Side Effects With Progesterone/Progestins in MHT
What are the options?
Reproductive hormones seem to cause no side effects for some women, and for others, they can lead to premenstrual syndrome and premenstrual dysphoric disorder, postpartum depression, and menstrual migraines, to name a few conditions. The prevailing belief is that some women have a greater sensitivity to fluctuations in hormones, but why and who is at risk, and sometimes even which hormone, for that matter, is largely unknown.
Therefore, it’s not surprising to hear that some women report that they have trouble mood-wise with the progesterone/progestin part of menopausal hormone therapy (MHT). Researchers have been trying to understand the complex interactions between progesterone and mood for a while, and the best summary I have is that it’s complicated (which I appreciate is wholly unsatisfying). One of the theories about the negative effect of progesterone/progestins on mood is related to metabolites that interact with GABA(A) receptors in the brain.
If you have a uterus, progesterone or a progestin is needed to protect against endometrial cancer. Read about that risk here and more about progesterone vs. progestins here. The most common regimen is oral progesterone, which is either 100 mg daily or 200 mg for 12-14 days each month. We’ll address the nuances of daily versus cyclic therapy in another post. The levonorgestrel IUD is also growing in popularity as a progestin alternative.
If you are taking daily progesterone or a progestin and are uncertain if that medication is affecting your mood, one option is to switch to taking it for 12-14 days a month (in the appropriate dose for that approach). If you only experience troubling symptoms while you are taking progesterone or the progestin, then it’s pretty suggestive that that is the cause.
So what are the options when progesterone or a progestin negatively affects quality of life? Here are some options to consider, understanding none have been adequately studied for mood. Also, this is not ranked in any best-to-worst order; they are just options, and each one has pros and cons.
Consider Duavee, the conjugated equine estrogen-bazedoxifene product. The pro