Understanding Progesterone: Answering Your Most Common Questions
After the release of the episode Progesterone Made Easy, Bobbi Fischer received an overwhelming number of questions from listeners looking for more clarity. Progesterone is one of the most misunderstood hormones in women’s health, and it rarely fits into a short, surface-level conversation. In this follow-up episode of the Aesthetically Awkward Podcast, Bobbi addresses the most common listener questions, offering context, reassurance, and practical guidance for women navigating progesterone, perimenopause, menopause, and hormone therapy.
Why Progesterone Deserves More Attention
Progesterone plays a critical role in women’s health, particularly in regulating the menstrual cycle, supporting pregnancy, balancing estrogen, and influencing mood and sleep. Yet many women are prescribed or discontinue progesterone without fully understanding how it works or why it matters. This episode was created to slow the conversation down and address real concerns from real patients.
Spotting After Starting Hormone Therapy
One listener shared that she experienced spotting after starting hormone therapy despite not having had a period for three years. Bobbi explains that any bleeding after menopause should always be evaluated. While spotting can be alarming, it does not automatically mean hormone therapy needs to be stopped permanently. Progesterone’s role is to protect the uterine lining when estrogen is introduced, and bleeding often signals the need for evaluation, dose adjustment, or imaging rather than panic.
Irregular Periods, FSH Levels, and Perimenopause
Another common question centered around irregular periods and being told someone was menopausal based on a single FSH lab result. Bobbi clarifies that fluctuating cycles are often a hallmark of perimenopause, not menopause. FSH levels can vary widely day to day during this transition, making a single lab value an unreliable diagnostic tool on its own. Context, symptoms, and longitudinal patterns matter far more than one number.
Luteal Phase Defect Explained
Bobbi also discusses luteal phase defect, a condition where progesterone levels are insufficient during the second half of the menstrual cycle. This can present as short cycles, spotting before periods, fertility challenges, or significant PMS symptoms. Diagnosis requires appropriate timing of labs and a thorough symptom review. Treatment is highly individualized and based on both lab findings and how a woman is feeling, not just numbers on paper.
Progesterone and Mood Changes
Several listeners reported feeling emotionally flat, low, or unlike themselves after starting progesterone. Bobbi explains that progesterone interacts with the brain’s GABA system, which influences calm, sleep, and mood. While many women experience improved sleep and anxiety relief, others may feel blunted or down. These reactions are real, not imagined, and often improve with dose adjustments, formulation changes, or timing modifications.
Estrogen Pellets and Progesterone Balance
Questions also arose about estrogen pellet therapy. Bobbi shares that she prefers transdermal estrogen patches due to their adjustability and ability to fine-tune dosing over time. Pellet therapy offers limited flexibility once placed, which can complicate symptom management and progesterone balance. Individualized care and adaptability are key when managing hormones safely.
Hormone Therapy Is a Collaboration
A recurring theme throughout the episode is the importance of partnership between patient and provider. Hormone therapy is not one-size-fits-all. Symptoms, goals, risk factors, and quality of life all matter. Bobbi emphasizes that women should feel empowered to ask questions, report side effects, and participate actively in their care rather than feeling dismissed or rushed.
Closing Thoughts
Progesterone is powerful, nuanced, and deeply personal. If you are experiencing symptoms, confusion, or side effects, you are not failing and your body is not broken. With proper education, evaluation, and support, hormone therapy can be adjusted to meet your needs. You do not have to navigate this alone, and your questions deserve thoughtful answers.
Key Takeaways
Progesterone is essential for uterine protection during hormone therapy.
Any postmenopausal bleeding should be evaluated, not ignored.
Irregular cycles often reflect perimenopause, not true menopause.
Mood changes on progesterone are real and adjustable.
Hormone care works best when it is collaborative and individualized.
Tags: Progesterone, Women’s Hormones, Hormone Therapy, Perimenopause, Menopause, Luteal Phase Defect, Mood and Hormones, Aesthetically Awkward Podcast, Bobbi Fischer
