen is still in a healthy range.
What Are The Benefits of Taking Progesterone in Perimenopause?
The benefits of taking progesterone in perimenopause include:
- Better sleep
- Less anxiety
- Balanced estrogen and progesterone
- Reduced hot flashes and night sweats
- Supports bone health
- Supports heart health
Let’s explore these in more detail:
1. Supports Sleep and Reduces Night Wakings
Progesterone has a calming, sedative effect on the brain by interacting with GABA receptors, similar to how anti-anxiety medications work. This makes it helpful for improving sleep quality, especially for women struggling with insomnia or frequent nighttime awakenings.
Related: Why Can’t I Sleep? The Real Reasons for Perimenopause Sleep Issues (and What Actually Helps).
2. Eases Anxiety and Promotes Calm
Many women report feeling more anxious, irritable, or emotionally sensitive during menopause, in part because hormones affect brain health and because progesterone is dropping.
Progesterone acts as a natural mood stabilizer and can help in many cases to reduce symptoms of anxiety, mood swings, and nervous system overactivity. It can also positively impact libido, making it easier to cope with a low sex drive that's common during perimenopause and menopause.
Related: Potential Impact of Perimenopause on Sexual Health and Intimacy.
3. Balances Estrogen Therapy
For women using estrogen replacement therapy and who still have a uterus, progesterone is often prescribed to balance estrogen and protect the endometrial lining from overgrowth1 (which can increase the risk of endometrial cancer). Essentially, progesterone is used as part of a hormone replacement regimen to keep things running smoothly without causing complications.
4. Reduces Hot Flashes and Night Sweats (For Some Women)
While estrogen is the main hormone for managing vasomotor symptoms2 like hot flashes and night sweats, some women notice that progesterone helps reduce the severity or frequency3 of these symptoms. This is especially true when progesterone is paired with estrogen4.
For example, one randomized, placebo-controlled trial5 found that women with vasomotor symptoms who received 300 milligrams of micronized progesterone before bed experienced a significantly greater decrease in night sweats and improved sleep compared to women not taking progesterone.
5. Supports Bone Health
Progesterone is involved in bone metabolism and can support bone-building activity when used as part of a hormone therapy plan (such as one that also includes estrogen, which is a primary protector against bone loss).
6. May Benefit Heart Health
Emerging research suggests that bioidentical progesterone does not appear to have the same negative cardiovascular effects as synthetic progestins and may even support vascular tone and blood pressure regulation6.
In short: Even though menopause marks the end of your fertile years, progesterone still has powerful benefits for mood, sleep, hormone balance, and overall well-being, especially when used in bioidentical hormone replacement therapy (BHRT).
Related: Struggling with Sleep & Anxiety? Are Low Progesterone Symptoms to Blame | Dr. Carrie Jones and Which Hormones Affect Sleep? The Hormone-Sleep Connection Explained.
How Do I Know If I Need Progesterone in Perimenopause?
You might benefit from progesterone in perimenopause if you're experiencing symptoms related to low or fluctuating levels of this hormone—even if your cycle is still regular or your labs appear “normal.”
Common signs that progesterone may be low or out of balance include:
- Trouble falling or staying asleep
- Increased anxiety, irritability, or emotional sensitivity
- Worsening PMS or mood swings before your period
- Heavier, longer, or more painful periods
- Shorter cycles (e.g., bleeding every 21 days instead of 28)
- Breast tenderness
- Hormonal headaches or migraines
- Feeling “wired but tired,” especially at night
These symptoms often show up because ovulation becomes inconsistent in perimenopause, and progesterone is only produced after ovulation. That means even if you’re still getting periods, you may not be making enough progesterone to feel balanced.
If you're noticing a cluster of these symptoms, especially worsening sleep or mood shifts in the second half of your cycle, it’s worth talking to your provider about whether progesterone support could help.
Low Progesterone Symptoms During Perimenopause
During perimenopause, ovulation becomes less predictable, which means your body starts producing less progesterone. This can sometimes occur even when your cycle is still mostly regular.
A drop in progesterone during perimenopause can cause a wide range of symptoms that many women chalk up to “stress” or “just getting older.”
If you’re wondering whether low progesterone could be affecting you, here are some telltale signs that it likely is:
- Trouble sleeping or waking up too early
- Increased anxiety or irritability
- Breast tenderness
- Heavier, longer, or irregular periods
- Shorter cycles (such as bleeding every 21 days instead of 28)
- Headaches or migraines, especially around your period
- PMS that seems to be getting worse with age
If this sounds familiar, low progesterone in perimenopause might be the root cause of at least some of your symptoms.
