Which Hormone To Supplement? Progesterone, Oestrogen or Both?

Hormone balance is critical for our health and wellbeing, but which hormone or hormones do you need, and how do you decide?


Women are ruled principally by two hormones: oestrogen and progesterone, and the reality is we need both of them. Historically at menopause women’s levels of both hormones drop but whereas in the past the balance could be more easily maintained as women continued to produce oestrogen from their fat cells and progesterone in the adrenals, the balance has shifted.

Oestrogen is not a villain, though you may think so based on its bad press in relation to being a risk factor for breast cancer and heart disease. The ‘villain’ is actually the excess oestrogen women have been exposed to over the last 50 years since the advent of synthetic hormones in the Pill/Coil, artificial HRT and the xenoestrogens in our environment and food chain.

This was the situation that led the late Dr John Lee to describe what he saw in his female patients as ‘oestrogen dominance’. This situation occurs when progesterone levels are lower than oestrogen and so not able to balance out the effects of any excess. What is less commonly realised is that women can have low oestrogen levels and still be oestrogen dominant if their progesterone levels are even lower.

Who needs progesterone?

Women need both hormones from puberty to post menopause and there are many conditions identified where progesterone may need to be supplemented. Again what is not often realised is that a woman can be menstruating regularly but not ovulating, in which case she is not producing progesterone to balance her oestrogen. These are the most commonly seen conditions where bioidentical progesterone supplementation is helpful:

  • Menopause (hot flushes, sweats, anxiety, mood swings, weight gain)
  • PMS
  • PCOS
  • Infertility/Miscarriage
  • Baby Blues/Post natal depression<
  • Heavy bleeding
  • Endometriosis/Fibroids

Who needs oestrogen?

Women with vaginal dryness/discomfort and vaginal atrophy will benefit from additional oestrogen as will women who have found that progesterone alone does not fully control severe menopausal symptoms. Dr Jeffrey Dach in the USA has also found that menopausal women with depression and anxiety benefit from additional oestrogen, balanced by progesterone.

How to decide what you need

The key role of progesterone is to protect from the excess oestrogen that can lead to breast cancer, heart disease and more. Essentially its role is to balance out oestrogen so that it can:

  • Protect the breast and endometrium
  • Help break down fat, stabilise blood sugar and be a natural diuretic
  • Be an anti-depressant and increase libido
  • Help fertility and women with history of miscarriage
  • Facilitate thyroid function
  • Build up bone

Women from puberty to pre or peri menopause generally only need progesterone to deal with their symptoms as they relate to excess oestrogen and oestrogen dominance.

Menopausal women, and those who have had a hysterectomy (which is a surgical early menopause), also need progesterone but may also need a small amount of oestrogen in a balanced formula so they get the protection from oestrogen excess. They are usually women who show signs of low oestrogen as above and and those on long term HRT usually do better on a combined cream when they switch to bioidentical hormones.

Post menopausal women still may have hot flushes and generally need progesterone to protect their bones from osteoporosis.

As a general rule, most women find that bioidentical progesterone alone – like that provided by Wellsprings Serenity Cream – is sufficient to control their symptoms and only switch to a combination cream like Wellsprings Twenty to One if they have a specific need for oestrogen or their symptoms are severe and not sufficiently controlled by progesterone alone.