The Dr Louise Newson Podcast - 295 - Natural progesterone: what mental health benefits can it bring?

Episode Date: February 11, 2025

Content advisory: this episode includes themes of mental health and suicide In this week’s podcast, Dr Louise Newson is joined by Consultant Psychiatrist Dr Rachel Jones to delve into the critical role hormones, particularly progesterone, play in women's mental health. They discuss the importance of understanding hormonal changes throughout a woman's life, the differences between natural and synthetic hormones, and the need for individualised treatment plans. The conversation emphasises the significance of balancing hormones and considering lifestyle factors that impact mental health. Dr Louise and Dr Rachel share insights on how natural progesterone can help with mental health symptoms, including mood and anxiety, and encourage women not to give up on finding the right hormonal balance for them. Click here to find out more about Newson Health. Find out more about Dr Rachel on Instagram @the_hormone_clinic Contact the Samaritans for 24-hour, confidential support by calling 116 123 or email [e-mail].

Hello, I'm Dr Louise Newsom. I'm a GP and menopause specialist and I'm also the founder of the Newsome Health Menopause and Wellbeing Centre here in Stratford-Pon-Avon. I'm also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments and often share moving and always inspirational personal stories. This podcast is brought to you by the Newsome Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So today on the podcast, I'm going to talk about an area of hormones that is really, really important. And the more I do work in menopause, perimenopause, but also women with

PMS, premenstrual syndrome, PMDD, premenstrual dysphoric disorder. I worry actually about so many people not understanding the role of hormones in the brain. So I'm really delighted today to have with me, Dr. Rachel Jones, who's a psychiatrist I've recently connected with. And many psychiatrists are fantastic in mental health, but they don't always know so much about hormones. So to find a psychiatrist that not only understands, but also prescribes, but also prescribes, hormones. It's quite unique. So I'm really, really honored to have Rachel with me today. So

thanks for coming, Rachel. Thank you so much for inviting me. So I know when we spoke a while ago when I first met you, we were both being quite open about we've learned so much over the years. And actually, if I'd had this conversation with you maybe 20 years ago, I think it would be a very different conversation. It would be from me, definitely, but would it be from you as well? Absolutely. And actually, even if I'd have this conversation with you, probably five years ago, it would have been a different conversation as well, because all of my knowledge and interest and learning has occurred since then, since I was working in general psychiatry. And I started to see patterns in presentations of women throughout the lifespan. So I'm not just talking about sort of, you know, women in their late 30s, 40s, 50s. I'm also talking about sort of from 18 onwards. So, yeah, so I began to notice all sorts of patterns. It's really interesting, isn't it? Because one of the first things that you learn as a medical student is it's all in the history. You have to take a really good history and it's not just what's happened to the patient on that day. It's the leader. What else has been going on? And I think we sometimes lose that, especially because it's so easy now to order tests and investigations.

Medicine's quite fast-paced if you've only got 10 minutes. So you sometimes forget to put things into context. but I was talking to my daughter, my oldest daughter's 22. She recorded a podcast with me a few months ago now, talking about her PMDD, and she uses transdermal eustard. So she uses natural hormones. And she was said to me yesterday, I mean, I was saying to some of my friends,

I feel the same mentally every day of my cycle. And all her friends, without exception, said, what? What do you mean? How do you do that? And she said, I hadn't realized. And I just thought, wow, actually, do we just normalise the fact that our hormones change and effect the way we feel? And it's often, I mean, people can get physical symptoms, but certainly for this podcast, I really want to concentrate on the mental health symptoms.

Because for so long, it's just her hormones. She is a hormonal person. Don't worry, she's due on soon. Yeah. But actually, should we be normalising it? No, and also we know for some women, it can be really, really quite severe. So the type of women that I will see in psychiatric services, for example, have made it to psychiatric services. So their symptoms that they're presenting with very severe.

