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Low Progesterone: A Possible Culprit to PMS, Perimenopausal Symptoms, & Infertility

Me and my "baby girl"

Me and my “baby girl”

I sent out a request in Facebook for article topics and the 2 most requested topics were: 1) female hormone balance and 2) kid nutrition.  This really excited me, as these are two topics I have been doing quite a bit of research on recently.  Let’s face it, we tend to research topics that pertain to us personally.  I guess that’s the beauty of blogging.

I’m going to start by talking a little bit about my personal story with female hormone balance.  About a year ago, my husband and I decided we’d like to start a family.  So, the first thing I did is research everything possible about creating a healthy body for fertility and pregnancy.  I purchased Chris Kresser’s Healthy Baby Code, listened to almost every speaker on the Joyfully Pregnant Summit, downloaded Donielle Baker’s (Naturally Knocked Up) Fertility Checklist, among reading many other articles form experts in this area.

It wasn’t in God’s plan for us to get pregnant last year, as I ended up having an early pregnancy miscarriage.  When I found out I was initially heartbroken, but then the questions came: “how can this happen to me?  I eat healthy, take the right supplements, and have even incorporated liver into my diet!  I’m a Dietitian. I’m supposed to be the one who knows how to do this right.”   Well, after I calmed down a bit (talk about hormone imbalance), and accepted God’s plan for us, I went and did a complete physical by a Functional Medicine doctor.  I wanted to make sure that in addition to eating healthy, exercising, and taking the right supplements, my hormones where in the right balance.

The main result: low progesterone.

In this article, I’m going to talk about low progesterone, including it’s symptoms, causes, treatment, and how it relates to both infertility and perimenopausal symptoms.

Symptoms of Low Progesterone

When talking about low progesterone, we also have to consider estrogen.  Dr. Sarah Gottfried, author of The Hormone Cure, describes these hormones uses the analogy of a seesaw shifting rhythmically back and forth over the course of the menstrual cycle.When progesterone levels drop, the result is a higher ratio of estrogen:progesterone, also know as estrogen dominance. This is characterized by the some (or all) or the following symptoms:

  1. 1.  Headaches, especially around the menstrual cycle
  2. 2.  Painful or difficult periods
  3. 3.  PMS- irritability, anxiousness, mood swings, sugar cravings, bloating, weight gain
  4. 4.  Water retention
  5. 5.  Fibroids
  6. 6.  Swollen, tender, cycstic breasts
  7. 7.  Trouble sleeping, or even night sweats
  8. 8.  Acne breakouts
  9. 9.  Dry skin (progesterone contributes to “pregnant glow”)
  10. 10.  Hair loss
  11. 11.  Low body temperature


Causes of Low Progesterone

Some common causes of dropping progesterone levels include:

  1. 1.  Stress: see Pregnenelone Steal*
  2. 2.  Lack of ovulation: happens if you run out of eggs or have another hormone imbalance such as excess testosterone (characteristic in Polycystic Ovarian Syndrome)
  3. 3.  Low thyroid: thyroid hormones are necessary to make pregnenelone, the precursor to progesterone.


*Pregnenelone Steal

Stress is the most common reason for low progesterone levels, so I want to adequately explain the relationship.  The following diagram provides a good visual on how progesterone is made and how stress can affect this process.


With unmanaged, chronic stress, pregnenelone is being “stolen” to make cortisol, the hormone produced by the adrenal glands in response to stress.  Therefore, it is not available to make other hormones, such as DHEA, progesterone, and testosterone.  Keep in mind that stress can come from several different avenues, including: emotional, physical, mental, physiological, and environmental.   It may be a high amount of one or a combination of many that affects us.With unmanaged, chronic stress, pregnenelone is being “stolen” to make cortisol, the hormone produced by the adrenal glands in response to stress.  Therefore, it is not available to make other hormones, such as DHEA, progesterone, and testosterone.  Keep in mind that stress can come from several different avenues, including: emotional, physical, mental, physiological, and environmental.   It may be a high amount of one or a combination of many that affects us.

Low Progesterone & Fertility/Pregnancy

Progesterone has several important roles for promoting fertility and throughout pregnancy.  Here are a couple:

  1. 1.  Maintains lining of the uterus, allowing fertilized egg to attach and survive.
  2. 2.  Makes cervical mucous accessible by sperm
  3. 3.  Allows the embryo to survive
  4. 4.  Prevents immune rejection of the developing baby
  5. 5.  Allows for a full development of the fetus
  6. 6.  Helps the body use fat for energy during pregnancy


So, you can see without adequate progesterone, the risk of infertility or miscarriage increases.

