Progesterone Side Effects & Intolerance: Why You Feel Worse on Progesterone| Dr. Jolene Brighten

[00:00:00] So you finally got your progesterone prescription to help you start feeling better, and instead of feeling better, you're actually feeling more anxious, more moody, and that sleep you were promised, you're not getting it. You may have progesterone intolerance. And while we expect progesterone to make us feel calm and relaxed and promote sleep and love life.

This is not the reality for everyone, and we do not talk enough about when women struggle with progesterone. And today, we're gonna get into that in this episode of the Dr. Brighten Show, and I'm gonna share insights with you from the research as to why this may happen for some women.

So if you're someone who has taken oral micronized progesterone, or in the US what's known as prometrium and felt worse. This episode's for you, and listen, if you're someone and you're tuning in, you're like, wait a minute, I'm nowhere near this hormone replacement therapy conversation in my life, but [00:01:00] maybe you've identified, you have PMDD, you've been diagnosed with PMDD, which is a severe, severe form of PMS.

Maybe you do have PMS, or you're someone who. Struggles with sleep and mood during your luteal phase. That's the two weeks leading up to your period right after ovulation. Then I definitely want you to tune into this episode as well, so stay with me. And if you're new here, hi. Welcome to the Dr. Brighten Show.

I'm your host, Dr. Jolene Brighten. I'm board certified in naturopathic endocrinology. I'm a nutrition scientist. I am a menopause certified practitioner, and I'm very passionate about helping women understand their hormones, especially when the standard advice and protocols just aren't. Cutting it. I have been treating women in menopause for over a dozen years and prescribing HRT and progesterone intolerance is something I have seen quite a lot of Today we are [00:02:00] gonna talk all about how to identify if you have progesterone intolerance and how you may need to change your prescription if you are taking.

Oral micronized, progesterone, or any form of HRT. We're actually gonna talk about estrogen as well and how that fits in. I'm also going to go over why progesterone intolerance happens, including some fascinating new brain science that just came out this year. This doesn't necessarily explain it for everyone, and we don't have great studies just specifically on progesterone intolerance, but we do have enough information about how progesterone in its metabolite.

Is interacting in the brain, especially in certain populations like those with PMDD. That have a worse time with progesterone. So we're gonna talk about that, how to know if you might have it, and most importantly, what you can do about it. Now, before we jump in, if you've already left me a review, thank [00:03:00] you so much.

And if you haven't, could you take just a quick second to just hit the five stars or leave a little note for me? It helps this podcast get out into the world and support the efforts of myself and my team. And if you're watching this on YouTube. Please hit the subscribe button and hang out with me. We do this show twice a week.

Alright, with that said, let's get into what is progesterone intolerance. Now, we don't have a lot of research and we don't have a formal definition for this, but we do understand that some women don't respond the way we expect them to when they take progesterone.

So progesterone intolerance is when your nervous system, especially your brain, has an exaggerated or paradoxal reaction to progesterone. So this isn't a progesterone deficiency. We're gonna talk about how it's, it's also, you know, not necessarily about the levels. This is also [00:04:00] not a progesterone allergy.

And on that note, it's also not in your head, so you should know that things are happening in your head, but you're not making this up. This is a sensitivity in how your brain responds to progesterone or namely allopregnanolone. We'll get into that and it can show up whether that's progesterone that's coming from an oral capsule, or from your body, from your own ovaries. So for a lot of women, when progesterone goes up, it is going to pro promote this sleepy feeling, this calming effect. But for others, and this may be you, that's probably why you're here. The same rise sets off more of like panic or panic attacks, insomnia, mood swings, even feelings of rage sometimes. So. I realize, as I say, all allopregnanolone, and I allude to that, we should talk about where do you get progesterone from?

There's only [00:05:00] two places that you get progesterone. You either make it or you take it in the form of progesterone. Progestin is not the same as progesterone and we are gonna get into more of that. But if you have tried the pill, the patch, the ring, the implant, the uh, depo shot, the IUD and you had mood symptoms or you felt terrible.

That is not progesterone. That is not progesterone intolerance. That is a progestin issue. And we know that progestin comes with side effects. Yes, yes. Any of us who have taken it. But we also know from the research that progestin based contraceptives are very much associated with adverse mood changes. So.

If you have adverse mood symptoms when you are using birth control, that's progestin not progesterone. So that doesn't necessarily mean you won't be able to take progesterone.