Related:
How to Increase Progesterone Levels Naturally
Does Progesterone Cause Weight Gain?
Testing Progesterone Levels in Perimenopause
It’s common for progesterone to decline gradually over time during perimenopause, which typically begins in your mid-40s to early 50s. Progesterone can begin to drop even if your estrogen is still within range. That’s why you can feel “off” even when blood tests say you're normal.
A typical serum progesterone test should be done about 5–7 days after ovulation, usually around day 21 of a 28-day cycle. In perimenopause, ovulation is inconsistent, so testing can be tricky. In those cases, talking to your provider about your specific symptoms and patterns can offer better clues than lab tests alone.
When Should I Take Progesterone During Perimenopause?
The best time to take progesterone during perimenopause depends on your symptoms and whether you’re still ovulating.
There are two main ways to take progesterone:
1. Cyclic Progesterone
This approach mimics your body’s natural rhythm—because progesterone rises after ovulation and drops just before your period. So cyclic progesterone involves taking progesterone during the 2nd half of your cycle (days 14-28) when it would normally be high. This approach is good for:
- PMS
- Heavy or painful periods
- Trouble sleeping
- Mood swings before your period
Who it's best for: Women who still have cycles7 and want to support ovulation or ease symptoms like PMS, heavy periods, and sleep issues.
When to take it: Days 14 to 28 of your cycle (with day 1 being the first day of your period).
2. Continuous Progesterone
Continuous use means it's taken every day without breaks. Continuous progesterone can be used when cycles are irregular, ovulation is unclear, or you’re experiencing symptoms like anxiety, insomnia, or estrogen dominance.
This continuous dosing is often used to ease symptoms like:
- Insomnia
- Anxiety
- Estrogen dominance symptoms (like breast tenderness or irritability)
- PMDD
Who it's best for: Women with irregular periods, skipped cycles, or those in later perimenopause.
When to take it: Every night, consistently throughout the month.
Work with a hormone-literate provider to determine the right dosing schedule for your body and where you are in the perimenopause transition.
Note that oral contraceptives8 (birth control pills) do not contain progesterone, they are formulated with progestin and are used for women who aren't trying to get pregnant. They do not help with anxiety and sleep in the way progesterone does.
Related: Can I Get Pregnant During Perimenopause?
What Dose of Progesterone is Typically Used?
Oral micronized progesterone is often prescribed at 100–200 mg, typically taken before bed. Topical doses vary more widely. Always start low and work with a practitioner.
What Time of Day is Best to Take Progesterone?
Most providers recommend taking oral progesterone at night, especially if you're using it to support sleep, since it has a natural calming effect on the brain.
Supportive Supplements for Progesterone and Perimenopause
Adaptogens & B Vitamins
Chronic stress can disrupt ovulation and lower progesterone, which is why supporting adrenal function is essential during perimenopause. Cortisol dysregulation contributes to progesterone imbalances. Adrenal Support helps buffer stress and support healthy cortisol rhythms, which is why it is best taken with breakfast.
Phosphatidyl Serine, Passion Flower, and L-Theanine
If you're taking progesterone for sleep, combining it with targeted nutrients that calm the brain can enhance results.
Sleep struggles are a hallmark of low progesterone. This blend supports GABA pathways and nighttime relaxation, which pairs well with bioidentical progesterone. You’ll find this in our Adrenal Calm supplement, which is designed to be taken before bedtime.
Omega-3 Fatty Acids
Omega-3s support brain health, hormone production, and inflammation—all critical during perimenopause. It is useful for mood, cardiovascular health, and cellular hormone signaling. Check out our high quality, well tested Omega Plus to support your perimenopause health needs.
Is It Safe to Take Progesterone Without Estrogen?
Yes, and in fact, for many women in perimenopause, it’s the best place to start.
Unlike estrogen, which can increase the risk of endometrial thickening if taken alone, progesterone is generally safe to use by itself9 (especially in bioidentical form). It helps balance the effects of fluctuating or high estrogen levels—common in early perimenopause—and doesn't require estrogen to be effective.
Synthetic (man-made) progesterone is called progestin. Progestin or bioidentical progesterone-only support may be especially helpful if you’re not yet in full menopause, have heavy periods, or are sensitive to estrogen therapy.
That said, if you’re already postmenopausal or have very low estrogen, your practitioner may recommend combining both hormones for optimal support.
