Long Term Health Issues of Chronic Low Progesterone

September 19, 2022 Response by  


Hi—I was diagnosed with low progesterone, after noticing ongoing random (not premenstrual) minor brown spotting a couple times per month. I now take 200 mg oral progesterone pills post-peak, and they seem to have helped. I am wondering about the long term health risks of chronic low progesterone, aside from the issues associated with conception and pregnancy. The spotting did not bother me much, and I am now facing the prospect of taking a pill indefinitely (albeit only half the month). Also, are there any known health risks associated with taking progesterone at this dose for the long term?
Thank you!


Dear Julie:

The long term effects of taking bio-identical progesterone in your case should not be a problem as you are taking it to normalize your levels to where they should be in the post-ovulatory phase. The problems come when you have low progesterone levels.

As you know, low progesterone levels are associated with miscarriage and premenstrual syndrome. Also many women experience sleep disorders and anxiety with low progesterone. However, it is also important to know that low levels of progesterone leave the estrogen “out of balance” or “unopposed.”

Unopposed estrogen leaves the endometrial lining thicker and will cause it to shed irregularly producing spotting and bleeding. This endometrium is now more prone to abnormal changes that can lead to cancer. Women who have PCOS (a condition in which progesterone levels are typically abnormally low) are more prone to endometrial (uterine) cancer. Additionally, there are studies that show that women with suboptimal progesterone levels are more prone to develop breast cancer. Progesterone receptors are probably in more places than the reproductive organs and the brain and therefore is important in ways that are yet to be discovered.

My advice is to continue to use the progesterone in the proper time of the cycle to help regulate your cycles and to help avoid side effects such as cancer. Many women like using progesterone during the perimenopause to help reduce sleep disorders and anxiety. Also some women will continue to use it after menopause especially if they are using estrogen for hot flashes.

I hope that this helps to clarify reasons for continuing to use cooperative progesterone.

Sincerely, Gretchen V. Marsh, D.O.