Naturally produced progesterone
Progesterone is a hormone produced by the ovaries that is primarily responsible for triggering your menstrual cycle and it also helps a foetus develop in pregnancy. As well as this, it has an important linked role with estrogen. Without progesterone, estrogen thickens the lining of the womb, whereas progesterone keeps the lining thin and the cells healthy. Having the right balance of estrogen and progesterone in your body at different times of the month is key to having regular, problem-free periods and also for optimised fertility.
Synthetic progestogens
Artificial progesterone has been created for use in some medications and it is present in most forms of hormonal contraception such as the combined pill, the mini-pill, contraceptive implants, injections and in hormonal intrauterine systems (ie coils such as the Mirena or Levosert). Artificial (or synthetic) progesterone is known as a progestogen, or progestin.
Progesterone intolerance
Some women have a heightened or adverse sensitivity to either their own natural progesterone or (more likely) the synthetic type, progestogen. It’s often not until they start using a particular type of contraception or take progesterone as part of their HRT that this sensitivity to progesterone is noticed.
Progesterone intolerance describes a certain set of symptoms that occur in response to this sensitivity to progesterone or progestogen in the body. Symptoms are often similar to premenstrual syndrome, as that is the time of the month when your natural levels of progesterone are at their highest.
Symptoms of progesterone intolerance
Symptoms affect around 10-20% of women and most often they are taking hormonal forms of contraception or HRT that contain a progestogen. Symptoms can be grouped into psychological, physical, or in rarer cases, metabolic.
Possible psychological symptoms of progesterone intolerance are anxiety, panic attacks, low mood, heightened emotions including irritability and aggression, forgetfulness and trouble concentrating and feeling restless.
Physical symptoms are similar to that of PMS: abdominal cramping or bloating, fluid retention, fatigue, headaches, dizziness, breast tenderness, and skin changes like spots and having oily skin.
For a few women, progesterone/progestogen can affect the metabolism and cause changes to cholesterol, blood sugar levels or blood pressure.
Progesterone as part of HRT
If you still have your uterus (womb) and take estrogen for symptoms of perimenopause or menopause, you will be advised to take a progesterone treatment to counteract the thickening effect the estrogen has on the womb lining and to keep the cells healthy. This is described as ‘combined HRT’ as the treatment contains both estrogen and progesterone hormones.
The two main ways progesterone is usually taken in combined HRT is either as an oral capsule (known as micronised progesterone eg Utrogestan, Gepretix are common brand names) or by having a coil inserted into your uterus. Some combined patches also contain a synthetic progesterone.
The micronised progesterone capsule, is chemically the same as your body’s natural progesterone and is the type that has the lowest risks associated with taking it.
The synthetic type of progesterone (progestogen) used in hormonal coils, levonorgestrel, is still very safe but is not considered quite as safe as micronised progesterone in relation to risks of a blood clot, heart or blood vessel disease, or breast cancer risk. These risks are extremely small though, and are much more influenced by your overall health, weight, lifestyle and genetics than by the type of progesterone treatment you use.
When might you notice symptoms of progesterone intolerance?
If you take micronised progesterone:
If you had a period within the last 6-12 months, you’ll most likely be on a cyclical regime with your progesterone. This means you take it for two weeks of the month then have two weeks of not taking it (or occasionally 12 consecutive days out of each cycle), (during which time you may bleed).
You may notice that when you’re taking the micronised progesterone , your symptoms start or are more pronounced, and then they get better in the fortnight that you’re not taking it.
If it’s been more than 12 months since your last period, you’ll most likely be on a continuous regime with your progesterone and this means you take it every day of every month. You may have noticed when you started taking the progesterone that you had some of the symptoms listed above. They may get better after a few months, or for some women, symptoms continue for as long as they’re taking the progesterone treatment.
If you have a hormonal coil fitted:
It is quite common for women to experience some of the symptoms described here when they first have their coil fitted and these could last for a few months. For most women, it settles down after 3-6 months when the body is used to the hormones.
