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Progesterone Deficiency: How Too Little Progesterone Can Mean Big Problems

posted on January 30, 2020 by Allison Jung, PA Allison Jung, PA

Typically, in the United States, Premenstrual Syndrome (PMS) is considered to be a normal side effect of being a woman. If problematic enough, the common treatment is the birth control pill or anti-depressants. But, what if I told you that PMS is not a diagnosis, but actually a symptom of an underlying disorder that could be much more serious? What if that symptom, if left untreated, could lead to recurrent miscarriages, Post-Partum Depression (PPD), and possibly even breast or endometrial cancer? 

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As a physician’s assistant specializing in OB-GYN medicine, I can tell you that PMS is actually a sign of low progesterone, and low progesterone can have multiple effects on your body and fertility. The good news is that progesterone deficiency can be corrected (sometimes completely naturally)! It’s important to understand the ovarian cycle in order to understand how low progesterone can affect our bodies. 

Where progesterone comes from

Women are born with all the eggs we will ever have in our bodies. However, in each cycle, only one (or sometimes two) of those eggs is chosen and enveloped in a follicle which produces estrogen. As the follicle grows, it produces more and more estrogen, until this hormone comes to a peak. Then, Luteinizing Hormone (LH) signals the ovary that it’s time to ovulate, and the egg leaves the ovary. The follicle then immediately becomes a corpus luteum, which now produces progesterone. As the corpus luteum grows, so does the progesterone level. If a pregnancy occurs, the presence of human chorionic gonadotropin (hCG), a hormone produced by the placenta after implantation, tells the ovary to keep producing that progesterone. If hCG is not detected, the corpus luteum shrinks, is reabsorbed into the body, and the process starts all over again.

How progesterone affects your body

Now that we’ve covered where progesterone comes from, what are its effects in the body? Progesterone is a natural relaxant and antidepressant, and it helps us use fat for energy. Progesterone facilitates thyroid function, regulates blood sugar levels, protects us from endometrial cancer, and may protect against breast cancer as well. In pregnancy, progesterone will maintain the uterine lining, provide endometrial nutrition for the fetus, and will prevent premature uterine contractions.

What happens when you have low progesterone?

Insufficient progesterone can lead to PMS, thyroid dysfunction, insulin resistance, irregular periods, infertility, miscarriage, pre-term labor, and post-partum depression. PMS consists of multiple negative symptoms that occur anytime after ovulation and can continue through a woman’s period (menses). An insufficient amount of progesterone results in a decrease in endorphins in the brain. Endorphins are chemicals that reduce pain and increase the presence of happiness. So, the absence of these endorphins is associated with emotional symptoms including irritability, crying easily, anger and depression.

Physical symptoms of low progesterone may include breast tenderness, bloating, weight gain, carbohydrate cravings (including chocolate), headache, fatigue, insomnia, or pelvic cramps. These symptoms can start as early as the day after ovulation and last through menses. If progesterone is very low, or combined with underlying depression, PMS could turn into Pre-Menstrual Dysphoric Disorder (PMDD). PMDD is a severe depression that, in rare cases, can lead to child abuse or even homicide. In most cases, anti-depressant medications are required. However, it would be incomplete treatment if progesterone was not investigated and replaced as well.

How do you know if you have low progesterone?

The signs of low progesterone can also be seen within a woman’s menstrual cycle. One such sign is “‘tail-end brown bleeding” (three or more days of brown spotting at the end of menses). Other signs include more than two days of spotting before the full flow of the menses, or a luteal (post-ovulatory) phase of less than 10 days. Charting your cycle with a Fertility Awareness-Based Method (FABM) helps one identify these signs and notice trends with the help of a certified instructor.

Progesterone deficiency and pregnancy problems

Low progesterone is also a risk factor for complications in pregnancy. After conception, the new life travels through the fallopian tube, and implants in the endometrial lining in about 6-9 days. If the luteal phase is fewer than 10 days, the embryo would not be able to implant, and would be lost in the menstrual flow. This early miscarriage, before many women know they’re pregnant, is often called a “chemical pregnancy.” A woman may experience miscarriage later in the first trimester if she has low progesterone and the endometrial secretions are weak, thus starving the fetus before the placenta can take over. If the progesterone is not replaced throughout the entire pregnancy, premature labor could ensue, resulting in a pre-term baby. After delivery, low progesterone can also cause postpartum depression.

Does birth control solve progesterone deficiency?