Now when it comes to progesterone intolerance, the nervous system [00:06:00] driven symptoms we see, I've talked about insomnia or disturbed sleep. Yes. Panic attacks, racing thoughts, feeling anxious.

Your mood is running away with you, so maybe you'll have crying spells. Maybe you'll feel rage, you feel really irritable. If you are feeling physically restless, like you can't settle in your own skin, that can also be a sign of progesterone intolerance. Now, if it is your natural cycling progesterone, we're gonna see that it tends to get worse about five, seven days after your period.

And then, so let me explain this, you ovulate. You then form a structure in your ovaries called the corp corpus lutetium that releases progesterone. That spikes five to seven days after ovulation. Then the rollercoaster comes back down. So usually in that five to seven days and then coming down is when women really feel their [00:07:00] worse.

But if you are on oral micronized progesterone, that could just be every single time that you're taking it. Now I wanna talk a little bit more about progesterone and progestins because researchers get this wrong. Doctors get this wrong, prescribers get this wrong. People often are saying. Progesterone when they mean progestogen, progesterone, when it should be progestin.

They are different structures altogether. Progesterone gets metabolized to allopregnanolone, stimulates the GABA receptor in the brain. Makes you feel really good. Okay. That's the way it should flow. Progestins, do not get metabolized to allop. Pregnant alone, cannot interact with the receptors, the GABA receptors in the same way, and they can be really problematic in your system.

We're gonna talk about how they act in your body, but I just think it's [00:08:00] really important that we recognize that even like the progesterone only pill is not progesterone, it's progestin. The difference matters. Not just on the chemical structure level, but how they interact with your system level.

Now we don't just make progesterone from the corpus lium PO post ovulation, we also make it in pregnancy. So we've got our ovary only via ovulation. Can you make progesterone? This is why when you stop ovulating in perimenopause as regularly or it's weaker, you don't get that progesterone. And in pregnancy it's initially the corpus lithium, which is kind of crazy and cool and awesome, that like this little tiny baby structure can do all of that.

And then when you get into the second trimester, it flips over and the placenta starts to take over. Now, compared to progestin and progestins, the synthetic compound that was designed to mimic some of progesterone's effects, mostly it was made to prevent pregnancy by stopping, , stopping anything from [00:09:00] implanting in the uterine lining by keeping it thin, and also thickening the cervical mucus

so that sperm cannot pass. , I want you to keep in mind that when it comes to the breast cancer risk and everyone being afraid of like hormone placement therapy is gonna cause breast cancer, it's progestins. That really seemed to be implicated in that. So I want you to understand, um, if you hear that progesterone might raise breast cancer risk, it's progestin.

So that's another part of where like even the media gets it wrong and, and people get nervous. Now progesterone binds to progesterone receptors. That makes sense, right? And it interacts with your nervous system, your immune system. It's anti-inflammatory. It's great for your bones, your brain, and again, it should help reduce anxiety.

It should help with sleep. It also can help with histamine, and it can also help your thyroid hormone in doing its job. So a lot of roles for [00:10:00] progesterone. Progestins, depending on the formula, can bind not only to progesterone receptors, but also to androgen receptors and even cortisol receptors in some cases, and that can create side effects that ma natural progesterone does not.

Some progestins have a strong androgenic effect, so that means testosterone and acne and oily skin and hair growth. So those excess androgen symptoms that we see in PCOS

and then others can have anti androgenic effects. So sperone that's in certain birth control pills that can help with lowering acne risk. So your skin might look better, but sometimes your mood might get worse and you could have electrolyte imbalances. So when it comes to medications, we always wanna weigh the risk versus benefit for you. Now that you understand a bit about that, I had told you about the allopregnanolone pathway or alle, maybe I should just call it that. It's a lot [00:11:00] easier. So your natural progesterone, or the bioidentical one you take is converted into a neurosteroid called allopregnanolone or alle. Now, that can have a calming effect through the GABA receptors in the brain.

Progestins don't convert to aloe, and this means that you're gonna miss out on progesterone's natural sleep and mood supporting benefits. And in some women, progestins have been shown to be associated with worsening mood, worsening depression, and worsening anxiety. In fact, research shows that certain progestins can increase the risk of depression.

