Low Progesterone - Symptoms, Causes and Treatment
Progrestrone’s importance is often underestimated. This vital hormone not only counterbalances oestrogen but also plays an important role in women's health and well-being. A shortened menstrual cycle, spotting, premenstrual syndrome (PMS) and water retention – all of these symptoms point to low progesterone (which consequently leads to oestrogen dominance.) It’s time to take a closer look at this important hormonal issue, what causes it and how to find relief.
When we think of menopause, we often automatically think of oestrogen deficiency. But that’s not the whole story. At the start of menopause, during the perimenopause phase, low progesterone and high oestrogen are actually much more common. Many younger women also have low progesterone levels. So, what causes low progesterone and what can you do about it? Let's find out.
Progesteron – The Star of the Luteal Phase
Get ready to meet the star of the show of the second half of your menstrual cycle - progesterone! Alongside oestrogen, progesterone is one of the most important sex hormones in women and people assigned female at birth. Known as the “corpus luteum hormone”, it's produced in the ovaries, within the corpus luteum. Picture it as a little sac-like structure that forms from the ruptured follicle, where the egg was released during ovulation. This unique group of cells not only helps regulate your menstrual cycle but also supports a pregnancy if fertilisation occurs.
The corpus luteum takes the spotlight after ovulation. After the egg is released, the remaining follicle transforms into the corpus luteum. It now becomes a hormone factory, producing progesterone that plays a vital role in preparing your uterus for potential pregnancy. If fertilisation happens, the corpus luteum continues to provide support during the early stages of pregnancy. If fertilisation doesn't occur, the corpus luteum gracefully bows out.
The key to adequate progesterone production is ovulation. It's the key to unlocking the magic. Without ovulation, there's no ruptured follicle and, subsequently, no corpus luteum. But of course, the exception to this rule is pregnancy. In the early stages of pregnancy, the corpus luteum takes charge and produces progesterone. As the pregnancy progresses, the placenta and your adrenal glands take over to produce progesterone. But the placenta becomes the primary source of progesterone production because the adrenal glands only produce very small amounts.
Just like oestrogen, progesterone follows the rhythm of your menstrual cycle. In the first half, known as the follicular phase, progesterone levels remain relatively low since ovulation is yet to occur. After ovulation takes place, progesterone starts to rise, gradually climbing to its peak approximately one week later. As your period approaches, the corpus luteum gradually degenerates. It produces less and less progesterone until you have your period. Pregnancy is, once again, the exception because menstruation does not occur and progesterone levels remain high.
Progesteron – The Well-Being Hormone
In the first half of the menstrual cycle, oestrogen, among other things, stimulates the growth of the uterine lining. In the second half, or luteal phase, progesterone ensures that:
- The lining of your uterus continues to thicken
- The uterus is supplied with enough blood and oxygen in anticipation of the implantation of a fertilised egg.
Progesterone has multiple roles beyond reproduction and is involved in maintaining overall hormonal balance and homeostasis in the body. It’s an important hormone that is involved in many other important bodily functions, including:
- Regulating body temperature
- Supporting thyroid function
- Acting as a natural diuretic (increasing urine production)
- Promoting relaxation
As you can see, progesterone affects many different processes in our body. For that reason, low progesterone can have far-reaching consequences. This is particularly significant because it disrupts the balance between oestrogen and progesterone. It leads to (comparable) oestrogen dominance, as the proportional values shift in relation to each other.
The Most Common Causes of Low Progesterone
There are several causes of low progesterone. Let's take a closer look at the four most important ones.
#1 Low Progesterone During Menopause
Women and people who identify as women are born with a finite number of eggs - around one to two million. This number naturally and gradually decreases over time. On average, by the age of 35, a woman may have around 100,000 to 150,000 eggs remaining. This can occasionally result in missed ovulation, leading to low progesterone as our body doesn't produce progesterone when we have not ovulated.
As we transition into menopause, specifically during the early perimenopause phase that typically begins in our forties, missed ovulation becomes more common. As a result, progesterone levels further decrease. That is why during perimenopause it's not a lack of oestrogen that is the main concern, but rather low levels of progesterone and elevated levels of oestrogen. This imbalance is completely normal but can cause unpleasant symptoms.
#2 Low Progesterone and Stress
From your body’s perspective, stress and reproduction don't go hand-in-hand. And it makes sense if you think about it. Back in prehistoric times when a sabre-toothed tiger was prowling near the entrance to a cave where humans lived, it certainly wasn’t the right time to be thinking about sexy underwear. Even nowadays, with sabre-toothed tigers a thing of the past, our body focuses on everything but sex and reproduction when we are under stress.
During perimenopause, our progesterone levels are already low. Add stress to the mix and our body produces even less of this feel-good hormone. In this way, stress intensifies the symptoms of low progesterone during perimenopause. It also becomes a problem during menopause and postmenopause.
Why? Well, we have stopped ovulating and only our adrenal glands continue to produce small amounts of progesterone. The catch is that our adrenal glands also produce our stress hormones. In stressful times and situations, they find themselves in a conflict of interest and prioritise producing vital stress hormones like cortisol. So, progesterone takes a back seat.
#3 Low Progesterone Caused by Thyroid Dysfunction
Our thyroid and sex hormones interact closely with one another. When one of these systems becomes imbalanced, it has an effect on the other as well. The body needs the hormones our thyroids produce to convert cholesterol into progesterone. So, an underactive thyroid (hypothyroidism) often leads to long-term low progesterone. However, this interaction is not a one-way street. Low progesterone can also worsen the symptoms of an existing thyroid condition.
