Introduction: Hormone Harmony with Progesterone as a Key Player

The power of our hormones to impact our mind and body is impressive. Due to their influence on almost all bodily processes, when these potent, yet delicate, molecules are swayed, wide-spread symptoms can emerge. In fact, if even one hormone is out of balance, the feedback between them all gets muffled. As a result, our physiology and psychology suffer.

In my previous post, I highlighted some natural tips to prevent stress, one of the most common factors that triggers hormonal chaos. In the follow up, I started to discuss one of the key players to hormonal harmony, progesterone.

Specifically, part one topics on progesterone included:

• Its main function
• Its biological structure and makeup
• Its main roles in the body (fertility and reproduction)
• All its systematic affects in biological females and males
• How it is regulated
• Healthy ranges for progesterone

Now, in part II, I review: *

• What happens if progesterone becomes dysregulated
• The symptoms of high and low levels of progesterone
• Testing for progesterone (and caveats)
• Treatment with progesterone (bioidentical and synthetic hormone replacement therapy)
• Naturopathic and functional medicine approaches to optimize progesterone

*Note: This post provides additional, fresh material not found in my original version published on Rupa Health. However, if you want more of the science, additional details, and specific brands of tests mentioned, you will want to check out the Rupa Health article.

The Highs and Lows of Progesterone

In part I, I highlighted the ranges for normal progesterone. These levels vary depending on biological sex, pregnancy, and the time of one’s menstrual cycle. For convenience, I’ll post them again below (as referenced in my article on Rupa health):

• Female (pre-ovulation): less than 1 ng/mL
• Female (mid-cycle): 5 to 20 ng/mL
• Male: less than 1 ng/mL
• Postmenopausal: less than 1 ng/mL
• Pregnancy 1st trimester: 11.2 to 90.0 ng/mL
• Pregnancy 2nd trimester: 25.6 to 89.4 ng/mL
• Pregnancy 3rd trimester: 48 to 150 to 300 or more ng/mL

There are some caveats to be aware of when assessing levels of hormones. These include timing of the tests, the method used (reviewed below), and interfering factors.

For accuracy, you will want to be consistent on (1) when you test your hormones (i.e., time of day, time of month) and (2) the method used (i.e., blood, saliva, urine). You and your doctor should also consider any hindering factors that could impact results (e.g., stress, fasting vs. non-fasting, blood sugar, exercise, etc.).

All things considered, if one is consistently falling outside of normal ranges, and having hormonal symptoms, there could be an underlying issue that needs addressing for optimal health and fertility. These are highlighted below.

High Progesterone Levels May Indicate:

• Pregnancy (most obvious)
• Ovarian cyst(s)
• A disorder in the adrenal glands (rare)
• Ovarian cancer (rare)
• Excessive levels of stress (eventually leading to lowered levels)

High Progesterone Symptoms

Symptoms of higher progesterone have been associated with lower sexual interest and emotional eating and cravings. If a woman is cycling, these symptoms will likely be more present during a specific time of the month.

Rarely, the pathologies mentioned, such as ovarian cysts and cancer, can also be causing high progesterone levels. These can be confirmed through imaging and additional testing. The symptoms for ovarian cysts include pressure or fullness in the abdomen, bloating, and pelvic pain. Ovarian cancer can have similar symptoms as cysts, as well as urinary frequency and appetite changes.

Lower Progesterone Levels May Indicate:

• Ectopic pregnancy (egg fertilization outside the uterus)
• Miscarriage
• Irregular periods
• Absence of menstruation (amenorrhea)

Low Progesterone Symptoms

Low progesterone symptoms are often linked to fertility and reproduction causes, due to these being this hormone’s main functions. Symptoms include:

• Uterine bleeding abnormalities
• Menstrual cycle irregularity or missed periods (anovulation)
• Blood spotting and pain during pregnancy
• Miscarriages
• Early labor
• PCOS (polycystic ovarian syndrome)
• Symptoms of high estrogen (e.g., lower sex drive, weight changes, and gallbladder issues)
• Mood fluctuations
• Worsening of menstrual related disorders, including PMS (premenstrual syndrome) and PDD (Premenstrual Dysphoric Disorder)

Progesterone as a Medication and Treatment

Progesterone has been indicated as treatment for the following conditions:

• amenorrhea (absent periods)
• infertility
• endometriosis (a condition in which uterine tissue grows outside the uterus)
• fibrocystic breasts
• premenstrual syndrome
• supporting the luteal phase (the second phase of the menstrual cycle) during IVF treatment (IVF: in vitro fertilization)
• prevention of pregnancy loss
• protection of the endometrium (uterine lining) during HT (hormone replacement therapy) with estrogen

MP (micronized progesterone) is a form of Bioidentical Hormone Replacement Therapy (BHRT) that was shown in some studies to be better tolerated than synthetic forms of HT. However, BHRT use is controversial among various hormonal experts.

Integrative medicine doctors tend to view BHRT as a natural and safer alternative to conventional HT. Many conventional physicians disagree.

Regardless of using HT or BHRT, both can come with side effects and serious risks. Risks include blood clots, breast cancer, and stroke. (These appear to be most often associated with improperly prescribed estrogen and synthetic progesterone.)

It is imperative that exogenous hormone dosages are personalized and monitored by an expert physician for safety. When used appropriately, these options can be very beneficial.

Monitoring and Testing Progesterone Levels

A baseline test and consistent examination of hormone values can help to personalize HT, BHRT, nutritional and/or supplemental support. If one is prescribed ANY form of HT, for safety, I feel testing should be done regularly.