Especially in adolescents and in women who are starting hormonal contraception for the first time. So this is just to illustrate they work differently in the brain as well. Now progesterone is essential for a healthy luteal phase. Uh, it also is important if you wanna get pregnant for supporting implantation [00:12:00] successful pregnancy, and it can help with reducing PMS symptoms.

Progestins. Are found in contraceptives that often stop ovulation and suppress your natural hormone rhythms, which means you don't get any progesterone, and that's very effective for preventing pregnancy, but it's also meaning that you lose the cyclical progesterone benefits like bone pro protection and anti-inflammatory effects and helping with histamine.

So. When it comes to progestin contraceptives, there are the combination ones like you'll find in the pill. Then there is the mini pill, which only sometimes shuts down ovulation altogether. There's the IUDs. They don't always shut down ovulation, so it's not always clear cut that you will absolutely shut down ovulation.

The combination ones, yes. However, with an IUD, some women stop ovulating. Some women don't. But the reality is, is that these progestins [00:13:00] can bind more strongly to your progesterone receptors. So even if you are making your progesterone, you may not fill those benefits. Now within the United States, I said that there's Prometrium. So Prometrium is the micronized progesterone, unless you're getting compounded. This is the. Only type of progesterone that's bioidentical the progestins. Those are not interchangeable with progesterone. If the goal is to help with the luteal phase to help you get pregnant, um, and to help with perimenopause symptoms, quite frankly, progesterone's gonna be a lot better.

We want bioidentical progesterone. So if your doctor gives you something, says it's progesterone, if it's not prometrium. Or it's not, it doesn't say it's, there's generics, bioidentical, progesterone, oral micronized, progesterone. It may be a progestin

Okay. Now that we've had the progestin [00:14:00] talk, let's talk about who is most susceptible to progesterone intolerance. Again, I'm talking about bioidentical progesterone. So we know that certain groups of women are more likely to experience progesterone intolerance, like those with PMDD, which is premenstrual dysphoric disorder.

I should have said that before. Sorry about that. I said PMDD is f. Everybody knew it at the start of this episode. Other women that we see are susceptible are those who fall under the neuro divergent umbrella. So we see a lot more research with A DHD and autism. We see less research around those with ticks or OCD or other forms of neurodivergence, but we do understand that in neurodivergence, your brain works a bit differently.

Now women in perimenopause, when their hormone [00:15:00] fluctuations get more erratic and we try to come in with progesterone, they can sometimes be susceptible with to progesterone intolerance. And women who have a history, and maybe you haven't been diagnosed with PMDD, but you've had some really significant mood swings.

You have not felt well in your luteal phase. You may also be someone who is at risk for this. So those are some of the clues.

So if you're someone who's your symptoms reliably worsen like seven to 10 days before your period, and then they go away. Once you start your period, like within a couple of days, that can be a sign that you have progesterone intolerance. Uh, if you've taken progesterone and you're. I went crazy. That's literally the words that women will use.

And if you can see me, I'm doing air quotes of went crazy. Um, because that's how women feel. Uh, if you are not feeling calm when you take your progesterone or your progesterone rises and instead you [00:16:00] start feeling like kind of amped up, overstimulated, emotionally unstable. If that's you, your next step is to track your cycle and your symptoms.

Even just two months of good tracking can give you and your provider some clear insight. And this goes to, I said, if you're cycling, but even if you're not cycling, maybe you're cycling progesterone or you are taking continuous progesterone, track your symptoms. We want to be able to correlate what happens to you and your symptoms when you take.

X amount of progesterone. That is really insightful. And as we're gonna talk later in this episode, I'm gonna go over like different dosages of progesterone and what you can be trying, because this can take some fine tuning. You know, a lot of people. They're gonna go on HRT and you know, uh, so if you've been with me in other episodes and you know, I usually start women with progesterone because I'm seeing them early enough in perimenopause.

But if we're starting [00:17:00] them in, um, on estrogen, HRT, we're gonna be bringing on progesterone as well. Especially if there's a uterus. You know, when women jumpstart on that, ' cause it is like a jumpstart, right? Especially taking 200 milligrams. They are sometimes like, they're like, oh, I feel pretty good. And then they miss a dose and they feel awful and they go back on and they're like, oh, I'm still not, uh, feeling well.

