EP.288/ Low progesterone signs and how to test
(Trigger warning: This episode discusses infertility)
Okay so this week we’re moving onto hormones and how to test for them.
Today, we’re beginning with one that I see a lot of my clients having problems with and that’s low progesterone. I did a progesterone 101 a year or two ago which covered everything from what progesterone is, to what it does in the body and signs of it being too low or too high, but let’s do a recap of some classic low progesterone symptoms.
Signs of low progesterone include:
Low moods, depression, and anxiety after ovulation and in the lead up to your period – During your follicular phase and ovulatory phase, your oestrogen levels are giving serotonin a nice boost. Serotonin is a feel-good neurotransmitter which can make you feel more content and happier. When your oestrogen levels begin to decline, your serotonin levels drop too.
But nature is smart, and progesterone should in theory come along and bump up your GABA levels. GABA is another neurotransmitter, and it promotes relaxation and has a calming, soothing effect on the brain. Progesterone boosts GABA activity in the brain by increasing the sensitivity of GABA receptors (they’re like the locks and GABA is the key) and promoting the release of GABA. When we’re lacking GABA, we can end up feeling anxious, depressed, overwhelmed, and tearful. We may also find that we’re more irritable and short-tempered too.
Sleep disturbances in the second half of your cycle – Just as we discussed previously, progesterone supports healthy GABA activity and GABA, due to its soothing and calming effects on the brain, plays a role in sleep. If our GABA levels are low, we can have trouble getting to sleep and especially stay asleep, which is where GABA really shines, as it helps to inhibit neural activity. A really good clue that your progesterone is not quite right, it is sleeping okay or well in your follicular and ovulatory phases and then struggling once you hit your luteal phase.
PMS (bloating, sore breasts, etc.) - Okay so, you might be thinking, aren’t PMS symptoms like water retention, premenstrual cramping, and sore breasts a sign of oestrogen dominance or excess? Yes, they are.
But here’s what happens when your progesterone levels drop too low – by default, you become oestrogen dominant. It doesn’t have to mean you have an excess of oestrogen or a problem metabolising oestrogen, your oestrogen levels may be perfectly fine, but the problem could be that your progesterone levels are just too low.
We won’t dive into the science behind every PMS symptom, but let’s look at a classic one to understand the relationship between oestrogen and progesterone. Oestrogen is a proliferative hormone, meaning it stimulates growth and development. The proliferative effects of oestrogen on breast tissue can contribute to breast tenderness.
Oestrogen stimulates the growth and proliferation of breast ducts and glands, leading to increased breast volume and sensitivity. Additionally, oestrogen can cause fluid retention and swelling in breast tissue, further exacerbating breast tenderness.
Progesterone helps counterbalance the effects of oestrogen by promoting fluid secretion in the breasts and reducing the growth-promoting effects of oestrogen on breast tissue (and other things!). When progesterone levels are insufficient, oestrogen is essentially allowed to go to town without progesterone reigning it in, potentially leading to increased breast tenderness.
Before we move on, it’s important to remember that signs of PMS don’t always mean your progesterone is low, PMS, especially breast tenderness, could indicate you’re having trouble metabolising (clearing out) oestrogen, so it’s important to look at that as well.
Fertility struggles including difficulty getting pregnant and miscarriages – unfortunately, a number of my clients who come to me after having multiple miscarriages and fertility challenges, have low progesterone levels. If a client comes to me with that history, progesterone is one of the first things I’m checking and honestly, I am shocked and appalled that this isn’t checked by doctors sooner.
Progesterone plays many roles in maintaining a pregnancy. If an egg is fertilised, progesterone will begin stimulating a steady blood supply to the lining to nourish the egg, via the formation of new blood vessels and additionally will trigger the release of nutrients from glands hidden in the endometrial lining (which is just another fancy word for uterine lining). It will also prevent uterine cramping so the egg can stay nice and secure and plays an absolutely essential role in maintaining the endometrial lining and pregnancy throughout. Progesterone is also immune suppressing, and this is so the immune system doesn’t reject a potential implanted egg by seeing it as a foreign invader.
Spotting in your luteal phase – Progesterone plays a key role in looking after your uterine lining. It maintains the lining and as shared already, gets it ready for implantation. When progesterone levels fall just before our period, this event, coupled with an increase in inflammatory chemicals like prostaglandins, which stimulate contractions, triggers the shedding of the uterine lining.
If progesterone levels are too low during the luteal phase, your uterine lining will not be properly maintained, and you may experience light shedding, that manifests as spotting.
So, if after listening to this, you suspect your progesterone is struggling, here’s how to test.
