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The Role of Progesterone in Perimenopause: Understanding the First Hormone to Decline
Anna Harrelson • July 8, 2024

How the Decline of Progesterone in Perimenopause Affects Your Body and What You Can Do About It

Estrogen gets so much attention in the conversation of women's hormones, but too often progesterone does not get the attention it deserves!  Today, we’re exploring how progesterone, often the first hormone to decline during perimenopause, affects our bodies and contributes to the symptoms many of us experience during this transition.


Progesterone: The First to Fall

Progesterone is a hormone produced primarily by the ovaries following ovulation each month. Its primary roles include:

  • Regulating the menstrual cycle
  • Supporting early pregnancy
  • Balancing the effects of estrogen

During perimenopause, the process leading up to menopause, progesterone levels begin to decline earlier and more significantly than estrogen. This decline can start as early as the late 30s or early 40s, even if periods remain regular.


Symptoms of Low Progesterone

The decline in progesterone levels can lead to various symptoms, often signaling the beginning of perimenopause. These symptoms include:

  • Irregular Periods: Progesterone helps regulate the menstrual cycle, so its decline can cause irregular periods or changes in menstrual flow.
  • Sleep Disturbances: Progesterone has a calming effect on the brain, promoting restful sleep. Lower levels can lead to insomnia or disturbed sleep patterns.
  • Mood Swings and Anxiety: Reduced progesterone levels can lead to mood swings, irritability, and increased anxiety, as it plays a role in stabilizing mood.
  • PMS-like Symptoms: Women might experience more intense premenstrual symptoms, such as bloating, breast tenderness, and headaches.
  • Hot Flashes and Night Sweats: While commonly associated with estrogen, fluctuating progesterone levels can also contribute to these symptoms.

The Physiology Behind Progesterone Decline

The decline in progesterone is primarily due to fewer ovulations as women age. Without ovulation, the corpus luteum (which produces progesterone) does not form, leading to lower progesterone levels. This imbalance between estrogen and progesterone is often referred to as "estrogen dominance," which can exacerbate symptoms.


Managing Symptoms of Low Progesterone

  • Lifestyle Changes
  • Diet: Eating a balanced diet rich in whole foods can support hormone health. Include plenty of fruits, vegetables, whole grains, and lean proteins.
  • Exercise: Regular physical activity helps balance hormones, reduce stress, and improve sleep.
  • Stress Management
  • Relaxation Techniques: Practices like yoga, meditation, and deep breathing can help manage stress and improve overall well-being.
  • Adequate Sleep: Prioritize good sleep hygiene to support hormone balance.
  • Supplements and Natural Remedies
  • Chasteberry: This herb has been said to help balance progesterone levels and alleviate symptoms.
  • Magnesium and Vitamin B6: These nutrients support hormone balance and can reduce symptoms like irritability and mood swings.
  • Hormone Replacement Therapy (HRT)
  • Bioidentical Progesterone: For some women, supplementing with bioidentical progesterone can help restore balance and alleviate symptoms. Consult with your menopause doctor to see if this option is right for you.


Conclusion

Understanding the role of progesterone and its decline during perimenopause can help you navigate this transition more effectively. By recognizing the symptoms and implementing strategies to manage them, you can maintain your quality of life and well-being during this phase.


Stay informed, take proactive steps, and consult with your healthcare provider to find the best approach for managing your symptoms.

