Why low progesterone can be a real pain—literally

Low progesterone

When it comes to hormones, estrogen steals the spotlight—but low progesterone levels deserve just as much attention and are common as we age or with conditions that affect the adrenal glands and/or ovulation.

What is the hormone progesterone, how does your body produce it, and what does it do?

Progesterone is one of your sex hormones, just like estrogen and testosterone. Even though there’s not much talk about progesterone, it’s incredibly important to your body’s function and well-being and how you feel. Progesterone is important for menstruation, pregnancy, breastfeeding, memory, and sleep. It helps reduce feelings of anxiety and counters the growth-like effects of estrogen. However, it also affects water retention, how your body stores fat, and helps you maintain good cholesterol.

To make progesterone, you use pregnenolone, which is a derivative of cholesterol. In small amounts, progesterone is produced by the ovaries themselves, as well as by the adrenal glands. Progesterone levels are low during the first part of your menstrual cycle (the follicular phase). Then, they begin to increase as your body produces luteinizing hormone (LH). Once you’ve ovulated (when your ovaries release an egg), the corpus luteum begins to produce a significant amount of progesterone during the luteal phase of your menstrual cycle. As a result, progesterone peaks about one week after you ovulate. If conception doesn’t happen, levels drop, the lining of your uterus sheds, and you get your period.

What types of things cause low levels of progesterone?

The major culprit behind low progesterone is irregular or anovulatory menstrual cycles (when your body doesn’t release an egg). Anovulatory cycles can happen for natural reasons. (Like transition into perimenopause and menopause.) In fact, many women’s progesterone levels naturally decline around age 35 as cycles become irregular. But there are also other conditions that can cause anovulatory cycles. As a result of them, you might end up without enough progesterone.


One condition that can be behind irregular cycles is polycystic ovarian syndrome, or PCOS. PCOS is common. It affects nearly 1 in 10 women of reproductive age. Many women with PCOS deal with irregular cycles and anovulation. Because of this, they don’t produce enough progesterone.


Having an under-active thyroid can also lead to an-ovulatory cycles. (And therefore, low progesterone.) The most common cause of hypothyroidism is autoimmune and called Hashimoto’s thyroiditis. Your two main thyroid hormones are triiodothyronine (T3) and thyroxine (T4). If you have trouble producing them, or you don’t convert T4 into T3, every cell in your body slows down. You may have a wide range of symptoms, from fatigue to weight gain, low body temperature, irregular menstrual cycles, and more.

Disordered eating, eating disorders, gut-related issues, and/or over-exercise

Whether or not you get a cycle requires a delicate balance and coordination of a number of hormones. Women’s bodies are highly susceptible to fluctuations in energy consumption or output. We need enough calories to function reproductively. Also, we need carbohydrates, protein, and healthy fats to produce hormones like progesterone. We also need to be able to absorb a variety of micronutrients, whether from diet or supplements.

High stress hormones, like cortisol

When your stressed, your body produces adrenaline and cortisol. High levels of these hormones make your body divert energy toward muscles and mechanisms needed for survival. Reproduction gets put on the back burner. Plus, if you stay stressed for a long time (like a lot of us do!), your body eventually turns to progesterone to keep up your cortisol levels. You might notice your cycles becoming irregular or stopping.

What symptoms will I notice if I don’t have enough progesterone?

Not enough progesterone can lead to:

  • Headaches or migraines
  • Hot flashes
  • Disinterest in sex
  • Weight gain or fluid retention
  • Irregular periods (absent, or, if your progesterone to estrogen ratio is off, too frequent and heavy)
  • Spotting
  • Mood changes or an increase in anxious thoughts
  • Depression
  • Irritability or trouble relaxing
  • Sleep issues
  • Full or tender breasts

How can I get my progesterone levels tested?

Unless you’re having an issue with your cycles, your progesterone may not get tested. If you’re curious, dealing with one of the conditions we mentioned, or are in your mid-thirties and approaching perimenopause, talk with your provider about testing. Testing might get done via blood work, saliva, or even urine.

Make sure to double-check that your provider is testing for levels of other sex hormones at the same time. You’ll want to be able to calculate your progesterone to estrogen ratio. If you still menstruate and have regular periods, track your cycle. Try to time your labs for days 19, 20, or 21, when progesterone’s at its peak. If your cycles are longer than 35 days, your test should be a week after you ovulate. If you skip cycles, ask your provider when you should test.

Looking at sex hormone binding globulin and fasting insulin levels can also be helpful. Also, request a full thyroid panel. This includes TSH, free T3, free T4, reverse T3, TPO and TGAb antibodies, and cortisol. If under-eating, diet, or you have a gut issue that affects absorption, talk about checking some micronutrients. One important to menstruation is zinc. Zinc signals the pituitary gland to release follicle stimulating hormone, or FSH. FSH then sends a message to your ovaries to make more progesterone. So, if you don’t get enough zinc from your diet, then you won’t have enough FSH or progesterone.

Is low progesterone bad for my health?

Progesterone isn’t just about comfort and a regular cycle. When levels drop and estrogen is normal or elevated, the result is something no one wants: estrogen dominance. Without progesterone to counter it, estrogen is associated with increased growth. Think: more fat storage and breast tissue, along with a greater risk of cancer and other disorders.

Are there ways to help encourage ovulation and raise progesterone naturally?

A good first line of defense for progesterone imbalance is to make lifestyle modifications. Here a few that can help bring balance back to your body and encourage ovulation.

1. Up your zinc

Evaluate your diet to see if you need to improve your intake. Our bodies don’t store this mineral, so make sure you’re eating enough food sources daily—meat, legumes, shellfish, and dairy. Another option? Zinc is available as a supplement; talk to your doctor to see if it’s right for you.

2. Get more B vitamins and vitamin C

Eat more leafy green vegetables, whole grains, meat, eggs, and fruits, like citrus and avocado.

3. Try organic options

When it comes to food, what you see isn’t always what you get. Pesticides used to grow food supply can end up disrupting our body’s natural hormone balance.

4. Breathe deep

Try to lower cortisol by practicing stress-reducing methods like deep breathing, yoga, taking up a hobby, or reading.

5. Don’t limit your calories or restrict foods, and get enough healthy fats

Healthy fats are really important to hormone levels. Pay close attention to your intake of polyunsaturated fats. These are found in both plants and animal products. You can get more by eating plenty of salmon, nuts, seeds, and healthy vegetable oils.

Are there replacement options I can discuss with my doctor?

If you’re interested in progesterone replacement, you have options. Progesterone comes in many forms, from compounded creams to troches dissolved under the tongue to oral micronized progesterone pills, or prometrium.

Progesterone replacement should have an identical chemical structure to what your body naturally produces. It should be bioidentical. The choice that’s right for you depends on your goals, lifestyle, and other considerations.

What if my provider suggests birth control to help with my symptoms?

Contraceptives are sometimes sold as a way to regulate an irregular cycle. Know this: many of these options contain progestin. Progestin isn’t bio-identical to the progesterone your body produces. And just as importantly, its pros and cons aren’t identical, either. Before you make a decision, go over the benefits of each with your provider.