Progesterone After 40: The Hormone Too Many Women Are Told They Don't Need

Host David J. Bauder, PA-C, founder of Weight Loss & Vitality, is joined by Dr. Christopher Reeves, Medical Director, and Stephanie Lattimore, FNP-BC, for an important discussion about one of the most overlooked hormones in women's health: progesterone. 

Many women are told that progesterone's only purpose is supporting pregnancy and protecting the uterus during the reproductive years. As a result, its importance during perimenopause and menopause is often underestimated. In this episode, the team challenges that misconception by explaining the many physiological roles progesterone continues to play throughout a woman's life. 

The conversation explores how declining progesterone levels can contribute to insomnia, anxiety, mood changes, irritability, fatigue, and reduced quality of life. David, Dr. Reeves, and Stephanie explain progesterone's interaction with GABA receptors, its balancing relationship with estrogen, and its role as a precursor to several other important hormones involved in stress regulation, metabolism, and neurological function. 

Additional topics include estrogen dominance, proper hormone testing during perimenopause, timing of laboratory evaluation, individualized treatment strategies, and why oral micronized progesterone is commonly preferred over topical formulations for systemic hormone replacement.

Whether you're approaching menopause, experiencing changes in sleep or mood, or simply want to better understand hormone therapy, this episode provides an evidence-based overview of why progesterone deserves far more attention than it often receives.

In This Episode

• Why progesterone is misunderstood
 • Hormonal changes after age 40
 • Progesterone and sleep quality
 • Mood, anxiety, and GABA receptors
 • Estrogen dominance explained
 • Progesterone as a hormone precursor
 • Hormone testing during perimenopause
 • Oral versus topical progesterone
 • Individualized hormone replacement therapy
 • Improving quality of life through comprehensive hormone evaluation 

Learn More About Bioidentical Hormone Therapy

🌐 https://www.weightlossandvitality.com/services/bioidentical-hormone-therapy

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📞 571-550-9000

Key Takeaway

Progesterone continues to play a critical role throughout a woman's life. Looking beyond fertility and understanding its influence on sleep, mood, neurological health, and hormonal balance allows for a more comprehensive and personalized approach to women's healthcare.

⚠️ Disclaimer
This podcast is for educational purposes only and does not constitute medical advice. Listening to this episode does not establish a provider-patient relationship. Always consult your qualified healthcare professional regarding medical concerns, diagnosis, or treatment.

Transcript

SPEAKER_01 0:00

Vitality.

SPEAKER_02 0:02

Vitality Unfiltered.

SPEAKER_01 0:04

Unfiltered. With David Bowder.

SPEAKER_02 0:10

Welcome back to another episode of Vitality Unfiltered. I'm your host, David Bowder, and with me today from Weight Loss of Vitality is Dr. Christopher Reeves, Medical Director, and nurse practitioner Stephanie Lattimore from the Washington, D.C. Clinic. Today's conversation will be centered around progesterone after 40. This is often a hormone that is dismissed in women. A lot of times, many women are actually told that progesterone is no longer needed. But unfortunately, this is another one of these classical examples of misinformation. Progesterone is a very necessary hormone in the body and it does a lot of important things. Today's discussion, we're really going to be talking about how progesterone works, where the myth comes from, and kind of get to the explore the uh explore this hormone in a little bit more detail. So to kick this off, I'm going to have Stephanie talk about where did the myth that progesterone isn't needed come from?

SPEAKER_00 0:59

So the myth that women don't need progesterone post-fertility or childbearing age, in my opinion, came from the the idea that there was really no role for it post-fertility, post-childbearing. We don't need it to protect the uterus, to carry a pregnancy. As Dr. Reeves and I just discussed offline, um, another theory, the myth came from the fact that hormone replacement therapy is driven by estrogen. So that estrogen became the primary hormone to replace and progesterone kind of took a back seat.

SPEAKER_02 1:33

I think that uh it's interesting where you know there is some there is some language and discussion out there about when progesterone is needed, right? So if you're going to use it on therapy of a woman, then a lot of people understand that, oh, okay, if you're going to take estrogen, then you need progesterone. But this idea that you never need progesterone bias, you know, like it it is really interesting.

SPEAKER_00 1:53

Trevor Burrus, Jr.: It's really crucial as we're living longer and living as the progesterone declines to nearly nothing, women have great interference of sleep, relaxation, and mood without this essential hormone.

SPEAKER_03 2:07

Well, it's also you've you've you're negating the part about like kind of the balancing effect of progesterone. Progesterone has a role to kind of keep um you know the estrogen in b in in balance and and kind of from over over-affecting, you know, side effects and affecting the body in some negative and deleterious ways. And so it's it's uh kind of a kind of uh the concept of you heard uh unopposed estrogen, you know. So it's that's kind of the catchphrase that was set mentioned years ago. Progesterone is that kind of that function to kind of keep that that balance uh with uh estrogen.

SPEAKER_02 2:41

A lot of women start experiencing it early on in the 40s, they'll start to experience the estrogen dominance where their progesterone levels start to fall off, their estrogen level peaks, and immediately you know what is one of the first symptoms that's associated with low progesterone is insomnia. That's right.

SPEAKER_00 2:58

Insomnia comes to mind because progesterone interacts with those GABA receptors, that primary inhibitory neurotransmitter that is responsible for the calming effect that we experience before sleep, initiation of sleep, staying asleep, mood regulation. So without that, we see women approaching menopause with big changes in their mood, energy levels, and sleep.

SPEAKER_02 3:22

That's right. And then you have the again, another symptom of estrogen dominance is irritability. No progesterone and just estrogen, irritability. So there is that mood, you know, you apply the progesterone back and you balance out the estrogen, you're gonna have improvement of mood, irritability factors. And um I cannot tell you the number of patients that have had improved sleep by just giving them progesterone and magnesium. You just give them progesterone and magnesium and what do you think the greatest misunderstanding is about progesterone?

