Missing the Mark on Progesterone: What Most Menopause Doctors Get Wrong

Featuring Dr. Phyllis Bronson & Carol Petersen, RPh | Hosted by Jill Chmielewski

September 10, 2025 at 10am MST/11 am CST

Introduction (Jill)

• Welcome audience, introduce Phyllis & Carol.
• Context: After the 2002 WHI study, menopause medicine was largely abandoned. Training stopped, myths spread, and providers were taught incomplete or inaccurate information, especially about progesterone.
• Purpose: To shine a light on overlooked truths, answer common questions, and empower both providers & women to make informed choices.

The Progesterone “Bombshell” (Phyllis)

Prompt: “Many women are told that transdermal progesterone doesn’t really absorb, doesn’t impact mood or sleep, and doesn’t protect the uterine lining. What are your thoughts about that?”

• Debunk the myth of poor absorption.
• Share evidence of therapeutic levels, GABA receptor impact, calming vs. sedative effects.
• Discuss clinical use of transdermal vs. oral, or in combination (i.e., what does progesterone prescribing look like in your practice(s) – Phyllis and Carol.

Common Myths & Misconceptions (Carol)

Prompt: “Many women are told that progesterone is only made after ovulation, only needed to protect the uterine lining, or isn’t necessary without a uterus. What are your thoughts about that?”

• Clarify physiology: progesterone levels through the menstrual cycle, progesterone-to-estrogen ratios and ranges (ng/mL vs. pg/mL) – Address the “luteal phase only” myth.
• Explain the importance of progesterone beyond the uterine lining: brain, bones, mood, and receptors.

Dosing Concerns & Clinical Judgment

Prompt: “Many women are told they only need very low doses, like 100 mg, or that if they don’t have a uterus, they don’t need progesterone at all. As experts, what are your thoughts about that?”

• Are women being underdosed compared to physiology?
• When to consider higher doses, cycling, or alternative routes. 
• How do women know if their dose is optimal?

Prompt: Many women say that they feel worse after starting progesterone, such as increased anxiety, achy, reflux, flu-ish, constipation, increased brain fog, or that their symptoms return after a few months. They often are told that they are “progesterone intolerant” and that they should switch straight to a synthetic progestin or a progestin-containing IUD. As experts, what are your thoughts about that?”

• Why side effects may occur.
• How to distinguish true intolerance vs dose/route issues.

• Clinical pearls for managing side effects or intolerance (grogginess, reflux, worsening PMDD) – Differentiating intolerance vs estrogen rebound effects.
• Touch on why providers confuse progesterone with progestins.

Prompt: “Many women are told that bleeding after starting progesterone, or even losing their cycles, is abnormal. As experts, what are your thoughts about that?”

• Normal vs concerning bleeding.
• Does bleeding or spotting always mean more progesterone is needed ot balance estrogen’s stimulatory effects on the uterine lining?
• Does progesterone suppress ovulation or cycles?

Hormone Testing

Prompt: “Many women are told that serum testing is the best way to track progesterone therapy. As experts, what are your thoughts about that?”

• Limitations of serum testing.
• What really matters: receptor activity vs numbers.
• When testing may or may not add value, and what type of testing do you recommend?

Special Populations & Clinical Considerations

Prompt: “Many women are told that progesterone has no role in younger women, or conditions like endometriosis, PMS, postpartum, pregnancy, or even after breast cancer. As experts, what are your thoughts about that?”

• Endometriosis & endometrial hyperplasia.
• PMS, PMDD, premenstrual seizures.
• Breast cancer risk & protective evidence.
• Other clinical applications for progesterone, such as post-concussion syndrome, post-stroke, etc.

Closing (Jill)

• Reiterate why this conversation matters: misinformation harms women by creating fear and limiting options.
• Invite attendees to carry this knowledge forward – providers in their practices, as well as women in their healthcare decisions.

Registration Link: https://us06web.zoom.us/webinar/register/WN_3e4e0rmbTeGVLWKb4TF2Ew