Progesterone Therapy for Night Sweats in Perimenopause

Question

I'm 42, waking most nights about 1am and having bad hot flushes some nights. I had to stop the Pill because I got increasing migraines. What can I do to help my night sweats and get some good sleep without taking estrogen and making migraines worse?

Answer

Thank you for your question. You didn't say, but it sounds like you are in early perimenopause probably still having regular menstrual cycles. Yours would be an easy question to answer if you didn't have migraine headaches. Here's what I believe: progesterone is an effective and safe treatment for troublesome perimenopausal night sweats and sleep problems. My belief is based on personal experience with progesterone treatment of hot flushes and night sweats in perimenopause as well as on the positive reports of many perimenopausal patients whom I have treated with progesterone. I already know, again from personal experience, and that of many perimenopausal women I've treated, that progesterone helps sleep and yet does not cause daytime drowsiness or trouble thinking clearly.

Although I believe that progesterone is effective for night sweats in perimenopause, there aren't any studies that have proven it to be (or even tested it). We just got funding to do a small observational study of night sweats in perimenopausal women with regular periods. One of our purposes is to see if we can better show the pattern of night sweats within cycles. Another is to see if the pattern of hormones in the urine helps us to understand why the night sweats occur and why they may occur at a particular part of the cycle. This study is in preparation for a randomized controlled trial of progesterone for perimenopausal night sweats and hot flushes that we hope to start in the fall of 2009.

What we don't know is whether "cyclic progesterone" might make migraines worse. Cyclic means that progesterone is taken for the last two weeks of the menstrual cycle (days 14-27) (See "Cyclic Progesterone Therapy"). Some women with migraines react with increased headaches to stopping or starting progesterone, just as they may to changing weather, barometric pressure or to bright light. Unlike estrogen, progesterone doesn't cause migraines.

If your menstrual cycles are regular, I recommend taking Prometrium (oral micronized progesterone, OMP) 300mg at bedtime during cycle days 14-27. (Day 1 of the cycle is the first day of the period.) Your sleep problems should improve on the very first night. I'd keep track of your sleep, night sweats and headaches using the Daily Perimenopause Diary©. However, if you find you get any worsening of your migraines on cyclic progesterone, then daily OMP 300 mg at bedtime is a safe and probably effective treatment for you. In contrast to the regular periods of premenopausal women, daily progesterone in early perimenopause will not suppress your own estrogen level. It will also be unlikely to take away your period, although your flow may be quite light.

However, if you have skipped one period, or have menstrual cycles that are unpredictable because they are irregular, you should take progesterone therapy daily if treatment is needed for sleep problems, heavy menstrual flow and/or day and night hot flushes. Again the progesterone dose is 300 mg at bedtime. This daily progesterone therapy is safe for women who have had blood clots. It will also not increase the risk for stroke, heart attacks, breast cancer or bone loss. If you are allergic to peanuts, then you need—instead of Prometrium, which is dissolved in peanut oil—to use oral micronized progesterone dissolved in olive oil and made by a compounding pharmacist. The dose would be the same—300 mg of progesterone by mouth taken as you get into bed.

Whether you take progesterone cyclically or daily, I am sure that it will improve your sleep and decrease your hot flushes.

I hope this is helpful for you.

All the best,

Jerilynn