And even with sorts of harming themselves or suicide, and they may have harmed themselves, and they may have acquired diagnoses such as emotionally unstable personality disorder. But as you say, it's all in the history. And when you spend time asking them questions in detail, and in particular about their menstrual history, which, interestingly, is not part of a standard history and mental stage examination that we use in psychiatry. It's one that I've sort of developed is that you see a clear pattern where these women are often feeling relatively okay in the first half of their cycle, but they will then have thoughts about harming themselves, they may even harm

themselves and having thoughts of suicide. But there's a pattern to it, and it's focusing on that pattern and understanding the pattern in the context of the menstrual cycle, which is really key. Absolutely, and I think also we forget, don't we? Some of us might remember from biology days at school, but our hormones naturally change throughout our cycle. So when people are having, you know, regular periods, we get a peak of the eustodial, progesterone, and even a little bit of testosterone as well, surge when we produce an egg when we ovulate. But it's the second half of the cycle, isn't it, where we have this huge rise actually in progesterone, a less so, but still a rise in eustodial, the natural estrogen. And then they plummet quite quickly, don't they, before we have a period.

Yes, yes, they do. And it's that period where some women just find, from a mental health perspective, find it so debilitating. And that's what I'm interested in, really. Certainly seeing the women I see in psychiatric services. And if you can help them from a hormone-dispective there, it reduces the need to prescribe other medication, you know, with associated side effects. So I think it's really important to understand their mental health symptoms in the context of their menstrual cycle. Yeah, and I remember sitting in a clinic many years ago, actually, where there was a lady who came in who was quite young. She was a follow-up patient, and she'd been diagnosed with PMDD, premenstrual dysphoric disorder. She'd had a dreadful time a few days before her periods, very classic history. And the doctor

had prescribed her some natural hormones, so eustodil progesterone, and he'd also given her testosterone, and had added that in, and she'd been a patient for about a year of his. And when she was being reviewed, she was just saying how her life had been transformed. And afterwards, she left the consulting room. And I said to the doctor, but what? Why are you giving hormones? Like, I've always been taught you give antidepressants for two out of four weeks. Or you think about lifestyle and everything else.

And he said, but Louise, you're just replacing what's missing, you're topping up those hormones that have become low and having a problem in some women. And I thought, yeah, that's so simple. But it's almost so simple it's been forgotten, hasn't it? It has. It has. With antidepressants, I think sometimes there is a place for antidepressants, and they do take the edge of. They will take the edge off symptom.

But then you're not treating the problem with the right thing. And natural hormones are natural. As you say, they're replenishing what's missing, what needs to be rebalanced. And as a consequence, their minimal side effects. Women respond incredibly well. And as you said, and many of our women tell me that it's life-changing. and that they will go and not even know that their period is arriving. So they're surprised they'll get the period and think,

but I've had no symptoms leading to this, to my period. And they almost can't get their heads around. How transformative it's been for them. Yeah, and it's interesting because we mentioned these three hormones, but I'd like to just spend a little bit of time, if I may, talking a bit about progesterone, because progesterone means different things to different people, because we've got the progesterone-only pill.

We know the combination pill contains progesterone, We know implants, deapropervera contains progesterone. But, and the big caveat here is they are all synthetic. So they're chemically altered. They're not the same as their natural progesterone. And I can't seem to say it enough. And even when I say it to doctors, they're like, hang on, say that again. Because it's all called progesterones.

It's very confusing. But it's not progesterone. We have progesterone. We produce ourselves. We make it in our ovaries. We make it in our brains. We make it in other tissues. the natural progesterone.

But all contraceptives are not natural, are they? Absolutely not. And they are not the same. So I can't tell you how many women I've seen in my clinic who have not tolerated the progesterone-only pill. They haven't tolerated the combined pill. They haven't tolerated the myrana coil, for example, evenly. And then you prescribe the natural progesterone,

and they tolerate it, they respond, and their symptoms improve and disappear. So they're not the same. They really are the same. No. And I often say to people, our hormones are obviously chemical messengers, but I think if you think of them as a key and the receptors like a lock, which are the receptors on cells. And once the key goes into the lock and unlocks, you have these lovely biological processes that occur. Now the synthetic progesterone or the synthetic hormones, they've been chemically altered.

