Progesterone-only HRT in perimenopause: what you need to know
If you’re in perimenopause and spending any time on social media or women’s health forums, you may have seen lots of discussion about something called progesterone-only HRT.
Many women come to us asking:
“Can I just take progesterone?”
“Why am I not being offered this on the NHS?”
“I’ve heard progesterone is calming and helps sleep — is that true?”
These are sensible questions. Let’s talk through what progesterone-only treatment actually is, why it isn’t routinely offered in the UK, and when it might be considered.
What do people mean by “progesterone-only HRT”?
Most of the time, people are talking about oral micronised progesterone (often known by the brand Utrogestan), taken on its own, without added oestrogen.
Progesterone is a hormone your body naturally makes after ovulation. In standard HRT, progesterone’s main role is to protect the lining of the womb when oestrogen is prescribed. That’s why many women are told they “need progesterone” if they still have a uterus.
Progesterone-only use is different. In this case, progesterone is being used for symptoms, not to protect the womb from oestrogen.
Why are so many women interested in progesterone-only treatment?
There are a few very common reasons:
sleep has completely fallen apart (difficulty dropping off, waking at 2–4am, feeling wired at night)
anxiety feels physical and relentless rather than “in the head”
night sweats or hot flushes are disrupting sleep
past bad experiences with certain contraceptive pills or progestogens
fear of oestrogen, often based on confusing or outdated information
a desire to “start gently” rather than jumping straight into full HRT
For many women, this interest comes from feeling unheard, rushed, or side-tracked when asking for help.
Why isn’t progesterone-only HRT routinely offered on the NHS?
This isn’t because progesterone is unsafe or “wrong”. It’s mainly about how guidelines are written.
In the UK, menopause treatment is built around the idea that oestrogen is the main hormone that treats menopause symptoms, particularly hot flushes, night sweats, joint pains, vaginal dryness and long-term bone health. Progesterone is added if needed to keep the womb lining safe.
Because of this, progesterone on its own has never become a standard first-line treatment in NHS guidance. There has historically been much less research looking at progesterone alone, especially in perimenopause where hormones are fluctuating rather than consistently low.
Guidelines tend to move slowly and cautiously, following the strongest and largest bodies of evidence.
So why do people talk about progesterone-only treatment in other countries?
In parts of Europe and North America, progesterone-only treatment is discussed more openly for a few reasons:
there are well-designed studies showing that micronised progesterone can reduce night sweats and hot flushes in some women
more recent research has specifically looked at perimenopausal women, not just post-menopause
progesterone has known calming effects in the brain, which may explain why some women sleep better when they take it at night
there is more public discussion around “body-identical hormones” (sometimes helpful, sometimes confusing)
This doesn’t mean progesterone-only is a miracle treatment — but it does explain why women hear about it more in international spaces.
What progesterone-only treatment may help with
Based on current evidence and real-world experience, progesterone-only treatment may help some women with:
night sweats and hot flushes, particularly those that disrupt sleep
difficulty falling asleep or staying asleep
feeling “on edge” or overstimulated at night
Some women describe it as taking the sharp edges off their symptoms rather than fixing everything completely.
What progesterone-only treatment does not usually help with
It’s equally important to be clear about its limits.
Progesterone on its own does not usually improve:
vaginal dryness or painful sex
urinary symptoms such as urgency or recurrent infections
joint pains or muscle aches driven by falling oestrogen
bone protection
overall energy and motivation where oestrogen deficiency is a major factor
It is also not contraception. Pregnancy is still possible in perimenopause.
Why progesterone-only isn’t the right answer for everyone
Perimenopause is unpredictable. Hormones can swing high, low, and sideways within the same month. For many women, symptoms come from a combination of hormone changes rather than progesterone loss alone.
That’s why some women try progesterone-only treatment, feel a bit better, but then reach a plateau. At that point, adding oestrogen (usually through the skin) often makes a significant difference.
Progesterone-only treatment can be a stepping stone — but it’s rarely the final destination for women with broader menopausal symptoms.
Safety and practical considerations
Even “body-identical” hormones are still medicines.
Things we always talk through include:
drowsiness or dizziness (this is why progesterone is usually taken at night)
changes to bleeding patterns in perimenopause
allergy considerations (some progesterone capsules are not suitable if you have a peanut or soya allergy)
contraception needs
a clear plan to review whether it’s helping
How we approach this at Sirona Health
When someone asks about progesterone-only treatment, we don’t dismiss the question — and we don’t automatically prescribe it either.
Instead, we focus on:
what symptoms are bothering you most
how those symptoms are affecting your life
where you’re likely to be in perimenopause
what you’ve tried before and how your body reacted
what your priorities and concerns are
For some women, a time-limited trial of progesterone-only treatment, with clear goals and review, is a reasonable option.
For others, the most effective and evidence-based plan involves transdermal oestrogen alongside progesterone, or vaginal oestrogen, or sometimes non-hormonal support.
There is no one-size-fits-all answer — and there shouldn’t be.
The bottom line
Progesterone-only HRT isn’t routinely offered in the UK not because it’s unsafe, but because menopause care has traditionally focused on oestrogen as the main treatment.
There is growing evidence that progesterone alone can help some perimenopausal women, particularly with night sweats and sleep — but it’s not a complete solution for many menopause symptoms.
The most important question isn’t “Can I have progesterone only?”
It’s “What’s driving my symptoms — and what’s the right plan for me?”
FAQ
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NICE guidance frames systemic HRT as oestrogen-based treatment for menopause symptoms, with a progestogen added to protect the womb lining if you have a uterus. Progesterone-only for symptom relief isn’t a standard NICE pathway.
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There is modern randomised placebo-controlled trial evidence in perimenopausal women suggesting oral micronised progesterone (300 mg at bedtime) can improve night sweats/hot flushes for some women. Responses vary.
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“Safer” depends on your baseline risks and what you’re comparing. Micronised progesterone may have a different risk profile than some synthetic progestogens when used with oestrogen, but the absolute risk differences for short-term use are small. Decisions should be individualised.
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Usually not. Vaginal and urinary symptoms related to menopause (GSM) typically respond best to local vaginal oestrogen (and sometimes systemic oestrogen if appropriate).
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No. In perimenopause, pregnancy is still possible. If contraception is needed, we build that into the plan.
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UK product information advises that people with peanut allergy should avoid Utrogestan capsules, and soya allergy is also relevant. Always discuss this with a clinician/pharmacist.