Sleep problems? It could be your progesterone.
Hormones make life, energy and sleep go round. And if you’re a woman, progesterone is a key player.
“What is progesterone,” you ask? Here’s the scoop.
The Sleep Epidemic
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, more than half of American women (60%) say they only get a good night’s sleep a few nights per week or less and 67% say they frequently experience a sleep problem–particularly perimenopausal women.
Perimenopause is defined as 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 key to getting better sleep is a hormone that your body already produces: Progesterone.
What is Progesterone?
Progesterone is a steroid hormone that is made primarily in the ovaries of cycling (premenopausal) 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.
Here’s everything you need to know about how progesterone works in the body.
Progesterone vs. Progestins
Before we dive deeper into understanding how progesterone works, let’s first clarify the difference in natural Progesterone vs. Synthetic Progestins.
Progesterone and progestins are two completely different compounds that are frequently (mistakenly) lumped together and referred to interchangeably.
- Progesterone is the hormone naturally 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.”
These are umbrella terms for hormones that act like progesterone in the uterus, and therefore includes both progesterone and progestins.
With these two differences summarized, now let’s dig deeper into how progesterone works to enhance your sleep (and energy), and how it interacts with other hormones.
Progesterone is a natural sleep aid
Progesterone is considered our ‘calming, soothing’ hormone.
It helps us to sleep because it makes a metabolite (or by-product) called allopregnanolone which interacts with GABA a receptor in the brain. GABA is a calming neurotransmitter.
Note: Please know that when using external hormones, this similar soothing benefit is derived from using oral progesterone, not progesterone cream. More on that later.
Progesterone, Sleep & Age
In perimenopause, which can begin anywhere from the mid 30s to the early 50s, progestrone drops, sometimes sharply, due to decreased ovarian function. Once it drops, it never comes back.
Estrogen, on the other hand, still pumps 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 (Jehan et al, 2015) 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 knowledgeable physician.
Progesterone, Sleep and PMS
Aside from menopause, women who suffer from PMS also report trouble falling asleep, 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 progesterone usage in PMS,” even though more studies are needed.
The Bottom Line: Improve Sleep with Progesterone
So if you can’t sleep well and you’re a woman, should YOU use progesterone.
Maybe. And maybe not.
The best way to assess whether or not you could benefit from progesterone is to first conduct a hormone test using the DUTCH (dried urine total complete hormone test). This 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 also shows which metabolite pathway your body prefers: alpha or beta pregnanediol.
If you do find your estrogen or cortisol is out of range–high or low–and your progesterone is out of balance, then progesterone therapy may be a consideration.
In a 2018 study by Cintron et. al, the balancing of hormones (both estrogen and progesterone) produced better sleep improvements than the placebo used. This means we will likely see hormonal balancing becomes a centerpiece for sleep disorder treatment in the coming years!
Q. Oral vs. Topical Progesterone: Which is better?
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 progesterone’s well known effects on sleep.
Incidentally, there is no way to change your body’s preferred 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.
Want to learn more?
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