This post hits a triple-hitter: First, we are graced with the wisdom and expertise of one of the world's most renowned researchers on perimenopause and women's health, Dr. Jerilynn Prior.
Second, Dr. Prior explains how very (very!) important progesterone is--not only to women navigating perimenopause, but for our long-term brain and bone health post menopause too.
And thirdly (please listen to the end!), Dr. Prior leaves us with some very empowering language and "script tips" for how to talk to our doctors in order to get the health care we all deserve!
Have a listen and let me know your thoughts:
It takes two to tango:
The importance of putting progesterone out on the dance floor
with Dr. Jerilynn Prior
Like couples on a dance floor, problems arise when one partner dominates and the other doesn’t follow.
The same is true with our hormones, and progesterone is long overdue for its time in the spotlight.
Why? For starters, progesterone protects the lining of the uterus, supports our sleep and mood, protects our brain and is essential to cardiovascular, breast and bone health.
Outdated thinking put estrogen at the forefront (some health providers still talk this way unfortunately!)
In November 2020, as I wrote Women’s Reproductive System as Balanced Estradiol and Progesterone Actions—a revolutionary, paradigm-shifting concept in women’s health, I also turned to Google.
“Women’s reproduction AND estrogen” resulted in 223,000 citations while “women’s reproduction AND progesterone” yielded only 88,300. Our culture has long been estrogen-centric, and so has the science behind it.
The truth is progesterone is every bit as important as estrogen when we talk about women’s reproductive health, ovulation, menstrual cycle, perimenopause, menopause, and beyond!
During perimenopause (the phase of life marked by hormone fluctuations leading up to menopause), women will sometimes experience breast tenderness, irregular, heavy or painful periods, mood swings, brain fog, decreased sexual desire, bloating, sleep challenges and frequently women report PMS (premenstrual syndrome) for the first time in their lives.
But when estrogen and progesterone are working in step with one another, the opposite is true: women feel emotionally grounded, their metabolism is forgiving, their skin feels hydrated and clear, and their bones and cardiovascular system are strong.
Another way of explaining this dance is the ratio of estrogen-to-progesterone is balanced: during every menstrual cycle, estrogen is the dominant hormone for the first two weeks leading up to ovulation, and then it is balanced by progesterone during the last two weeks.
For decades, there was a commonly referenced dichotomy of “testosterone is a male hormone and estrogen is a female hormone.” It was at the forefront of media and medical messaging, but it is untrue. Then, “estrogen deficiency,” stepped in as the catchphrase for menopause. It is time (long overdue!) to ignite a paradigm shift around these outdated misconceptions.
Yes, it is true that estrogen naturally declines after menopause (12 consecutive months without a period), but what happens first is perimenopause.
So generally speaking, first a woman has a regular, healthy menstrual cycle, where she is likely producing a healthy amount of progesterone.
However, as she enters perimenopause and begins anovulatory cycles (no egg released), progesterone production goes down—sometimes leading to symptoms disruptive to her quality of life.
This experience is confusing for women as they still have their period (even if it’s lighter, heavier or irregular) and they are unaware that lack of progesterone could be the culprit.
So what can we do, as women and as health professionals, to shift the paradigm and bring more awareness to the important role of progesterone?
1. Make it yourself. Encourage healthy ovulation and menstrual cycles. Progesterone is essential for women’s health, and the number one strategy is healthy ovulation. Let’s all tune into our “body literacy” and become more curious about our cycles—and encourage our daughters to do the same.
2. Pick one benefit and highlight it. I know that talking to a woman about her long-term brain health might be challenging when she is barely getting through her day, or sleeping through the night. Therefore, the content of this article might be too overwhelming for some to fully take in. Pick one positive role of progesterone—maybe its ability to provide calmness, or support her sleep for example. To someone who is stressed out, tired-yet-wired and in constant overdrive, a simple “did you know…?” and mentioning progesterone’s calming abilities could be just the thing to spike her curiosity, and motivate her to have a conversation about progesterone with her physician or pharmacist.
3. Introduce the word “invest”: I’m inviting everyone to stop thinking of progesterone as only a short-term fix for what ails us (hot flashes, irregular bleeding, and sleep disturbances) and to shift our thinking to progesterone as an investment in our long-term health: brain, bone and heart. Let’s use prevention of osteoporosis as an example. Progesterone stimulates formulation of new bone. Current statistics show that 50% of women are going to break a bone due to osteoporosis. Now, let’s imagine what would happen to this statistic for the next generation if more women could be made aware of the benefits progesterone offers.