So they might fit into the lock. so they might stimulate the receptor, but they won't unlock it. So we've all had dodgy keys cut in the past where, oh, great, go in and then it doesn't turn. And it's that sort of thing. So it, I think, has a double negative effect because it blocks any natural hormone working and it doesn't have the same effects. And there are a lot of women, certainly in my experience, and I'm sure in yours,

who have quite severe PMDD or PMS, and they tell me that they cannot tolerate any progesterone at all. Like they've literally gone mad even with their marina coil, for example, or try to rip out their implant. And they're so scared of progesterone because they think it's all the same. Yeah. But when they have the natural progesterone, they often respond even better than other women. Yeah, they do.

I think that progesterone, for me, it really is the key hormone that is forgotten about from a mental health perspective. It's just fantastic for mood, for anxiety, for irisibility, for race, for sleep, all of those symptoms. And if you prescribe the natural progesterone, it changes women's lives. And every single day I'm in my clinic, I'm speaking to women that just can't speak highly enough of how they've responded to natural progesterone. Yeah, and it's very interesting.

I mean, when I was first learned about hormones, it was almost, you have estrogen as the main hormone. You have progesterone if you've got a womb because you protect the lining of the womb and testosterone is only for really reduced libido when women are taking HRT. But when we look at how our hormones are manufactured, they come from progesterone. Progesterone is like the main hormone and then you get testosterone, which as you know gets aromatase to estradiol. Yes. But also progesterone forms cortisol and corticosterone as well. Yes. Which are really important associated with inflammation but also stress as well. Yeah. So it's almost like a seesaw, isn't it? If your progesterone goes down, your cortisol can go up as well, so your stress hormone

can go up. So that's also like something that I think a lot of people don't think about. These hormones don't exist in isolation. They form an equilibrium with one another. And if one gets low, that impacts the other hormones. And if one gets too high, that impacts the other hormones. So it's about finely tuning them alongside one another. So I always, as you say, I've always got this cascade in my head of what's converting to what and understanding that they need to balance, they don't exist in isolation. And I think that leads me on to saying that progesterone in my opinion, bearing in mind I'm looking at it from a mental health perspective and as a psychiatrist, in my opinion, should not just be prescribed to keep the lining of the uterus thin. It's got many,

many, many, many more benefits than that psychologically. Yeah, and I totally agree, especially when we think it is a neurosteroid, it's a hormone that's produced in our brain. So it's produced in our brain for a reason because it has these beneficial effects. And like you say, very calming, actually, really can help anxiety reduce. It can help sleep. It can just help with mental thought processes as well, actually, and clarity of thought. And I first sort of saw quite a few people who'd had hysterectomy, they'd been on HRT, and then their gynaecology said, well, you haven't got a womb now, you don't need progesterone and they'd come back and say, but I can't sleep, I'm really anxious. And no one thought about their progesterone.

They said, but I had some left over, so I took it and everything improved. So, you know, they'd learnt themselves almost, but then when you read how the hormone works. So we've got a lot of work from Katrina Dalton, who was very inspirational way ahead of her time doctor, who prescribed a loss of progester to women with PMS, PMDD, and really incredible results. also postnatal depression as well. Yes. But, you know, she was reported to the GMC, the General Medical Council, the gynaecologist tried to strip her of her registration.

But she was quite formidable. I've spoken to quite a few people who were her patients. And she actually went to my old school, so she came in lecture when I was about 13. And she was quite, you wouldn't really argue with her. She was very forthright, very outspoken. She was really understood the difference between natural and synthetic hormones

in a way that I don't think anyone has spoken about it in the way she has until recently when we're all connecting and joining the dots again. Yeah. And I feel the same about this, I have the same issue with women actually who are on natural estrogen and have a myrana coil because that's not the same as having natural systemic progesterone.

And often I will have women that come into my clinic who are anxious, they're low, they're not sleeping, they've got migraines, and they're not on any progesterone. So I prescribe progesterone and they get better. It's often as simple as that. Yeah, I think we certainly do, and I see lots of women who sadly doctors have refused to prescribe progesterone because they've got a marina coil in. But it is a natural hormone and it is really important, but it's about having the right dose and type because sometimes people take a little while to get used to the progesterone, don't they? Sometimes when they start it, they can sometimes feel a bit worse

and making sure that they have it in the right way, that it's absorbed in the right way, the right dose for them. Some people need higher doses. Some people prefer it as a pesir. There's options, which I think is also really important as a doctor to allow people to know that there are options, even with the progesterone, the way that you can have it and the dose, because that's important too, isn't it? Yeah, I think. Absolutely. And for women not to give up. So another thing, I will see women coming to the clinic, or they say, oh, I just didn't tolerate the progester and I had to stop it. And that was the end of it. So then to sort of, you know, extend the conversation and say, well, that doesn't mean that it's not going to work, that we can't make it work for you.

