Progesterone During Perimenopause: Symptoms, Testing & Treatment

Perimenopause is the transitional period leading up to menopause, lasting anywhere from a couple of years to a decade. It usually begins in a woman’s late 30s or early 40s, but the timeline can vary from person to person.

During perimenopause, your body experiences biological shifts. You reach the end of your menstrual cycles, ovulation, and reproductive years, and then, once you’ve gone 12 months without a period, you enter menopause. Not sure if you're in perimenopause? Learn: Perimenopause Symptoms: Complete Guide

These shifts are largely driven by hormonal changes, including significant changes to two key reproductive hormones: progesterone and estrogen.

Here’s what you need to know about progesterone during perimenopause, including what exactly happens to progesterone levels during this transition, and how that can impact your body and your life.

What is progesterone?

To understand progesterone during perimenopause, it’s useful to start with a reminder about progesterone’s role in your body.

Along with estrogen, progesterone is one of the central reproductive hormones. Progesterone regulates your menstrual cycle and is crucial to pregnancy. This hormone is mainly produced by the ovaries and the corpus luteum, a temporary gland created during ovulation.

Progesterone plays a key role in your menstrual cycle, supporting:

• Cycle regularity 
• Period flow
• Uterine lining growth

Related to pregnancy, progesterone is necessary for:

• Implantation of the embryo
• Development of the embryo
• Preventing miscarriage and maintaining the pregnancy
• Preparing for milk production and breastfeeding (or chestfeeding)

However, progesterone is not just a reproductive hormone, it also regulates functions outside of the reproductive system. For example, progesterone affects your:

• Mood
• Energy level
• Thyroid function

Because progesterone affects various functions within your body, when progesterone levels change, you might experience symptoms in multiple areas. Want a deeper understanding of how progesterone works? Read: Low vs. High Progesterone Symptoms: What's the Difference?

Progesterone during perimenopause

So, what happens with progesterone during perimenopause? With the onset of perimenopause, your progesterone levels start to decline.

As you get older, your ovulation and menstrual cycle become less regular, and the number of eggs in your ovaries decreases. These changes in your ovaries and ovulation mean that your body produces less progesterone. 

With less progesterone production, levels of this hormone decrease. The decline isn’t necessarily steady: instead, your progesterone will likely fluctuate from cycle to cycle.

At the same time, your body is also producing less estrogen, though not necessarily in the same proportions. This means that the balance between your progesterone and estrogen can change significantly.

>>MORE: What is a Hormonal Imbalance?

The decline, fluctuation, and unstable balance with estrogen make it difficult for progesterone to continue regulating body functions as usual. This can lead to physical and emotional symptoms.

Low progesterone perimenopause symptoms

Changes in progesterone levels are part of the totally normal biological process that leads you to the also-totally-normal menopausal phase of your life. 

While the changes are natural, the physical symptoms they may cause can be unwelcome, uncomfortable, and even horrible. (Although some people may not experience many symptoms at all!) 

Some of the more common symptoms of declining progesterone levels include:

• Irregular and/or heavy periods: With lower progesterone, your periods will likely come more irregularly, sometimes skipping cycles altogether. And, since your uterine lining will be less stable, the periods you do get may be heavier.
• Mood swings and depressive symptoms: Lower progesterone and the newly-unstable balance with estrogen can make your mood fluctuate and trigger depressive emotions, like feelings of sadness, anxiety, loss of interest, or irritability. This may sound similar to premenstrual syndrome (PMS), but during perimenopause, it’s common to experience these mood symptoms throughout your cycle, not just in the lead up to your period. Understanding hormone changes helps manage symptoms. Discover: How Stress Affects Your Hormone Levels.
• Fatigue and lethargy: As progesterone levels decline, you may feel tired or just generally low-energy. You may also experience sleep disturbances, like having a hard time falling or staying asleep, which can lead to increased fatigue, as well.
• Low libido: Progesterone (and estrogen) also helps regulate your sex drive and arousal. When progesterone falls, it can lower your libido and make you less interested in sexual activity.
• Breast tenderness: Low levels of progesterone coupled with high levels of estrogen can cause changes or swelling in breast tissue, including fibrocystic breasts (noncancerous lumps) or breast hypertrophy (overgrowth of dense, heavy breast tissue). This can lead to breast tenderness, breast pain, and general discomfort.

