Can progesterone help relieve menopause symptoms?


Can progesterone help relieve menopause symptoms? Can’t lose weight on a ketogenic diet? And could keto help with neurodegenerative conditions?

Get the answer to these questions in this week’s Q&A with fertility specialist Dr. Fox:

Can progesterone help relieve menopause symptoms?

I am 60. I had a partial hysterectomy at age 29. I suffered from migraines from age 18 to 50. They stopped when I began topical progesterone. Later, I was given topical estrogen cream, but it didn’t help the hot flashes at all. You don’t recommend progesterone, but what if the saliva tests show I am low in it?

1. Do I go by saliva tests or not?
2. How can I stop these hot flashes and night sweats?

Thank you,

Dr. Fox:

Good questions, Bobbie. Progesterone is not needed except to prepare the uterus for pregnancy. It is absent in menopause and in the first two weeks of every cycle during the reproductive years. If it was necessary women would really be in trouble. If I measure progesterone in any menopausal patient it will be extremely low. That is normal…..not abnormal and does not require replacement. Progesterone does cover up symptoms such as headaches, hot flashes, night sweats etc, so women “feel better” when they are on it and think that they are healthier. Without needed estrogen, the hormone that truly treats the problem, deterioration can continue despite the progesterone “cover-up.”

Saliva testing for progesterone and estrogen has been shown to be very inconsistent and vastly less accurate than blood testing.

Estrogen topical cream is inconsistent in delivering adequate and consistent serum levels of estradiol. Many creams are mostly estriol and estrone which are 1000X and 100X respectively, LESS effective than estradiol in controlling symptoms. You need estrogen delivered in a consistent way with blood monitoring of the estradiol levels (make sure estradiol). The appropriate range is 60-200 or so depending on age.

Can’t lose weight in ketosis

Please help me. I lost just over 100 lbs (45 kg) on the low carb South Beach diet in my late 20s, so I know the low carb lifestyle works. I gained back approximately 30 pounds (14 kg) after being hospitalized for 8 days due to severe asthma and treated with high dose steroids for a couple months. I kept the rest of the weight off, and it’s been over 15 years.

The SB diet didn’t work for me to take off the steroid weight, and I also have PCOS, so I tried the LCHF/keto. I have been in ketosis with readings between 1.1-1.9 consistently on blood tests, and the urine sticks always turn medium to dark purple. I never go over on carbs, rarely go over on protein (if I do it’s by a gram or two) and have a calorie deficit every day. By all indicators, I should be losing weight, but I’m not. When I did the SB diet the weight dropped off so fast I couldn’t keep up with getting clothes that fit.

Now it’s been 7 weeks of being in moderate ketosis and exercising regularly, and I have lost nothing, zero, zip, nada. My measurements haven’t changed, the amount of flab hasn’t changed, I’m no better toned, and it’s almost two months. My doctor says my thyroid is fine, and naturally tells me that no wonder I’m not losing weight eating butter and bacon and coconut oil and that I need to start eating whole grains and low-fat snacks. Conventional medicine (I’m a critical care/ER nurse myself) just cannot accept the keto concept, but I know for a fact that if I eat brown rice and whole-wheat pasta I’ll gain 5 lbs (2 kg) in a week. Please help me. I’m so discouraged and desperate. What is the point of staying keto if I’m going to be exactly the same size and shape as when I was eating lasagna and baked potatoes?


Dr. Fox:

Don’t be discouraged! I would definitely stay the course. You may feel ebtter with a TSH <1.5. If you are working nights or a rotating schedule this can be extremely stressful and raise cortisol. I would ask for an am cortisol test. Healthy values are <10. Another sleep disturbance such as sleep apnea is also a huge issue. I would recommend not to cut calories. In women, this sometimes produces stress and foils the efforts. Some other of my general recommendations based on my clinical experience are: No aerobic exercise cut out coffee, sleep 7-8 hours, frequent q3 hr intake of 200+ Cals to prevent hypoglycemia. Check and replace vitamin D. Replace iodine and magnesium thru supplements. These should help you. No matter if you lose weight or not, you will certainly be healthier on this approach.

Will the keto diet help with neurodegenerative conditions?

I have been told that the keto diet will help prevent neurodegenerative conditions getting worse, however most of what is on this site is information for weight loss. I’m wondering will this website help me in the neurodegenerative condition area and if so is it the same approach to the recipes?


Dr. Fox:

Yes, the brain is very sensitive and responsive to ketosis. In certain situations, the recovery may be slow.

More questions and answers

Questions and answers about low carb

Read all earlier questions and answers to Dr. Fox – and ask your own! – here:

Ask Dr. Fox about nutrition, low carb and fertility – for members (free trial available)

Videos with Dr. Fox



How to reverse PCOS with low carb


  1. Tanya
    I noted that the lady who is struggling to lose weight didn’t mention fasting, I wonder Intermittent fasting with time restricted feeding would help, of course eating a nutritionally dense well formulated ketogenic diet too. Perhaps she is eating too much fat and needs to lessen that lever a bit and up the protein. These are things I found helpful.
  2. Robyn
    Just a message for Wildangle72, after I became an "mature" woman my protein needs declined significantly. For me, 65 grams of protein a day is about all I can have and lose weight. More than 65g, I won't gain but I won't lose. Also, I have to avoid almost all dairy (just butter for now). Hope this helps.
  3. Glad
    "You need estrogen delivered in a consistent way..." How is this done please? Thanks.
  4. Emma
    This is not correct. Progesterone is needed for optimal health. It is an airway muscle stimulant. Perhaps people have heard of sleep apnea, weight gain, dementia and diabetes? A patent airway, including during sleep, is vital to optimal health. Symptoms include waking up with a racing heart, and nocturnal urination as experienced by many women in Perimenopause and Menopause are two signs that need to be screened for, as well. OSA increases four-fold (4x) as women lose their Progesterone.

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