Did I ever tell you about the time I almost divorced my husband because he got a cold? 

Yep.  True story.  And, spoiler alert, I did NOT divorce him--with a LOT of thanks to Progesterone for that.  So for more details, let's move along into the blog. 

In case you don't know me, before you learn about my almost divorce,  I'm Dr. Kelly, a double board certified pelvic floor physiotherapist, continuing my blog series all about Hormone Replacement Therapy Basics.  As research surrounding HRT is EXPLODING, many primary care providers are struggling to keep up, and my real humans are having to be ever-more proactive in their own health care.  Henceforth, this mini-blog series.  Today we're going to learn why and when you might consider talking to your primary medical provider about if Progesterone hormone replacement therapy (HRT) is appropriate for you.  

Progesterone Basics

When we talk about hormones in the female body, we are meant to have the greatest concentration, or amount, of Progesterone, followed by Testosterone, followed by Estrogen. This surprises many people, who think that Estrogen is the most dominant female hormone.

While Estrogen is responsible for our gender-dominant traits, like boobs, and how much the endometrial lining builds up each month before our period, it is NOT our most prevalent hormone--that distinction falls to Progesterone. 

Progesterone keeps Estrogen in check.  It controls the amount of endometrial lining.  It also keeps our moods in check.  It helps control our emotions.  It helps regulate our temperature.  It helps us sleep.   

Testosterone drives libido, maintains bone density and muscle mass, and helps with our energy level and stamina.  

All three of these hormones need to exist in a "proportional way"for us to feel "balanced" and feel our best.  

In Perimenopause, Progesterone is the First Hormone to Decline

In Perimenopause, which is the 10-year period before menopause (when our periods finally stop for 12+ months), progesterone is the first hormone to decline.  

Since it is meant to be our most prevalent hormone, it is unsurprising that this can cause a plethora of symptoms.  The AVERAGE AGE of onset of perimenopause is 40-42 years old, with many women beginning perimenopause at 35 (Gold study). 

Additionally, women with ADHD suffer from more severe perimenopause symptoms than women without ADHD (Jakobsdóttir, et al, 2025).

So  if you begin to experience ANY of these symptoms, from age 35+, you should talk to your doctor about if Progesterone Hormone Replacement Therapy, OR ANY TREATMENT TO ADDRESS THESE SYMPTOMS, is for you.  

Top 4 Symptoms that can be helped by Progesterone HRT

The medically accepted "first sign of perimenopause" is a woman "not feeling like herself."  

This is because as progesterone drops, Estrogen begins to be unregulated and you enter relative Estrogen dominance.  And Estrogen has MANY bodily functions.  If Estrogen is unchecked, it results in the following symptoms, the presence of ANY OF WHICH could be a reason to discuss Progesterone HRT with your primary care provider or hormone specialist: 

1.  Increase in general anxiety or depression. 

2.  Increased IRRITABILITY or "quiet rage"

3.  Increased (or any) boob soreness, or pre-menstrual mood swings

4.  INCREASE in period frequency or bleeding amount
**this symptom typically occurs later in perimenopause, whereas the first two symptoms occur MUCH earlier

The frequent and heavy periods is perhaps what used to be "commonly known" as the "only" sign of perimenopause--but the emotional changes happen 3-5 years before period changes.  And if you DON'T HAVE A UTERUS, you'll have to determine if you are in perimenopause by these emotional changes.  

Frequent and heavy periods need to be addressed as quickly as possible, as prolonged heavy bleeding WILL deplete your body of Iron levels, which ironically make you bleed MORE.  Low iron levels (ferritin) are associated with their own host of symptoms, many of which minimic perimenopause.  

3 more (lesser-known) symptoms of perimenopause related to reduced progesterone

1.  Itchy eyes, skin, nose or EARS!!!

This is a huge one. While it is truly Estrogen that helps regulate skin hydration, oil (sebum) production, and collagen levels...if the Estrogen levels are now fluctuating due to changing Progesterone, we can have dry and itchy ears, eyes, and noses!!  

