Progesterone: The forgotten hormone in midlife mood
- Nicola Shubrook
- Mar 20
- 4 min read
Oestrogen gets SO much attention when it comes to women’s health, especially in perimenopause and menopause. Of course it is a really important hormone, but it gets far more airtime than its sister hormone, progesterone.
Progesterone is one of the most important – and most overlooked – hormones when it comes to midlife mood, anxiety and sleep.
Why progesterone matters for mood
Progesterone is sometimes called the body’s “hormone of calm” because of how it interacts with the brain’s main calming neurotransmitter, GABA (gamma‑aminobutyric acid). As progesterone is metabolised, it forms allopregnanolone, which powerfully enhances GABA’s calming effect at its receptors, helping us feel more relaxed, emotionally steady and able to switch off at night.
Progesterone is often the first hormone to fall in perimenopause, which weakens GABA’s signalling, and many women notice new or worsening anxiety, early‑morning dread, low mood, irritability, “tired but wired” evenings and disrupted sleep – even if they have never struggled with their mental health before.
The impact of stress on progesterone
When you add chronic stress into the mix of perimenopause, progesterone can drop even further and mood often suffers disproportionately. High, persistent cortisol from stress interferes with the brain–ovary signalling that drives healthy ovulation, leading to more anovulatory cycles and therefore lower luteal progesterone levels, even in otherwise healthy premenopausal women. [1][2]
Rather than literally “stealing” progesterone, chronic activation of the stress (HPA) axis turns down the reproductive (HPG) axis at the level of the brain and pituitary, reducing GnRH, LH and FSH. This makes ovulation less reliable, so the ovaries simply produce less progesterone. For a woman already experiencing the natural progesterone decline of perimenopause, this extra stress‑related suppression can mean far less of progesterone’s GABA‑supporting, calming influence on the brain, intensifying anxiety, low mood, overwhelm and sleep disruption beyond what hormonal transition alone might cause.[3][4][5][6]
The missing link in midlife mental health
We know that perimenopause is associated with changes in brain GABA levels and a higher risk of major depressive episodes, yet this connection is rarely discussed in routine care. In the UK, the first‑line response to a midlife woman presenting with low mood, anxiety or poor sleep is often a prescription for antidepressants, with little or no exploration of whether fluctuating hormones or early perimenopause might be driving those symptoms.[7]
National menopause guidance focuses on prescribing oestrogen with enough progesterone to protect the womb lining, but does not yet fully integrate progesterone’s broader effects on mood, sleep and emotional resilience. This means many women are left feeling as though their symptoms are “all in their head”, when in reality their brain is responding to very real hormonal changes.
Why GPs rarely test progesterone
In UK primary care, progesterone is usually not tested for women in perimenopause because current NHS and NICE‑aligned guidance relies mainly on symptoms and, sometimes, FSH to assess menopause status, rather than detailed hormone profiling across the cycle.
Progesterone fluctuates dramatically from day to day in the luteal phase, which makes a single blood draw harder to interpret, and guidelines emphasise using progesterone primarily as part of HRT regimens to protect the endometrium, not as a marker of brain or mood health. As a result, many women are told their blood tests are “normal”, or aren’t offered testing at all, while the very hormone that underpins their sense of calm may be declining in the background.
How we use DUTCH testing, GABA and genetics
Here at Urban Wellness we use DUTCH testing (a comprehensive dried urine hormone test) to look beyond a single hormone snapshot and map how you are actually producing and metabolising progesterone. DUTCH measures the main progesterone metabolites (5α‑ and 5β‑pregnanediol), which helps us understand whether you have ovulated recently and how much of your progesterone is being converted into metabolites that can cross the blood–brain barrier and support GABA activity.
We regularly use this test with both cycling and non‑cycling women, and we can help you work out the best time to run it to get a meaningful view of your progesterone, as well as oestrogen, testosterone and cortisol. DUTCH is still a snapshot in time – and in perimenopause hormones are fluctuating all the time – but it can often provide really valuable data. We also consider GABA‑related cofactors and pathways, as well as your genetics, because variations in how your brain responds to GABA, how you clear hormones and how you process stress can all influence how sensitive you are to progesterone shifts.
Once we have this data, we can write a detailed letter to your GP recommending that progesterone be considered as part of a hormone‑informed approach to your mood and midlife mental health. While NHS and private doctors must work within prescribing guidelines and will usually base HRT decisions on symptoms plus, where appropriate, blood tests, a clear clinical picture and structured information from functional testing can often help build a strong enough case for them to take action.
Where appropriate, we also collaborate with trusted private HRT prescribers who can tailor micronised progesterone as part of an individualised HRT plan, so we can support both symptom relief and longer‑term brain health alongside nutrition, lifestyle and nervous‑system support.
Ready to explore whether progesterone is part of your story?
If you would like to chat to us about hormones, progesterone and your mental wellbeing, you can book a complimentary call with us today. You can also find out more about Hormones & Mood here
