I recently wrote a blog about how to ensure your thyroid was being properly tested. Well, the same principle applies to other hormones.
I would like to turn your attention to one of my favorite hormones: PROGESTERONE. A woman who has ovulatory menstrual cycles only makes progesterone after she has ovulated and a corpus luteam has formed from the follicle from which an egg was released. This period of a menstrual cycle is called the luteal phase and it typically lasts 10-14 days before your period starts again. Take a look at this graph and pay attention to the purple line indicating progesterone production.
If I am trying to help a patient get pregnant, I need to know what her PEAK progesterone levels are and therefore when I give her a lab slip, she will be told to do her blood test 7 days after ovulation. If she has very regular periods, this means she will do labs 7 days before she expects her next period to start. If she has irregular periods, I will ask her to use an Ovulation Predictor tests and to do her blood draw 7-8 days after a positive OPK test.
If a woman does not ovulate, her ovaries will not produce progesterone. If a woman is post-menopausal and does not get periods anymore, her ovaries will not be producing progesterone.
What are common symptoms of low progesterone?
In a pre-menopausal woman:
- Heavy, long, painful periods
- Irregular cycles
- PMS with irritability, depression, anxiety or poor sleep
- Infertility
In a post-menopausal woman:
- Insomnia
- Irritability
- Depression/anxiety
How do I get tested?
- If you are post-menopausal and not taking hormone replacement therapy, you do not need to get tested. We already know that your progesterone levels are non-existent!
- If you are pre-menopausal and not taking birth control pills, you can ask your doctor to order a saliva or blood test but make sure to do it during the peak progesterone time of your luteal phase (5-7 days after ovulation)!
- If you are trying to get pregnant, you will also need another set of blood tests on the third day of your period (I’ll explain that in a future blog article).
What are my treatment options if my progesterone is low?
- If you are a post-menopausal woman, I usually recommend oral micronized progesterone. There are other options via compounding that allows for progesterone drops, troches, capsules and creams. Your doctor can explain each of these options.
- If you are a pre-menopausal woman not wanting to get pregnant, I recommend anything from dietary interventions to herbal medicines to natural progesterone creams.
- However, if you are a pre-menopausal woman and you WANT to get pregnant, I strongly recommend you TREAT THE CAUSE! You do not need progesterone supplementation. What you really need is to treat the cause: optimize the hormones during the follicular phase of your menstrual cycle (the first 2 weeks) so that your egg matures nicely and ovulates from a follicle that can turn into a healthy, progesterone-produce machine. You need a healthy, robust corpus luteum. Progesterone supplementation will not treat the underlying disorder but sure, progesterone supplementation can be used as secondary support for the the body during early pregnancy and to reduce your chance of a miscarriage.
Take home messages:
- Post-menopausal women do not need progesterone testing to determine they are low in progesterone. Testing can be used to clarify your baseline levels and to monitor if you’re on progesterone supplementation.
- Pre-menopausal women should do their testing 5-7 days after they ovulate to identify their peak progesterone levels during their luteal phase. Treatment goals should optimize this level.
- Women who are wanting to get pregnant should treat the underlying cause of why their progesterone levels are low and focus on optimizing ovulation to ensure for a healthy pregnancy.
