Progesterone Can Make You Tired. Here’s Why

You finally got a prescription for progesterone to help with menopause symptoms like hot flashes, irritability, brain fog, and insomnia. The medication seems to be doing its job—except now you’re fighting to keep your eyes open during early-morning meetings.

It’s well-known that progesterone can make you tired, and it’s all due to how the hormone works in the brain. But when managed correctly, the sleep-enhancing properties of progesterone are a big perk during the menopause transition, not a bug. Here’s why progesterone makes you so sleepy, and what to do if fatigue lingers.

About the Experts

Carol Lynn, M.D., an OB/GYN and menopause specialist in Tennessee.

Jerilynn C. Prior, M.D., professor of endocrinology at the University of British Columbia and founder of the Centre for Menstrual Cycle and Ovulation Research.

Why Progesterone Makes You Sleepy

Progesterone makes you tired because it increases your brain’s ability to absorb and use gamma-aminobutyric acid (GABA), a neurotransmitter that calms the nervous system and makes you feel relaxed.

When your body breaks down progesterone, it creates a byproduct called allopregnanolone, which improves the way some GABA receptors in the brain work. ¹ Once these receptors get GABA where it needs to be, the neurotransmitter reduces the excitability of neurons in the brain, producing a calming, drowsy, mood-regulating effect. ²

Progesterone has a sedating effect because it helps GABA work more effectively, supporting the body’s natural ability to wind down.

GABA levels tend to drop during menopause, which can fuel menopause symptoms like mood swings, poor sleep, and anxiety. Progesterone’s calming effect may help counteract some of that turbulence. ³

Hone Your Hormones, Find Relief

Fatigue, mood swings, menstrual changes—these aren’t just “life.” They could be signals that your hormones need fine-tuning. Our tailored plans uncover the root causes and deliver lasting relief.

Let’s Get Started

How long does progesterone make you sleepy?

When you first start taking progesterone as a form of hormone replacement therapy (HRT), it’s not unusual to feel a bit groggy the next morning. But that effect typically wears off within a few nights.

Progesterone’s sleepiness effects should last for fewer than eight to 10 hours, says endocrinologist Jerilynn C. Prior, M.D. But the exact amount of time, as well as the onset of sleepiness, depends on various factors.

“The length of the sleep-promoting effect of progesterone depends on whether you took it with food and how an individual’s metabolic enzymes work,” says Prior. It may also hit harder when you first start taking it because your body is catching up on deep sleep it’s been missing, she says.

Because of progesterone’s sedative effects, Prior recommends taking it before bedtime. But it won’t act like a sleeping pill. “It won’t put you out,” she says. “If you have to wake up for an emergency, you will wake up. If you have something stressful the next day, you’ll probably still get less sleep.”

Fatigue as a progesterone HRT side effect

When trying to determine whether taking progesterone makes you tired, it’s important to distinguish between temporary feelings of sleepiness versus long-term perimenopause fatigue. Like any medication, bioidentical progesterone or synthetic progesterone (progestin), might cause side effects like fatigue, but this experience isn’t supported by research.

While progesterone can make you sleepy, bothersome long-term fatigue is not a typical complaint, says Prior.

In Prior’s research on progesterone for hot flashes and night sweats, common side effects included musculoskeletal pain, nausea, and dizziness—not long-term fatigue. ⁴ Chills, chest pain, and flu-like symptoms are other commonly reported adverse effects. ⁵ “The biggest ‘adverse effect’ of progesterone—which is actually a benefit—is that progesterone improves deep sleep,” she says.

In fact, one study found that postmenopausal women who took 300 mg of oral progesterone had 45 percent more slow-wave sleep—the deep, restorative stage where your body repairs tissue, builds muscle, and strengthens the immune system. ⁶,⁷

Progesterone

Learn More Get Started

Symptoms of Low Progesterone

Progesterone levels naturally decline during perimenopause and menopause, and that drop can affect everything from sleep to mood to stress tolerance. Common symptoms of a progesterone deficiency include:

• Sleep disturbances
• Low energy
• Mood changes and anxiety
• Increased sensitivity to stress