So we're gonna, we're gonna talk about the nuance of like what can happen with dosing and different strategies that you can talk to your provider about trying. Now, a lot of the research that I look to in understanding progesterone intolerance comes from those with PMDD because PMDD women, they sometimes do feel better if you give them progesterone, but. It is during the progesterone phase of their cycle that they fill their worst. So when we look at the research, there was a new study that just came out and what it showed us is that the main metabolite of [00:18:00] progesterone aoe.

Or alo pregnant alone. I feel like, I don't wanna just call it aloe because I'm like, are we all on the same page with that? Anyhow, it's supposed to enhance the activity of the GABA receptors, and then that is supposed to calm the brain. GABA system's, the brake system. But in some women. Allopregnanolone effects are flipping.

So instead of pressing the brake pedal, it's almost like it's slamming on the gas and it's leading to anxiety and agitation and trouble sleeping. And so the study that just came out this year, I'll link in the show notes. It was on PMDD, and this has a lot of, um, overlap with progesterone intolerance. And what it found is that in the luteal phase when progesterone is naturally higher.

These women had a lower expression of the GABA, subunit of gaba, the GABA receptor. That's kind of a mouthful to say, but basically one of the GABA [00:19:00] receptors was down regulated. So you might be like, well, what does that even matter? So this particular subunit is a key site where Allopregnanolone is supposed to dock and do its calming work.

And so if it's not there. Allopregnanolone can't do its job. So even if your progesterone levels are fine, this is why I'm like, it's not like all about the levels all the time and you're metabolizing it just fine. You might not be able to use it. Now, even more striking in this study is that women who had a lower subunit of the GABA receptor expression, they had higher amygdala activation when they looked at emotional faces.

So the amygdala is the brain's emotional center, and in these women it's firing more strongly, meaning they're more reactive, more overwhelmed, like, um, they're much more sensitive to the environmental inputs that may mean that they're in [00:20:00] danger. And so what we can see. Is that HPA access, the stress in system from the brain to the adrenal glands can be getting activated.

And what's really interesting is that when I piece this together, so I'm currently working on a new book and something that I've been, um, reading a lot about is just HPE access Regulation and Dysregulation at different phases of our life. And what's interesting. Is that if in puberty, your HPA access is more dysregulated, more reactive, you are at higher risk for having depression.

And if you have depression, you are at higher risk of having heightening symptoms during the luteal phase. This phase that we're talking about, that's a high progesterone phase in your cycle. So putting that all together some women with PMDD, they have a lower [00:21:00] expression of the GABA receptors where allopregnanolone, the metabolite, progesterone is supposed to dock.

Tell them chill, be cool, be calm, go to sleep. Okay. Less receptors to do that work and a heightened amygdala. Getting stressed by looking at, like having this emotional reaction just by looking at other people's faces.

And what does this all tell us? That progesterone intolerance isn't just a hormone story, a hormone problem, it's a brain adaptation problem. And so for. Some women, the nervous system can't recalibrate the GABA receptors when the hormones are shifting. And these are big shifts happening in your cycle. And so this is leaving them more emotionally reactive, right?

When allopregnanolone should be calming things. Down. So it's like, are, are you intolerant to progesterone? Is that the best thing that we could be [00:22:00] calling it? Um, or is it that you're insensitive to progesterone? We need more research to know exactly what is going on. Now other studies have also pointed to there might be receptor hypersensitivity, so even when you have normal progesterone levels, they feel too high to your body. You also might be someone who's a rapid metabolizer, and so you're taking your progesterone and you're pushing allopregnanolone really high, too hard, too fast, and then dropping too fast.

And then as I was saying, there's also that cortisol dysregulation piece where chronic stress will prime your nervous system to overreact, to hormonal changes. So it's, I, I just, you know, want you to understand that it is complicated. There are a lot of things going on, and the answer is not always. Just give more progesterone.

So I have actually seen a lot of women be told, just take more progesterone. You have [00:23:00] PMS, you have PMDD. Just take more progesterone. And to be clear, that is life changing for some women. For some women, it's like the best thing that ever happened to them and for others. It's overwhelm in their brain and they don't feel better.

And so this is where we have to believe patients, listen to patients because they're definitely guiding us in where we need more research and more information. Okay, so let's talk about dosing progesterone. So I've been talking a lot in the context of just a natural cycle and um, having that luteal phase. But if we live long enough, which is the goal, which is why I have this podcast, I give you all this information, we will lose a luteal phase.

