Low Progesterone Holistic Options

Let’s focus today on ways to optimize progesterone in adult women during the cycling/premenopausal years, perimenopausal and postmenopausal years.

The graphs shown above provide some context in regards to progesterone levels at various times in the female lifespan:

• Top image: a real menstrual cycle showing optimal progesterone surge in a cycling women
• Middle image: Hormonal birth control usage suppressing healthy progesterone surge that normally would occur in the luteal phase
• Bottom image: menopause showing low estrogen and low progesterone that will eventually decline with age

Discussing the nuances of hormone function is a big can of worms. I have multiple blogs all about sex hormones (like estrogen and progesterone) and their ebb and flow – which some reasons are intended and some are unintended consequences. There are different reasons for fluctuations in the premenopausal, perimenopausal and post menopausal phases of a women’s life.

Symptoms of Progesterone Deficiency

More women today than ever are dealing with progesterone deficiency (self or your own labs here and have drawn at any Quest labs!) which is multifactorial. This can show up as: 

• Hot flashes and night sweats
• Insomnia and mid night waking
• Fertility or menstrual problems
• PMS or PMDD
• Anxiety and restlessness 
• Migraine headaches before cycles
• Irritability and nervousness
• Low mood and depression, especially around ovulation and pre-period
• Mood swings
• Weight gain and cellulite, especially around the thighs and buttocks
• Fluid retention – your fingers and toes swell up (as the estrogen is often dominating relative to the progesterone and these two should be ying and yang and be buds)
• Brain fog
• Weakening bones or osteoporosis
• Excessive menstruation
• Decreased libido
• Decreased HDL cholesterol

Why is Adequate Progesterone in a Woman’s Body is Imporant?

Progesterone can help mitigate the list above; it is often mentioned as the hormone necessary in fertility and pregnancy but it actually does many things in the body in pre/peri/postmenopausal women.

Here are some of the reported health benefits of having leveled progesterone (which the reference range is different depending upon the age):

• Reduction of hot flashes and night sweats for those who are peri or menopausal
• Reducing risk of osteopenia or osteoporosis
• If cycling, reduction in PMS symptoms, bloating, water retention, and mood swings
• Restoration of a healthy menstrual cycle (less bleeding, shorter days, less menstrual pain)
• Restoration of ovulation and a healthy luteal phase in cycling women
• Improve quality of sleep
• Reduction of uterine fibroids and endometriosis
• Improved libido
• Breast cancer risk reduction!
• Improved fertility
• Deeper and more restful sleep
• Anxiety relief

Progesterone and Estrogen Dominance

Low progesterone symptoms result not just from the progesterone being low but also because of the impact of the progesterone to estrogen ratio. You usually want to see this 1:10 in premenopausal women in their luteal phase. Sometimes the ratio of estrogen being too high relative to the mid luteal progesterone can contribute to any women have those symptoms listed above; the reference ranges are different in menopause but estrogen dominance can still occur.

When progesterone levels drop below a certain level, estrogen becomes the dominant hormone, and this change in the relative balance between the levels of these two hormones is what ultimately leads to many of the symptoms that women experience; This can be true for postmenopausal and premenopausal women.

Why Can Adult Women Get So Depleted in Progesterone?