2. sleep disturbances

Related to the nervous system changes, and increase in general anxiety and depression, as progesterone drops, our sleep depth and quality is dramatically affected.  Reduced sleep quality is a HUGE flag for discussing a potential progesterone HRT with your provider.

3. Weight gain, fatigue and reduced libido

These are all due to the altered "percentage or proportion" of hormones, as well as functional ramifications of perhaps not sleeping so well!  Improving your sleep quality will directly improve energy levels and libido, as well as help with weight gain, as you will have more energy to move your body.  

With weight gain, however, it's not as simple as "work out harder" in perimenopause.  Honor your body, and LISTEN to energy levels.  If they remain LOW after starting progesterone, you could potentially need additional HRT, or perhaps you are low in Ferritin if you've had heavy periods for a while?  While "normal" is 8-150, anything less than 30 is considered "iron deficient", and "ideal" is above 50 for a 40 year old female.  So ferritin matters.  More on that in another post.  

So how did I almost divorce my husband over a cold? 

I am so glad you're still here for this :). And this IS a 100% true story.  

I have severe ADHD, so lucky me, have severe perimenopause symptoms.  I began "not feeling like myself" around 34.  I was diagnosed with ADHD around 36, and between 36 and 38 I STRUGGLED with ever-increasing agitation and irritability, as well as what I would later discover was building anxiety.  The entire time, my libido was dropping, as were my energy levels.  

When I turned 40 years old, my period started coming every other week...then hemorrhaging every other week.  It was around this time when my sweet husband got his infamous cold, and I am not really exaggerating when I say that I was considering divorce (after being happily married for 22 years at the time) because "that was the final straw".  

Lucky for him (and me), I realized that the vehement rage that I felt (and I did TRULY feel the rage--as irrational as it was), was not okay.  I went back to my primary provider who now that my periods were being weird, was like 'OH! PERIMENOPAUSE!", and we started Progesterone.  That improved the periods...helped me sleep again and MAY HAVE saved my marriage.  

In my case, with the ADHD, I did also do focus aids, Lexapro and nutritional modifications, but the Progesterone was a KEY piece, and I do wish we had started it AGES sooner.  

I can't promise Progesterone will save your marriage, but it might make your periods better and help you sleep :) 

If you notice any of the signs of early Perimenopause: 

- "not feeling like yourself"
- Increase in irritability or "quiet rage" 
- Not so quiet rage :)
- Increase in PMS symptoms
- Change in Bleeding Patters
- Itchy eyes, ears or nose
- Sleep Disruption
- Weight Gain
- Fatigue
- Reduced Libido

All of these CAN be signs of reducing progesterone!  Please talk to your primary care provider about if Progesterone HRT is possibly right for you, or if an alternative treatment to treat the symptom is appropriate for you!!!  

WHILE HRT can be great, the key is to treat the symptom, NOT TO SUFFER IN SILENCE.  

Thanks for being here :) 

I hope you found this helpful and enlightening, and a place to start a conversation with your primary care providers, friends and families about the changes our amazing bodies are going through.  If you did find this helpful, please share it with friends and family, so that you can assist Pelvic Floored in spreading evidence based pelvic health information to the masses!  Drop comments below, or pop over my socials for fun, community interaction on these topics (and more). Thanks for being here!

XOXO
Dr. Kelly 💋

Davis SR, Wahlin-Jacobsen S. Testosterone in women--the clinical significance. Lancet Diabetes Endocrinol. 2015 Dec;3(12):980-92. doi: 10.1016/S2213-8587(15)00284-3. Epub 2015 Sep 7. PMID: 26358173.

Gold EB. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011 Sep;38(3):425-40. doi: 10.1016/j.ogc.2011.05.002. PMID: 21961711; PMCID: PMC3285482. link here

Jakobsdóttir Smári U, Valdimarsdottir UA, Wynchank D, de Jong M, Aspelund T, Hauksdottir A, Thordardottir EB, Tomasson G, Jakobsdottir J, Lu D, Nevriana A, Larsson H, Kooij S, Zoega H. Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. Eur Psychiatry. 2025 Sep 4;68(1):e133. doi: 10.1192/j.eurpsy.2025.10101. PMID: 40903825; PMCID: PMC12538516. link here