Progesterone vs Progestins: Why the Difference Matters for Women’s Health | Felice Gersh, MD

Why It Matters

Understanding the true difference between progesterone and progestins guides safer prescribing and empowers women to choose hormone products that align with their health goals.

Key Takeaways

• Progestins are synthetic, not identical to natural progesterone.
• Natural progesterone has neuroprotective, bone‑building, anti‑inflammatory effects throughout the body.
• Progestins often derive from testosterone, causing androgenic side effects.
• Oral contraceptives use progestins to suppress ovulation, not bioidentical progesterone.
• Drospirenone mimics progesterone more closely but remains a synthetic progestin.

Summary

In this video, integrative OB/GYN Dr. Felice Gersh clarifies the often‑confused distinction between progesterone—the body’s native hormone—and progestins, the synthetic compounds marketed in contraceptives and hormone‑therapy products.

She explains that progesterone is a single, neurosteroid produced by the ovaries, adrenal glands and brain, whereas progestins belong to the broader progestogen class and act as endocrine disruptors that interfere with natural hormone pathways. Progestins are manufactured from testosterone or spironolactone derivatives and are the active agents in combined oral contraceptives, IUDs, menopausal therapy, and bleeding‑control regimens. Natural progesterone cannot be used in oral birth‑control pills because its short half‑life and extensive hepatic metabolism would require impractically high, sedating doses.

Gersh uses a strawberry‑flavored jelly bean analogy to illustrate that a progestin may look like progesterone but lacks its benefits and carries unique risks. She notes that most progestins, such as levonorgestrel, stem from 19‑nortestosterone and can cause androgenic side effects, while drospirenone, derived from spironolactone, more closely mimics progesterone’s profile but still differs. By contrast, bioidentical progesterone supports bone formation, neuroprotection, anti‑inflammatory pathways, and may down‑regulate estrogen receptors in breast tissue.

The distinction matters for clinicians prescribing contraception or menopausal therapy and for patients evaluating safety and efficacy. Mislabeling progestins as “progesterone” can lead to unexpected side effects, suboptimal bone or brain health outcomes, and confusion over drug mechanisms, underscoring the need for precise terminology in women’s health.

Original Description

In this talk, I explain one of the most misunderstood topics in women’s hormones: the difference between progesterone and progestins.

These words are often used interchangeably, even in medical literature, but they are not the same thing. I review what progesterone actually is, what progestins are, why progestins were developed for pharmaceuticals like birth control pills and IUDs, and how their effects differ throughout the body.

I also discuss why progesterone has important effects on the brain, bones, blood vessels, immune system, and breast tissue, and why I generally do not use progestins as menopausal hormone therapy except in select situations.

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I am a full time practicing doctor. I see patients in my office in Irvine, CA and worldwide via telemedicine. If you need more healthcare assistance than I can provide in a video series, please contact my office:

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#Progesterone #HormoneTherapy #WomensHealth #MenopauseHealth #HRT #Progestins #BioidenticalHormones #Menopause #IntegrativeMedicine #DrFeliceGersh

----- Contents of this video ---------------------------

00:00 progesterone vs progestins overview

05:00 why progestins are used in pharmaceuticals

09:00 how progestins prevent ovulation

11:00 why many progestins are derived from testosterone

14:00 drospirenone and how it differs from other progestins

16:30 the whole-body benefits of progesterone

23:00 why Dr. Gersh avoids progestins in menopause hormone therapy