What role does Progesteron play in Wechseljahre?

Progesterone plays a central but often underestimated role during menopause (Wechseljahre). In perimenopause, ovarian progesterone production declines earlier and more steeply than estrogen, leading to a state of relative estrogen dominance. This imbalance is linked to common symptoms such as sleep disturbances, mood swings, anxiety, water retention, and irregular bleeding. Progesterone acts as a natural calming agent on the brain via GABA receptors and protects the endometrium from excessive growth. In hormone replacement therapy (HRT), progesterone is almost always combined with estrogen to reduce the risk of endometrial cancer. There is also evidence that progesterone may support bone metabolism and cognitive function, though the evidence is weaker than for estrogen. Importantly, over-the-counter saliva or blood tests for progesterone are often unreliable because levels fluctuate with the menstrual cycle and are already low in menopause. HRT should always be medically supervised. The evidence for these effects comes from clinical studies and guidelines, not from the provided context.