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Why I am rethinking oral progesterone for HRT | Felice Gersh, MD
I wanted to better understand the relationship between progesterone and sleep. On the one hand, many women feel like they can't do cyclic hormones because they need nightly progesterone to sleep. And yet, in a reproductive aged woman, high progesterone as seen towards the end of the luteal phase right before menstruation begins is associated with higher rates of insomnia and generally worse sleep quality.
What I learned is making me rethink oral progesterone. A very high percentage of oral progesterone, when it is metabolized through the liver, gets converted to allopregnanolone, which is both a sedative and an antidepressant. In reproductive aged women, some progesterone gets converted to allopregnanolone, but not nearly at the rates that oral progesterone does.
This means (a) women are getting much lower doses of actual progesterone than we think and (b) oral progesterone is really functioning more like a drug than a physiologic hormone. Maybe this is helpful for women who would benefit from a sedative-antidepressant. But I don't think we should be drugging women without full understanding or consent. And, women aren't getting adequate progesterone.
I'm not ready to change my prescribing just yet. My patients taking cyclic oral progesterone are doing really well. But I do want to be transparent that this is something I am looking into and considering.
Check out my latest talk on Hormones, HRT, and Sleep:
https://youtu.be/4KSUC0RBGV8
I explain why both estradiol and progesterone are essential for quality sleep and why Hormone Replacement Therapy in menopause should be striving to replace hormones as physiologically as we can.
#menopause #perimenopause #HRT #bHRT #sleep #menopausesleep #estradiol #progesterone
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