Reframing Progesterone Intolerance: A Phenotype Based Approach for Advanced Hormone Practice

Course overview

Progesterone intolerance has become a clinical dead end. It is a label that halts rather than piques clinical curiosity, and prevents women from potentially achieving the symptom control her body craves. This session introduces a phenotype-based clinical framework that replaces the tolerant/intolerant binary with actionable pathways. Attendees will learn to phenotype their patients in order to determine the best progesterone dosing strategy, screen for PMDD spectrum neurosteroid sensitivity, understand the effects of concurrent SSRI use, and identify when gut dysbiosis is undermining hormone metabolism. The session includes ready-to-use clinical tools: a 5-question phenotyping screen, a gut assessment decision tree, a formulation comparison guide (IR vs. SR vs. vaginal), and pathway-specific dosing flowcharts. Designed for clinicians already prescribing HRT who want to move beyond trial and error into mechanism-based prescribing.