Warm regards,

Dr. Anna


WonderCreek Health Blog

By Anna Harrelson March 30, 2025
Let’s start with this: there is nothing shameful or trivial about wanting a healthy sex life. If you're in your 30s, 40s, 50s, or beyond and wondering where your libido went, why sex feels different (or uncomfortable), or why no one ever warned you about vaginal dryness, you’re not alone. And you’re not imagining it. At Wondercreek Health, I talk to people every week who feel confused, dismissed, or ashamed about the sexual changes happening in their bodies. Many are thriving in every other area of life—careers, caregiving, health—but when it comes to intimacy, they feel stuck or unseen. So let’s say this together: sexual health is part of whole-person health. And pleasure is not optional . It’s a reflection of nervous system safety, hormonal balance, connection, and self-awareness. It belongs to you. What Happens to Sexual Health in Midlife and Beyond? Hormonal shifts during perimenopause and menopause can affect every part of your sexual experience. But so can chronic stress, birth control, antidepressants, trauma, and the weight of daily responsibilities. This is never just one thing. Common symptoms include: Vaginal dryness, burning, or itching (genitourinary syndrome of menopause, or GSM) Pain with sex (dyspareunia) Loss of libido or arousal Less intense or harder-to-reach orgasms Urinary urgency or UTIs Pelvic floor tension or dysfunction These changes aren’t "just in your head" and they’re not a moral failure. They reflect real shifts in tissue, blood flow, hormones, and brain chemistry. Sex Isn’t Just for Someone Else’s Benefit Let’s say the quiet part out loud: many of us were raised to believe that sex was about someone else's pleasure. That we should be desirable, responsive, available—regardless of how we felt. That conditioning runs deep. But sex isn’t about performance. It’s about connection, intimacy, and pleasure—for you. Pleasure is your birthright. Intimacy can be tender, playful, spiritual, or wild— but it should never feel like pressure. Your desire may look different than someone else's, and that’s okay. This is true whether your partner is male, female, nonbinary, or you're navigating intimacy solo. There is no one-size-fits-all experience. Why Your Desire Might Feel "Off" Sexual changes can happen at any age. Oral contraceptives (OCPs) can suppress libido by lowering free testosterone. SSRIs and other antidepressants are well known to impact arousal and orgasm. Perimenopause often starts in the mid-30s, long before you notice hot flashes. Chronic stress and the mental load of caregiving, multitasking, and decision fatigue can leave no room for desire. Because here’s the reality: desire doesn’t live in your genitals. It starts in your brain . And when your brain is overloaded with to-dos, responsibilities, or unspoken resentment, it’s nearly impossible to shift into a space of curiosity, connection, and arousal. Unwinding the mind can be hard. For some of us, it means learning to use tools like mindfulness, breathwork, somatic practices, therapy, or just having space and time away from the demands of the world. Creating room for desire isn’t selfish. It’s a form of self-trust and reclamation. The Good News: This Is Treatable Sexual health doesn’t have to decline just because estrogen does. There are safe, effective, empowering ways to reconnect with your body and reclaim your pleasure. 1. Local vaginal estrogen (or DHEA or testosterone): Restores tissue health, lubrication, and blood flow Improves comfort, arousal, and pelvic health Safe for most people, even those with a history of breast cancer (with appropriate guidance) 2. Systemic hormone therapy: Can improve libido, mood, sleep, and confidence Testosterone therapy (when indicated) can support arousal and orgasm 3. Pelvic floor physical therapy: Addresses pain, tension, and coordination issues Supports better sensation and comfort 4. Nervous system regulation: Practices like breathwork, somatic therapy, or trauma-informed care help shift from "fight or flight" into connection When the nervous system feels safe, desire can return 5. Sex therapy or coaching: Helps explore personal blocks, relationship dynamics, and pleasure mapping Let’s Talk About Desire You might notice you don’t feel spontaneous desire anymore— but that doesn’t mean you’re broken . For many people, responsive desire (desire that follows arousal) becomes the norm in midlife. And it’s perfectly valid. Touch, connection, and intimacy may need more warming up. But your ability to experience pleasure is still intact—and it can grow deeper, richer, and more grounded as you reconnect with your body on your own terms. Final Thoughts You don’t need to be fixed. You deserve to be heard. You deserve to feel good in your body. Sexual health is not about keeping up with anyone else’s timeline or expectations. It’s about reclaiming what intimacy and connection mean to you in this season of life. At Wondercreek Health, I’m here to help you connect the dots, reduce shame, and support you with science-backed, judgment-free options that honor your experience. Because this is not the end of your sexual story. It might just be the beginning of the most powerful chapter yet.
By Anna Harrelson March 30, 2025
Let’s be honest: midlife can feel like your body is changing the rules without warning. You’re doing what used to work, but the results aren’t the same. The scale doesn’t budge, your sleep is disrupted, your energy is inconsistent, and your moods might feel like a rollercoaster you didn’t sign up for. And while hormone therapy, supplements, and nutrition are powerful tools for navigating perimenopause and menopause, movement—especially strength training and nervous system-aware exercise—is one of the most underutilized forms of medicine. As a lifestyle medicine physician and menopause specialist, I talk about this daily with my patients. Movement isn’t just about burning calories. It’s about retraining your stress response, building metabolic resilience, preserving muscle, and improving insulin sensitivity. Why Movement and Muscle Matter in Midlife During perimenopause and menopause, we experience natural declines and fluctuations in estrogen, progesterone, and testosterone. These shifts impact far more than reproduction—they affect how we regulate blood sugar, manage stress, build muscle, sleep, and recover from daily life. In this stage of life: Muscle mass declines more rapidly if not actively maintained Insulin sensitivity drops, raising the risk for metabolic syndrome and weight gain Cortisol levels rise and become harder to regulate, especially in women with high stress or trauma histories Nervous system resilience weakens, making it harder to bounce back from emotional or physical stressors Movement is the antidote to all of this. What the Research Shows Muscle is a metabolic organ. It stores glucose, improves insulin sensitivity, regulates inflammation, and even contributes to hormone production and detoxification. Building and maintaining muscle in midlife is one of the most powerful ways to protect against: Type 2 diabetes and insulin resistance Cognitive decline Cardiovascular disease Falls, fractures, and osteoporosis And beyond the physical? Movement is critical for regulating the autonomic nervous system, which influences: Your ability to sleep Your mood and anxiety levels Your response to daily stressors Your digestive and immune function Not Just Any Movement This isn’t about hitting the gym for 90 minutes or going hard every day. It’s about intentional movement that supports your biology. Here’s what I recommend: 1. Prioritize strength training. 2–3 times per week of bodyweight, resistance bands, dumbbells, or machines Focus on form, tempo, and functional movement—not just reps or weight 2. Include low-impact, nervous-system regulating movement. Walking, mobility flows, Pilates, yoga, or tai chi Think of this as your recovery and resilience training 3. Move throughout the day. Break up sedentary time with stretching, light movement, or standing tasks Movement snacks matter for metabolic health 4. Don’t overtrain. Too much high-intensity exercise can increase cortisol, disrupt sleep, and worsen hormonal symptoms Listen to your body and focus on consistency over intensity It’s Not About Looking Fit. It’s About Feeling Well. This phase of life isn’t just about managing symptoms—it’s about building your future resilience. Every time you lift something heavy, take a walk, or stretch with intention, you are: Supporting your insulin and glucose balance Reinforcing your bone, brain, and cardiovascular health Regulating your nervous system Building muscle that keeps you independent and active for decades to come Movement is medicine, & muscle is your midlife superpower. Final Thoughts If you feel like your metabolism has shifted, your sleep is off, or your body feels unfamiliar—you’re not alone. But you’re not broken. You’re evolving. And your body is still responsive to thoughtful support. Start small. Lift something. Go for a walk. Move in a way that honors your nervous system, builds strength, and reminds you that this phase of life is not a decline—it’s a recalibration.
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