Here is what you need to know about progesterone + 9 Reasons for LOW Progesterone

Okay everyone wants to know about progesterone….

Why?

Because right now we seem to have an alarming rate of suboptimal progesterone levels among women. (& I am going to explain why ) 

While conventional medicine is completely ignoring progesterone, other restorative reproductive practices are still only taking a band-aide approach.

Supplementing with progesterone is NOT getting to the root cause of WHY your progesterone is low.

Wondering if you need to be concerned about low progesterone? Here is a list of symptoms to look out for:

• Difficulty concentrating / foggy thinking
• Breast tenderness prior to menstruation
• Anxiety/irritability (esp. prior to menstruation)
• Feeling tearful or depressed (esp. prior to menstruation)
• Spotting/brown bleeding prior to menstruation
• Insomnia (esp. prior to menstruation)
• Low libido
• Absent or short cycles
• Luteal phase <10 days long
• Miscarriage
• Infertility

Before we dive into the WHY your progesterone is low, let’s first talk about HOW progesterone is MADE & why its important. 

Progesterone is primarily produced in women by the ovaries, specifically by the corpus luteum, and to a lesser extent by the adrenal glands and, during pregnancy, by the placenta. Here’s a detailed look at the process of progesterone production:

1. Ovulation

• Follicular Phase: At the beginning of the menstrual cycle, several follicles develop in the ovaries under the influence of follicle-stimulating hormone (FSH). The maturing follicle primarily produces estrogen, not progesterone.
• Ovulation: Once the follicle has matured, estrogen rises rapidly which signal to the brain to produce a surge of luteinizing hormone (LH), which triggers the release of a mature egg from the follicle, which is called ovulation and form the corpus luteum
• Corpus Luteum Formation: After ovulation, the ruptured follicle transforms into a structure called the corpus luteum. The corpus luteum is responsible for producing high levels of progesterone during the luteal phase (the second half of the cycle).

Any suboptimal levels of estrogen or LH can lead to a suboptimal/weak corprus lutem- one example of this a known as Luteinized Unruptured Follicle.

2. Role of the Corpus Luteum

• After ovulation, the corpus luteum forms and starts producing progesterone in response to LH.
• Progesterone prepares the uterine lining (endometrium) for potential implantation of a fertilized egg. It thickens and maintains the endometrial lining and increases blood flow to support embryo implantation and early pregnancy.
  • any issues with the uterine lining, can lead to implantation issues which increases risk of infertility or miscarriage
• If pregnancy occurs, the corpus luteum continues producing progesterone until the placenta takes over progesterone production (around the 10th week of pregnancy).
• If pregnancy does not occur, the corpus luteum degenerates, progesterone levels drop, and this triggers menstruation.

Why is this important? 

BECAUSE THE RISE OF YOUR PROGESTERONE LEVELS IS DEPENDENT ON HOW HEALTHY YOUR OVULATION IS AS THIS IS WHAT IS RESPONSIBLE FOR THE  FORMATION OF THE CORPUS LUTEM.

IF YOU HAVE A WEAK OVULATION & SUBSEQUENTLY CORPUS LUTEUM, YOU WILL HAVE LOW PROGESTERONE. 

ROBUST PROGESTERONE IS A RESULT OF A HEALTHY OVULATION AS WELL AS UTERINE ENVIRONMENT.

Another potential factor in progesterone production: Egg/Follicle Quality

While more research is needed to fully back this theory- another factor is creating healthy progesterone, is having a healthy follicle (synonymous term with “egg quality”). 

Having a healthy follicle will support healthy ovulation. If the follicle/egg quality is poor, the follicle may not mature adequately, leading to a weak or underdeveloped corpus luteum that produces insufficient progesterone.

Additionally, poor follicle/egg quality is often due to ovarian factors like inflammation, blood sugar imbalance, nutrient deficiencies, and hormonal imbalances. These same factors can impair follicle development, ovulation quality, and therefore progesterone production.