As you say, in different doses or different forms of taking it, one shouldn't give up. If they've just tried it and they said they haven't tolerated, that's not a reason just to give up and not try again. Yeah, and I think also, like you said before, these hormones all work together. And so balancing the hormones is really important. So it's not just about keep going with estrogen as much as you can and then don't worry about the other hormones. You know, it is looking at how they balance with progesterone and also testosterone as well. And someone said a while ago, there's like a triangle really of the hormones. And I think that is really right.

And actually even Katrina Dalton spoke a lot about nutrition. and making sure people ate regularly, they weren't putting too much stresses on their body, especially with their glucose and insulin. And I think that's really important, too, certainly looking holistically at how we do anything to reduce anxiety. Very much so. But that can be very hard unless you've got your hormones balance. Yeah, and absolutely.

And as you said, because you said earlier, that testosterone can convert to estradiol. So whenever I'm prescribing testosterone, I've always got at the back of my mind, well, some of that is converting to estrogen. So therefore we're going to have to balance with even more progestone than we would have if they weren't on testosterone. So it's always considering what you're prescribing, what doses you're prescribing, and making sure that they're adequately balanced with the progesterone.

I think that's so important because, you know, about just over 50% of people we see in our clinic are already taking hormones. Now, they're not coming because they want to come to our clinic. They're coming because they're still having symptoms. And that individualisation of care is really important, isn't it? Oh, it's so important, certainly from a mental health perspective. I mean, I rarely see, if I'm completely honest, when obviously the type of women that I see in my clinic have quite debilitating significant mental health psychological symptoms. And it's never, ever, ever a one-size-fits-all approach.

They all respond individually. and you have to go very, very carefully with the doses, with the individual hormones that you prescribe, and gradually titrate them over time until you get the balance right for them. And likewise with you, so many of the women that come into my clinic have either taken HRT and have given up or is still on HRT and they haven't got the right balance and are about to give up. And that's not the end of it. It's about getting the right doses for them. Yeah.

And it's interesting when we think about some of the, the psychiatric medication that people are taking. And I did quite a lot of psychiatry as part of my training. I'm very interested in mental health. But I hadn't realised, Rachel, the impact of mental health on hormones until, like you say, pattern recognition. So we see a lot of women who are on quitoopine and antipsychotic. They've been on two, three, four, sometimes five different antidepressants with not good effect. I've seen quite a few women. I've lost count, actually, the number who have had electroconvulsive therapy, increasing emphy, and women have had ketamine infusions. Yet, like you say, it's not built into the history taking, asking about any potential

hormone changes, thinking about periods and so forth. But one of the things that we notice, and we've just writing up some data, is that women, once they have their hormones balanced, obviously we keep them on their same medication, because they've been on it, they start to then be able to deprescribe some of their medication. And we found that when people are on a combination of all three hormones, they can deprescribe better than just on estrogen, for example. And I think that's really interesting. Because I think it's a bit like a Ben diagram with mental health and hormones.

I think there's some people who it's all a psychiatric condition and it's nothing to do with hormones. I think there's some people, it's probably mostly due to their hormones and it's not being diagnosed. nose and I think there's some in the middle that are both. And that's always difficult, isn't it, to know which they are? It is. But I think getting across everything is so important, isn't it?

Yeah. And the approach that I take, firstly, I always listen to them because they've always got, we usually got a pretty good idea themselves of what's happening with their cycle and their patterns. And they will often come to me and say, I'm sure it's my hormones, or I'm sure my hormones have got something to do with it. So that's the first thing is I really listen to what they say because they often know deep down. The second thing is I always say I'm not, especially if they're under psychiatric care from another psychiatrist or another team and they come to me.

