Progesterone Intolerance
Find out more about progesterone intolerance and how it is managed
What is progesterone intolerance?
Progesterone is essential to prevent hyperplasia (overthickening) of the lining of the womb while taking oestrogen replacement but some women are progesterone intolerant.
Progesterone intolerance is estimated to affect between 10-20% of women and is defined as a sensitivity to progesterone or the synthetic progestogens which are used as part of HRT. These women typically experience psychological and physical symptoms during the days they take the progesterone ecomponent of HRT. Symptoms include low mood and irritability as well as bloating, headaches, fatigue and insomnia. The bio-identical Progesterone (Utrogestan) is usually better tolerated than the synthetic progestogens but even this can cause marked symptoms in some women.
Women who are progesterone intolerant, typically find it difficult to tolerate most contraceptive pills because they contain synthetic progestogens.
How can it be managed?
The management of progesterone intolerance depends on the severity of symptoms and your individual health profile. At our clinic, we offer alternative options for women who are identified as progesterone-intolerant and treatment is individualised considering the patient’s overall well-being and safety.
The symptoms of progesterone intolerance can be minimised by:
- Using natural progesterone instead of a synthetic progestogen.
- Vaginal administration of progesterone is associated with fewer side effects.
- A lower dose of progesterone can be used to minimise the side. effects, but this will require close monitoring to avoid endometrial hyperplasia.
- The Mirena intra uterine device releases a synthetic progestogen that will protect against endometrial hyperplasia. The progestogen from the Mirena is mostly concentrated in the womb with minimal absorption into the rest of the body so that in most cases the progestogenic side effects are avoided.
In rare cases, a hysterectomy with removal of the ovaries followed by appropriate oestrogen replacement may be helpful in those rare cases where progestogenic side effects persist despite trying the other options listed above.
Book your appointment
Book your appointment with our specialist team
Dr Neale Watson
Consultant Gynaecologist
Dr Mike Savvas
Consultant Gynaecologist
Dr Marilena Nicou
GP Menopause specialist
Frequently Asked Questions
What Causes Progesterone Intolerance?
The exact cause of progesterone intolerance is not known, but it may be related to hormonal imbalances or genetic factors. Women with a history of depression, PMS/PMDD, or post-natal depression are more likely to be progesterone intolerant.
How is Progesterone Intolerance diagnosed?
This is a clinical diagnosis and there are no specific biochemical markers that can confirm or rule out this diagnosis. Most women will find that their symptoms completely resolve when they stop taking the progesterone component of their treatment. Some will benefit from taking lower dose of progesterone or an intra-uterine device such as the Mirena, where the progesterone is released into the womb directly with very little absorption into the blood stream.
What can I do to help with Progesterone Intolerance?
In addition to medical treatments, there are steps you can take to manage progesterone intolerance symptoms on your own. These include:
- Eating a healthy diet that is low in sugar, alcohol and caffeine
- Getting regular exercise, such as walking, swimming, or yoga
- Practising stress reduction techniques, such as meditation or deep breathing
- Getting enough sleep
- Keeping a journal to track symptoms and identify triggers
Progesterone intolerance can be a frustrating and uncomfortable condition, but with the right support and care, you can find a treatment plan that works for you.
What to Expect From Your Visit
The first visit will entail a comprehensive consultation, examination and hormone profile testing if required. Our highly qualified menopause specialists will guide you through the process of choosing the safest and most effective treatment to manage your symptoms.
A prescription will usually be issued, at the first visit if appropriate and a follow-up is arranged after 2-3 months to assess the effectiveness of the treatment and make changes as required. Our clinic allows for remote consultation for those who cannot make an in-person follow-up. This may be via a video or telephone call.
Additional services such as pelvic ultrasound scan, coil fittings, smear tests and bone density scan (DEXA) may also be performed as appropriate. We can also arrange for you to have a mammogram if you need one.