Why low progesterone can be a real pain—literally

Low progesterone

When it comes to hormones, estrogen steals the spotlight. But there’s another hormone that deserves just as much press—and it’s high time it landed on our radar.

Let’s talk progesterone

Progesterone is mostly made in the ovaries but it’s also produced in the adrenal gland. It may not get as much attention as other hormones, but it should. If you’re pregnant or nursing, adequate levels are critical. But the rest of us need enough progesterone, too.

Progesterone fluctuates naturally throughout the menstrual cycle’s four phases: menstruation, follicular, ovulation, and luteal. It’s highest right after ovulation because it’s preparing the uterus lining for fertilization. If conception doesn’t happen, levels drop, the lining sheds, and you get your period.

Progesterone has a lot of positives, making it important to every woman regardless of family planning. It has an overall calming effect, helps us get a good night’s sleep, opposes estrogen’s effects, and even mitigates bloating and water retention.

When progesterone levels go wrong

It’s no secret that hormones decrease in menopause. Both estrogen and progesterone drop, but not always at the same rate. However, progesterone can also decline much earlier, in peri-menopause (the time around menopause) or even in a woman’s thirties.

When not associated with menopause, low progesterone has a number of causes. If the ovaries aren’t working well, they might be unable to produce the levels of hormone needed for ovulation or menstruation. Because the adrenal gland also makes progesterone, adrenal insufficiency or high cortisol output can lead to a deficiency over time.

Another culprit of low progesterone is an underactive thyroid, or hypothyroidism. Not having sufficient thyroid hormones, triiodothyronine (T3) and thyroxine (T4), slows down and affects every process in the body, including our monthly cycles.

Symptoms of low progesterone

Remember how we said progesterone is an important counter to estrogen? Depending on your ratio of progesterone to estrogen, your symptoms could range from mild to severe. You might feel:

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

Checking your progesterone levels

Want to have your progesterone checked? Blood work is the most common way, but some physicians use saliva testing. Make sure you:

  • Ask for all sex hormones to be tested. Request levels for other sex hormones at the same time, so you can calculate your progesterone to estrogen ratio.
  • Sync your labs and cycle. If you still menstruate, track your cycle. Try to time your labs for days 19, 20, or 21, when progesterone’s at its peak. If you can’t get in those days, let your physician know when you had your last period.

Investigating for root cause

Knowing what’s causing your low progesterone can be helpful. Even if there’s no quick fix, having an answer is valuable. We think it’s worth discussing these tests with your physician.

Thyroid panel

Since progesterone and thyroid function are linked, it’s reasonable to request thyroid testing. Be sure to ask your physician how he or she evaluates thyroid function. Many providers only look at TSH (thyroid stimulating hormone). However, other markers may provide more insight.

  • Free T3 is the active, bioavailable thyroid hormone that’s ready for your cells to use.
  • Free T4 is your inactive thyroid hormone. Your body converts it to T3 as needed.
  • Reverse T3 (rT3) is T3 that has been reversed into an unusable form. Adding it to your panel is simple, but be aware that there’s some controversy over how much rT3 levels matter. Some providers believe that rT3 sits on thyroid receptors and blocks your active hormones, while others do not.


In the right amount, this adrenal hormone is a star. It helps us deal with stress, influences our energy and circadian rhythm, and positively affects our health and wellbeing. But too much or too little can cause issues. When chronic stress sends cortisol production into overdrive, our body steals progesterone to meet the demand.


True zinc deficiencies aren’t that common. But it’s possible and easy to check. 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 there’s not enough zinc, then you won’t have enough FSH. And, in turn, progesterone.

Why addressing low progesterone is critical to your 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.

Five ways to 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:

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

Remember how high cortisol correlates to low progesterone? Try to lower cortisol by practicing stress-reducing methods like deep breathing, yoga, taking up a hobby, or reading.

5. Think body composition

Reducing body fat percentage may boost progesterone. Along with eating a healthful diet, pick up heavy dumbbells or use your body weight to exercise and build muscle. Having more lean muscle mass equals burning more calories at rest. And that’s a major player in fat loss.

Other options to discuss with your 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. The choice that’s right for you depends on your goals, lifestyle, and other considerations. But, if you struggle with insomnia, bring it up to your doc. Taking prometrium at night may help you catch some much-needed rest.

Be wary of taking birth control for low progesterone

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.


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