I have been experiencing increased hot flushes, and my sleep is often interrupted at night. Someone recommended a progesterone cream. Is there any harm in trying?
—Anonymous
Progesterone is a key hormone in regulating our menstrual cycle and a critical component of most hormonal contraceptives and hormone therapy regimens. Its role in all of those cases is to stabilize the uterine lining. When progesterone levels drop abruptly during a natural menstrual cycle or when hormonal contraception is withdrawn, the uterine lining sheds, which we experience as uterine bleeding.
In conventional thinking, that is progesterone’s only role in hormone therapy. In fact, if someone has had a hysterectomy, we typically treat them with estrogen only. The benefits of hormone therapy are largely ascribed to estrogen, and if a person doesn’t have a uterus, they don’t have a uterine lining to stabilize and protect from overgrowth. However, some researchers have called this conventional thinking into question.
In one study of progesterone for hot flushes and night sweats, high doses of progesterone did reduce participants’ symptoms compared with a placebo, but there was a strong placebo effect observed in the study. Additionally, while the study did not compare estrogen with progesterone — this would be nearly impossible to do because most women need to take estrogen with progesterone — estrogen appears to be more effective than progesterone for treating hot flushes and night sweats.
The data is more compelling for sleep. It is important to note, though, that the progesterone used in all of these studies for both hot flushes and night sweats and for sleep used oral progesterone capsules given at bedtime. Progesterone was also given in doses many times as high as most over-the-counter progesterone creams. To get the 300 milligrams of progesterone used in the study for hot flushes, you would need to apply something close to 15 times the dose recommended on most OTC progesterone creams, depending on the brand.
Progesterone used incorrectly or inconsistently can result in irregular bleeding. Add to that that OTC progesterone products are regulated as foods, not as medications, so it is not guaranteed that you are actually getting what the product label says you are getting. As a result, I would recommend discussing your symptoms with your doctor and asking if a prescription progesterone capsule with or without estrogen might be appropriate for you.
Ultimately, because the evidence for progesterone involves the use of high doses of oral progesterone and because the quality of OTC progesterone creams is not well regulated, I would not recommend trying an OTC progesterone product but rather discussing hormone therapy with your doctor.
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