Keep in mind that you may experience other perimenopause symptoms, including symptoms more closely related to changing estrogen levels, like hot flashes, vaginal dryness, lower bone density, and brain fog.

While progesterone typically declines during perimenopause, some women experience temporary spikes that can intensify PMS-like symptoms. Read about high progesterone symptoms during perimenopause.

How to test progesterone levels during perimenopause

Unlike during regular menstrual cycles where timing is predictable, testing progesterone during perimenopause can be tricky because your cycles become irregular.

Normal progesterone ranges:

• Follicular phase: Less than 1 ng/mL
• Luteal phase: 5-20 ng/mL (healthy ovulation)
• Perimenopause: Often 2-8 ng/mL even after ovulation
• Post-menopause: Less than 1 ng/mL

Blood tests through your doctor:

Traditional blood tests measure progesterone at a single point in time, typically on day 21 of your cycle or 7 days after suspected ovulation. However, during perimenopause when cycles are unpredictable, it can be difficult to know when to test.

At-home hormone testing:

At-home testing with Oova provides a more complete picture by tracking progesterone throughout your cycle. This is particularly valuable during perimenopause because:

• You can see if and when you're ovulating (it may not be every cycle)
• You can track how much progesterone you produce after ovulation
• You can identify patterns across multiple cycles
• You can share comprehensive data with your healthcare provider

What your results mean:

Consistently low progesterone (under 5 ng/mL during luteal phase) suggests you're either not ovulating or producing insufficient progesterone after ovulation.

Fluctuating progesterone from cycle to cycle is normal during perimenopause as your body transitions.

Very low or absent progesterone for several cycles may indicate you're approaching menopause.

When to test:

If you're still having somewhat regular periods (within 7 days of expected), test 7 days after suspected ovulation. If cycles are very irregular, consider testing multiple times throughout the month or using continuous daily tracking with Oova to catch the progesterone rise when it happens.

Progesterone vs. estrogen changes during perimenopause

While both progesterone and estrogen decline during perimenopause, they don't drop at the same rate or in the same pattern and this timing matters.

The typical pattern:

Progesterone drops first: Often beginning in your late 30s or early 40s, progesterone production starts declining as ovulation becomes less consistent. This can happen years before you notice other perimenopause symptoms.

Estrogen fluctuates wildly: During early to mid-perimenopause, estrogen levels actually spike and drop erratically rather than steadily declining. Some cycles you may have very high estrogen, others very low.

This creates "estrogen dominance" i.e., when progesterone is low but estrogen remains relatively normal or high, you experience estrogen dominance. This isn't because estrogen is too high in absolute terms, but because the ratio between estrogen and progesterone has changed.

Read: Estrogen Dominance Symptoms: The Complete Guide

Eventually, estrogen drops too: In late perimenopause and post-menopause, estrogen levels finally decline significantly, leading to classic menopause symptoms like hot flashes, vaginal dryness, and bone density loss.

Why this matters for treatment: Understanding that progesterone typically drops first explains why some women benefit from progesterone-only therapy early in perimenopause, while others need combination estrogen-progesterone therapy later in the transition.

Compare symptoms: Low vs. High Progesterone Symptoms: What's the Difference?

Treatment options for low progesterone during perimenopause

If low progesterone is causing bothersome symptoms, several treatment options can help restore balance and improve your quality of life.

Bioidentical progesterone therapy

Bioidentical progesterone (also called micronized progesterone or Prometrium) is molecularly identical to the progesterone your body produces naturally. It's considered safer than synthetic progestins used in traditional hormone replacement therapy (HRT).

Available forms include: 

• Oral capsules (100-200mg, typically taken before bed)
• Vaginal suppositories or gel
• Topical creams (though absorption can be inconsistent)

Benefits of bioidentical progesterone:

• Regulates irregular periods
• Reduces heavy menstrual bleeding
• Improves sleep quality
• Reduces anxiety and mood swings
• Protects the uterine lining if you're also taking estrogen
• May reduce hot flashes

Most women start noticing improvements within 1-2 cycles of starting progesterone therapy.