Actions of progesterone besides reproduction:

• Supports healthy menstrual cycle: Helps maintain regular cycles by balancing estrogen levels.
• Promotes breast tissue health: Aids in the development and maintenance of breast tissue, preparing it for potential lactation.
• Enhances mood stability: Acts on the brain to support mood balance, reduce anxiety, and promote feelings of well-being.
• Supports sleep: Has a calming effect on the brain, contributing to improved sleep quality.
• Reduces inflammation: Exhibits anti-inflammatory effects throughout the body.
• Supports bone health: Aids in bone density maintenance by reducing bone loss.
• Regulates immune response: Modulates immune function, reducing excessive immune responses.
• Supports cardiovascular health: Influences blood vessel tone and reduces the risk of atherosclerosis.
• Affects skin health: Helps maintain skin elasticity and hydration, which can affect overall skin appearance.
• Balances blood sugar: Assists in stabilizing blood glucose levels by influencing insulin release and sensitivity.
• Counteracts testosterone/androgen production. So if progesterone is low, you’re more likely to have elevated androgens. This is why progesterone has a positive effect in those with PCOS.

Here are going to be your TOP factors contributing to low progesterone:

1. Low Sex Hormones (estrogen, testosterone, DHEAS)

Estrogen and testosterone are essential for stimulating follicle development in the ovary.  When estrogen or testosterone are low, follicle growth can be impaired, leading to poor ovulation or even anovulation, resulting in a lack of progesterone production in the luteal phase.

DHEA-S serves as a precursor for both estrogen and testosterone, meaning it contributes to the overall pool of sex hormones that support ovarian health. Low DHEA-S can lead to lower levels of estrogen and testosterone, impacting follicular development and, therefore, progesterone production. Insufficient DHEA-S may also reduce the body’s resilience to stress, which can further disrupt hormonal balance and lower progesterone.

In short, low levels of estrogen, testosterone, and DHEA-S compromise the quality and strength of the ovulatory process, which then weakens the corpus luteum’s capacity to produce progesterone. 

However, again, we would need to figure out WHY your sex hormones are low. Many of those root causes are discussed below.

Possibly signs & symptoms of low sex hormones:

• Headaches
• Night sweats / hot flashes
• Fatigue
• Depression / irritability / low mood
• Acne / dry skin / dull skin
• Vaginal dryness / painful sex
• Low libido
• Osteoporosis (bone loss)
• Poor muscle recovery
• Muscle loss
• Cycle biomarker
  • Absent or irregular cycles
  • Lack of fertile cervical mucus (<2 days of stretchy, clear, or lubricative mucus)
• Lab markers:
  • Estradiol <50 ng/dL on cycle day 3, 4, or 5
  • Testosterone: <20 ng/dL
  • DHEA-S: <150 ug/dL

2. PCOS (polycystic ovary syndrome)

PCOS often causes irregular or absent ovulation (anovulation) due to elevated androgens. The ovaries might form many small follicles that do not mature enough to release an egg, so ovulation does not occur. Thus, leading to low progesterone.

Women with PCOS tend to also have lower egg/follicle quality due to the underlying mechanisms that are driving PCOS like insulin resistance and inflammation. For a more in depth post about PCOS you can click here! 

Classic signs & symptoms associated with PCOS include:

• acne/oily skin
• long/irregular/ missing periods
• excess hair growth on chin, chest, or back (known as hirsutism)
• hair thinning or loss on head
• infertility
• Clinical and/or biochemical signs of hyperandrogenism (excess male hormone levels)
  • testosterone > 45
  • DHEAS > 250

3. Chronic Stress and the Hypothalamic-Pituitary-Adrenal (HPA) Axis:

Elevated cortisol levels can interfere with the hypothalamic-pituitary-ovarian (HPO) axis, which regulates reproductive hormones, including progesterone.

When cortisol is elevated, it can suppress the release of luteinizing hormone (LH) and gonadotropin-releasing hormone (GnRH), both of which are crucial for ovulation. Without proper ovulation, the corpus luteum (the structure that produces progesterone after ovulation) does not form or functions inadequately, leading to low progesterone.