1. Number one reason in premenopausal women: use of hormonal birth control. Hormonal birth control stops ovulation so by default you will not have a mid luteal progesterone surge every month because no egg was released. Taking “the pill” is a medication induced state of estrogen dominance and linked to breast cancer among so many other health problems like increasing risk of hypothyroidism, depression, suicide, DVT, PEs – very serious things! Many women are sadly not given true informed consent and just told it “will regulate hormones.” Many experts argue it’s not “regulating” – it’s just stopping ovulation and naturally this will stop mid luteal progesterone surges (which are good for women’s bodies regardless of intent to have a child or not). The pill will make things consistent but arguably not consistently healthy.
2. Gastrointestinal dysbiosis; Yes the gut microbiome when suboptimal can influence negatively sex hormones. Too many studies to list, but when the beta glucuronidase in high on a GIMAP – relative estrogen dominance/lower progesterone is usually prevalent.
3. Heavy metal bioaccumulation; many studies showing these toxicants can negatively influence sex hormones and even lead to infertility. Go do a basic Pubmed search on heavy metals and their harm to humans. Screening for, reacting to, and putting preventative strategies in place is crucial!
4. Nutrient deficiencies like zinc, b vitamins, or magnesium being inadequate can contribute to low progesterone. Zinc (as one nutrient example) has an impact on a number of different areas of your body which are essential in the production of progesterone, including the ovaries and your pituitary gland. Zinc supports ovulation and leads to the production of progesterone.
5. Aging. As you get older, your estrogen and progesterone levels  will both drop as this is par for course. However, because progesterone drops more significantly, the estrogen to progesterone ratio becomes higher than it was when you were younger, which is associated with estrogen dominance/low progesterone symptoms. This is where BHRT can be so helpful as aging is something that is inevitable.
6. Chronic Stress and trauma can cause progesterone levels to drop. When in a state of “fight or flight” humans can release higher levels of the hormone cortisol. Both cortisol and progesterone are produced from pregnenolone. When you are in chronic stress, the body will divert the available pregnenolone to produce higher amounts of cortisol to help you get through stress. This means there might not be enough to produce proper levels of progesterone. Mold stresses the body tremendously can lead to low progesterone.
7. Using toxic Skincare and House Cleaning Products as known as “endocrine disruptors” which do what they say they do: they disrupt endocrine or normal hormone function.
8. Living in toxic indoor mold. Mold contributes to the body not feeling safe and both the testosterone and progesterone will often be too low when a women is living in mold.

So I would strongly recommend you overturn all those stones FIRST if you are questioning if your hormones “are off” especially if you are PREmenopausal.

(& note this is not an exhaustive life). If menopausal and perimenopausal, progesterone will be inevitably lower and going right to bioidentical progesterone is sometimes best if you are a candidate.

If you are doing “all the things” and overturning stones, and progesterone is either “low” or low end of normal” – there is a time and a place for adding on exogenous progesterone (meaning it’s coming from an external source – not your body making it internally which is normal physiology).

The Benefits of Bioidentical Topical Progesterone

Oral and topical are the main options. Many argue topical is “better” as putting topical progesterone on your body allows it to bypass the liver. Why is this a benefit?

1. You don’t burden you liver with yet another compound to be absorbed and metabolized.
2. If your liver is not functioning optimally, you are running the risk of your body breaking down progesterone into progesterone metabolites. When you take oral progesterone, it converts in the liver into allopregnaneolone – a derivative of progesterone. It is recognized on a lab test as progesterone, but is not able to attach to progesterone receptor sites as well and this is controversial.
3. Transdermal progesterone may be safer than oral progesterone.
4. You need less transdermal progesterone than oral progesterone for a similar effect- so financially it may be a win. Dosing is not apples to apples. Topical progesterone is also available OTC are generally less expensive!

Oral versus transdermal is a highly debated topic so discuss with your Doctor your unique situation. But for these reasons above, many choose cream progesterone.

Elephant in the room: Bioidentical and Synthetic Progesterone (aka Progestin)

Historically there has been fear around hormone replace therapy in general due to a flawed study in the 1990s. Since then, society and the medical establishment still can’t seem to shake this despite so much evidence showing the pros are now drastically outweighing the cons when in come to longevity and quality of life that BHRT (bioidentical hormone replacement therapy) not progestin can provide. 

The misinformation and hesitation can be debunked once a woman and her Doctor are educated and on the same page that there is a big difference between bioidentical progesterone and progestin that is found in the birth control pill or “old school” hormone replacement therapy. Also note that Birth control with progestin doesn’t actually regulate hormones (it stops ovulation so it stops progesterone) and Bioidentical progesterone won’t protect against pregnancy – it encourages optimal physiology.

