The Role of Progesterone in Perimenopause: Understanding the First Hormone to Decline
Anna Harrelson • July 8, 2024
How the Decline of Progesterone in Perimenopause Affects Your Body and What You Can Do About It
Estrogen gets so much attention in the conversation of women's hormones, but too often progesterone does not get the attention it deserves! Today, we’re exploring how progesterone, often the first hormone to decline during perimenopause, affects our bodies and contributes to the symptoms many of us experience during this transition.
Progesterone: The First to Fall
Progesterone is a hormone produced primarily by the ovaries following ovulation each month. Its primary roles include:
- Regulating the menstrual cycle
- Supporting early pregnancy
- Balancing the effects of estrogen
During perimenopause, the process leading up to menopause, progesterone levels begin to decline earlier and more significantly than estrogen. This decline can start as early as the late 30s or early 40s, even if periods remain regular.
Symptoms of Low Progesterone
The decline in progesterone levels can lead to various symptoms, often signaling the beginning of perimenopause. These symptoms include:
- Irregular Periods: Progesterone helps regulate the menstrual cycle, so its decline can cause irregular periods or changes in menstrual flow.
- Sleep Disturbances: Progesterone has a calming effect on the brain, promoting restful sleep. Lower levels can lead to insomnia or disturbed sleep patterns.
- Mood Swings and Anxiety: Reduced progesterone levels can lead to mood swings, irritability, and increased anxiety, as it plays a role in stabilizing mood.
- PMS-like Symptoms: Women might experience more intense premenstrual symptoms, such as bloating, breast tenderness, and headaches.
- Hot Flashes and Night Sweats: While commonly associated with estrogen, fluctuating progesterone levels can also contribute to these symptoms.
The Physiology Behind Progesterone Decline
The decline in progesterone is primarily due to fewer ovulations as women age. Without ovulation, the corpus luteum (which produces progesterone) does not form, leading to lower progesterone levels. This imbalance between estrogen and progesterone is often referred to as "estrogen dominance," which can exacerbate symptoms.
Managing Symptoms of Low Progesterone
- Lifestyle Changes
- Diet: Eating a balanced diet rich in whole foods can support hormone health. Include plenty of fruits, vegetables, whole grains, and lean proteins.
- Exercise: Regular physical activity helps balance hormones, reduce stress, and improve sleep.
- Stress Management
- Relaxation Techniques: Practices like yoga, meditation, and deep breathing can help manage stress and improve overall well-being.
- Adequate Sleep: Prioritize good sleep hygiene to support hormone balance.
- Supplements and Natural Remedies
- Chasteberry: This herb has been said to help balance progesterone levels and alleviate symptoms.
- Magnesium and Vitamin B6: These nutrients support hormone balance and can reduce symptoms like irritability and mood swings.
- Hormone Replacement Therapy (HRT)
- Bioidentical Progesterone: For some women, supplementing with bioidentical progesterone can help restore balance and alleviate symptoms. Consult with your menopause doctor to see if this option is right for you.
Conclusion
Understanding the role of progesterone and its decline during perimenopause can help you navigate this transition more effectively. By recognizing the symptoms and implementing strategies to manage them, you can maintain your quality of life and well-being during this phase.
Stay informed, take proactive steps, and consult with your healthcare provider to find the best approach for managing your symptoms.
Warm regards,
Dr. Anna
WonderCreek Health Blog
Many of the women who find their way to me share a common story: They’ve seen multiple specialists. Their labs are “normal.” Their symptoms are scattered across systems—joints, gut, mood, hormones, skin—and yet every provider focuses on one piece at a time, never the whole picture. They’ve often been told they’re anxious, dramatic, or “too sensitive.” And yet, they’re also some of the most intuitive, self-aware, and relentlessly curious patients I’ve ever met. They know their bodies. They know something isn’t right. And they won’t stop searching until someone finally sits down and helps them connect the dots. That’s where connective tissue disorders come in. What Do We Mean by “Connective Tissue Disorders”? When I talk about this group of conditions, I’m referring to women who often fall somewhere on the spectrum of: Hypermobility spectrum disorder (HSD) Ehlers-Danlos features Mast cell activation (MCAS) Endometriosis PMDD and other hormone sensitivities POTS or other dysautonomias The common thread? Their connective tissue is different—looser, more fragile, more reactive. And when the scaffolding of the body isn’t as stable, symptoms spill over into every system: joints, vessels, immune response, mood, hormones, digestion, even the brain. Why Midlife Feels Like a Breaking Point Estrogen has always been a stabilizer. It strengthens collagen, calms mast cells, and helps buffer the nervous system. So, it’s no surprise that perimenopause—when estrogen begins to fluctuate dramatically—can feel like the rug is being pulled out. I see women who: Once held things together with sheer willpower Managed PMDD, migraines, or endometriosis in their younger years Suddenly feel like everything has intensified: joint pain, bloating, histamine reactions, mood shifts, insomnia, brain fog For women with sensitive connective tissue and sensitive nervous systems, hormonal shifts don’t just cause hot flashes—they destabilize the entire body. Hormone Therapy for the Orchid Patient Many of my patients have tried hormones before. Sometimes birth control left them moody, swollen, or miserable. Sometimes a patch or pill was prescribed quickly, with no attention to how sensitive their system might be. So when they hear “hormone therapy,” they’re understandably hesitant. This is where my orchid theory comes in. Orchids are not weak flowers—they’re strong, beautiful, and resilient. But they need careful