What Is Progesterone Intolerance & How Can We Fix It?

Progesterone is great, unless…

Right hormone, wrong way

Although progesterone intolerance isn’t an official textbook diagnosis, clinicians use the term to describe bothersome side effects from progesterone, most often from oral micronized progesterone (e.g. Prometrium, Utrogestan, etc).

How it happens: progesterone crosses the blood–brain barrier and can slow things down in the central nervous system and digestive tract—similar to its effects during early pregnancy, when progesterone is highest.

Progesterone is nevertheless important for: metabolism (with this in turn having many knock-on effects), mood, bone turnover, and is protective against some cancers (e.g. uterine/endometrial cancer*), as well as improving sleep quality without usually being a sedative (simply, for most people it won’t make you sleep, but it’ll make your sleep more restful when you do sleep).

*Note: at one point, Dr. Hirsch mentions that you don’t need progesterone if for example you’ve had a hysterectomy, but it seems she’s only talking about the cancer issue in that case, i.e. you can’t get uterine cancer without a uterus, and endometrial cancer is rather dependent on having endometriosis, which while strictly speaking isn’t impossible to get without a uterus (endometriosis is, after all, hormonally-mediated uterine tissue getting generated somewhere it shouldn’t and it can even appear far from the uterus’s normal position) but it’s very unlikely, as we may hypothesize that it requires at least one starting cell to proliferate, and in the case of uterine tissue appearing apparently spontaneously elsewhere, it’s probable that a cell that that was originally grown correctly in utero accidentally took a tour through the circulatory system to get somewhere else, where it got stuck and then proliferated, mistaking its new location for a uterine site.

However, all the other reasons to take progesterone still stand whether you have a uterus or not, with bone turnover being the least negotiable consideration.

That said, there are possible side effects, including sedation, dizziness (sometimes severe), next-day grogginess, mood worsening and/or depression, bloating, constipation, and water retention that can make weight appear to jump up suddenly.

If this is a problem, the recommended solution is simply to take it a different way, with transdermal options being best—however, since compounded progesterone creams don’t absorb well, this makes pessaries a top choice (this writer uses Cyclogest pessaries and has never had a problem with them, for what it’s worth).

For more on all of this, enjoy:

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Take care!