Additionally, progesterone and cortisol share a common precursor hormone: pregnenolone. Inflammatory states often drive the body to produce more cortisol, which can “steal” pregnenolone away from progesterone synthesis. This phenomenon is sometimes called the pregnenolone steal.

The increased demand for cortisol in response to inflammation leads to lower availability of resources for progesterone production, particularly during the luteal phase (the second half of the menstrual cycle).

Stressors on the body/ things that will increase cortisol production:

• Over-exercising / Under-eating
• Mental/ emotional stress
• Long periods of fasting
• Inflammation
• Infections
• Insulin resistance / blood sugar imbalances

4. Inflammation-Induced Ovarian Dysfunction:

Chronic inflammation can impact ovarian function directly. Cytokines (pro-inflammatory signaling molecules like TNF-α, IL-6, and IL-1β) can interfere with normal ovarian function, particularly ovulation and decrease egg/follicle quality- leading to low progesterone.

Inflammation may also be a factor in progesterone resistance- often found in those with endometriosis, which I discuss below.

Things that can increase inflammation/activate the immune system:

• Infections
• Gut dysbiosis and intestinal permeability (“leaky gut”)
• Highly process foods/excess alcohol or caffeine intake
• Over exercising, under-fueling
• High toxic burden, poor ability to detox via the liver/gut
• Low antioxidant status / high free radicals
• Insulin resistance / high blood sugar and insulin
• Chronic stress
• Autoimmune diseases like Celiacs, Hashimotos, Lupus, etc

Tests I use to identify inflammation:

• hs-CRP > 1 mg/L
• ESR > 8 mm/hr
• homocysteine > 10 (this is debated, and I have seen other reference >15)
• uric acid 3.2-4.4 mg/dL
• billirubin <0.5
• Gamma-glutamyl Transferase (GGT) 10‐22 U/L
• GI Map stool test to identify infections or gut dysbiosis

5. Insulin Resistance

Insulin resistance plays several roles in disrupting healthy progesterone levels. 

Insulin resistance leads to higher levels of androgens (male hormones) and can disrupt the delicate balance between estrogen and progesterone. Estrogen dominance (where estrogen levels are disproportionately high compared to progesterone) may result, which further suppresses progesterone.

Symptoms you may be struggling with insulin resistance:

• Headaches
• Weight gain/weight loss resistance
• Irregular or missing periods
• Skin tags
• Patches of dark velvety skin called acanthosis nigricans
• Hair loss
• Chronic acne
• Sugar craving
• Afternoon 24pm crashed
• Chronic fatigue

Labs that suggest insulin resistance/glucose dysregulation:

• Fasting insulin > 6 mIU/L
• Fasting glucose > 88 mg/dL
• Hemoglobin A1C > 5.5%
• Triglycerides > 90 mg/dL

6.  Nutrient Deficiencies

Nutrient deficiencies can contribute to anovulation (lack of ovulation) by disrupting hormone regulation, energy metabolism, ovarian function, and egg/follicle quality. Some of the key nutrients associated with anovulation include:

• Vitamin D
• B Vitamins (especially B6, B9/Folate, and B12)
• Iron
• Zinc & Copper
• Magnesium
• Iodine
• Omega 3 Fatty Acids
• Antioxidants: Vitamins A, C, & E
• Sodium & Potassium

Nutrients I assess via blood labs:

• ferritin > 30 ng/mL
• copper 95-105 ug/dL
• sodium, potassium
• magnesium
• Storage & active Vitamin D
  • Storage D (25(OH)) ~30 ng/mL
  • Active D (1,25(OH)2D3) ~40 pg/mL

7. Thyroid Dysfunction:

Low thyroid function can reduce progesterone production because thyroid hormones are essential for maintaining the luteal phase of the menstrual cycle. Thyroid issues also exacerbate HPA axis dysfunction, further impairing progesterone production.

