Over the course of your life, it’s likely you’ve blamed a lot of women’s health issues on your hormones. If you’re irritable the week before your menstrual cycle starts, you assume it’s premenstrual syndrome (PMS). If you’re having trouble getting pregnant, it could be a hormonal issue. Or if you’re dealing with night sweats and other symptoms of menopause, you may chalk it up to a changing levels of progesterone and estrogen.
However, you might not realize that you’re not producing enough progesterone unless you’re in tune with these low progesterone symptoms and indicators.
What is progesterone?
Progesterone is a sex hormone produced by the ovaries after ovulation occurs. More specifically, it’s the corpus luteum that produces this hormone as a natural part of the menstrual cycle. The corpus luteum is the cyst that forms every month inside the ovaries right after an egg leaves the ovary. It releases progesterone to help make the uterus ready for pregnancy by stimulating the endometrium (the lining of the uterus) to secrete proteins that make the uterus more hospitable for nourishing a fetus.
If you don’t become pregnant, the corpus luteum breaks down, your progesterone levels dip, and menstruation eventually starts. However, if you do become pregnant, the placenta will eventually also produce progesterone to support the corpus luteum—and the growing fetus. This prevents your body from producing more eggs, and it also helps get your breasts ready to produce milk. Progesterone also affects your mood and helps to regulate your blood pressure, according to the Cleveland Clinic.
How is progesterone tested?
If you have some infertility concerns–maybe you’re having trouble getting pregnant–your healthcare provider might suggest getting your hormone levels, including your progesterone levels and your estrogen levels, tested. The best time to sample serum progesterone is during the mid-luteal phase, 18 to 24 days after the onset of menses or seven days before the next menses are expected
Luckily, it won’t require anything too invasive. It just involves some bloodwork. You don’t even need to do anything in advance to prepare. You’ll just have to roll your sleeve up to give a blood sample, which will be taken to the lab and analyzed. This blood test is known as a serum progesterone test.
However, a single serum measurement may not provide all the information that’s necessary for a diagnosis, according to Heather Huddleston, MD, director of the PCOS clinic at UCSF and a medical advisor for Allara. Your progesterone levels may vary, depending on the time of day and the timing of your menstrual cycle. If you have an abnormal result, do not panic! You may need to have repeat testing 2 to 3 days later.
Your provider may want to discuss symptoms and the effect that they may be having on you.
It might make more sense to see if your symptoms last for several months. “One month could just be an outlier,” says Suzie Welsh Devine, MSN, RN, a women’s health nurse and founder of Binto.
What are normal progesterone levels?
A normal progesterone level will vary, depending on where you are in your menstrual cycle or your pregnancy. Typically, your levels will be low at the beginning of your menstrual cycle, and then they’ll rise when your ovaries release an egg.
Different levels may constitute normal for different women. If you don’t have symptoms, you may not need (or want) progesterone replacement even if your levels are low. “Some physicians will recommend replacement to avoid miscarriage, premature delivery of a pregnancy, or problems with the uterine lining which could eventually lead to uterine cancer,” says Greg Marchand, MD, OB-GYN and gynecological surgeon in Mesa, Arizona.
The following levels are considered a normal range for women during a typical cycle and during pregnancy.
Progesterone levels chart |
|
|---|---|
| Progesterone levels | Stage |
| 0.1 to 0.7 ng/mL | Follicular stage |
| 2 to 25 ng/mL | Luteal stage |
Progesterone levels chart for pregnancy |
|
|---|---|
| Progesterone levels | Stage |
| 10 to 44 ng/mL | First trimester |
| 19.5 to 82.5 ng/mL | Second trimester |
| 65 to 290 ng/mL | Third trimester |
Source: University of Rochester Medical Center
What do low progesterone levels mean?
It means that your progesterone levels are below the typical range (less than 2 ng/ml), which may cause you to have certain symptoms. It’s hard to say whether it’s common. “It is difficult to say for sure,” Dr. Huddleston says. “One issue is that it’s actually hard to accurately measure progesterone. Progesterone is pulsatile and can vary across different times in the day. Thus, it is difficult to make a diagnosis of low progesterone on the basis of a serum measurement.”
What causes low progesterone?
According to UCSF Health, conditions that could be responsible for low levels of progesterone include:
- Amenorrhea (absence of menstruation)
- Ectopic pregnancy (a pregnancy outside of the uterus)
- Irregular periods
- Miscarriage
- Fetal demise
In addition to these potential causes of low progesterone, aging also plays a role in an increased risk for low progesterone. “We do know that as women get older, particularly in the 40s, that low progesterone is more common,” Dr. Huddleston says.