There are several methods available for assessing progesterone levels. These include measuring progesterone amounts in the blood, salvia, and/or urine. Each type of test has unique advantages and disadvantages.

Serum tests are the most used and reflect bound, inactive hormones. Salivary tests measure free hormones and can monitor topical applications. Hormonal metabolite levels, found in the urine, can help to determine how one is metabolizing hormones and their estrogenic activity.

Which testing option chosen is often based on practitioner’s preference, experience, and type of medication used (i.e., topical, sublingual, tablet, or injection). Using a combination of them can be helpful.

You can learn more about the specific tests here.

A Naturopathic and Functional Medicine Approach to Balanced Progesterone

Before assessing the need to incorporate HT or BHRT, naturopathic and functional medicine practitioners will often focus on lifestyle, behavioral, and foundational support. By using the least invasive and lowest risk interventions first, the body can come into its natural baseline. From there, any supplemental hormones can be considered.

Integrative doctors will often consider the following key areas:

Stress

Stress can increase the level of cortisol, which can alter progesterone and other sex hormones.

Meditating, exercising, breathing techniques, journaling, and essential oils (aromatherapy) can help reduce stress levels.

Sleep

Sleep also plays a role in regulating hormone levels and balance. Most people do best on 7–9 hours of sleep every night.

(The Right Amount of) Exercise

Moderate and enjoyable levels of exercise can help to relieve stress and support progesterone levels by lowering cortisol. However, overexercising can have the opposite effects.

Excessive and intensive exercise can interfere with fertility and impact ovulation negatively. One should be mindful of this if they are trying to conceive and balance hormones.

Nutrition

Environmental exposures from food can also interfere with hormonal levels. Processed foods can contain synthetic hormones and growth factors, antibiotics, and pesticides.

Organic diets and eating whole foods can decrease exposure to these chemicals. However, socioeconomics and location can make this option inaccessible for many.

On the positive side, nutrients found in the diet, such as vitamin B6 and zinc, may also support progesterone levels. This is due to their role as cofactors in hormonal regulation and for enzymes that support hormone removal by the liver.

Herbs

Low dosages of chaste berry (Vitex Agnus-cactus) herbal extract has some evidence of increasing progesterone and prolactin levels, and decreasing estrogen.*

It is thought that this botanical inhibits the signaling molecule, follicle-stimulating hormone (FSH), and stimulates the release of luteinizing hormone (LH) from the pituitary. This results in the hormonal pattern favoring progesterone production from the ovaries.

*Note: Higher doses seem to have the opposite effect.

The Benefits of Putting the Foundation in Place for Hormone Health

Tweaking hormones using BHRT and HT is complicated. There are (1) many feedback loops to consider, (2) various biological systems impacted, (3) complex processes for regulation and metabolism, and (4) hormone receptor sensitivity alterations based on a hormone’s availability These factors all impact how one’s mind and body will respond to the intervention.

This is why a stable foundation must be achieved before supplementing with BHRT and/or HT.  (More information on this topic can be found here.)

Summary of Dealing with the Highs and Lows of Progesterone

Progesterone is a vital hormone for fertility and reproduction. It also has essential, systematic affects in women and men. Understanding more about this hormone including its functions in the body, regulation, and how to assess healthy and suboptimal levels, can help one address any underlying hormonal and metabolic issues.

Naturopathic and functional medicine doctors will often implement lower risk, lifestyle interventions to address progesterone imbalances first. These include supporting stress with mind-body therapies and essential oils, optimal movement, prioritizing sleep, nutrition, and herbal interventions. Once these are dialed in, if necessary, any additional supplementation with progesterone will be more beneficial.

I hope in educating yourself on this superstar hormone you have a better understanding of your body, and the role progesterone plays in your overall health and fertility.

To access additional details, please read my article on progesterone that is published on Rupa Health.

Naturopathic Medicine and Holistic Resources for Hormonal, Mood, and Digestive Support

• Free resources and more education on essential oils and mind-body wellness are available to you here.
• An Integrative Mental Health and Stress Resource Guide.
• Tools for coping with isolation and separation.

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Many blessings.

References

https://www.ucsfhealth.org/medical-tests/serum-progesterone

https://pubmed.ncbi.nlm.nih.gov/6427277/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5146195/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2887768/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570621/

https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/symptoms-causes/syc-20353405

https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/signs-and-symptoms.html

https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/reproductive-hormones

https://my.clevelandclinic.org/health/articles/15660-bioidentical-hormones

https://www.rupahealth.com/post/a-functional-medicine-approach-to-pms

https://pubmed.ncbi.nlm.nih.gov/22906865/

https://www.medscape.com/viewarticle/812792#vp_1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245250/

https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245250/

https://pubmed.ncbi.nlm.nih.gov/33403887/

https://www.medicalnewstoday.com/articles/321919#risks

https://www.menopause.org/docs/default-source/professional/nams-2022-hormone-therapy-position-statement.pdf

https://pubmed.ncbi.nlm.nih.gov/23966539/

https://www.ncbi.nlm.nih.gov/books/NBK20/

https://www.medicalnewstoday.com/articles/321919#natural-remedies

https://www.rupahealth.com/post/how-chemicals-are-effecting-our-hormones

https://www.aafp.org/pubs/afp/issues/2005/0901/p821.html

See all the additional references in the original article on Rupa Health here.