Combined hormone replacement therapy (HRT)

If you're experiencing symptoms related to both low progesterone AND low estrogen (like hot flashes, vaginal dryness, or bone density concerns), your doctor may recommend combination HRT that includes both hormones.

If you still have your uterus, you should always take progesterone alongside estrogen therapy. Estrogen alone can cause
excessive uterine lining growth, increasing cancer risk. Progesterone protects against this.

Natural approaches

While not as effective as prescription therapy for significant symptoms, natural methods can provide mild to moderate relief:

Lifestyle modifications:

• Stress reduction (yoga, meditation, deep breathing)
• Regular moderate exercise (but not over-exercising)
• Maintaining healthy weight
• Limiting caffeine and alcohol
• Prioritizing 7-9 hours of quality sleep

Dietary support:

• Foods rich in vitamin B6, C, zinc, and magnesium
• Healthy fats (avocados, nuts, olive oil, fatty fish)
• Reducing processed foods and sugar

Herbal supplements (always consult your doctor first):

• Vitex (chasteberry) may support progesterone production
• Black cohosh for hot flashes and mood symptoms
• Evening primrose oil for breast tenderness

Learn more: How to Increase Progesterone Naturally: 8 Evidence-Based Ways→

When to seek treatment

Consider talking to your healthcare provider if you experience:

• Periods so heavy you soak through a pad/tampon every 1-2 hours
• Bleeding lasting more than 7 days
• Periods occurring more frequently than every 21 days
• Severe mood symptoms affecting daily life or relationships
• Sleep disturbances significantly impacting your quality of life
• Symptoms that interfere with work or daily activities

Your doctor can run tests to confirm low progesterone and rule out other conditions, then work with you to find the right treatment approach.

Progesterone during perimenopause: the bottom line

Progesterone is one of the key reproductive hormones. During perimenopause, as your body undergoes major biological shifts in preparation for menopause, your progesterone levels fluctuate and decline. 

Changing progesterone levels is at the root of perimenopause symptoms like irregular or heavy periods, mood swings, fatigue, and decreased libido. While some people may not experience any symptoms, others may be completely overwhelmed by the changes happening in their body. 

If you’re having trouble with the effects of perimenopausal hormone changes, you can talk with your doctor about symptom management. progesterone for perimenopause is a treatment that aims to supplement your hormone levels to help relieve symptoms. Options for lower progesterone include progesterone supplements and combination hormone therapy. Looking for natural ways to support progesterone? Read: How to Increase Progesterone Naturally: 8 Evidence-Based Ways

Even though the symptoms from changing progesterone levels can be uncomfortable, understanding what’s happening in your body can help you take the right next steps for you.

Frequently Asked Questions

At what age does progesterone decline?

Progesterone typically begins declining in your late 30s to early 40s, often starting before you notice any perimenopause symptoms. This decline accelerates as you move through perimenopause.

Can you still get pregnant with low progesterone during perimenopause?

Yes, pregnancy is still possible during perimenopause, though fertility declines significantly. If you don't want to become pregnant, continue using contraception until you've gone 12 consecutive months without a period.

Does progesterone help with perimenopause weight gain?

Progesterone itself doesn't directly cause weight gain or loss, but balancing progesterone can help reduce bloating, improve sleep, and support metabolism, all of which may help with weight management during  perimenopause.

How long do I need to take progesterone during perimenopause?

This depends on your symptoms and goals. Some women take progesterone throughout perimenopause (4-8 years), while others use it short-term for specific symptoms. Work with your healthcare provider to determine the right duration for you.

Is bioidentical progesterone safer than synthetic?

Bioidentical progesterone (micronized progesterone) is generally considered safer and has fewer side effects than synthetic progestins. Studies show it carries lower risks for blood clots and breast cancer compared to synthetic versions.

Will progesterone stop my periods during perimenopause?

No, progesterone therapy during perimenopause typically helps regulate irregular periods and reduce heavy bleeding, it doesn't stop periods entirely. Your periods will naturally stop when you reach menopause.