Symptoms and Support of Low Progesterone
by Brook Ahnemann, ND
Progesterone is a primary sex hormone made in the ovaries in the second half of a woman’s menstrual cycle, following ovulation. It is essential for fertility, and some even call it the hormone of pregnancy. But it is also important for regular, healthy menses and much more.
Many displeasing menstrual symptoms may be attributed to low progesterone. Low levels of progesterone could be caused by poor production during a female’s younger years, or is the result of a natural decline since ovarian output winds down during perimenopause and menopause. Below are some of the most common symptoms, as well as a few natural treatments that might boost production.
When dealing with low progesterone, one of the most common symptoms is a shortened menstrual cycle. The average menstrual cycle is 28-30 days. Cycles shorter than 26 days may indicate low progesterone. This is often called a luteal phase defect (LPD), as progesterone is expected to be highest during the luteal phase (or second half of the cycle.) Progesterone helps maintain the uterine lining, so when it is low during the luteal phase, menses, or the shedding of this lining, may happen sooner.
LPD may lead to the next common symptom—spotting. Like a short cycle, low progesterone means that the body cannot maintain the endometrial lining once it is built up, so spotting can occur. Sometimes this occurs with a short cycle, but it can also happen with a regular cycle.
Miscarriage Early in the First Trimester
Related to spotting is one major consequence of low progesterone, miscarriage early in the first trimester. Progesterone from the ovary (specifically the corpus luteum) is essential for sustaining a pregnancy and the uterine lining until the placenta takes over production.
Low progesterone may contribute to estrogen dominance or an imbalance between estrogen and progesterone. This may happen even if estrogen is not high. When this is the case, typical symptoms can be heavy bleeding, painful menses, breast tenderness and mood swings.
Mood, Sleep, and Cognition Disturbances
Progesterone also affects GABA receptors which have many positive benefits for mood. GABA is a relaxing neurotransmitter and helps maintain sleep quality. Low progesterone has been associated with increased PMS, anxiety, and depression.
This is also a reason why low levels of progesterone are often associated with insomnia, particularly waking frequently. Lastly, progesterone is a neurosteroid which appears to have some major neuroprotective benefits. When it declines, there may be a decline in memory or increased brain fog.
Treating Low Progesterone
When discussing treatment, age can make a big difference. For younger, cycling females, much can be done to boost their own ovarian production of progesterone. Later in perimenopause and especially post menopause, ovarian output is diminished—narrowing treatment options to progesterone replacement hormone therapy.
For this discussion, let’s consider methods to support a cycling female’s own production of progesterone.
Vitex Agnus-Castus or "Chaste Tree Berry"
The first herb we often hear about is Vitex agnus-castus, commonly called chaste tree berry. There has been a significant amount of research showing that Vitex can improve progesterone levels. It has several mechanisms, including improving signaling from the brain to the ovaries as well as lowering prolactin which can inhibit ovulation and progesterone production.
More Nutritional Support
Other support for low progesterone includes nutrient support like vitamin C or essential fatty acids like evening primrose oil or borage oil. Vitamin C is highly concentrated in the ovary and is needed for good follicle development and progesterone levels. Fats are important for hormone health as they are the building blocks for sex hormones. Consuming healthy fats is essential to maintain normal hormone production. Some essential fatty acids like evening primrose or borage oil have higher levels of gamma linolenic acid which can be particularly helpful for increasing progesterone levels.
Diet and Lifestyle Factors Affecting Progesterone
It is essential to consider lifestyle factors that may be impacting progesterone levels. Fats are not the only nutrients that support progesterone levels. Lean protein is necessary as well. Foods high in nutrients like B6 and zinc can also be helpful. Some common ones include shellfish, salmon, beef liver, chickpeas and legumes, and nuts and seeds.
Another lifestyle consideration is stress management. Stress can raise both prolactin and cortisol, which can impact ovulation and progesterone. It is important to consider both “bad” stressors like a difficult job or poor sleep, as well as overdoing “good” stressors like exercise or fasting. The body does not distinguish between the source of the stress and all stressors have an impact. Consider a balance that leaves you feeling healthy, nourished and replenished.
Low Progesterone and the DUTCH Test
The symptoms of low progesterone should not be overlooked. If you are experiencing symptoms, bring them up to your provider. Tools like the DUTCH Test can help you and your provider evaluate your progesterone levels.
To learn more about the impact sex hormones can have on your health check out our blog.