The most basic, easy access progesterone test is a blood test from your doctor or a finger prick test you can order directly online. They are both the same test, but the test by your doctor will require a blood draw but often ones you can order online allow you just to prick your finger and order at home.
If you want to order one directly from a company online, I’ve linked to two I use with clients in the show notes. These are not affiliate links, I don’t get any commission for recommending them, but I trust their testing and accuracy.
This blood test can’t be performed randomly. Typically, you should get your levels tested between days 19 and 22 of your cycle, if your cycle is an average 28 days. If you know exactly when you ovulated, then get the testing performed five to seven days after that, but if you don’t know, just stick to days 19 to 22. If you have an irregular cycle or a longer or shorter cycle, speak to the test provider and they will be able to recommend which day to test – however, you may need a different type of test.
In terms of results, a functional medicine optimal range is15-22 ng/mL (nanograms per millilitre).
If your levels are higher than 7ng/mL but lower than 15, you’ve definitely ovulated, but you’re not making a great amount of progesterone and it would be worth working on boosting your levels.
If you haven’t ovulated, your progesterone levels are going to be under 1.5 ng/mL.
Remember, progesterone comes from the follicle which the egg erupts from during ovulation. After ovulation has occurred, that follicle turns into a temporary gland, which pumps out progesterone. If you haven’t ovulated, you can’t make sufficient progesterone.
Now, here’s the kicker. This test isn’t always accurate. Progesterone levels fluctuate throughout the day, so a single test is only providing a small snapshot of what is happening. However, if your levels are low on your test result and you’re experiencing symptoms, you can pretty much safely assume, your progesterone needs a helping hand.
If you’re not satisfied with the outcome of your test, you can look into salvia testing or DUTCH testing.
Some salvia tests will allow you to track the entire luteal phase, so you can actually see what your progesterone is doing on a daily basis. Depending on the type of test (for example, is it testing progesterone on one day or for several days), salvia testing can be relatively affordable, for example, around £40.
Finally, there is DUTCH testing, which is really the gold standard of hormone testing in female health. DUTCH testing uses dried urine samples to check your progesterone levels, but it also looks for metabolites of hormones, including oestrogen.
So, what it would tell you is how these hormones are being used and removed by your body. Your progesterone to oestrogen ratio might be fine, but if your body is metabolising your oestrogen poorly, then you could end up with a heap of oestrogen dominant symptoms and problems, which could, to a degree, look like low progesterone symptoms.
The DUTCH Complete will allow you to take five urine samples across the day, giving you a much more accurate picture of your hormones.
The DUTCH test offers a cycle mapping version, which allows you to track your hormones every day of your cycle, so you would again, get to see what your progesterone is up to throughout the entire luteal phase, not just one day.
Additionally, DUTCH tests your DHEA, which is a hormone that essentially, produces progesterone and when levels are lowered, we can end up with lowered progesterone levels, so this can give you an extra clue as to what’s going on.
Finally, DUTCH testing can also test your stress response/HPA axis (and by the way, if you’re wondering what the hell your HPA axis is, then I’ve linked to an episode in the shownotes). If you have high or low cortisol levels, this suggests you’re struggling with the effects of chronic stress, which can dampen your progesterone output and is one of the biggest factors to consider in low progesterone cases. DHEA tends to lower in cases of chronic stress too, which is one of the reasons why progesterone takes a hit.
Both the salvia test and DUTCH test will provide you with a clear breakdown of your results.
Now, just like the blood tests, I have no affiliate links here, so whatever you order, is not going to bring me any commission! I’ve linked to the DUTCH website so you can have a little look, but if you want to order that, you do need to work with a practitioner. If you want to order a saliva test, I typically use the lab I work with, but that’s through a practitioner only, so I’ve linked to a few I’ve found online but I haven’t personally used them myself or with clients.
Okay, so that’s it! You now know signs of low progesterone and how to test. Everything you learn in this podcast – from blood sugar, to gut health to stress management, will help you boost your progesterone levels, but I’ll do an episode on that soon.
Show Notes
Progesterone menstrual cycle/imbalances
https://www.ncbi.nlm.nih.gov/books/NBK279054/#female_the-normal-menstrual-cycle-and-the-control-of-ovulation._1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653859/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436586/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5689497/
https://pubmed.ncbi.nlm.nih.gov/20595939/
https://pubmed.ncbi.nlm.nih.gov/11994369/
https://onlinelibrary.wiley.com/doi/abs/10.1111/jne.12179
HPA axis dysfunction
https://www.theendobellycoach.com/podcast/tired-all-the-time-hpa-axis-dysfunction-and-endo?rq=HPA%20axis
Blood serum test
Saliva testing
DUTCH
https://dutchtest.com
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