Can I Take Progesterone Without Estrogen in Menopause?

If Dickens wrote about menopause, he’d have said “It’s the best of times (so long, messy monthly bloodletting) and the worst of times (hello, hot flashes).” Lucky for you, hormone therapy (HT)—also known as menopause therapy (MT) or the older terminology hormone replacement therapy (HRT)—can help you make a smooth transition to the rest of your life. HT is a prescription medication usually made up of the hormones estrogen and progesterone. But what happens if you take progesterone without estrogen? 

To get into that, it helps to know how the two work together: In the premenopausal years, this pair of hormones prepare your body for a possible pregnancy every month. But once you enter perimenopause, your levels of estrogen and progesterone start nosediving, with progesterone declining first. That comes with a few unhappy side effects. Menopause may be perfectly natural—every day, more than 6,000 American women experience it—but for as many as 80 percent of them, it can sometimes be uncomfortable (1).   

For many women, hormone replacement therapy (HRT, also called hormone therapy or HT) can bump up your hormone levels and help you cope with uncomfortable menopause symptoms. This is commonly a package deal: estrogen and progesterone together. Estrogen treats hot flashes, night sweats, and vaginal dryness, while preventing the bone-thinning that leads to osteoporosis (2).  

Okay, so you know estrogen and progesterone are almost always prescribed together for menopausal symptoms, but you may also wonder, can I take progesterone without estrogen? 

About the Experts

Joanne Pinkerton, M.D., is the Mamie A. Jessup Professor of Obstetrics and Gynecology and division director of Midlife Health at the University of Virginia. She has published in more than 90 peer-reviewed journals and has frequently been the principal investigator in research on the treatment of vasomotor symptoms with hormonal and non-hormonal therapies.

Stephanie Faubion, M.D., Director Center for Women’s Health at the Mayo Clinic in Jacksonville, FL and Rochester, MN. Dr. Faubion’s research encompasses sex- and gender-based differences in disease, menopause, hormone therapy, healthy aging, and sexual health and dysfunction in women

Natalie Kunsman, M.D., who practices in Colorado Springs, is board-certified in family medicine and antiaging and regenerative medicine. 

Why Your Body Needs Progesterone

While you’re still menstruating, it goes like this: At the beginning of your cycle, progesterone levels are tiny: Less than 1 nanogram (ng) per milliliter (mL) of blood. (A nanogram is one-billionth of a gram; a milliliter is one-one thousandth of a liter.) 

In the middle of your cycle, when you ovulate, your progesterone jumps up to as much as 24 ng/mL. And if you become pregnant, by the third trimester your levels may soar to 214 ng/mL (3).  Those are some pretty big jumps, and there’s a good reason: Progesterone prepares the lining of your uterus for a fertilized egg, then helps your uterus nourish a fetus as it grows. It strengthens your pelvis to prepare for birth and even helps your breasts get ready to feed a newborn baby. Progesterone is pretty killer.

And if you don’t have enough progesterone, that can mean trouble. You might not be able to become pregnant in the first place, and if you do, you’re more likely to have a miscarriage (4). 

By the time you reach menopause and your body is out of baby-making mode, your progesterone levels plummet by more than 77 percent (3).  While you don’t need the hormone to support a pregnancy anymore, it still plays a role in keeping you healthy. 

Estrogen loss is viewed as the main driver of menopause symptoms, but the drop in progesterone also contributes.

HELLO HRT

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HRT With Estrogen & Progesterone

Combined estrogen and progesterone or estrogen-only HRT is popular and considered safe. Progesterone only? Not so much.

Benefits

Both progesterone and estrogen fluctuate wildly in the years-long lead-up to menopause, says Natalie Kunsman, M.D., an integrative medicine practitioner. Which is why many doctors prescribe a combination of the two. “An estrogen-dominant state can cause other problems as well,” including increasing breast and ovarian cancer risk (6). Progesterone may offset some of that risk.

Side effects

Combined estrogen and progesterone therapy does come along with a few common side effects, including:

• Headache
• Nausea
• Acne
• Breast tenderness
• Changes in menstruation or irregular bleeding

These side effects may go away on their own, or your doctor may change your dose of HRT.

Progesterone Without Estrogen

In rare cases, women don’t tolerate estrogen well, says Stephanie Faubion, M.D., medical director of The Menopause Society and director of women’s health at the Mayo Clinic in Jacksonville, FL. “So we might prescribe progesterone-only HRT.”

Benefits

Taking progesterone without estrogen after menopause may be the right move for people who have had (or perhaps have a strong genetic tendency toward) estrogen-sensitive cancers.

That said, some functional medicine doctors, including Kunsman, say progesterone without estrogen can be a boon during perimenopause. When estrogen is naturally too high and progesterone is too low during this phase, a bit of added progesterone can counter this and relieve symptoms, says Kunsman.
There is some consensus that progesterone without estrogen can help with insomnia, especially.  “Progesterone alone can reduce night sweats and hot flashes. It can even help with mood issues. One of the side effects, though, is that it can make you drowsy,” says Pinkerton. That can be a bonus, though, for women whose quality of sleep suffers during menopause.

So does progesterone without estrogen help with hot flashes?  A recent study found that women who received progesterone only (rather than a placebo) noticed a lot fewer night sweats and hot flashes. They also reported fewer emotional problems and improved sleep quality (7).

Side effects

Major medical organizations, such as the Menopause Society, say that with few exceptions, these two hormones are a package deal. “We don’t typically give progesterone by itself,” says Faubion.

If estrogen is prescribed without progesterone, it could lead to problems. “For people who have a uterus,” explains Jo Ann Pinkerton, M.D., director of Midlife Health at the University of Virginia and former executive director of The Menopause Society, “you need to ‘oppose’ the estrogen with progesterone. There are a few different kinds of progesterone you can take—either the natural hormone or a lab-made kind (those are known as synthetic progestins).” 

How come? Unopposed estrogen may increase your risk for uterine cancer if you have a uterus. So if you’ve had a hysterectomy, estrogen alone is fine. If you haven’t, says Pinkerton, “you need progesterone along with estrogen.” 

How Do I Decide Whether or Not to Take Progesterone Without Estrogen?

Don’t decide on your own—talk to your doctor or provider. Hormone therapy, just like menopause itself, can be a little complicated. 

When you’re entering into the menopause transition, says Pinkerton, seek out a doctor who’s familiar with all the options for progesterone HRT. That might be your trusted family doctor, your gynecologist, or a menopause expert you find through the Menopause Society. “We listen to each woman’s story,” Pinkerton explains, “and based on what’s going on with their symptoms, we offer solutions that can help.”