With symptoms including weight gain, depression and heavy periods, progesterone intolerance is one of the main reasons why women stop HRT, says Dr Nighat Arif.
Between 10-20% of women are thought to be intolerant to progesterone. This can result in premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), more severe menopause symptoms and difficulty tolerating HRT. Dr Nighat Arif dives into the details of this lesser-known condition, as well as tips for bringing hormonal health back into balance.
Have you ever wondered why you experience (or used to experience) irritability, bloating and/or tender breasts in the days before your period starts? Or that you noticed similar symptoms while taking hormonal contraception? Or perhaps you’ve found that taking progesterone as part of your HRT doesn’t suit you. If any of the above are true for you, it’s likely due to progesterone hypersensitivity, otherwise known as progesterone intolerance.
It’s estimated that progesterone hypersensitivity affects up to a fifth of women, but many believe these estimates are conservative and that many more women are affected. It’s difficult to determine the exact figure as there’s no large-scale data looking into the condition across all age groups.
The theory is that women with progesterone hypersensitivity have more progesterone receptors than other women, as well as genes that affect how hormones are absorbed or metabolised by the body. This is why we see variable responses to hormone fluctuations throughout the month or when taking hormonal contraception or HRT. Progesterone insensitivity is also believed to play a role in premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS).
Progesterone, PMS and PMDD
Progesterone is a sex hormone that’s released by the ovaries to prepare the womb for pregnancy. It’s released in higher levels after a woman ovulates (around day 14) in the expectation that the egg may be fertilised. If that doesn’t happen, levels start to drop again, the woman has her period and a new cycle begins.
When progesterone levels are at their highest, many women experience PMS. Scientists believe that, in some women, progesterone affects the part of the brain that controls emotions, behaviour, and our ability to manage anxiety and stress, as well as our general sense of wellbeing. PMDD is a rarer condition that comes with more severe symptoms. As the International Association for Premenstrual Disorders (IMPMD) describes, ‘Sufferers of PMDD report damaging and impulsive behaviours that may include suddenly leaving a
