SKIP AHEAD. . .
WHAT IS PROGESTERONE?
Progesterone is a natural hormone produced by the ovaries and in small amounts within the adrenal cortex (6). It plays a major role in the reproductive cycle, and also supports conditions for the healthy development of a fetus during pregnancy.
If you can remember that chart from sex education class (or not, because you were never taught this stuff) – progesterone dances with estrogen in big waves as they promote the growth and shedding of the uterine wall, every menstrual cycle, in preparation for a possible pregnancy.
When an egg is released from the ovaries, blood progesterone levels begin to rise through around ovulation (2). If the egg isn’t fertilized, progesterone levels decrease causing the uterine lining to shed (5). We call this a menstrual bleed or a period. Now if the egg does become fertilized, progesterone levels will continue to increase to support implantation into the uterine wall and a healthy pregnancy. Progesterone is super helpful during pregnancy. It inhibits the uterine muscles from contracting before it’s safe for it to, and helps to develop the breasts/chest for milk production (5). Progesterone also assists in preventing the immune system from rejecting a developing fetus, which can be a cause of miscarriage if levels are low (3). Progesterone levels in a pregnant person can be 10x higher than a person on a regular menstrual cycle and this can be a good indicator of how a pregnancy is progressing (1).
In addition to the stuff your body naturally produces, there is also synthetic progesterone (or, progestin) which is the shining star of hormonal birth control. It’s this progestin that’s primarily responsible for preventing pregnancy by inhibiting ovulation (13). Progestin can also make the cervical mucous uninhabitable for sperm to travel through the cervix and upper genital tract (13).
Outside of fertility, progesterone can assist in bone development, regulates body weight, and can prevent cancers of the reproductive organs in any body. Small amounts of progesterone are produced in the brain, which is known to have a calming effect. This can account for symptoms like fatigue after ovulation or during pregnancy when progesterone levels rise (3). In semen-producing bodies, small yet necessary amounts of progesterone are produced in the adrenal glands and testes. Progesterone acts as a precursor to testosterone development and sperm production (4).
SYMPTOMS OF LOW PROGESTERONE
When progesterone levels are normal, we can feel great. If our progesterone levels are low, we can experience a range of irregular emotional and physical symptoms, which could possibly develop into long term abnormalities in the body.
Below is a common list of symptoms that could indicate a low level of progesterone (2):
Many of these symptoms we could easily put down to having a bad day! If left untreated, low progesterone can affect your ability to conceive and also your quality of life, relationships and sense of well-being if having children is not for you! If you suspect or are experiencing possible symptoms of low progesterone – reach out to your healthcare provider and ask to have your progesterone blood levels tested.
How to test levels
The most accurate progesterone test measures the level of progesterone hormone in the blood (1). This is a low-risk procedure, often referred to as a “serum progesterone test” and is performed by your doctor, midwife, or care provider. A progesterone test can be recommended if your ovulation is not functioning at a normal level or if there are challenges conceiving. Other indications for needing a progesterone test can be increased risks of a miscarriage, monitoring a high-risk pregnancy and diagnosing an ectopic pregnancy (1).
Progesterone levels vary across your menstrual cycle, so it is important that your doctor or midwife takes a measurement at the correct time. The best time to measure blood levels of progesterone is 7 days after ovulation or 7 days prior to an expected bleed (the mid-luteal phase), where progesterone levels should be at its peak (2). They may also choose to take a test on several different days. Knowing when you are due for your next bleed and understanding your cycle patterns can be helpful in assisting your doctor to make an informed decision of when the most accurate time is to take a blood sample. Some medications can interfere with progesterone levels, so always discuss this with your doctor if there are any concerns. Alternate tests for measuring progesterone levels can include a saliva test or monitoring basal metabolic temperature (BBT charting).
You may have questions about the test itself, your results, and what actions to take if your progesterone levels are low. Check back with your provider after getting your results so you can make a comprehensive plan that’s right for you.
Should I be concerned about low levels?
Symptoms like the ones we mentioned above can be present if low progesterone has been detected. Low progesterone levels can explain the emotional and physical discomforts you are experiencing in your daily life, and could also indicate the presence of conditions such as PCOS and Endometriosis.
PCOS and Endometriosis can impact your quality of life and ability to conceive. Hormonal imbalances caused by PCOS can limit the body’s ability to release an egg, which will affect progesterone production. Endometriosis is an inflammatory disorder that affects more than 5 million people in the USA alone (9). Studies have shown that progesterone reduces the progression of endometriosis by inhibiting cell growth, inflammation, and the development of new blood vessels and may be used as a therapeutic treatment for managing symptoms (10).
With any disease or irregularity in the body, this can at times be challenging to overcome. But, with a treatment plan from a care provider, complimentary practitioners and a supportive community, you can regulate rebalance your progesterone levels.
What can I do about low progesterone?
One of the main causes of low progesterone can be an increased level of estrogen in the body (2). Estrogen dominance can occur due to several reasons including:
- Eating large amounts of soy products which can function like estrogen in the body
- The increased presence of estrogens in commercial meats and dairy products can impact hormone balance in the body if regularly consumed.
- The increased presence of estrogens in plastics such as BPA
- PCOS can cause excess estrogen in the body.
- Weight gain can result in increased levels of estrogen production.
