Progesterone-only HRT is increasingly requested by women in perimenopause, often because sleep, anxiety and night sweats feel unmanageable and they’re wary of oestrogen or synthetic progestogens. But progesterone-only isn’t a standard NHS pathway — largely because guidance is oestrogen-led and progesterone’s established role is womb protection. The emerging evidence (including perimenopause-specific trial data) suggests progesterone can help some women, but it isn’t a complete solution for many perimenopause symptoms. Here’s how to make an evidence-based, personalised decision.