The overlooked hormone: Why progesterone is essential to women's health beyond pregnancy
Many South African women in their 40s and 50s find themselves lying awake at 3 am, feeling anxious, irritable or simply unlike themselves. For some, it starts with restless nights. For others, it's brain fog, unexplained anxiety or a feeling that they are no longer coping as well as they used to. As women move through perimenopause and menopause, fluctuating hormone levels can affect everything from sleep and mood to energy levels and overall well-being.
Perimenopause – the transition leading up to menopause – can begin several years before periods stop completely. During this time, levels of estrogen and progesterone fluctuate significantly, often triggering symptoms, such as hot flushes, night sweats, poor sleep, anxiety, mood changes and brain fog.
Women’s health extends well beyond the reproductive years, yet the symptoms associated with hormonal changes during mid-life are still often overlooked or misunderstood. For many women, recognising the link between hormones and symptoms can be an important first step towards finding effective support and improving quality of life.
“Many women are surprised to learn that hormonal changes can affect emotional well-being just as much as physical symptoms,” says Ingrid Singels, Associate Director of Pharma Dynamics’ Scientific Division. “These symptoms are common during the menopausal transition, but they are often overlooked or attributed to stress alone.”
Understanding progesterone's role
Progesterone is a naturally occurring hormone produced mainly by the ovaries. While it is best known for regulating the menstrual cycle and supporting pregnancy, it also plays an important role in sleep, and may influence emotional wellbeing and overall hormonal balance.
As estrogen and progesterone levels fluctuate during perimenopause, many women experience irregular periods, sleep difficulties, anxiety and increased emotional sensitivity. Research has shown that micronised progesterone – alone or with estrogen - may improve sleep quality and reduce night sweats and hot flushes in some perimenopausal women.
“Poor sleep can have a profound impact on quality of life,” explains Singels. “When women start sleeping better, they often report improvements in mood, concentration, resilience and day-to-day functioning.”
Bioidentical progesterone vs synthetic progestins
There are two main categories of progesterone-related medicines used in women's health, namely bioidentical progesterone, such as micronised progesterone and synthetic progestins.
Micronised progesterone is chemically identical to the progesterone naturally produced by a woman's ovaries. It has been processed into tiny particles to improve absorption by the body. Synthetic progestins, on the other hand, are laboratory-created compounds that mimic some actions of progesterone but differ structurally from the natural hormone.
This type of progesterone has been shown to have a lower risk of side effects and health complications than synthetic progestins. Research has found that micronised progesterone:
- Is not linked to the same increased risk of breast cancer that’s seen with some synthetic progestins
- Has minimal impact on blood clot risk (venous thromboembolism or VTE)
- Doesn’t negatively affect cholesterol or blood sugar the way some synthetic versions can.
This distinction has become increasingly important in recent years as researchers have gained a better understanding of how different progesterone formulations affect the body.
Singels explains that there is some hesitancy about hormone therapy, because of concerns raised by studies published more than two decades ago. However, she points out that many of those studies involved older hormone formulations, and that our understanding of menopause treatment has evolved considerably since then.
One hormone, two pathways
Many women are surprised to discover that micronised progesterone can be prescribed either orally (swallowed) or vaginally (inserted into the vagina). The route used often depends on the woman's stage of life, treatment goals, and individual needs.
Oral micronised progesterone is commonly prescribed as part of menopausal hormone therapy (MHT) to help protect the lining of the uterus. It has been shown to provide effective endometrial protection when used alongside estrogen therapy. In addition, oral progesterone produces natural metabolites that can cross the blood-brain barrier, which may have a calming effect and help improve sleep quality.
Vaginal progesterone, by contrast, is widely used in reproductive medicine because it delivers the hormone directly to the lining of the uterus. It is a well-established treatment for supporting early pregnancy, particularly during fertility treatments such as in vitro fertilisation (IVF), where it is considered standard practice. It may also be an alternative option for women using menopausal hormone therapy who cannot tolerate oral progesterone.
Advice for women navigating mid-life hormonal changes
Singels encourages women not to dismiss persistent symptoms as simply “getting older”.
“If you're experiencing disrupted sleep, worsening anxiety, mood changes, night sweats or other perimenopausal symptoms that are affecting your quality of life, speak to your healthcare provider. Effective treatment options are available, and you don't have to suffer in silence.”
She also recommends prioritising regular exercise, a balanced diet, stress management, good sleep habits and routine health screenings.
Supporting women's health
Hormonal changes are a natural part of life, but the symptoms associated with perimenopause and menopause can have a significant impact on a woman’s physical and emotional wellbeing. Greater awareness and understanding can help women recognise when symptoms may be linked to hormonal changes and encourage them to seek appropriate medical advice and support.
Pharma Dynamics remains committed to expanding access to evidence-based women's healthcare solutions that help women navigate hormonal transitions with greater confidence, comfort and quality of life.