Hormonal imbalances become more common around perimenopause as your body begins to prepare for menopause. Symptoms of menopause such as hot flashes, night sweats, insomnia, vaginal dryness, and mood swings indicate that a woman’s body is no longer producing its usual levels of estrogen and progesterone.
“It’s not unusual that that is going to happen,” Devine says. “However, if you are experiencing bad or frustrating side effects and symptoms, then that is something you should talk to your doctor about.”
You could discuss the possibility of starting hormone replacement therapy, which should help relieve some of the symptoms of menopause. You could opt for a therapy that incorporates both estrogen and a synthetic form of progesterone known as progestin, or you could go with an estrogen-only version.
Low progesterone in pregnancy
Progesterone levels can interfere with your ability to successfully get pregnant. As Dr. Huddleston notes, “When progesterone is low, it is possible that this could contribute to difficulty with conceiving and/or maintaining a pregnancy.”
Low levels might also be problematic for some women when it comes to carrying a pregnancy to term. As such, progesterone is often prescribed for recurrent pregnancy loss and preventing preterm birth, according to Dr. Marchand.
You’re unlikely to develop low progesterone during pregnancy. “In the early part of conception, progesterone is produced by the ovary. But by the later weeks of the first trimester, progesterone is produced by the placenta,” Dr. Huddleston says.
Symptoms of low progesterone
One of the most noticeable symptoms of low progesterone levels is a shorter menstrual cycle—or to be more specific, a shorter luteal phase of the menstrual cycle. The luteal phase is the phase that begins after ovulation. It typically lasts between 12 and 15 days, with 14 days as the average.
But a woman who’s not producing sufficient progesterone with ovulation may have a shorter-than-expected luteal phase, like around nine days. And her period may start sooner than she would expect. “On occasion, a woman with lower progesterone may notice that she has several days of spotting prior to her menses,” Dr. Huddleston adds.
Your progesterone levels can have an impact on your estrogen levels. So, the symptoms of low progesterone are pretty much the same symptoms of higher-than-normal estrogen levels, such as irregular menstrual cycles and intermittent spotting between periods, Devine explains.
Other possible signs of low progesterone levels include:
- Mood swings or mood changes
- Sore breasts
- Vaginal dryness
- Sleep troubles
- Migraines or headaches
- Low sex drive
- Weight gain
Low progesterone can have negative health effects, including difficulty getting pregnant or maintaining a pregnancy, increased risk of endometrial cancer, and irregular menses.
High progesterone levels
But it’s also possible to have high progesterone levels, which can cause their own set of symptoms, such as:
- Breast tenderness
- Anxiety
- Fatigue
- Weight gain
High progesterone is a lot less common in older women, who are more likely to have lower levels as they head into menopause. But high progesterone levels could suggest the possibility of an underlying health condition such as congenital adrenal hyperplasia. If you’re experiencing any of those symptoms, it might be worth mentioning them to your healthcare provider. High progesterone can have negative health effects including acne, hair thinning, depression, lactation, and liver dysfunction.
How to increase progesterone
You may not want to undergo any treatments for low progesterone levels if you’re not trying to get pregnant or carry a pregnancy to term–or you’re not experiencing symptoms of menopause that you want to address.
If you do want to address your symptoms or make sure your progesterone levels won’t undermine your ability to get pregnant and carry a baby, talk to your healthcare provider about low progesterone treatment possibilities.
You do have a few options for treatment for low progesterone, such as:
- Progesterone pills that you take by mouth
- Progesterone creams, gels, or suppositories inserted vaginally
- Progesterone injections
Injections are most likely to be used by people undergoing IVF, notes Devine. If you were hoping for a natural supplement to help boost your progesterone levels, you may be disappointed. “There’s really no supplement that you can take for low progesterone,” says Devine.
RELATED: List of progesterone products
Progesterone supplementation can cause side effects. Common progesterone side effects include:
- Headache
- Breast tenderness or pain
- Upset stomach, vomiting, diarrhea, or constipation
- Tiredness
- Muscle, joint, or bone pain
- Mood swings, irritability, excessive worrying
- Sneezing or runny nose
- Coughing
- Vaginal discharge
- Urination problems
The bottom line is that you don’t necessarily have to take any action if you have low progesterone if it’s not interfering with your goals or quality of life. If you are concerned, or have questions, call your healthcare provider.
