Did you know that sleep disorders are more prevalent in women than in men? Menstrual cycles, pregnancy, and menopause are sex-specific factors that can impair sleep quality. In a National Sleep Foundation poll, 15% of women overall reported problems sleeping. That number jumps to 25% in perimenopausal women, perimenopause being the 10 or so years leading up to menopause, which on average, occurs at 51. This get worse with age as 30% of postmenopausal women report getting a good night’s sleep only a few nights per month. Sleep is as important is good food and exercise. In fact, without good sleep, our exercise and food intake often suffers. With women twice as likely to suffer from sleep disorders, what is one to do? One solution to getting better sleep is a hormone that your body already produces: progesterone.
What is progesterone?
Progestrone is a steroid hormone that is made primarily in the ovaries of cycling (pre-menopausal) women by the corpus luteum (a temporary endocrine gland that is formed at ovulation). It is also made by the adrenal glands of both men and women in lesser amounts. In menopausal women, the adrenal glands become the primary source of a woman’s progesterone production.
Because there is so much confusion around progesterone and progestins, even in medical journals, I want to clarify the difference. They are two very different compounds that are frequently lumped together and referred to interchangeably. Progesterone is the hormone produced in the body, or produced from a plant source made to be chemically and structurally identical to human progesterone.
A progestin is a synthetic hormone that differs in structure from progesterone. Drospirenone, levonorgestrel, or medroxyprogesterone are progestins commonly used in hormonal birth control and hormone therapy. These progestins are not progesterone.
You may also come across the term ‘progestogen’ or “gestagen.” This is an umbrella term for hormones that act like progesterone in the uterus, and therefore includes both progesterone and progestins.
Progesterone as a natural sleep aid
Progesterone is considered our ‘calming, soothing’ hormone and helps us to sleep because it makes a metabolite (or by-product) called allopregnanolone which interacts with GABAa receptor in the brain. GABA is a calming neurotransmitter. Please note that this benefit is derived from using oral progesterone, not progesterone cream, and may be dependent on what type of metabolites (also called by-products) that your body makes from progesterone. More on that later.
Hormones stages of life and sleep
In perimenopause, which can begin anywhere from the mid 30s to the early 50s, progestrone drops, sometimes sharply, due to decreased ovarian function. And once it drops, it’s never coming back. Estrogen, however, is still pumping out unpredictable amounts of hormone. One month it may surge and the next month, hardly at all. This creates either a relative or absolute excess of estrogen, also called estrogen dominance, and estrogen dominance impairs sleep. Another hormone that can run amok in perimenopause is cortisol, an adrenal stress hormone. High levels of cortisol can block receptors for progesterone. High cortisol and low progesterone form a double whammy that can make sleep hard to come by for some women.
In menopause, both estrogen and progesterone are low and both may be needed to restore sleep. In an August 2015 article from the Journal of Sleep Disorders and Therapy, the authors suggest that vaginal dryness with sexual dysfunction in this stage of life could be an important psychological factor in depression that eventually leads to sleep disturbance. Of course, there are other factors associated with menopausal sleep troubles, such as restless leg syndrome and hot flashes to name a few. Women with severe menopausal insomnia may benefit from taking oral micronized progesterone capsules at a dose of 200 or 300 mg per night in addition to bio-identical estrogen. Risk versus rewards for this type of therapy should be decided by each individual woman in conjunction with a trusted and knowledgable physician.
Sleep and PMS
Women who suffer from PMS report trouble falling alseep, frequent night wakings and lack of restorative sleep that peaks two days prior to menstruation. During the luteal phase, which occurs after ovulation, you have a big surge, followed by a decline in estrogen and progesterone. This is the normal ebb and flow of hormones and only becomes a problem when you have too much estrogen and not enough progesterone to keep this all balanced. According to Tierona Low Dog, MD, there is some ‘biological plausibility for progesrone usage in PMS’ even though more studies are needed.
Will everyone’s sleep benefit from progesterone therapy?
According to Carrie Jones, MPH, ND, medical director of Precision Analytical Lab, oral and sublingual progesterone explodes into a ton of metabolites in the body and it’s the alpha metabolites that helps to create the sedative like effect of progesterone. Transdermal (cream) progesterone does not create the metabolites that are helpful for sleep.
Jones goes on to say that if your body prefers the alpha-pregnanediol urine metabolite, you are likely going to benefit from the sedative effects of taking progesterone in the evening to help with sleep. If your body prefers the beta-pregnanediol urine metabolite pathway, you are less likely to benefit from oral progesetrone’s well known effects on sleep.
Adding progesterone may help you to sleep better and doing a DUTCH (dried urine total complete hormone test) helps you to pinpoint exactly what type of therapies will be suited to your unique levels of hormones and metabolites you produce.The DUTCH hormone test shows which metabolite pathway your body prefers: alpha or beta pregnanediol. Incidentally, there is no way to change this pathway. It is inherent. If you produce beta metabolites, you may still want to use progesterone ( there are numerous benefits besides sleep to using natural progesterone), but may need additional support to help with sleep.
For more information on this topic, grab Maria’s free guide to understanding hormone testing here.