Because we'll be in menopause. So let's talk about how do we first approach progesterone and perimenopause? Because I told you I start with progesterone. If I'm seeing someone early enough, we're already to the phase where estrogen's going and where I'm in hot flashes and brain fog. We're not feeling great, Trisha.

[00:24:00] Sure. I'm not gonna deny anybody estrogen, but if you are like 42. And you're like, well, my cycles are still regular. Maybe they're a little bit shorter, but I have anxiety like two days before my period and um, my periods are getting really heavy and clotty and we start to get all these low progesterone symptoms.

You can't sleep. We're gonna start with progesterone. And I start with oral micronized progesterone. Most clinicians are going to start with typically 100 to 200 milligrams of oral micronized progesterone at night because it can make you groggy. Some go as high as 300 milligrams. That's something that you see comes up in a lot in PCOS protocols. But in perimenopause, if you're still cycling, it's typically going to be 200 milligrams for about two weeks of your cycle.

But there's a caveat, and if you feel worse on it than you do off of it, we will have to change things. So [00:25:00] typically why we're cycling progesterone in early perimenopause is because you still have a cycle and you are meant to have all of that wonderful estrogen. Bathing your brain in the follicular phase, and we don't want to mess with that.

We don't want to oppose that and we don't wanna confuse the body. So you know, if we know when you ovulate, we'll start you on it post ovulation, so the day after ovulation, and then continue that until typically when your period comes. So we say two weeks, but it might be like 12 days. , Oftentimes what a provider will do is they'll take your cycle and they'll split it in half and say, this is about when ovulation would be, let's continue the progesterone during this time.

And that should help periods get easier because when you don't have enough progesterone, ' cause even if you ovulate the corpus, lium can be weak. It doesn't give you what you need in your progesterone, and though your periods can become heavier, you can have more clots, you can have more cramps [00:26:00] sometimes, uh, especially problematic if you have a history of endometriosis or adenomyosis.

So with that, we wanna have that progesterone coming in and opposing things to make it easier.

Now, I did say there's a caveat, right? Because there should be, because in bio individualized medicine, there should always be a, if this doesn't work, what else can we do? Because it doesn't always work. Things don't always work in the typical fashion, right? So if you're feeling worse when you're on it, uh, you're on progesterone taking oral micron, nice progesterone, you're like, I don't, I just feel.

Awful. All the things we described before, that's when we start looking at doing something like maybe a hundred milligrams continuously. We may even go lower to 50 milligrams continuously. Again, I don't wanna block out estrogen. I don't want estrogen to do her thing, but. You may need to stay continuous.

This works really well in PMDD as well, by the way. So this, the reason why this improves symptoms is [00:27:00] because you have a steady dose of allopregnanolone throughout the month, and that appears to be more favorable for the GABA receptors. Um, as my friend, Dr. Sarah Hill, who's. Brilliant researcher explains it.

She's like, your brain builds GABA receptors and then allopregnanolone drops, and then suddenly they're like, eh, I'm naked. Uh, you know, like I'm totally naked here. Um, and just as awkward as it would be like if you were out in a crowd and suddenly found yourself naked, that's like the brain being like, what do we do here?

Um, anyhow, I just think that's a, a great analogy because. What is happening in the luteal phase is that as those progesterone levels are rising, the brain is adapting and making all these GABA receptors. And then when you get to like a few days before your period that progesterone drops and now all those GABA receptors are like, don't look at me, I'm naked right now.

Um, and that could like make the [00:28:00] brain feel vulnerable, which might be part of why we get. Those symptoms. So keeping the continuous progesterone means continuous allopregnanolone, and there's no drop off. There is that constant simulation of calm, and that may also be helpful even for these women who had less of the GABA subunits that I was talking about, because it's giving them an opportunity to adapt slowly, gently adapt, sustain the adaptation rather than.

Wildly. You know, like in 10 days just be like flip, change the brain again. Like maybe your brain needs us to be a little more patient with the progesterone. Now if you're someone who is no longer cycling and using just hormone replacement therapy or menopause hormone therapy, we may only use a hundred milligrams of progesterone 'cause you are using a, a different kind of estrogen, a topical estrogen, not an ovarian produced [00:29:00] your own estrogen. But if this still doesn't work for you.