Sleep disturbances

Declining progesterone levels are linked to shorter sleep, light sleep, more sleep disruptions, and sleep apnea, a sleep disorder characterized by repeated pauses in breathing during the night. ⁸ As many as 40 to 60 percent of women report problems with sleep during menopause, which could be from low progesterone. ⁹

Low energy

If you’re not routinely getting enough good-quality sleep—perhaps driven in part by low progesterone levels—you may experience fatigue or low metabolism. One study found that two-thirds of women reported fatigue during menopause. ¹⁰

Mood changes and anxiety

Irritability. Anger. Depression. Anxiety. Research suggests that mood instability during perimenopause is the result of a combination of fluctuations in estrogen and low progesterone. Stress and anxiety can create a negative feedback loop with sleep in which it’s harder to fall asleep, stay asleep, and get the rest necessary to recover from these negative mental health challenges. ¹¹

Increased sensitivity to stress

We have progesterone receptors in our brain (different from GABA receptors), and progesterone plays an important role in our body’s stress regulation system. This can affect your experience of stress—or your ability to process and manage it—thereby impacting your mood. ¹² In preliminary research on people who have alcohol use disorder and PTSD, progesterone therapy helped reduce the effects of stress on craving, anxiety, and negative emotions, showing just how impactful the hormone may be. ¹³

How to Combat Progesterone Fatigue

To lessen the potential of lingering morning sleepiness or grogginess after taking progesterone, talk to your physician about these strategies:

Time your dose

Take progesterone at bedtime to work with your tiredness, rather than against it. “If you take it during the day, you will be fatigued and sleepy,” says Lynn.

Prior recommends taking progesterone after you’ve brushed your teeth, put on your pajamas, and are literally heading to bed, since its effects can hit some people quickly.

That said, there’s a bit of an art to taking progesterone as a form of HRT for sleepit. “If you’re already sleep-deprived when you first start progesterone, which many women are, start on a Friday night when you can sleep in during the weekend,” Prior says.

Adjust your dose

If you’re experiencing side effects like sleepiness or grogginess from progesterone and they’ve lasted longer than expected, talk to your doctor. They may recommend lowering your dose of progesterone HRT.

Lynn starts women at 100 mg per night, increasing from there as needed, and decreasing if the dose is too high. Women in perimenopause may benefit from up to 400 mg of progesterone given in the second half of their cycle. “If a patient is having unwanted side effects, I tend to adjust the dose,” says Lynn.

Try a different form

Oral micronized progesterone is often preferred for improving sleep. ¹⁴ But if it makes you too sleepy, you might want to talk to your healthcare provider about other forms of progesterone, like gels, creams, or pellets.

Ask your doctor if you can take it vaginally

Some doctors may recommend taking oral progesterone vaginally as a suppository to see if it reduces grogginess, says Lynn. (Do not take vaginal progesterone orally, however.) That said, always get the go-ahead from your doctor first. There isn’t a lot of research on whether taking oral progesterone vaginally offers enough protection for the endometrium.

Exercise

Exercise improves sleep quality and reduces fatigue—even during menopause. One meta-analysis found that exercise alleviated insomnia and other sleep disruptions in women going through the menopause transition. ¹⁵ Exercise burns off energy, boosts the release of feel-good endorphins, and affects body temperature in ways that are beneficial for sleep, researchers say.

Consider supplements

Some supplements may help increase your energy. Depending on a patient’s medical history and other factors, Lynn often recommends:

• Vitamin B12
• NAD+ (a vitamin B3 derivative)
• DHEA
• Ashwagandha
• Iron

Although these are safe to take alongside progesterone, says Lynn, it’s unlikely you’ll need to take all of the above, so talk to your provider first about what they recommend for you and when to take it. Always choose third-party certified brands and consult your provider to tailor the regimen to your needs.

Manage anxiety

Anxiety is a common symptom of perimenopause, and fatigue often comes along for the ride when you have a mind that’s always busy with worry. ¹⁶ Anxiety often pairs with fatigue. Breathing exercises—like slow, sighing exhales—or cognitive techniques like “checking the facts” (a DBT exercise that helps you compare your emotions to the facts of your situation) can help reframe spiraling thoughts and reduce stress for a better night’s sleep. ¹⁷