Optimal Thyroid labs:

• TSH: 1.5-2.0
• Ft4: 1.0-1.5
• Total T3: 100-180
• Free T3: 3.0-4.0

Signs of low thyroid:

• Cold intolerance (hands+feet)
• Constipation
• Hair falling out (thin eyebrows)
• Dry skin/brittle nails
• Hard time losing wright
• Anemic
• Brain fog/mental fatigue/depression, sluggish
• Poor wound healing

8. Low energy intake & low weight / Body Mass Index (BMI)

When the body is in a state of low energy intake (due to under-eating or high levels of exercise with insufficient food), it prioritizes energy use for essential functions, like breathing and brain activity, and reduces energy for non-essential functions, like reproduction. This energy deficit suppresses the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus, lowers estrogen, and increases cortisol production which, in turn, affects the pituitary gland’s release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), both crucial for stimulating ovulation. 

Without enough LH and FSH, the ovaries may not release an egg, leading to anovulation (absence of ovulation) or a “weak” / suboptimal formation of the corpus luteum

Signs you may be under-eating:

• losing hair
• acne
• cold all the time
• irritable and moody
• you get sick easily
• you have irregular or missed periods
• trouble falling asleep / frequent night wakings
• lack of fertile cervical mucus
• infertility
• lacking energy and motivation
• not having 1-2 bowel movements/day
• constantly thinking about food

Signs you’re under-weight:

• BMI <19

9. Progesterone Resistance 

Progesterone resistance occurs when the body’s tissues, particularly in the ovaries/uterus, become less responsive to progesterone. This resistance can disrupt processes like the thickening of the uterine lining, ovulation, and embryo implantation. 

Common in conditions like endometriosis and polycystic ovary syndrome (PCOS), progesterone resistance is thought to result from alterations in progesterone receptors or downstream signaling pathways. 

As a result, even with normal or high levels of progesterone, the body may not respond adequately, leading to irregular menstrual cycles, infertility, and other reproductive challenges.

More research is needed to understand the driving factors of progesterone resistance. Currently studies suggest that it is the inflammatory environment of the uterus (driven by inflammation, insulin resistance or environmental toxins, all of which are characteristic of PCOS and endometriosis) driving progesterone resistance. 

So if haven’t already figured it out after reading this newsletter- the best way to support healthy, robust progesterone is to figure out what YOUR ROOT CAUSE is!

This is exactly why certain supplements/diets/lifestyle changes may be helpful for one women and her progesterone levels, but not the other. 

In our practice we have seen women time & time again naturally improve their own progesterone production through diet & lifestyle but only AFTER we get targeted testing & evaluate their diet & lifestyle to identify what their driving factors are. 

Here are my TOP TIPS to start supporting your progesterone:

• Replace refined carbohydrates (white flour & sugar like cereals, bread, soda, etc) with whole food carbohydrates like legumes, Ezekiel or sourdough bread, sweet potatoes, and fruit
• Significantly reduce ultra- processed foods
• Majorly reduce alcohol to less than 2 drinks per week (especially in the luteal phase)
• Reduce caffeine to <200mg daily 
• Increase monounsaturated fats – like avocados & extra virgin olive oil
• Wide variety of anti-oxidant rich foods like fruit & non-starchy veggies (>6 servings daily) to support micronutrients
• Increase fiber- nuts & seeds , fruit, non-starchy & starchy veggies, whole grains, legumes
• Incorporate fish weekly to get in omega-3 fatty acids
• Ensure you’re getting 100g of protein a day to support blood sugar balance & hormone activity

Support healthy blood sugar:

• Eat enough overall calories based on your height, weight, & activity level
• Have 25% or more of your calories come from protein and 40% or less from carbohydrates
• Start your day with a breakfast with 25+g of protein or more
• Do not go more than 5 hour between meals
• 25+g of fiber per day

Improve Lifestyle

• Prioritize sleep!
• Consistent exercise routine
• Manage stress/ start implementing strategies to reduce stress
  • meditation/prayer
  • improving work/life balance
  • leaning into friendships/ high quality relationships

Want to work together? I gotchu!

If you’re looking for more 1:1 coaching to get to the root cause + in depth support + functional lab testing, you can apply for my 4 Month 1:1 Coaching program here.​

Want more details about what working with me and my team looks like? You can find out more here!