I've had a couple of doozy interactions this past week, all centering around progesterone.  

1. A 43 year old woman who was experiencing irregular cycles and trying to conceive.  Her naturopathic doctor measured her progesterone and found it was low- so she put her on progesterone, 100 mg in the first half and 200 mg of the second half of her cycle.  Her cycles had stopped all together and she worried she was in menopause.

2. A newly pregnant woman with a history of early losses was worried about her progesterone levels and her OB refused to check it.

3. A 32 year old woman had her hormones tested with her OB/Gyn and was told everything looked good, except that her progesterone was low- and when I checked her labs, it had been measured on cycle day 3 with the rest of her hormones.

So, it's clearly time to cover some more details about progesterone!

Number 1: What it is

 Progesterone is our "pro pregnancy" hormone- it is produced by the corpus luteum (cells in the ovary left behind after ovulation, almost like the "egg shell") and has the purpose to retain that thick, juicy endometrial lining in your uterus that you built in the first half of your cycle to be receptive to an embryo.

Number 2: How to measure it

Progesterone should always be measured 7 days after ovulation.  This is cycle day 21 for a 28-day menstrual cycle, but can be adjusted to 8 days after a positive ovulation predictor kit or 6 days after a temperature shift if you're charting your cycles and/or you have irregular cycles.

Measuring progesterone on other days of the cycle is not very helpful.  It shouldn't be around early on in the cycle (because it's only there after you ovulate) and if you don't catch cycle day 21, you might not catch the peak and it's hard to compare to published values.

Number 3: Normal v Optimal Levels & what Progesterone tells you

Normal: >6

Optimal (for fertility): >15

Progesterone greater than 6 tells you that ovulation has occurred during that cycle.  If progesterone is above 6 but less than 15, I would consider that to be physiologically low, and would want to support it.  

If it's >15- awesome! 

Number 4: What does low progesterone tell you?

Low progesterone is a sign that the corpus luteum is not as healthy as it can be.  This can be due to a number of factors-

• Your ovarian cells need some love- high oxidative stress and low mitochondrial function can impair the cells of the ovaries and cause low progesterone
• Your estrogen levels aren't optimal- This can lead to a smaller-than-desired LH surge (the hormone that triggers ovulation).  See, LH is responsible to "prime" the ovarian cells and transform them into the corpus luteum- if that hormone is low, the cells don't transform sufficiently enough to make optimal progesterone
• Your LH surge is low- this can be a matter of timing, or also a result of poor communication along the HPO axis (Hypothalamus- pituitary- ovary).  The biggest things I see here are sleep & stress disruption.

Please notice I did not say that you are low in progesterone because you have a deficiency of progesterone cream! 

This is one of the BIGGEST mistakes I see even good integrative practitioners make- progesterone is low & we jump to prescribe it.

So, this brings us to the all important

Number 5: How to boost progesterone 

If progesterone is low, and you're cycling regularly and measured on the correct day, here are a few of my fave ways to boost progesterone naturally.

• Flood your body with the rainbow of fruits & vegetables.  The wide array of antioxidants you eat can improve the health of your ovarian cells and boost progesterone.
• Focus on gut health- there are a lot of estrogen mimicking compounds out there, and sometimes, progesterone levels can be normal by lab but FEEL low due to the imbalance of estrogen & progesterone.  Fiber, probiotics, and making sure you have a bowel movement daily can ensure that your body is processing estrogens well to keep it in balance.
• Vitamin C:  Studies have shown that even relatively low amounts of vitamin C, like 750 mg daily, can increase progesterone up to 77%!
• Zinc- 25-30 mg daily can increase progesterone and improve progesterone's effects in the uterus
• Magnesium- 200 mg daily
• Vitex (I like tincture)- 2 dropperfulls in the am to improve communication between the brain and the ovaries.  This can be taken daily throughout your cycle.

Progesterone support (anything that directly impacts progesterone) such as progesterone creams or herbs with progesterone like action (like Wild Yam) should only be given in the luteal phase, between ovulation and the start of your period.

So, what was wrong with the cases I mentioned above?

1. A 43 year old woman who was experiencing irregular cycles and trying to conceive.  Her naturopathic doctor measured her progesterone and found it was low- so she put her on progesterone, 100 mg in the first half and 200 mg of the second half of her cycle.  Her cycles had stopped all together and she worried she was in menopause.

Administering progesterone during the first half of the cycle can prevent ovulation (this is how oral contraceptives work!). This doc could be causing anovulation in a patient trying to conceive.

2. A newly pregnant woman with a history of early losses was worried about her progesterone levels and her OB refused to check it.

 Low progesterone is a relatively common (and completely preventable) cause of miscarriages.  There's no way to tell without testing what the levels are.  This is a totally reasonable request, and if it's low, HERE's a good place for prescribed progesterone!

3. A 32 year old woman had her hormones tested with her OB/Gyn and was told everything looked good, except that her progesterone was low- and when I checked her labs, it had been measured on cycle day 3 with the rest of her hormones.

Remember, progesterone should be near zero in the first half of the menstrual cycle- only after ovulation will it rise.  It should be measured at its peak about 7 days after ovulation.

Progesterone is such an important hormone- let's make sure we handle it with care!