Reducing your exposure to estrogens through diet and also environmental exposure can improve your hormone balance. Positive changes include eating hormone-free organic animal products and limiting exposure to xenohormones; substances found in nature that can have a direct impact on our estrogen levels (2). Simple changes like drinking filtered water, removing solvents and plastics from your household and beauty products, limiting exposure to car exhaust and pesticides, can have deserved benefits.
Stress is that big bust word we all know and as humans, we battle to manage stress on a daily basis. Stress can have a huge impact on our endocrine system, so finding tools to help you stay balanced is always a plus for any treatment plan. Sticking to a regular sleep cycle (7-9hrs sleep per night) is beneficial for anyone trying to recorrect hormone imbalances.
Your doctor or midwife may recommend taking a hormonal contraceptive pill like the combination pill (COCs) which contains estrogen and progestin, and the mini-pill (progestin-only pill) (12). This is a patient-specific conversation, and it may take several months to find a pill that is most appropriate for you. Taking a contraceptive pill can assist with initial hormone balancing by providing a regular dose of hormones. However, this doesn’t have to be a long term solution if you aren’t feeling it. It is also important to note that it works more as a band-aid than addressing the underlying cause. Diet and lifestyle have been shown to be effective at increasing progesterone and decreasing estrogen levels as well.
Alternative treatments for regulating progesterone levels can include taking herbal supplements such as Chasteberry (Vitex) (7). Chasteberry affects hormonal imbalances at the source, by interacting with the hypothalamic-pituitary-ovarian axis (hormonal feedback loop), which is key in regulating reproductive cycles (2).
Pro Tip from our resident medical badass, Heather Bartos, MD, "You can also try wild yam, which is the best source of natural progesterone, and available over the counter!"
Supplementing with natural-progesterone therapy has been documented and can be prescribed by your doctor to assist in regulating hormone production (6,3). Visiting an acupuncturist or naturopath can assist with treatment too. They can develop a treatment plan with meals nutritional supplements like Zinc and B to support rebalancing hormones.
Don’t forget to always consult your doctor, midwife, or health care provider before administering any form of treatment and ask them to explain the benefits and risks of each, so that you are educated and fully informed on the best course of therapy for your body.
All content found on this Website, including: text, images, audio, or other formats, was created for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
1. “Progesterone Test: MedlinePlus Lab Test Information.” MedlinePlus. U.S. National Library of Medicine, November 7, 2018. https://medlineplus.gov/lab-tests/progesterone-test/.
2. Rodriguez, Hethir. “Progesterone Fertility Guide.” Edited by Kim Langdon Cull, MD. Natural Fertility Info. The Natural Fertility Company, December 3, 2018. https://natural-fertility-info.com/progesterone-fertility-guide.
3. Rodriguez, Hethir. “5 Ways Low Progesterone Affects Fertility & Pregnancy.” Edited by Christine Traxler, MD. Natural Fertility Info.com, June 14, 2019. https://natural-fertility-info.com/5-ways-low-progesterone-affects-fertility-pregnancy.html.
4. Oettel, M, and A K Mukhopadhyay. “Progesterone: the Forgotten Hormone in Men?” The aging male : the official journal of the International Society for the Study of the Aging Male. U.S. National Library of Medicine, September 2004. https://www.ncbi.nlm.nih.gov/pubmed/15669543.
5. “Serum Progesterone: MedlinePlus Medical Encyclopedia.” MedlinePlus. U.S. National Library of Medicine. Accessed September 23, 2019. https://medlineplus.gov/ency/article/003714.htm.
6. Regidor, P-A. “Progesterone in Peri- and Postmenopause: A Review.” Geburtshilfe und Frauenheilkunde. Georg Thieme Verlag KG, November 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245250/.
7. “Chasteberry.” National Center for Complementary and Integrative Health. U.S. Department of Health and Human Services, November 29, 2016. https://nccih.nih.gov/health/chasteberry.
8. Parenthood, Planned. “What Is the Effectiveness of Birth Control Pills?” Planned Parenthood. Accessed September 23, 2019. https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/how-effective-is-the-birth-control-pill.
9. Parenthood, Planned. “What Is Endometriosis?: Signs, Symptoms and Causes.” Planned Parenthood. Accessed September 23, 2019. https://www.plannedparenthood.org/learn/health-and-wellness/endometriosis.
10. Li, Yanfen, Malavika K Adur, Athilakshmi Kannan, Juanmahel Davila, Yuechao Zhao, Romana A Nowak, Milan K Bagchi, Indrani C Bagchi, and Quanxi Li. “Progesterone Alleviates Endometriosis via Inhibition of Uterine Cell Proliferation, Inflammation and Angiogenesis in an Immunocompetent Mouse Model.” PloS one. Public Library of Science, October 24, 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5077092/.
11. Parenthood, Planned. “Polycystic Ovary Syndrome (PCOS).” Planned Parenthood. Accessed September 23, 2019. https://www.plannedparenthood.org/learn/health-and-wellness/polycystic-ovary-syndrome-pcos.
12. Parenthood, Planned. “How to Use Birth Control Pills: Follow Easy Instructions.” Planned Parenthood. Accessed September 23, 2019. https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/how-do-i-use-the-birth-control-pill.
13. Cooper, Danielle B. “Oral Contraceptive Pills.” StatPearls [Internet]. U.S. National Library of Medicine, August 14, 2019. https://www.ncbi.nlm.nih.gov/books/NBK430882/.