Perimenopause and progesterone

Progesterone is a hormone made mainly after ovulation. It helps prepare the lining of the womb for a possible pregnancy. As ovulation becomes less regular during perimenopause, progesterone may rise and fall differently from one cycle to the next. Oestrogen also fluctuates, so symptoms cannot be explained by progesterone alone.

This changing pattern may accompany shorter or longer cycles, heavier or unpredictable bleeding, breast tenderness, premenstrual symptoms, low mood or disrupted sleep. A single hormone test may not capture the pattern because levels vary across a cycle. Pregnancy remains possible while periods continue, even when cycles are irregular.

Track bleeding, sleep, mood, breast symptoms and medicines for several cycles, noting contraception and pregnancy possibility. Do not start progesterone or a compounded hormone product without a clinician's advice. If hormone treatment is considered, the choice depends on symptoms, whether you have a womb, contraception needs, medical history and the balance of benefits and risks. Ask how treatment will be reviewed and what bleeding changes to expect.

Arrange an appointment for new persistent symptoms, troublesome bleeding or symptoms that interfere with daily life. Seek prompt assessment for bleeding between periods, after sex, or after a long gap without bleeding, and for severe pelvic pain. Urgent help is appropriate for very heavy bleeding with weakness, breathlessness or faintness.

Ask whether your symptoms need tests, whether progesterone treatment is suitable, and how it would interact with contraception or other medicines. Discuss alternatives, expected bleeding changes, warning symptoms and the date for checking whether treatment is helping.