Because you've tried a few months and you still feel awful. We may need to bypass your liver and do a vaginal suppository. And when you bypass the liver, you're not gonna get that allopregnanolone in the same way that you would if you were taking it orally. And that can sometimes lower the side effects.

There's some studies that also show that, um, vaginal suppository is actually better for the uterine lining. Not necessarily better for the brain effects, but if you're having negative brain effects, then this would be a better route for you and it will protect your uterine lining. In fact, in fertility cases, you're not gonna take oral progesterone because it's a little less predictable than the vaginal suppository.

So vaginal suppository is pretty predictable in terms of absorption in what is happening at the uterine level. And we don't have to worry about like, is your liver metabolism [00:30:00] different than your liver metabolism? When we give it vaginally. Some women also opt for rectally. That's up to you. Um, I haven't seen any research that necessarily says like, oh, it's far better if you use progesterone rectally.

But some women they say like, listen, progesterone's still not cutting it when I use it vaginally. So I went the rectal route and I feel so much better. Okay. If that's true for you. And I know someone's gonna come in the comments and be like, that might be placebo maybe, but they feel better. They don't feel like they're losing their mind.

And we can do scans of the uterus, um, via a transvaginal ultrasound and see like, how is their uterine lining? And if everything's looking good, then we're, we're not gonna worry about that. You also need to know that if you use progesterone as a vaginal suppository, there can be an increased risk of yeast infection. So it's important to be aware of. It's also really messy and is messy and you have to wear panty [00:31:00] liners 'cause it's messy or it'll ruin your underwear. And that's not necessarily a deal breaker for people, but I just.

I'm like, as a doctor, I think this is like the last thing we think of, and yet it does impact your quality of life, so we should talk about it. The other thing to know is that 200 milligrams vaginally might not be enough. So some women we will go up to like 200 milligrams three times a day or maybe 400 milligrams twice a day. Um, it just is something that we have to be very nuanced and individualized with. And I also wanna bring up that if you can't tolerate progesterone, then having estrogen HRT is gonna be tough.

So in general, there are protocols where progesterone is given every three months to induce a bleed. Um, and then annually you're having a transvaginal ultrasound, so that's a wand inserted in the vagina so that we can visualize the lining of the uterus. [00:32:00] We have to do that. Because the risk with estrogen unopposed, uh, with progesterone, so estrogen therapy alone is endometrial hyperplasia, super thick lining of the uterus that can turn into endometrial cancer.

So we gotta be careful with that. And if you've had a hysterectomy. Then the choice is yours if you wanna use progesterone or not. I think it's definitely better to use progesterone because progesterone isn't about your uterus or your breasts alone. Okay. This is, um, you've probably heard several podcast episodes where guests have brought up bikini medicine, and that is a lot of how HRT is viewed.

Does it affect where the bikini top, where the bikini bottoms go? No. God, don't worry about it. No, I'm gonna worry about it. I'm gonna worry about it, okay? Because progesterone is super important for your brain health. Okay? I mean, estrogen's having her [00:33:00] moment right now, and everybody's like, you need estrogen.

So your brain stays healthy, but you need progesterone too. It's involved in like the myelin sheath of your brain. So how you're actually able to run your thoughts and do your behaviors. Um, it's involved in your. Bones. I mean, I said this at the top. It's important for your bones and your brain and your heart.

I mean, we have progesterone receptors all over the body, so we want to be using progesterone, but if you've had a hysterectomy, you can opt for progesterone cream instead. There are women who say it has potential for, um, reducing anxiety. It's had tremendous benefits for their mood overall, their sleep.

You can't use it if you have a uterus though, as an alternative to progesterone. So if you have a uterus and you're taking estrogen, you need to have oral vaginal, or even rectal progesterone coming in as well.

You [00:34:00] cannot use a cream because the research doesn't show us that we can protect you from cancer with the cream. Okay? But if you don't have a uterus, you've had a hysterectomy. Then you can use a progesterone cream if that makes you feel good. And that is something that when you're looking at progesterone creams, I wouldn't necessarily just go buy something.

Online without vetting it and making sure that the mixture is going to ensure that every dose of the cream is going to give you the right dose of progesterone because as we were saying before, you know the ups and downs, they can have an major effect on the brain. And right now, progesterone cream ups and downs.

