By Cathy Margolin L.Ac. Dipl. OM for Pacific Herbs

How many of your patients are female, over 40, menopausal or perimenopausal, complaining of weight gain and showing signs of early onset diabetes? Could these complaints have a common link?

As a holistic health practitioner, it is common to see patients with a multitude of symptoms. Many times symptoms don’t appear to be related. Diving head first into a patient’s individual history we can see the threads linking their symptoms. That is exactly what happened with this patient we will call Mary.

Mary’s symptoms are fairly typical of many patients her age. Mary is 48 years old and has been gaining weight the last two years. In the past she could lose weight with minimal effort but now 30 pounds have accumulated, and she is not successful shedding them after trying a variety of diets. She hasn’t changed eating habits and says she is committed to a healthy diet. She is usually too tired to exercise.

Logically, her weight gain could simply be calories in vs calories burned. But Mary has other complaints including menopausal hot flashes and her recent blood work indicates pre-diabetes.

Mary is not the only patient with these symptoms. We’ve seen a growing trend of similar complaints with women aging from 40 to 55. We began looking at the similarities in my female patients. This article’s focus is on progesterone deficiency and insulin resistance affecting weight loss.

When patients are struggling through menopause, we carefully consider endocrine disruption and Mary was easy to file under “hormone imbalance.” Estrogen dominance is fairly easy to diagnose in women like Mary, but after two months of an estrogen detox protocol, we made little improvement and changed treatment directions.

After much discussion with Mary, we started to notice many symptoms that fell under the label of “Progesterone Deficiency.” These symptoms include belly-centric weight gain, chronic constipation, low libido, cravings, fatigue, depression and irritability during perimenopause and menopause.

C.W. Randolph, M.D., co-founder of the Natural Hormone Institute, says that women with low progesterone may experience these symptoms and others such as lumpy breasts that are painful to the touch, severe premenstrual symptoms of bloating, moodiness, pain, or especially severe hot flashes during menopause. Because these symptoms can be attributed to many causes, progesterone deficiency is often overlooked and misunderstood. Mary exhibited nearly all of these symptoms.

Additionally, after a short course of Hormone Replacement Therapy (HRT) a year ago, she decided to stop the artificial hormones and try a more natural approach for menopause. Looking at her earlier health history she had been on birth control pills for over 20 years having stopped three years prior to our treatment. Originally, there was no success improving Mary’s symptoms. When we started to consider an insulin imbalance due to progesterone deficiency, everything turned around. Here’s what we learned.

We know insulin is necessary for the body to breakdown carbohydrates. Studies on hormonal contraceptives have documented changes in glucose tolerance and insulin resistance. Some will say the evidence is inconclusive. Some studies claim artificial hormones DO NOT affect carbohydrate metabolism in women without diabetes. However, few of those studies compared the same types of birth control.1

Progesterone plays a vital role in controlling blood sugar levels. In fact, after a large meal, progesterone levels are known to drop. Many studies have confirmed progesterone can impair insulin sensitivity in fat and muscle. What we know for sure is too much progesterone or too little progesterone can affect blood sugar regulation.2-4

Mary, like so many women, was taking a hormonal birth control for 20 years of her life. Therefore, most of her adult life she produced very little (if any) of her own natural progesterone. Artificial progestin, found in birth control pills and HRT is NOT the same endogenous form of progesterone made by our body. Progestin can bind to some receptors in the body but not all. Progestin is not equal to human progesterone. Artificial progestin do not provide many of the protective effects of our own progesterone.

Women who do not ovulate, due to taking hormonal birth control for years, miss out on the progesterone made from the corpus letuem of a mature egg. Since this is the dominant source of progesterone in a women’s body, without it, progesterone deficiency symptoms can appear. Compounding the problem is the rampant estrogen dominance we are exposed to via chemicals in our environment. The combination is creating a significant number of ovulating women who experience symptoms of progesterone deficiency.

The question we had with Mary, and similar patients, was could years of progestin usage be blocking some of the positive effects progesterone has on insulin levels and is progesterone deficiency playing a role in her insulin resistance?

The answer to this question, we believe may only be answered on an individual basis. The lesson we learned here is it always comes back to balance. As Traditional Chinese Medicine teaches, the way to health is through balancing the many complex body systems. Progesterone excess creates insulin problems, progesterone deficiency and again, insulin problems. Balance is the key.

We can tell you when we supplemented Mary with progesterone cream and a low carbohydrate diet, we made tremendous progress on her symptoms. Mary continues to lose weight and improve every month (as do other patients). The take away is to make sure to consider the ENTIRE picture with each patient and always consider the difference between synthetic and natural progesterone when it comes to insulin resistance.

cathy_head_shot_circleCathy Margolin L.Ac. Dipl. OM is a primary health care physician, a Licensed Acupuncturist and Diplomate of Oriental Medicine practicing in Beverly Hills, CA.  Cathy’s career in complementary and alternative medicine began more than 30 years ago. She now focuses on Traditional Chinese Medicine (TCM) and specializes on bringing Eastern medicine to Western audiences with her herbal wellness company, Pacific Herbs. She is the author of two books on hormones balancing and dedicated to sharing and teaching the health benefits of TCM in everyday life to cope with our modern world. Cathy is an avid skier and hiker with her four legged companions, husband and daughters. 


You can read Cathy’s previous Natural Partners blog, Estrogen and Hormonal Imbalances – The Quest for Balance here. 


  1. Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus
  2. Potential role of estradiol and progesterone in insulin resistance through constitutive androstane receptor.
  3. Progesterone inhibits glucose uptake by affecting diverse steps of insulin signaling in 3T3-L1 adipocytes.
  4. Longitudinal Study of Insulin Resistance and Sex Hormones over the Menstrual Cycle: The BioCycle Study

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.