Progesterone Intolerance
Progesterone intolerance , affecting approximately 10–20% of women, occurs when individuals are particularly sensitive to progesterone or its synthetic counterpart, progestogen. While progesterone typically has calming, anti-anxiety properties, some women experience adverse reactions, leading to symptoms similar to premenstrual syndrome (PMS).
Symptoms of Progesterone Intolerance:
Psychological : Anxiety, irritability, aggression, restlessness, panic attacks, low mood, poor concentration, forgetfulness, and heightened emotions.
Physical : Acne, greasy skin, abdominal cramping or bloating, fluid retention, fatigue, headaches, dizziness, and breast tenderness.
Metabolic : Negative effects on cholesterol, blood pressure, and blood sugar regulation. Notably, natural (body-identical) progesterone does not usually have these metabolic effects.
Types of Progestogens
Natural (Body-Identical) Progesterone : Structurally identical to the hormone produced by the ovaries, brain, and other organs, and derived from sources like yam root or soy. It is associated with fewer side effects and lower risks compared to synthetic versions.
Synthetic Progestins: Chemically created and structurally different from natural progesterone they were created to stop endometrial thickening. These are commonly used in various contraceptives and some HRT formulations. Intolerance symptoms are more prevalent with synthetic progestogens, which are also linked to a slightly increased risk of blood clots, heart disease, and breast cancer.
Who Is Affected?
Women who experience premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) are often more at risk of progesterone intolerance.
Progesterone intolerance can also be experienced by those using contraceptives containing synthetic progestogens, such as the combined pill (eg Oralcon, or Marvelon), mini-pill (norethisterone, or levonorgestrel), contraceptive implants, or hormonal intrauterine systems (IUS). Additionally, some women taking certain types of body identical hormone replacement therapy (HRT), utrogestan (progesterone) may also experience side effects, but it is just less common.
Factors like underlying mental health conditions, age, environmental stressors, and genetics may also influence sensitivity to progesterone.
Management Strategies
For those experiencing progesterone intolerance, several approaches can be considered
Switching to Body-Identical Progesterone : Options like Utrogestan, a micronized progesterone, may result in fewer side effects. Taking Utrogestan vaginally can reduce systemic absorption, helping to minimize side effects such as mood changes.
Considering Different Progestogen Forms : For some women, alternatives like the Mirena coil, which releases levonorgestrel directly into the uterus, may be better tolerated. Lower-dose intrauterine devices like the Jaydess or Moni Mirena can also be options for those who are sensitive to higher doses.
Exploring Alternative Progestogens: Interestingly, some individuals find they tolerate older synthetic progestins such as Provera (medroxyprogesterone) or norethisterone better than newer formulations, despite their traditional association with more side effects.
Newer Progesterone-Only Pills : Some women do better with progesterone-only contraceptives like Slinda (drospirenone) or Cerazette (desogestrel), which can provide a more stable hormonal environment.
Considering a Hysterectomy: In cases where progesterone intolerance is severe and significantly impacts quality of life, some individuals opt for a hysterectomy to remove the need for progesterone altogether.
If progesterone intolerance is affecting your ability to tolerate HRT or contraception, it’s important to explore different options with a healthcare professional to find the best approach for your individual needs.
