Progesterone Management

The image shows a doctors notes page stating the word 'progesterone'. This is to reflect the difficulty people face with progesterone management.

Progesterone Intolerance: Symptoms, Management, and the Role of Menopause Hormone Therapy (MHT)

Progesterone is a vital hormone in the female reproductive system, playing a crucial role in various processes such as pregnancy, menstruation, and menopause. However, some individuals may experience progesterone intolerance, a condition where their bodies struggle to tolerate or process this hormone effectively. In this blog, we will explore the symptoms of progesterone intolerance, ways to manage it, and its connection to hormone therapy during menopause. We will also delve into the different forms of progesterone, including the Mirena coil, oral tablets, and vaginal progesterone, while addressing their off label use in the UK.

Understanding Progesterone and Its Role in the Menstrual Cycle

Before diving into progesterone intolerance, it’s essential to grasp the role of progesterone in the menstrual cycle. Progesterone is produced by the ovaries during the second half of the menstrual cycle (luteal phase). Its primary function is to prepare the uterine lining (endometrium) for potential pregnancy. If fertilization does not occur, progesterone levels drop, leading to menstruation.

Symptoms of Progesterone Intolerance*

  1. Menstrual Irregularities: One of the hallmark signs of progesterone intolerance is irregular menstrual cycles. This can manifest as heavy or prolonged periods, frequent spotting, or even missed periods.
  2. Mood Changes: Some individuals with progesterone intolerance may experience mood swings, anxiety, or depression. These symptoms are often attributed to hormonal fluctuations.
  3. Breast Tenderness: Progesterone can cause breast tenderness or pain, which may be more pronounced in individuals with intolerance.
  4. Digestive Issues: Progesterone can relax smooth muscle tissue, including the digestive tract, leading to symptoms like bloating, constipation, or diarrhoea in those with intolerance.
  5. Headaches: Hormonal fluctuations, including changes in progesterone levels, can trigger headaches or migraines in susceptible individuals.

Managing Progesterone Intolerance

The management of progesterone intolerance often involves addressing the symptoms and underlying causes. Dr. Joanne Hobson, Clinical Lead Director of The Menopause Consortium and British Menopause Society Accredited Specialist, suggests the following approaches:

  1. Menopause Hormone Therapy: In cases where progesterone intolerance is related to menopause symptoms, MHT can be beneficial. This typically involves oestrogen replacement therapy along with a form of progesterone to protect the endometrial lining.
  2. Alternative Therapies: Non-hormonal approaches, such as cognitive-behavioural therapy, dietary changes, and exercise, can help manage mood swings and other symptoms associated with progesterone intolerance.
  3. Consultation with Specialists: Consulting with experts like Dr. Joanne Hobson can provide tailored guidance and treatment options for individuals experiencing progesterone intolerance.

The Mirena Coil

The Mirena coil is a contraceptive device that releases a low, steady dose of levonorgestrel, a synthetic form of progesterone, directly into the uterus. While primarily used for birth control, it can also help manage heavy menstrual bleeding and some menopause symptoms. However, it’s crucial to note that the Mirena coil is not intended to treat progesterone intolerance specifically.

Oral Tablets and Vaginal Progesterone

Oral tablets and vaginal progesterone are other forms of progesterone therapy. Oral tablets are commonly used in hormone replacement therapy, while vaginal progesterone is sometimes prescribed to manage specific gynaecological conditions. In the UK, the use of these forms of progesterone may be off label for certain indications, meaning they are used for purposes not approved by the Medicines and Healthcare products Regulatory Agency (MHRA). Physicians may choose to prescribe them based on clinical judgment and patient needs.


Progesterone intolerance and progesterone management can present various challenges for individuals, impacting their menstrual cycles, mood, and overall well-being. However, with proper management and guidance from experts like Dr. Joanne Hobson, it is possible to alleviate the symptoms and improve the quality of life for those affected. Whether through hormone therapy, alternative treatments, or specialized care, addressing progesterone intolerance is essential for women’s health and hormonal balance.