LOW PROGESTERONE SYMPTOMS AND CAUSES
It is very possible that you may have low progesterone symptoms and not even realize it. Low progesterone is more common than you might think, and can lead to changes in your mood, weight gain or irregularities in your menstrual cycle. It is important to find out if you have low progesterone because progesterone (along with estradiol/estrogen) helps to maintain and keep the other hormone systems in your body in balance.
Low Progesterone Symptoms
One of the most basic reasons why you should care so much about your progesterone levels is that progesterone is the perfect balance to estrogen in the body, and it directly counteracts the growth hormone-like effects of estradiol and estrogens. Progesterone fluctuates throughout the month to help keep estradiol in balance, as well as maintain other hormonal levels. Even when you have small imbalances in progesterone, they can result in rather big symptoms because of the balancing effect that this hormone has on other hormones, as well as your cells. You actually have more progesterone than you have estrogen, and while estrogen helps build tissue up (breast tissue, uterine tissue, fat cells) progesterone helps to slim down the exact same tissue. Progesterone even impacts your mood, sex drive and emotions.
Below are some of the most common low progesterone symptoms.
Low Progesterone Symptoms:
- Water retention or bloating
- Sleep disturbance (Insomnia)
- Menstrual irregularities (if still menstruating)
- Irritability, depression or other unexplained mood changes
- Breast tenderness or pain
- Breast lumps or cysts
- Uterine fibroids
- Hot flashes (rare but does occur)
- Anxiety or difficulty relaxing
- Decreased libido
- Premenstrual syndrome or PMDD
- Endometriosis and/or issues with fertility
The balance of estrogen to progesterone is also incredibly important in women, and while some of these symptoms may be directly related to your progesterone levels, some may also be related to the other hormone imbalances that can occur when you have low progesterone.
Having low progesterone or high estrogen may result in similar symptoms because the ratio tips in favor of estrogen over progesterone. This can make it difficult in some cases to distinguish low progesterone symptoms from high estrogen symptoms. In the United States, the vast majority of the time women suffer from low progesterone symptoms due to stress and age, as well as high estrogen caused by weight gain and exposure to endocrine disruptors. This means that most women may require a combination of therapies targeted at both lowering estrogen and increasing progesterone.
With all of this in mind, it’s also important to understand what having a “normal” progesterone balance is like in your body.
Adequate Progesterone levels:
- Improved sleeping patterns (falling asleep and staying asleep)
- Feeling more relaxed
- Regular menstrual cycle
- Feeling more like “yourself” the last 2 weeks of your cycle
- Reduced breast tenderness around cycle (if menstruating)
- Improved mood (reduced depression and irritability)
- Increased libido
A combination of the 3 major sex hormones (Testosterone, Progesterone and Estradiol) come together to create your unique physiology, and if you were to line up 100 healthy women and test these 3 hormones you would find high variability between each and every one. You would also find differences in their bust size, body fat percentage, basal metabolic rate, basal body temperature and menstrual cycles. This means that the exact level and amount of progesterone that you needed is different for every woman, so in most cases a combination of symptoms and serum progesterone levels are needed to figure out what your “optimal” progesterone level is.
If you have determined that you do in fact have low progesterone symptoms, the next thing you will need to do in order to regain balance in your body is to try and find the underlying cause.
Some Causes of Low Progesterone
- Undiagnosed or Untreated Hypothyroidism
- Weight Gain
- History of Birth Control Use
- Excessive Stress and/or Adrenal Fatigue
- Cellular Progesterone Resistance (As seen in PCOS & Endometriosis)
- Sensitivity to Xenoestrogens or other Endocrine Disruptors
Many of the causes of low progesterone symptoms may actually be reversible, which means you don’t always necessarily want to jump to increasing your progesterone by forcing it with bio-identical progesterone replacement. Changes to 1 hormone system will almost always result in changes across multiple hormone systems, which is why adding progesterone replacement may be insufficient for resolving your symptoms long-term, and can even lead to more unwanted symptoms including weight gain, water retention, bloating and headaches.
With this in mind, let’s look at most common causes of low progesterone in more detail:
1.) Undiagnosed or Untreated Hypothyroidism
Thyroid hormone is a perfect example of how your hormone systems are linked. Regular ovulation and progesterone production both require adequate thyroid hormone and function. Studies have even linked T3 thyroid hormone (the active thyroid hormone) to the release and cycle of healthy progesterone levels.
So what does all of this mean? Well, it is estimated that around 10% of the population in the US is affected by hypothyroidism, with another estimated 10% affected by sub-clinical hypothyroidism. This means there is approximately a 20% chance that if you are reading this you may have an issue with your thyroid function. Simply being overweight has also been shown to reduce thyroid function and T3 levels as well, without even taking into account the effect that weight gain has on progesterone directly. The high rate of hypothyroidism combined with the current treatment paradigm that leaves many patients with sub-optimal thyroid treatment is why testing your thyroid is high up on this list when it comes to finding the cause of low progesterone.