And even if they're my patient, I'll always say I'm not going to change your psychiatric medication at the moment. And I'm going to just focus on your hormones and balancing, replenishing, finely tuning your hormones. And only when we've done that and where we see how much improved you are, how far we've got with that, will we then be in a position to even contemplate looking at your psychiatric medication and potentially reducing it and stopping it in a very gradual, controlled way. Firstly, because if you do more than one thing at a time, you never know what's doing what. You won't know. No, you just won't know.

And secondly, I think you do have to tread carefully with their medication. When you start to address it, I mean, they're often obviously understandably very keen. The moment they feel better, once they're on their hormones, they want to stop it immediately. But I really say to no, it's got to be done in a really controlled, careful way, often one at a time and titrating according again to their response. So it does have to be done very carefully. I don't want to tread on anyone else's toes, on any other psychiatrist's toes. I make it very clear that what we're doing is focusing on the. hormones first and only after that may we start to address their psychiatric medication. I think that's

really important. It's so important and certainly, you know, I did a lot of deprescribing as a GP and in the clinic we do it, but even just, I say just in inverted commas, antidepressants, I will reduce very, very slowly, especially when people have been on them for a length of time. And actually I have this unwritten rule that I'll only start reducing them in the springtime when the crocuses come up. Yes. Because like you say, sometimes people are. in a real rush to stop. But in the winter months, unless there's a real reason, I was just say, look, you've been on them for a while.

Let's just wait till the clocks of change. We see some spring flowers. And then we do it really, really, really gradually. Really slowly. Yeah. And I can't emphasise how slowly actually with these medications just because, just in my clinical experience, people have less problems coming off than when it's very slow.

Whereas when they do it quicker, that's when they can get more side effects. Yeah, and a rebound, a rebound, depression, rebound, low mood. I've seen that so many times. And I'm exactly the same with you really, really slowly. I mean, often I do it over a period of nine or ten months and tiny, tiny, tiny bits over a period of time because there's no harm in doing it that way. It's important to keep the patient on the side because they just often want to stop it and be done with it. But it's really, really important to do it like that.

Absolutely. we have a psychiatrist actually working with us in the clinic. So some of the drugs like quaterapine and the progobalin stronger drugs, I feel a lot more confident doing it in conjunction with a psychiatrist. But it's a team effort as well. So the patients feel really supported. And it's also looking at what else might be affecting their mental health. And as you know, often when our hormones are balanced,

we're more likely to eat a better diet. And, you know, the effect of the way we eat or what we eat on our mood is huge. But you don't realize until you, you sort of start to eat better, and that can have an effect. But if you are very low in your motivation, low in your mood, you're not going to be thinking about how to have a nutritious meal. So a lot of people comfort eat, don't they? Or snack and then they have the – yeah, so all of these can make a huge difference.

Yeah. And the same with exercise. The last thing that you feel like doing when you're feeling depressed, when you're feeling anxious, when you're feeling irritable, when you haven't got any motivation, is to do any exercise. So I always say when they start to feel better, It's just little, little steps, gradual, gradual changes over time build up to big changes. So, yeah, but absolutely emphasizing that lifestyle changes are also key alongside the hormones.

Absolutely. And I also think very much with our brain, our brain likes homeostasis, everything the same, doesn't it? So anything that can be routine is also very important, you know, even the way that some people respond very differently than others. So like you was saying, it's not everybody that gets PMS or PMD. Some people have these hormonal changes don't notice. And it's a bit like being hungry. Some people, when they're hungry, their mood goes.

And other people, it doesn't matter. They'll just eat because they need to. But they don't have that same, you know, changing the brain. And it's the same with anything, isn't it? The way people respond to alcohol, for example, is different. Our brain is so interesting. Yes. But there are some people, and we don't know whether.

whether it's the genetic thing or what, that I definitely respond more. And those women with PMS, PMDD, more likely, it's not guaranteed, are going to have a more difficult time in the perimenopause as well, aren't they, with their mental health? They are.

