Should I take progesterone?

Our read is that progesterone is well supported for a range of applications, from ameliorating PMS symptoms and improving sleep to protecting the endometrial lining in women with a uterus.

Experts note its use in HRT for anxiety and sleep, its role in balancing free androgen levels in men on TRT, and its potential in preventing Alzheimer's disease when timed correctly around menopause.

However, individual responses vary, and some individuals may experience negative mood impacts or other adverse reactions.

For PMS symptoms, taking oral progesterone for seven days is suggested. For inducing a withdrawal bleed, micronized progesterone at 200mg for 5 days is mentioned, or medroxyprogesterone acetate at 5-10mg for 5 days. A typical starting dose for oral progesterone is 100mg, potentially increasing to 200mg if estrogen doses are higher. After inducing a withdrawal bleed, letrozole is started on day three to seven of the cycle to ripen the follicle.

• 01Peter Attia and Andrew Huberman state that taking oral progesterone for seven days can ameliorate PMS symptoms (7x).
• 02Peter Attia and Andrew Huberman note that progestogenic activity acts as a GABA agonist and improves sleep (7x).
• 03Peter Attia states that in men on TRT, progesterone may help balance disproportionately high free androgen levels, which can lead to a perpetually keyed-up sympathetic drive (3x).
• 04Andrew Huberman indicates that micronized progesterone is used in HRT for anxiety and sleep issues, regardless of uterine presence, and is essential for endometriosis patients (1x).
• 05Peter Attia states that non-synthetic forms of progesterone have not been associated with an increased risk of breast cancer and are now being advised and used (1x).
• 06Peter Attia highlights that intervention timing around menopause is key for preventing Alzheimer's disease (1x).
• 07Peter Attia states that transdermal estradiol and micronized progesterone are preferred hormone therapy formulations over older oral conjugated estrogen and MPA (1x).
• 08Peter Attia notes that Natasia, a combination of progesterone and estradiol valerate, is the only contraceptive pill approved by the FDA to treat heavy menstrual bleeding (1x).
• 09Peter Attia states that if a woman has a uterus, progesterone must be prescribed to protect the endometrial lining (1x).
• 10Rhonda Patrick reports that people with severe brain trauma had a 2.4x higher likelihood of favorable recovery when administered progesterone and vitamin D (1x).
• 11Andrew Huberman states that combined oral contraceptives do not change the release of eggs from the ovarian reserve (1x).
• 12Rhonda Patrick suggests that multiphasic progesterone may be used during perimenopause transition, but postmenopausal women should maintain a steady, low-dose estrogen (1x).
• 13Andrew Huberman notes that cyclical progesterone can be used to induce a withdrawal bleed, providing an emotional benefit for women experiencing premature ovarian failure (1x).
• 14Peter Attia states that after inducing a withdrawal bleed, letrozole is started on day three to seven of the cycle to ripen the follicle (1x).

Peter Attia notes that for a subset of women, progesterone can negatively impact mood, leading to depression or severe irritability (1x). Peter Attia also points out that the Women's Health Initiative study, which found a 25% increased risk of breast cancer, used conjugated equine estrogen and medroxyprogesterone acetate, not bio-identical estradiol and micronized progesterone, suggesting its findings were misleading (2x). Peter Attia also states that oral contraceptives that do not contain 17 beta-estradiol or progesterone may compromise long-term health benefits like bone density (1x). Peter Attia and Andrew Huberman mention that not all women can tolerate oral progesterone, and for some, it can cause significant adverse psychological effects (2x). Peter Attia notes that approximately one-third of patients experience significant benefits from micronized progesterone, while another third notice no effect, and the final third are highly sensitive and may experience adverse reactions (1x). Peter Attia also states that some individuals can have extreme reactions or progesterone allergies, leading to side effects like excessive sleepiness or bloating (1x).

It is unknown if bioidentical micronized progesterone would increase breast cancer risk similarly to MPA, although some observational studies suggest a lesser increase (Peter Attia, 1x). Whether 100mg of progesterone taken systemically is sufficient to oppose estrogen requires more data, and patient bleeding may indicate a need for more progesterone (Peter Attia, 1x).