What are the types of “progesterone” available:

• “Real” Progesterone is naturally produced by the body during the reproductive/cycling year and occurs primarily after the woman’s ovary releases an egg – see top graph on image. This is when a surge of progesterone occurs in the luteal phase. In postmenopausal women minimal “real” progesterone surges as ovulation is no longer occuring and the adrenals only make a little at this point in life.
• Progestins are marketed as the yin to estradiol’s yang (questionable) and are synthetically altered in laboratories; taking progestins is better than taking estradiol by itself in most cases, but progestins don’t “fit” into the progesterone receptor the way natural progesterone does. You don’t get all the same benefits as real progesterone or bioidentical progesterone.
• Bioidentical progesterone that you consume also called “natural”, is derived from plants but the molecular structure resembles true progesterone produced by your own body.

What Progesterone or bioidentical progesterone CAN help with: 

• Helps balance estrogen
• Improves sleep
• Anti-anxiety effect
• Lowers high blood pressure
• Helps the body use and eliminate fats
• Lowers cholesterol
• Increases scalp hair (why hair in pregnancy becomes so thick – lots of progesterone)
• Increases metabolic rate – natural weight management
• Stimulates the production of new bone
• Improves libido
• Is neuroprotective, promoting myelination (a huge reason to take it in menopause)

Progesterone reduces Breast Cancer Risk Studies Show!

Moreover, studies like this one have shown that progesterone does NOT induce estrogen-stimulated breast cell proliferation. Experts are actually saying progesterone (not progestin) are actually helpful for cancer risk reduction. Natural progesterone has been shown to decrease the risk of developing breast cancer. 

How to Choose Your Bioidentical Progesterone

Many women start with a natural topical progesterone cream; It is important you choose one free of parabens, mineral oil, and petroleum and other known carcinogens and endocrine disruptors.

Where & When to Apply Topical Progesterone:

Rotation is key! Apply the topical progesterone alternating between fatty (abdomen, breasts, thighs) and non-fatty (forearm, hands, inner arms) areas.

• Women in peri-menopause or menopausal who suffer from sleep disruption, hot flashes, or night sweats, can generally use topical progesterone for up to 25 days out of a 30-day calendar, with 5-7 days off, or as recommended by your healthcare provider.
• Menstruating women are often advised to start topical progesterone around 7 to 14 days after the first day of the menstrual period and continue until the next period begins and rinse and repeat each month. (Note that “Day 1” is the first day of your menstrual bleed). If your period is irregular, start using topical progesterone 7 days after you begin a period and teach your body to learn a new cycle. Stop whenever your period comes back again, and repeat, or apply as recommended by your healthcare provider.

How Much Progesterone Should You Use?

It will depend on how low and symptomatic of low progesterone. Most start slow and then dose up. You can always test 6-12 weeks later and periodically monitor even though ACOG says to just go off symptoms.

Another way to dose is to use body weight.

• Women under 150 lbs: start with 20–30mg of bioidentical progesterone.
• Women over 150 lbs: start with 40-50mg of bioidentical progesterone.

Who Should NOT Use topical Progesterone?

Women with progesterone receptor-positive breast cancer should not use topical progesterone.

How Long Do You Have to Take Hormone Replacement Therapy?

BHRT is generally considered an ongoing therapy for perimenopausal and menopausal women. You experience hormone imbalance symptoms because your body has stopped producing hormones or produces them at insufficient amounts. There are currently no good options that can encourage the body to permanently produce more sex hormones, so BHRT replenishes the missing levels to provide symptom relief. If you stop BHRT, you will return to the lowered hormone levels you experienced before, which will lead to a return of the life-disrupting symptoms that caused you to seek treatment in the first place.

If you are premenopausal, it is often used temporarily as part of fertility treatment or until the real root cause or the low progesterone is found and properly dealt with.

Bioidentical Progesterone cream linked here at minimum 10% off and free shipping.

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