tending. They don’t thrive when thrown into the same soil or light as every other plant. They require patience, precision, and a slower hand. My connective tissue–sensitive patients are orchids. Their bodies respond to hormone therapy, but they need a methodical, gentle approach: Always bioidentical hormones Introduced slowly, step by step Carefully monitored, with adjustments made gradually Combined with lifestyle strategies to support the nervous system and reduce inflammation This is not a “one patch fits all” process. It’s a partnership. And when done thoughtfully, hormone therapy can bring profound relief and stability. Why Sensitivity Is a Strength The women I see are often neurodivergent—ADHD, autistic traits, or simply highly perceptive. They’re often told their sensitivity is a liability, but I see it differently. That very sensitivity is what helps them notice patterns others miss. It’s what fuels their curiosity to keep searching, even after being dismissed. Their intuition about their own bodies is spot on. Yes, their connective tissue is different. Yes, their mast cells fire more easily. Yes, their hormones seem to create more chaos. But these women are also some of the most resilient, resourceful, and insightful people I know. Moving Forward If you see yourself in this description, please know: You’re not “too sensitive.” You don’t have 27 different diagnoses—you have a pattern that makes sense. Hormones are not off the table for you—they may just need to be approached differently. Your lived experience matters as much as your lab results. This isn’t about fixing you—you are not broken. It’s about giving your body the tailored support it’s been asking for all along. This is just the beginning of a series I’ll be writing on connective tissue–related conditions: MCAS, PMDD, endometriosis, and more. Each deserves its own spotlight. But the first step is recognition. You deserve to be seen in your wholeness—not dismissed as “normal” when everything in your body is telling you otherwise.
You know how people say, "Just drink some water and take a magnesium supplement" like it’s the answer to everything? Well… they’re not totally wrong. But like most good advice, the devil is in the details. Magnesium is one of the most essential minerals in the body, involved in over 300 enzymatic reactions , yet it remains one of the most commonly overlooked deficiencies in midlife women. And no, your annual bloodwork probably didn’t catch it. So What Does Magnesium Actually Do? Think of magnesium as a multitasking background assistant—it keeps the lights on and the gears turning across nearly every body system: Brain & Mood: Regulates GABA and NMDA receptors, supporting calm, focus, and resilience against anxiety and overstimulation. Muscles: Prevents cramping and twitching, supports strength and recovery, and reduces restless legs. Sleep: Plays a role in melatonin production and nervous system regulation. Bowel Function: Helps pull water into the colon to prevent constipation. Cardiovascular Health: Regulates blood pressure and helps with vasodilation. Hormone Balance: Assists in estrogen metabolism and combats insulin resistance. In short: if you’re exhausted, bloated, moody, foggy, tense, or irregular in your gut or cycle—magnesium deserves a spot on your radar. Why Is Magnesium So Important in Midlife? Estrogen and progesterone both influence magnesium levels. As hormone levels decline or fluctuate during perimenopause and menopause, so does your ability to retain and utilize magnesium. Add to that: Chronic stress (which depletes magnesium) Modern diets (often low in magnesium-rich whole foods) Medications like PPIs, diuretics, or certain antibiotics High caffeine, sugar, or alcohol intake (all increase magnesium excretion) And suddenly, a " borderline magnesium issue " becomes a perfect storm. Why Your Blood Test Might Not Show It Serum magnesium tests only reflect ~1% of total body magnesium. Most magnesium is stored in bone and tissue. So it’s very possible to have "normal labs" and still be clinically deficient. In practice, we go by symptoms, risk factors, and therapeutic response. Common Signs of Suboptimal Magnesium Trouble falling or staying asleep Anxiety or nervous system overactivation Fatigue or burnout that doesn’t resolve with rest Muscle cramps, spasms, or eye twitches Constipation Menstrual migraines or tension headaches Joint stiffness or tightness Sugar cravings or blood sugar crashes Best Food Sources of Magnesium Magnesium-rich foods include: Dark leafy greens (spinach, chard) Nuts and seeds (especially pumpkin seeds and almonds) Avocados Legumes Dark chocolate (yes, really!) Whole grains like quinoa and oats That said, many of us still fall short even with a healthy diet, especially during high-stress seasons or if absorption is impaired. Supplements: Which Type of Magnesium Is Best? Not all magnesium is created equal. Here are the forms we most often recommend: Magnesium Glycinate: Best for sleep, anxiety, and muscle relaxation. Gentle on the stomach.** Magnesium Citrate: Useful for constipation, but can cause loose stools at higher doses. Magnesium Threonate: May support cognitive function and brain health. Magnesium Malate: Good for energy and muscle pain, often used in fibromyalgia. We generally avoid magnesium oxide unless constipation is the only concern, as it’s poorly absorbed. **Mag Glycinate is generally my go to recommendation and what we take at our house Also, BLENDS can be good- but generally more expensive Dosing & Timing Most women benefit from 200–400 mg daily, depending on needs. Take it in the evening if you're targeting sleep or relaxation. Divide doses if taking more than 300 mg (e.g. AM + PM). Always start low and go slow, especially with citrate forms to avoid urgent bathroom visits. Final Thoughts If magnesium had better marketing, it would be a top-tier wellness darling. But because it’s quiet, essential, and boring on paper, we tend to overlook it. Yet for so many midlife women, magnesium is the missing link that helps all the other systems and strategies finally click. So if you're doing "everything right" and still feel off? It might be time to start taking magnesium!