Low Progesterone & Perimenopause

One of the first changes that marks the beginning of perimenopause is a drop in progesterone.  In addition to this natural drop in progesterone, estradiol (form of estrogen) levels begin to fluctuate, often times up.  The result is uncomfortable symptoms characteristic of perimenopause including: heavy bleeding, breast tenderness, migraines, irritability, and sometimes anger.  Although this change in hormones is a natural part of aging, symptoms are exacerbated by other causes of this hormone imbalance (listed above).  It’s never to late to improve this, but one of the most important things to do before perimenopause is to strive for optimal balance of estrogen and progesterone.


What to Do:

1.  Check for symptoms (see above)


2.  Stress management and sleep.  Since stress is such an integral part of this equation, this is a crucial step, even before diet.  It’s important to first take inventory of any possible stressors


  • ^ Are there any you can get rid of?  If not, is there a way to change your perspective about the situation in order for it to not place so much stress on you?

    ^ Is your exercise regimen creating more stress? Overtraining, lack or rest or recovery-based days, and chronic cardio (long duration, moderate-high intensity) tends to be place higher demands on the body.


    ^ Is your diet creating stress?  Processed foods can be stressors on the gut as the body tries to digest them.  Excess sugar and refined carbohydrates can be stressors on the pancreas and blood sugar management system.  Food intolerances can be stressors on the gut and immune system as the body fights to protect itself.

  • ^Last, but most important, are you getting adequate quality sleep.  The body functions best on >7-9 hrs, ideally between the hours of 10 pm and 6 am


3.  Diet


  • ^Eat more of the right things.  Since low progesterone can negatively impact body composition, it’s common to first start by trying to cut back on calories in attempts to lose that “stubborn fat.”  However, this may be causing more harm than good and, in fact, feeding the problem.  A chronic caloric deficit can create additional cause stress on the body.


  • ^Decrease intake of estrogen-promoting foods: soy, pesticides, hormone-laden meats, gluten, and dairy


  • ^Include foods that naturally detoxify estrogen: green tea, cruciferous veggies (broccoli, cauliflower, cabbage, etc)


  • ^Eat enough cholesterol: if you see in the diagram above, cholesterol is the precursor to pregnenelone, which makes progesterone.


  • ^Match carbohydrate with activity.  We’ll talk about this more later.  But, for the most part, we tend to overdo it with carbohydrates.  This causes surges in blood sugar and insulin, which can negatively impact other hormones, including stress hormones and sex hormones.


  • ^Consider weaning off caffeine.  Caffeine boosts energy by raising cortisol levels.  As displayed above in the pregnenelone steal diagram, cortisol can negatively impact production of progesterone.


  • ^Limit alcohol.  Alcohol intake has been associated with premenstrual anxiety, mood imbalances, and headaches.


Environment.  Limit exposure to external toxins


  • ^Plastics (contain BPAs) for heating and storing food and water






  • ^Vitamin C: moderate amounts of supplemental vitamin C have been shown to improve hormone levels and increase fertility.1


  • ^Magnesium & B6 (animal foods): both of these nutrients are required to make progesterone


  • ^Chasteberry extract: increases progesterone by stimulating production of luteinizing hormone.  Studies have shown it to be effective in reducing infertility and PMS.2


Lab Testing.


  • ^Sex hormones: the best way to test sex hormones is salivary.  In fact, the best way to test female sex hormones is over the entire month.  Hormones fluctuate throughout the month based on the menstrual cycle; testing them at all stages gives the most complete picture.  You will then want to work with a functional-medicine based practitioner to look at trends and ratios of the hormones.


  • ^Stress hormones: the best way to test stress hormones is also salivary.  You want to look at DHEA and the rhythm of cortisol over the course of the day


  • ^Thyroid hormones:  the most important thing when look at thyroid function is to get a complete view.  A simple TSH level is not enough.  You also want to check other thyroid hormones including T4 and T3, and sometimes reverse T3.  I also recommend checking thyroid antibodies (TPO) and thyroid binding globulin (TBG)


Bio-identical Hormone Replacement


IF the above changes do not improve progesterone levels (as evidenced by lab test), then consider working with a practitioner on using bioidentical progesterone.  This is particularly important for late-stage perimenopausal women in which chasteberry will not work- their ovaries will not respond.




Low progesterone is a very common hormone imbalance.  It can happen at all stages during a female’s life.  Not only is it culprit of unwanted PMS symptoms and perimenopausal symptoms, but can also negatively effect fertility and pregnancy.  There are several steps you can take to naturally improve progesterone levels, and balance the ratio of estrogen:progesterone.  In my opinion, the most important step to take is managing stress.  It’s also always best to know where your levels are at, especially before doing any kind of hormone replacement.



  1. Henmi H et al. Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect. Fertility and Sterility August 2003; 80:459-461.
  1. Ebsco Publishing (2013). Chasteberry. Retrieved April 7, 2013, from
  1. Gottfriend, S. (2013) The Hormone Cure. New York, NY: Scribner.


  1. Turner, N. (2009) The Hormone Diet. Random House Canada

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My True Health R.D. 2011-2018 Andrea Mc Daniel, R.D.