As a physician’s assistant in OB-GYN medicine, I was taught in my traditional medical training that the cure for cycle irregularity and PMS was the birth control pill. However, after many years of seeing my treatment plan fail, I discovered a more holistic approach to women’s health with NaProTechnology (Natural Procreative Technology). I realized that the birth control “cure” could actually be very harmful. 

When a woman has low progesterone, she becomes “estrogen dominant.” So, placing her on birth control, which gives a steady stream of artificial estrogen all month long, will actually raise her estrogen levels even more. Plus, the artificial progestin contained in birth control, a synthetic hormone mimicking progesterone, is not well tolerated by many women. So, this treatment can result not only in unwanted symptoms of weight gain, nausea, headaches, depression, and decreased sex drive, but it can also put a woman at increased risk of breast and endometrial cancer due to the pronounced estrogen dominance.

How do you treat low progesterone without birth control?

Treatment of low progesterone is not complicated, but it does have some crucial details regarding the type of treatment and the timing of when it should be administered. First, all progesterone supplementation should be bio-identical. If a woman’s doctor determines she needs progesterone supplementation, she may be prescribed the synthetic hormone progestin (which is not the same as progesterone). Fertility-awareness trained doctors will opt for a bio-identical form of progesterone, which is actually quite easy and inexpensive. It is readily available in pill form. In injection form, most pharmacies have it available prepared in oil, or a compounding pharmacy can make it in the prescribed concentration. Using a bio-identical formulation of progesterone will ensure the proper natural replacement of what was missing from the body. 

Second, the route of administration is important. For most women, progesterone can be taken orally, but some won’t absorb it completely, resulting in continued low levels. Others may find side effects of nausea, fatigue, or headaches. For those women, using vaginal progesterone at night is often the solution. For women whose risk for adverse effects like miscarriage and PPD is high, or if the progesterone level is extremely low, injection form may be necessary.

Timing of progesterone supplementation

Finally, when it comes to progesterone treatment, the dose needs to be individualized and timed with a woman’s cycle. Synthetic prescriptions of progesterone produce static levels of dosage throughout a month. But, since in a natural cycle progesterone is produced only after ovulation, it should only be supplemented after ovulation. To know what part of her cycle she’s in, a woman will need to be charting with a Fertility Awareness-Based Method. 

Usually, bio-identical progesterone is prescribed nightly 3-12 days after ovulation, but a NaProTechnology doctor will determine the individualized dose and timing based on the previously drawn labs and the route of administration. Also, a NaPro doctor will recheck the progesterone level during the next cycle to ensure the proper dose has been provided. If a woman is pregnant, her NaPro doctor will evaluate her natural progesterone production every two weeks throughout her entire pregnancy. Replacement will depend on her lab levels and how far along she is in the pregnancy; progesterone should only be replaced to physiological levels.

Other ways to resolve low progesterone problems

There are other options to naturally raise a woman’s own ovarian production of progesterone, including bio-identical hCG, and easily available vitamin supplements. But, the key to long-lasting health is to find the underlying cause of the ovarian dysfunction. An investigation needs to be made into the woman’s other hormones (LH, FSH, and androgens), nutrition, and thyroid, adrenal and gut health, and even genetics. Our body systems work together, so an irregularity in one part can greatly affect our fertility health.  

For a woman seeking true healing rather than synthetic hormonal coverups, it is important that she choose a physician trained in this school of thought, and who is familiar with the NaProTechnology protocols that have been proven to improve fertility health for many years.

So, if you suffer with PMS, have had a miscarriage in the past, or see the tell-tail signs of premenstrual spotting, tail-end brown bleeding, or short luteal phase, it is vitally important that you get your progesterone levels checked. Contact a FABM-trained doctor and use this information to empower yourself and optimize your health.

This article is educational and in no way should serve as a prescription or medical advice. Contact your doctor for personalized medical advice.

Posted by Allison Jung, PA Allison Jung, PA
Allison Jung is a Physician Assistant with more than 18 years of experience in OB/GYN and fertility. She is also a health educator, teaching the Creighton Models System and NaproTechnology for almost 4 years. Through her own story of PCOS and infertility, Allison found the validity in a holistic approach to healthcare—searching for the causes of symptoms, instead of the routine treatment of covering up symptoms with artificial hormones, painkillers, or anti-depressants. Allison loves working with women with symptoms of irregular cycles, painful periods or PMS who have been told that birth control is their only answer, and showing them not only the reasons behind their symptoms, but curing them often with natural means. Allison's approach to women’s healthcare is one of hope and freedom.

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