SPEAKER_03 3:52

That it's not needed. That uh it like like Stephanie was saying, that it's it's just a fertility uh hormone. Um but again, you know, there are studies that have shown that like uh because of this bias towards estrogen and this under treatment or under underdiagnosis of low progesterone. I think up to 60 or 70 percent of postmenopausal women's have symptoms that are directly related to low progesterone, but are getting misdiagnosed as other things because people are not looking into progesterone as a causative factor for some of these symptoms.

SPEAKER_02 4:36

And in reality, all that would have to happen is you just treat the pa treat the patient with progesterone.

SPEAKER_00 4:41

Which is naturally it's a naturally occurring hormone in the body, just replacing, restoring, and optimizing a female to their previous levels if that's all it would take.

SPEAKER_02 4:52

Yeah, one of the one of the one of the greatest things that I think is overlooked in in or one of the what reasons that I think that it's a very s huge misunderstanding is progesterone is turns into a lot of different hormones. I mean progesterone directly directly there's a direct pathway to treat into cortisol. There's a direct line for progesterone to turn into aldosterone for fluid for fluid balancing. The sex the neuros uh the neurosteroids that you were talking about, allapy impregnolone. L-apregregnolone impregnolone. Um there's also progesterone converts into um testosterone, downrange from testosterone, and then testosterone can convert into aromatized into estrogen to have a benefit in women. So the idea that progesterone is not needed is just like it's I mean, it scratches my head. I really just like, how did that how did that ever come about? But you're right, it had to be because it's just it's all estrogen focused, it was all tied to fertility. When fertility is no longer needed, you don't need progesterone.

SPEAKER_00 5:50

Yeah, and we know from an we know from a from life from each and every one of us, but we know from an earlier episode how important sleep really is. And if your sleep is off, you're not gonna have energy to work out. Um, you're not gonna do well at your job, you're not gonna be on your game. So every other aspect of your life has this negative impact from lack of sleep or lack of quality sleep. Progesterone can actually um improve that deep sleep, that deep restorative level of sleep that women achieve, and they can't get there without it.

SPEAKER_02 6:21

I know in some of the other episodes you you went like this. Is the standard in in our patients. This is a standard evaluation when it comes to progesterone hormone. But for the listeners, like what does a standard evaluation look like when you're looking for progesterone level?

SPEAKER_00 6:34

Um, I'm definitely gonna ask first and foremost about sleep. Um, absolutely, but I'm also gonna ask about mood. Um, and this can look very different for different women. Um, it kind of depends on your threshold for you know coping strategies. A lot of women will have a positive outlook. So mood changes might look just like I'm getting frustrated more easily. Um, my mood is is more labile up and down. So mood is a big one, as well as energy. So their energy interest in things, um, do they have enough energy to work out? Um so it can look like a lot of different things, um, not just sleep, but um, mood and energy are just as important.

SPEAKER_02 7:14

If you're having labs drawn for progesterone, we always like to encourage our patients to have their labs drawn on day 21. For women that are perimenopausal that are still having a menstrual cycle, it's really, really important for that day 21 to try to establish a baseline. Even if that 28-day cycle is off, you try to get as act as as close to possible as that 21-day mark. It's really beneficial because we kind of can we kind of know what the progesterone level is supposed to be at on day 21. Any other day of the cycle, it's kind of very, very challenging to try to nail down a how low you actually are. Another factor, if if um even if you're not regularly cycling, you still can march out your 28-day cycle. Even if you're not regularly having a regular cycle, as long as you have the last cycle you had and you can march out your 28 days and you can do that hormonally, you're still cycling. It's just not often presenting presenting clinically.

SPEAKER_00 8:08

A lot of times progesterone is one of the first hormones to go, and it won't be as stark of a decline symptomatically as estrogen. Estrogen is a little bit more obvious with the symptoms, whereas progesterone starts to decline earlier and it's much more gradual. So it's hard to know. You really have to be tuned into those symptoms and think big picture, sleep, mood, energy, not just uh changes with the woman's cycle.

SPEAKER_02 8:33

That's right. It could be and it can be a variability of any it all these little subtle changes. Absolutely.

unknown 8:38

Yeah.

SPEAKER_02 8:39

So I know I think we kind of covered everything about this. You know, it's it's a we we've covered the progesterone a lot on other episodes, but this one was specifically to try to point out that progesterone is needed. There has been lack of attention given to women and progesterone therapy. It is a very, very good utilization tool to help women sleep at night and control anxiety and improve mood. And it and it does have quality of life associated with it. And there's different strategies as how you can take progesterone according to where you are, whether you're perimenopausal or menopausal, whether you take it daily or whether you take it just the last 14 days of your menstrual cycle. So there's a lot of different strategies that can be in place, and there's also different dosing. Um I I would just caveat one more thing is normally when we do treat women with uh progesterone, we're using oral medication. We're not using progesterone out of all the creams. We use a lot of hormonal creams in the clinic, and progesterone has the least ability to transfer through the skin into the body. So the oral medication is the preferred route when you're using progesterone therapy. So, in closing, if you don't feel like yourself, you're not imagining it. If you're perimenopausal or menopausal, just don't discount the possibilities that progesterone can be causing some of your symptoms. If you enjoyed the show today, click the subscribe button below so you don't miss the next episode, and we'll see you on the next show.

SPEAKER_01 10:00

Thanks for joining us on Vitality Unfiltered with David Bowder. Addressing norms, busting myths, and uncovering health realities for a more vibrant life today. For more expert insights and real talk, make sure to subscribe and join us next time.