You can learn more about perimenopause treatment options here:
Perimenopause Symptoms and Treatment
What is The Best Diet for Perimenopause
15 Perimenopause Supplements for Happy Hormones
How to Lose Weight During Perimenopause
Can You Take Progesterone Long-Term?
Wondering if you can take progesterone continuously or long-term?
As mentioned above, you can take progesterone continuously without breaks if you aren’t sure when (or if) you’re ovulating. Continuous low-dose progesterone can often help ease perimenopause symptoms and stabilize moods.
In terms of how long you can take progesterone for, the length of time a woman can safely take progesterone depends on a few factors, including her age, health history, whether she’s using estrogen therapy, and the form of progesterone she’s using. Here’s what to know:
If You’re Using Progesterone with Estrogen (in HRT):
If you still have a uterus and are taking estrogen as part of HRT10, you’ll likely need to take progesterone long-term, as long as you continue estrogen. That’s because progesterone protects the uterine lining from overgrowth11, which can happen when estrogen is unopposed. This protection helps lower the risk of endometrial cancer.
Many women take cyclical progesterone (such as 12–14 days per month) or continuous progesterone (daily) alongside estrogen for years with close monitoring from their doctor.
Bioidentical progesterone is considered safer and better tolerated, according to some practitioners, than synthetic progestins for long-term use.
If You’re Using Progesterone for Sleep, Anxiety, or Perimenopausal Symptoms
Progesterone can be used on its own (without estrogen) in perimenopause or early menopause to support sleep, mood, or reduce heavy periods.
Some women use it for a few months during transitional phases. Others continue low doses for several years, especially if they feel noticeable benefits and have no contraindications.
Is Long-Term Use of Progesterone Safe?
When prescribed appropriately and monitored, progesterone appears safe for long-term use in most healthy women12. Studies suggest it does not increase the risk of breast cancer13 the way synthetic progestins might and may even have a protective effect in some cases.
However, your provider should regularly monitor your:
- Symptoms and side effects
- Hormone levels (if indicated)
- Endometrial health (if you’re taking estrogen)
Bottom Line: You can take progesterone for as long as it's medically indicated and beneficial, whether that’s to balance estrogen therapy, ease perimenopausal symptoms, or support better sleep. Work with a knowledgeable practitioner to find the right dose, form, and duration for your needs.
What Type of Progesterone is Best for Perimenopause?
There are several forms of progesterone available:
- Bioidentical micronized progesterone14 (oral or capsule form): Often the most effective for supporting sleep, mood, and hormonal balance. It converts to allopregnanolone, which interacts with GABA receptors in the brain to promote relaxation.
- Progesterone cream: A transdermal option (applied to the skin) that can be helpful for mood and breast tenderness, but it might not be as effective for sleep or systemic support. Related: Is Progesterone Cream the Answer for Hormone Imbalance?
- Progestin mini pill: Sometimes used in perimenopause to help regulate bleeding patterns without full hormone replacement. This does not get metabolized to allopregnenolone like progesterone does, so it won’t have the same benefits for sleep and mood.
Always work with a provider trained in hormone therapy to choose the right type and dose for your individual needs.
FAQ on When to Take Progesterone and What Progesterone is Used For
What are possible side effects of taking progesterone?
Most women tolerate bioidentical progesterone well, but side effects may include drowsiness, bloating, breast tenderness, or mood changes. Talk to your provider if symptoms persist or worsen.
What’s the Difference Between Bioidentical Progesterone and Progestins?
Bioidentical progesterone is chemically identical to the hormone your body naturally produces. It’s often derived from plant sources and formulated to match human progesterone exactly. This is the form most commonly used in bioidentical hormone replacement therapy (BHRT).
Progestins, on the other hand, are synthetic versions of progesterone. They’re used in some birth control pills and traditional hormone replacement therapies. While they do bind to progesterone receptors, they’re not molecularly identical and can have different side effects, including mood changes and a less favorable impact on heart and breast health.
Bioidentical progesterone is generally better tolerated and safer for long-term use in most women.
Can Progesterone Help With Weight Gain or Sleep?
Progesterone may help with both, especially when symptoms are driven by hormonal imbalance.
- Sleep: Bioidentical progesterone interacts with GABA receptors in the brain, promoting a calming, sedative effect that can improve sleep quality and reduce nighttime awakenings. Many women report deeper, more restful sleep within a few weeks of starting oral progesterone. Here’s more about how to support sleep during perimenopause.