It's a big question mark and because it's a big question mark. We just wanna be cautious with it, and we want to use products that we know we're getting consistent dose of progesterone in, and that's legit, which [00:35:00] makes me have to bring up like wild yam cream. You are not converting that into progesterone and wild cre.

Yam cream can never be a substitute for oral micronized progesterone, vaginal progesterone, or rectal progesterone. It just cannot, because again, you are, you are not converting that into actual progesterone. You need to do that in a lab. We need a lab to do that for you. If you have a history of endometriosis, even if you've had excision surgery or adenomyosis, wait, maybe you don't know what these are. Okay? Endometriosis is when cells that are kind of like the lining of your uterus but not quite, are living other places in your body, and they respond to estrogen, they grow, they bleed, they activate your immune system, and then you're in pain.

Adenomyosis or mosis, depending on where you live in the world is when you have cells like that, but they're embedded in the muscle of your uterus and that can make it very [00:36:00] hard for your uterus to contract when you have your period, and it can make it to where you have really heavy bleeding and painful periods.

So if you have a history of those things, progesterone must be on board. If you are using estrogen now, if you've had a hysterectomy, progesterone needs to be on board. If you have a history of endometriosis, especially if you've retained your ovaries and you have endometriomas. Because estrogen alone and endometriomas may increase ovarian cancer.

If you have a history of endometriosis, no ovaries. 'cause there's two of them. You can see me on the camera right now on YouTube. Okay. Okay. Uh, so they remove your ovaries, atherectomy. And they removed your uterus, hysterectomy. Those are gone. You still need progesterone. Why? And wait. Somebody's gonna come for me.

It's not gonna be an endometriosis patient because you already know the answer. It's gonna be a doctor who [00:37:00] doesn't understand endometriosis and is like. But the guidelines that were never made for women with endometriosis say, you can just give estrogen. Don't give progesterone wrong. Oh my God. Because we don't know where those lesions are.

We don't know. We have no idea. Right. Because those lesions, we can do a scan, you can have excision surgery. Uh, we can think we got them all. And then we could give you just estrogen and light up some lesions we didn't even know exist. Some little cells waiting in the wing who are like, it's my time to debut and we hate that.

Sorry, endo cells. We hate you. You should never have your stage time. I say that as someone with endometriosis. So we always wanna give progesterone to have that opposition, to make sure that we don't stimulate some unknowing cells. And if your doctor says to you, well, you have a history of endometriosis, so just don't use any hormones, and then it'll go away again.

Bikini medicine, I am more than just my uterus and some robe freaking cells that wanna [00:38:00] bleed when I withdraw from estrogen and cause hell for my immune system like I am. More than that, I am a brain. Right. I'm a heart. I am bones. I am muscles. I am a person who deserves a full lived quality of life. Okay?

So we don't wanna withhold hormones from women just because they have a history of endometriosis. We want to do it. Right, and we need to bring in that progesterone. But why I'm spending some time with endometriosis is if you caught my episode about how women with A DHD and autism have a higher risk of having endometriosis, women with endometriosis have a higher risk of being diagnosed with A DHD and autism.

Then you can put it together that I set. The A DHD and autistic women are at risk for progesterone intolerance. So we may run into some trouble here, and this is where I help. This episode helps you because if we can be bringing in progesterone in the right way that works for you, and I gave you several options today, then [00:39:00] we can help your brain and we can protect against those endometrial lesions proliferating growing.

Another important thing to know about endometriosis is that it's highly tied trying to be besties with autoimmune disease if it's not already its own autoimmune disease to be continued in the research there, but there is a high overlap between endometriosis and autoimmunity. Estrogen and progesterone help us regulate our immune system, and they're essential to our gut microbiome, which is highly, highly involved with immune system dysregulation, which can play out is autoimmune disease.

So that's the other reason why we wanna consider bringing that progesterone and having HRT.

 I also should mention that if you have a history of histamine issues, um, or autoimmune disease without endometriosis, you should also consider progesterone. Progesterone stabilizes mast cells. It helps it so estrogen doesn't run on a m with histamine. Uh, I will [00:40:00] link to episodes that go into more detail about all of this, but if you have a history of, um, histamine issues, your doctor puts you on estrogen, uh, you have no uterus, they're like, you don't need progesterone.

And you feel worse, it could be histamine. So definitely check the show [email protected] for all of that. Now, I always love to give you outside of HRT support because I feel like, I feel like these days everybody's just talking about HRT and it. There's so much more that you can be doing. So if right now you are cycling no matter where you're at, okay, it buried menopause or before.