So it's a sort of warning almost to sort of make sure you don't want to wait until your perimenopausal before you think about hormones. I much prefer helping people younger. Yeah, absolutely. I think these, if you call them hormone conditions, whatever you call them, they, again, a bit like hormones and cells, they all blur into one another. They don't really exist in isolation. So women who suffer with PMS or PMDD are more likely

to have postnatal depression after the birth of a baby. And in my experience, are more likely to suffer from a mental health perspective through perimenopause, menopause and out the other side, unfortunately for them. So the early that you can get on top of it for them, the earlier you can balance their hormones and go on the journey with them as they age and go through the different, you know, periods in their life, the better the prognosis and the better response they make to the hormones. Yeah, I saw someone in my clinic yesterday who's 30, she's quite young, and she'd been diagnosed with PCOS, but only on a scan, it didn't really show the classical, just one of her ovaries was a little bit enlarged. But she's got definite PMS or PMDD, depending, and she's

responded really well, just on the small amount of hormones. And she was worrying about what's the diagnosis is. And I said, well, actually, it doesn't really matter. I know she wanted to know, but whether she might have PCOS, she might be PMS, it doesn't actually, she has hormonal changes. And all I'm doing is topping up her hormones. It's not going to worsen her fertility. It might improve her fertility if she wants or when she wants to become pregnant. But it's done in a very natural way. and increasingly, and I understand why, younger people don't want to have contraception. They know more about it. They know that they're synthetic.

And so knowing that there's a choice, it's not going to be a contraception because the dose is low and it's a natural hormone. But it doesn't mean we can't give these hormones to younger people, does it? No, it doesn't. And I also see women in the clinic that come in with PMS, but actually when you explore and look at their symptoms in detail, they also have symptoms of either PMS or PMS. So, you know, quite debilitating psychological symptoms before their period. And actually, they were swollen very well, to progesterone again.

So absolutely. And often I don't know whether you've found this as well, that I find often women's symptoms of PMS and PMDD start once they've been on the oral contraceptor combined pill for a significant period of time. So they never had it before. They go on the pill. They come off and then all the problems start moving forward for them. Yeah, absolutely. And like I say some of these people, such when they're young, they might only need progesterone. They don't always need all three hormones because they're producing them themselves, of course, aren't they? Yes. Yeah, absolutely. For me, progesterone seems to be this wonder hormone that sort of like helps with all the conditions all the way through. And postnatal depression as well. Progesterone is very effective in treating that too. So yeah, I think progesterone mustn't be the forgotten left behind hormone. It's absolutely key in.

treating mental health in the context of hormone, depletion or hormone imbalance. Yeah, no, that's been so useful. It's really good just to dig in a bit deeper, actually. And like I say, some of it is so obvious, but often in medicine, we forget the most obvious things and go for something more complicated. So I'm very grateful for your time, Rachel. It's a pleasure. Before we end, I always ask for three take-home tips.

Okay. So can I just ask you for three reasons why you think progesterone is such a great, an important hormone, especially in the context of mental health? Because it seems to treat everything. It seems to help with everything. It helps with sleep, which we know can be so debilitating to mental health. It helps with anxiety. It's a calming, soothing, natural antidepressant. And it seems to be a buffer. So it sort of balances everything out. So it sort of changes throughout the menstrual cycle. It seems to balance out. Changes in mood, mood swings. It balances.

out anxiety, it calms down, it lifts mood, it seems to have an effect across the whole range of symptoms. That's the first thing. The second thing I say about progesterone is don't give up. So women become very disheartened. They often hear that progesterone is good for their mental health. They try to take it. They don't react well to it. They give up and they say that's it, I can't have it. So that would be the second thing, don't give up. And certainly don't assume that synthetic progestone and natural progesterone are the same thing because they're not. And the other thing that I would say is consider progesterone throughout the lifespan. So not just for perimenopause, menopause, certainly not for just maintaining the lining of the womb,

but from a mental health perspective. So all the way up PMS, PMD, postnatal depression, perimenopause, menopause, and out the other side. So consider it throughout the lifespan is what I would say. Great advice, so thank you so much. Thank you so much for inviting me. You can find out more about Newsome Health Group by visiting www.new.com.uk. And you can download the free balance app

on the App Store or Google Play.