- Weight Gain: While progesterone doesn’t directly cause weight loss, it can support better sleep, reduce cortisol (stress hormone), and ease estrogen dominance—factors that all contribute to midlife weight gain. Improving hormonal balance can indirectly support a healthier metabolism. Read more about progesterone weight gain here.
Many women take progesterone at bedtime to support both sleep and mood.
Is Progesterone Cream Effective?
Progesterone cream can be helpful, but it may not be strong enough for full-body (systemic) support.
Creams are typically applied to the skin and absorbed transdermally. They may ease mild symptoms like breast tenderness, mood swings, or sleep issues, but the absorption can be inconsistent, and it’s harder to measure exact dosing.
If you're looking for more reliable support for sleep, anxiety, or heavy periods, oral micronized progesterone (like Prometrium) is often more effective. Oral forms convert to allopregnanolone, a metabolite that directly supports the brain’s calming pathways.
Creams can be part of a plan, but talk with your provider if you need deeper or more consistent symptom relief. Read more about progesterone creams here.
Can I Take Progesterone Continuously or Just Part of the Month?
It depends on your cycle and symptoms.
If you’re still having regular periods, cyclical progesterone—taken only during the second half of your cycle (typically days 14–28)—can help mimic your natural hormone rhythm. This works well for women with PMS, heavy periods, or sleep issues that flare before their period.
If your cycles are irregular, skipped, or you’re in later perimenopause, continuous progesterone (taken daily without breaks) may provide more consistent relief from symptoms like anxiety, insomnia, or estrogen dominance. You can take progesterone continuously.
Tip: Continuous dosing is often preferred when ovulation is inconsistent or unpredictable.
What Is Progesterone Used For?
Progesterone is a key reproductive hormone with a wide range of uses—both in natural body function and in medical or therapeutic settings.
In the body, progesterone is produced after ovulation and is essential for:
- Regulating the menstrual cycle
- Preparing the uterus for pregnancy
- Supporting early pregnancy
- Balancing the effects of estrogen
In clinical practice and hormone therapy, progesterone is commonly used to:
- Ease perimenopause and menopause symptoms like anxiety, insomnia, mood swings, and heavy or irregular periods
- Support hormone replacement therapy (HRT)—especially to protect the uterine lining when estrogen is prescribed
- Improve sleep and reduce nighttime waking through its calming effects on the brain
- Help regulate menstrual cycles in women with PCOS or irregular ovulation
- Prevent miscarriage in some high-risk pregnancies or during fertility treatments
Key Takeaways on When and How to Take Progesterone for Perimenopause
- Progesterone for perimenopause can often help ease anxiety, insomnia, PMS, and heavy or irregular periods.
- Both cyclical and continuous dosing can be effective depending on where you are in your cycle and your symptom patterns.
- You can take progesterone without estrogen, which is often a smart first step in early perimenopause.
- Bioidentical oral progesterone is generally preferred for systemic support and sleep.
- Testing isn’t always reliable, so working with a practitioner who listens to your symptoms is key.
If you’re struggling with perimenopause symptoms, including the all-too-common stubborn weight gain, and you want more support, be sure to grab my free resource: The Perimenopause Weight Loss Action Plan.
You’ll learn how to balance your hormones naturally, including how to eat, move, and supplement for better progesterone levels and a smoother transition through perimenopause. You'll access my 7-day anti-inflammatory meal plan, hormone-supportive recipes, strength training and movement guide, supplement recommendations, and much more.
References
- https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause ↩︎
- https://www.ncbi.nlm.nih.gov/books/NBK493191/ ↩︎
- https://www.medscape.com/viewarticle/994052 ↩︎
- https://www.health.harvard.edu/womens-health/perimenopause-rocky-road-to-menopause ↩︎
- https://www.nature.com/articles/s41598-023-35826-w ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7096310/ ↩︎
- https://www.medscape.com/viewarticle/983196 ↩︎
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause ↩︎
- https://www.mayoclinic.org/diseases-conditions/perimenopause/diagnosis-treatment/drc-20354671 ↩︎
- https://my.clevelandclinic.org/health/diseases/21608-perimenopause ↩︎
- https://pubmed.ncbi.nlm.nih.gov/29583028/ ↩︎
- https://cemcor.ubc.ca/resources/progesterone-therapy-menopause/ ↩︎
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3987489/ ↩︎
- https://cemcor.ubc.ca/resources/progesterone-therapy-menopause/ ↩︎
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