Vitamin C, vitamin B six. These things can help the corpus lium do its job in creating progesterone so that it stays consistent. We're not trying to get like a a saw tooth action going. Passion flour is a great as a tea, as a tincture. I put it in our adrenal calm formula because it helps stimulate gaba, so it can be that extra GABA support.

[00:41:00] L-theanine, really great one for neurodivergent minds and especially those that are restless and can't get to sleep at night. Um, l-Theanine, it's, you can take it on its own. It's found in green tea. Usually it's about 200 milligrams. That's what you'll find in the Adrenal Calm formula from Dr. Brighten Essentials that.

Can really help with your mood, your focus, and getting better sleep. I love using our adrenal calm formula, which has altheine, it has passion flour. It has, uh, builders of gaba herbs to support gaba, and it has something called phosphatidylcholine, which helps with bringing cortisol down. Using that in the luteal phase, something like that, um, can really help with helping the brain feel calm, helping the brain get sleep, go to sleep, and that can be done with progesterone.

So that's why I really love these kinds of combinations. Something else that you might be like, how is this connected? But trust me, it is making sure that you're eating [00:42:00] protein at every single meal. We need protein to build our neurotransmitters in our brain, for our brain to build the structures. Our brain that interact with our hormones and our neurotransmitters, and we wanna aim for 20 to 30 grams every single meal.

That's also going to keep your blood sugar stable. And if your blood sugar is unstable, if you've cut our insulin episode or any of my episodes where I talk about this, if your blood sugar's unstable, your cortisol's unstable, if your HPA access is getting thrown off, well. There's only so much allopregnanolone can do for you.

And so when we start to understand that this progesterone intolerance and this PMDD picture starts to relate to the GABA receptors actually linking onto allopregnanolone and what is happening in our stress response system, we can begin to understand that like. All of this stuff your mom told you, right?

Like get good sleep, move your body, drink your water. Like [00:43:00] yeah, there was a reason for it. Because all of these day-to-day practices that we kind of take for granted, 'cause we're like, yeah, I do that every day. They're really good for making the system, get the signal, everything's stable, everything's calm, and then we wanna do stress reduction practices as well.

And if. Yoga and meditation and mindfulness is not enough for you. Cognitive behavioral therapy, um, there's an article on dr Brighten.com. I have several on PMDD and I talk about the research on cognitive behavioral therapy. CBT can be super, super helpful and there's also like CBT for insomnia. So if you're someone who's like, no, progesterone and I can't sleep.

CBT. It's like CBTI for insomnia, so that you can get better sleep. I said this at the top, but it bears repeating. You gotta track your symptoms. So progesterone intolerance isn't just about, you know, hormone levels and it's, it's not this one [00:44:00] size fits all kind of approach. It's gotta be a lot more nuanced. And the way we understand the nuance is when you track your symptoms and you get that data for your provider, the data of living in your body.

Is so, so valuable. And you know, as I talk about all of this, I just want to remind you that data isn't just like I took Vetere on and this is how I feel, or this is this day of my cycle and this is how I feel. It's also like, you know what I exercise today? How did I feel today? Because we need to be exercising for our mental health.

Um, exercise increases your neuroplasticity and energy in your brain, so we want that, that's gonna be great for our mental health. So if you exercise, what kind of exercise, how did it make you feel like you can be your own scientist in your own home, in your own body? The reality is, and you've heard me say this before, is that.

The healing that happens doesn't usually happen in your doctor's office, [00:45:00] right? It's the steps you take every single day towards your health. So be sure to track your symptoms and to understand what is true for you and what is working in your body and what is helping you heal now, as always. Thank you so much for being here.

Please subscribe. So you never missed an episode. Leave me a review because that helps the show so much. My team is always like, this is the most important thing. I'm like, okay, I will tell people, please leave a review because this is how we reach more women and the women who need this information. If you know someone who's considering HRT, who struggles with PMDD, who is struggling with their hormone prescriptions or perimenopause, send them this episode and I will see you next time.

Thank you so much for joining the conversation. If you could like, subscribe or leave a review, it helps me so much in getting this information out [00:46:00] to everyone who needs it. If you enjoyed this conversation, then I definitely want you to check out this.