Progesterone Hypersensitivity: Why Do I Itch Before My Period?

If you’ve ever wondered, “Why does my body get itchy before my period?” you may have a condition called progesterone hypersensitivity (PH).

One of the main symptoms of PH is a rash or hives on the face or body several days before your period.

Here’s what you need to know about this condition.

What Is Progesterone Hypersensitivity?

PH is a rare allergic reaction to the reproductive hormone progesterone. Other names for PH are autoimmune progesterone dermatitis or progesterone allergy.

Progesterone is a female hormone produced mainly by the ovaries. It supports menstruation and pregnancy. Progesterone levels fluctuate every month with your period and get lower after menopause.

Doctors use synthetic progesterone (progestogen) in hormonal birth control and fertility treatments. It can also cause PH.

When Does PH Occur?

PH can happen anytime from your first period to menopause — in other words, during the childbearing years. It's most likely to develop during your mid-to-late 20s.

Typically, symptoms happen during the luteal phase of your menstrual cycle when progesterone levels are higher. That’s about a week to a few days before you get your period.

PH isn't common. There are only 200 reported cases to date.

However, doctors believe there are probably many more undiagnosed cases. PH is difficult to diagnose because the symptoms vary and can seem like other allergic reactions.

What Causes Progesterone Hypersensitivity?

Because PH is rare, there has been little research about the condition, and doctors don’t know exactly what causes it.

But they do know that in some people, a surge of natural or synthetic progesterone may trigger:

• An autoimmune response — When your body mistakes healthy cells (in this case, progesterone) for harmful invaders. This response is at its strongest when progesterone levels are highest.
• Delayed allergic reaction — When PH symptoms develop slowly after repeated exposure to synthetic progesterone in birth control or fertility treatments.
• Immediate allergic reaction — When PH symptoms happen quickly as a response to synthetic hormones in birth control or fertility treatments. The body forms antibodies specific to progesterone, which leads to an allergic response.

What Are the Types of Progesterone Hypersensitivity?

Doctors classify PH in one of two ways.

• Endogenous PH — You have PH symptoms that occur a few days before your period every month. That's when progesterone levels are highest.
• Exogenous PH — You have PH symptoms after your body receives synthetic hormones. Those could take the form of hormonal birth control (oral pill, vaginal ring, intrauterine device, or injections) or fertility treatments.

What Are the Symptoms of Progesterone Hypersensitivity?

Symptoms of PH may include:

• Blisters.
• Chest tightness.
• Crusty areas of skin.
• Eczema.
• Genital inflammation.
• Hives.
• Inflammation of the lining of the mouth.
• Itching.
• Rash.
• Shortness of breath, wheezing, and asthma-like symptoms.
• Symmetrical skin lesions on the face, torso, arms, or legs.

In severe cases, you could develop:

• Anaphylactic reaction — A severe allergic reaction that causes breathing trouble and a dangerous drop in blood pressure. It's a medical emergency that requires immediate medical attention.
• Stevens-Johnson syndrome — A rare but serious condition that results in a peeling rash and blisters. It's also a medical emergency.

Progesterone Hypersensitivity FAQs

You may have many questions about whether you have any of the symptoms above. Such as:

Can I get pregnant with autoimmune progesterone dermatitis?

Yes, getting pregnant is possible if you have PH. There's no proof that PH directly causes infertility. However, one recent study showed an association between miscarriage and skin test reactions to progesterone, which indicates an allergy.

Pregnancy can have different effects on people with PH. It can worsen or improve PH symptoms.

The bottom line? More research about how PH affects pregnancy is necessary. If you have symptoms of PH and want to get pregnant, talk to your doctor.

Can you have an allergic reaction to birth control?

In short, yes. The progestogens in hormonal birth control may trigger a rash, shortness of breath, or other signs of PH. If you develop these symptoms shortly after starting hormonal birth control, call your doctor right away.

Can hormones cause rashes due to your period?

If you have PH, you may develop a rash a week to a few days before your period starts.

Can hormones cause hives that aren’t because of your period?

The hormones in some birth control methods and fertility treatments can trigger skin problems and other PH symptoms.

How is PH different from regular allergies?

Seasonal and environmental allergies can have similar symptoms to PH. But their causes are different.

PH has a direct relationship with either your period or synthetic hormones from birth control or fertility treatments. If you have naturally occurring PH, you'll have symptoms around the same time each month.

How Do Doctors Treat PH?

It’s easy to mistake PH for other skin conditions and allergies. Your doctor will ask you about your medical history and symptoms to diagnose PH. They'll focus on when symptoms occur and whether you’ve had any synthetic progestogens.

Your doctor may ask you to keep a diary tracking your symptoms. They may recommend testing from an allergy specialist. Skin testing or a progestogen allergy challenge can reveal more information.

Treatment for PH includes:

• Lifestyle changes — Though lifestyle tweaks won’t cure PH, good overall health can support hormone function. Managing stress is important. Eat a healthy diet, develop good sleep habits, and get regular exercise to help minimize PH symptoms.
• Managing symptoms — Your doctor may prescribe medicine to calm your symptoms. These include antihistamines for skin problems and bronchodilators or corticosteroids for breathing issues. They may recommend the medication omalizumab for severe asthma and hives.
• Progesterone desensitization — Doctors can gradually increase the amount of synthetic progesterone to reduce your sensitivity to it.
• Suppressing ovulation — If you don’t plan on getting pregnant, stopping ovulation with certain types of birth control can reduce progesterone. Gonadotropin-releasing hormone (GnRH) agonists are medications that can also prevent ovulation for short-term use.
• Surgery — In severe cases of PH, your doctor may recommend surgical removal of the ovaries to stop ovulation. This is only an option if you don’t plan on getting pregnant.