If symptoms do not settle down by 6 months, speak to the healthcare professional that fitted the coil if possible, to discuss whether you want to continue with it or try an alternative form of progesterone for your HRT.
What can I do if I have symptoms of progesterone intolerance?
Firstly, it helps to keep a record of your symptoms and dates when you start/stop progesterone treatments. Speak with your healthcare professional about the symptoms you’re experiencing and they will help explain alternative options for you if it looks like it’s the progesterone (or progestogen) causing the symptoms.
Symptoms of progesterone intolerance can be more prevalent when HRT is first started. In the early weeks and months, estrogen levels are often still relatively low, however with time as these improve, so too do any side effects related to the progesterone. Adjustments in the dose of oestrogen replacement can help in some individuals.
Not all clinicians are experienced in managing progesterone intolerance, so you may wish to ask to see a professional specialising in women’s health.
Some of the possible ways to manage symptoms of progesterone intolerance are described below:
Change the way you take micronised progesterone
The type of progesterone that tends to be best tolerated by women is the micronised progesterone capsules. So if you haven’t tried this yet, it is definitely worth having a trial of it as part of your HRT.
If you have already tried micronised progesterone, have you tried changing the dose or the number of days you take it for, in discussion with your doctor? You’ll want to find a balance between protecting your womb and keeping the lining thin and managing your symptoms of progesterone intolerance. Any time you change the progesterone regime, there might be some bleeding.
When micronised progesterone is taken orally (swallowed), it is absorbed by the whole body but it’s really only the womb that needs it. An alternative way to take these capsules is to insert them vaginally (usually at nighttime) so they can be absorbed into the uterus where it’s most needed and there’s minimal absorption elsewhere. This will help reduce the chance of side effects.
Try a different type of progesterone
There are other types of progesterone treatments that are designed to be inserted vaginally (such as Cyclogest or Lutigest) so if you prefer the idea of using a ‘local’ treatment rather than a systemic one, but haven’t liked oral micronised progesterone, you could ask your clinician about these. These pessaries are more commonly used in fertility management.
Although statistically micronised progesterone is better tolerated than synthetic progesterone, we are all individual and it is always worth considering a synthetic form instead. Some synthetic forms of progesterone have been around for quite some time and are licensed as HRT or contraceptive pills, whilst there are some newer options eg in the form of ‘Mini-pills’/Progestogen-only-pills that are proving very successful in managing some cases of progesterone intolerance
The most popular way to have a progesterone treatment directly targeted to your womb is in the form of the hormonal coil (or IUS). The coil is widely used as a very effective method of contraception, and it also provides adequate progestogen for your HRT needs.
It is a small, plastic, T-shaped device that sits inside the uterus and slowly releases a low dose of levonorgestrel. It needs to be replaced after five years if being used as part of HRT.
Although it can be common to experience some mood changes, breast tenderness, nausea, headaches or other PMS type symptoms when a coil is first fitted, these side effects usually improve after a few months.
Lifestyle adjustments
Progesterone receptors in the brain can be very sensitive to components of our lifestyle, for example our intake of alcohol, nicotine, dietary elements such as sugar and dairy products, and stress. Strategies to reduce some or all of these elements can result in progesterone being better tolerated.
Surgical option for severe cases only
In very severe cases, some women choose to have their uterus removed by having a hysterectomy (either with or without removal of the ovaries). This means that contraception is not required (if it was before) and they don’t need to take progesterone as part of their HRT. If they have their ovaries removed too, their body will no longer produce most of it’s own supply of natural progesterone as well (although a small amount is still made in the brain and adrenal glands).
This surgical option should only be considered when all other treatment avenues have been exhausted and after thorough discussion with a clinician who can help weigh up the pros and cons of this big decision.
Seek advice before giving up on HRT
The symptoms of progesterone intolerance are a common reason why people decide to stop taking HRT, as they can be unpleasant to live with if they don’t settle down on their own. There are however different types of progesterone to try and different ways to take it as part of your HRT, so speak with your menopause doctor before giving up on HRT altogether and missing out on the other benefits HRT can bring.
Last updated: June 2026
