Why Does Peter Attia Swap Progesterone Pills for an IUD?

On the show, hormone replacement therapy for a woman is preferred from her gynecologist, with an endometrial ultrasound every year and a pap smear every year, so the cervix and the endometrium can be checked and the lining is not too thick. When a woman still has her uterus, estrogen solves most of the problems. The next decision is whether she can tolerate progesterone, because not all women can.

Systemic progesterone is a hundred to two hundred milligrams. For some women that dose is a life-saving intervention: they start sleeping better, their hair gets thicker, and they feel better. For some women it drives them crazy. On the show, that reaction is probably the reciprocal of what shows up in women with premenstrual syndrome. Oral progesterone then stops, and a progesterone-coated intrauterine device supplies local progesterone in the uterus for protection while estrogen stays systemic.