#4 Low Progesterone Caused by an Excess of Prolactin
Produced by the pituitary gland located at the base of the brain, prolactin is most commonly associated with being the hormone responsible for milk production after childbirth. But prolactin also helps to regulate the immune system and the body’s stress response, so whether you are pregnant or not, everyone produces prolactin. As long as it remains within normal levels, there is usually no cause for concern. But excessive amounts of prolactin can inhibit the release of progesterone, leading to low progesterone levels.
A number of factors contribute to elevated prolactin levels including pituitary tumours and certain types of medication like hormonal contraceptives, antidepressants and blood pressure medication. In addition, physical and psychological stress can also increase prolactin levels.
Common Symptoms of Low Progesterone
Now that we know the possible causes of low progesterone, let’s take a closer look at some of the most common symptoms.
Typical symptoms of low progesterone include:
- Shortened menstrual cycle
- Irregular bleeding
- Mood swings and irritability
- Difficulty concentrating
- Anxiety
- Sleep disturbances
- Water retention
- Sensitive breasts
- Increased premenstrual syndrome (PMS)
- Weight gain
- Tendency to develop fibroids or cyst
The symptoms of low progesterone are many and varied.
How do I know if I have low progesterone?
A healthcare provider can check your progesterone levels by measuring the amount of progesterone in your blood or saliva. The test is usually done during the second half of the menstrual cycle, around seven days after ovulation, when progesterone levels peak. If your cycle is 28 days long, the test would be done on approximately the 21st day of your cycle.
The test helps assess the progesterone status and may also include evaluating other hormones such as estradiol or 17-beta-estradiol to determine the ratio between the two hormones. This comprehensive approach provides a better understanding of hormone balance.
If you are in perimenopause, hormone testing can be more challenging as hormone levels often fluctuate significantly during this phase. It may be helpful to test your levels multiple times to obtain reliable results.
What are some treatment options for low progesterone?
Barring laboratory tests, there are many things you can do if you suspect you might have low progesterone.
#1 Nutrition
To produce progesterone, your body relies on micronutrients and macronutrients. These essential nutrients are also involved in various hormone regulation processes. This is why it’s crucial that your diet includes plenty of vegetables, predominantly plant-based protein and good quality omega-3 fats.
Your gut and liver are a dream team when it comes to regulating your hormones. This is why supporting your gut and liver function is crucial when dealing with low progesterone levels. Oftentimes, low progesterone coincides with an excess of oestrogen, leading to oestrogen dominance and worsening symptoms. The liver plays a vital role in metabolising excess oestrogen, while the gut ensures its smooth elimination. Talk about teamwork!
Your gut bacteria’s favourite food source is fibre. So it’s really important to nourish your gut flora with rich sources of fibre. Fibre can also bind to oestrogens and their byproducts, aiding in their removal from the body. You can support your gut by eating probiotic foods like tofu, tempeh, water kefir, kimchi or sauerkraut. Additionally, bitter substances can stimulate liver function and can be found in foods such as chicory, dandelion and radicchio.
#2 Stress Management
Stress can contribute to low progesterone which is why stress management is so important. This will look different for everyone, but some easy ways to keep stress at bay include exercising regularly, finding the relaxation technique that works best for you and getting enough quality sleep. Try yoga, deep breathing exercises, meditation or going for long walks in nature. All of these measures will reduce the impact cortisol and stress have on your hormone levels, allowing your body to produce the progesterone that you need to stay in homeostasis.
#3 Herbal Remedies
There are a number of herbal remedies you can try if you have low progesterone. Vitex agnus-castus or chasteberry, is an herb that has been traditionally used to regulate hormone levels, including reducing prolactin release. It can indirectly influence progesterone levels by supporting a balance between prolactin and other hormones.
Lady's mantle, scientifically known as Alchemilla vulgaris, is another herb that is often recommended for progesterone deficiency. While it may not directly increase progesterone levels, it is believed to have a supportive effect on hormonal balance.
The term "yam root" is often used in reference to wild yam or Dioscorea villosa. Wild yam contains a compound called diosgenin, which has a similar structure to progesterone. However, the human body cannot convert diosgenin into progesterone. While wild yam can support progesterone deficiency, it should not be considered a substitute for bioidentical progesterone hormone therapy.
#4 Hormone Therapy
When it comes to hormone deficiency, whether it’s a lack of oestrogen or progesterone, hormone replacement therapy is often recommended as a treatment option. In conventional hormone therapy, it's less common to use progesterone alone. Instead, it is typically combined with oestrogen. Unfortunately, synthetic progestins are often used rather than natural progesterone.
Progesterone as a standalone treatment is more commonly associated with hormone therapy using bioidentical hormones. In this approach, progesterone is administered during the second half of the menstrual cycle. Talk to your healthcare provider to see whether bioidentical hormone therapy is a suitable option for you. In our article "Bioidentical Hormones in Menopause," we have provided a comprehensive overview of important information and the pros and cons of bioidentical hormone therapy.
References and Sources
| Hormone und Hormonsystem – Lehrbuch der Endokrinologie | Kleine B, Rossmanith W, Springer Spektum, 2019 |
| V. agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials | van Die MD, Burger HG, Teede HJ et al., Planta Med, 79(7), 2013 |