If you are suffering from low progesterone, be sure to get a complete thyroid panel to evaluate both your total T3 and free T3 levels.
Here is an example of complete thyroid panel:
- Free T3
- Free T4
- Reverse T3
- Total T3
- Thyroid antibodies
2.) History of Birth Control Use
The use of birth control pills as a catch-all therapy for any PMS-like symptoms is another big reason for low progesterone levels among young women. When birth control pills are not used as a contraceptive, synthetic and pharmaceutically derived hormones are given to completely suppress the normal ovulatory pattern, and in turn the homeostasis and cycle of your hormones throughout the month. While using oral contraceptives in this way may help to temporarily reduce symptoms, it does nothing to treat the underlying cause. Even worse, many women suffer from complications with birth control medications such as infertility, weight gain, acne and worsening symptoms.
The bottom line?
Taking suppressive doses of synthetic hormones may result in suppressed progesterone levels, even after you discontinue the medication. Some women develop a condition known as post birth control syndrome as a result of the dysregulation of normal hormonal systems (remember the menstrual cycle is extremely complex, and has alternating levels of many hormones and hormone precursors over the course of a month) that are caused by long-term birth control use.
Taking any hormone, whether it is synthetic or bioidentical, may have consequences on the regulatory systems in your body, however bioidentical hormones (if necessary) are preferred over synthetic and pharmaceutically derived variations of progesterone. Bioidentical hormones are an exact replica of hormones that your body was evolved to use over thousands of years, rather than a pharmaceutical derivative of the same natural hormones.
3.) Weight Gain
Having a BMI of grater than 30 typically leads to a combination of the following issues:
- Hyperinsulinemia or insulin resistance (think PCOS-like symptoms)
- Excess estrogen (estrogen dominance)
- Increase in IGF-1 (growth hormone for all cells-including cancer)
- An increase in inflammatory markers
Some women are affected more by these negative issues than others, but in any case having excess weight is not healthy for your metabolic systems. Fortunately, you can oppose this cascade of negative changes by balancing and increasing your progesterone, but it may not be sufficient to help you lose weight.
Carrying around even just 10lbs of excess weight is also enough to increase your risk of developing endometrial cancer. This increased risk is due to how obesity alters estrogen and progesterone levels. This is illustrated in the chart below:
Age is an inevitable cause of low progesterone and low progesterone symptoms for every woman. Around age 35 your progesterone levels start to drop up until menopause, when they become and then remain very low (unless you supplement). Even without hormone imbalances, weight gain, thyroid disorders, etc. your progesterone will STILL lower slowly over time.
This is illustrated by the graph below:
Here you can see that both hormones, estrogen and progesterone, begin to drop off to very low levels starting at age 35, but the thing that is important to note is the dramatic decline of progesterone RELATIVE to estrogen that occurs during this time. Remember that it is not necessarily the exact levels of progesterone or estrogen you should be most worried about, but the RATIO of progesterone to estrogen.
This dramatic decline in progesterone compared to estrogen results in estrogen dominance and its symptoms for most women form around age 40 to menopause. Factors such as a healthy lifestyle, maintaining a normal weight and ensuring proper hormone balance can help delay this decline, and reduce low progesterone symptoms as you age.
Progesterone decline occurs in EVERY women after menopause. Menopause is the absence of ovulation that eventually all women will go through later in life. Ovulation is responsible for the majority of progesterone production in the female body, so that makes it easy to understand that when ovulation stops, progesterone subsequently falls to near zero levels. Not to worry, because there are many supplements and therapies you can use to reduce the symptoms associated with menopause, and to fight the decline of both estrogen and progesterone.
6.) Excessive Stress and/or Adrenal Fatigue
For women in the U.S., stress is possibly the most common reason for low progesterone. The potency and effect that chronic and sustained stress has on the physiologic processes in the body is often underestimated by most people. More and more people have heard of adrenal fatigue, which is usually a result of this prolonged stress, but still not many know exactly what it means – especially when it comes to your other hormones.
The graph below shows how acute levels of stress have been shown to spike both cortisol and progesterone:
On the other hand, long-term stress has quite a different effect on progesterone. Sustained stress causes changes in adrenal hormones, resulting in higher than normal cortisol and lower than normal progesterone levels. This adrenal preference to create pregnenolone (and therefore cortisol) over progesterone has been coined “pregnenelone steal.”
Chronic stress also increases the conversion of T4 to reverse T3, causing changes in thyroid physiology, and the resulting effect of decreased thyroid hormone is a reduction in ATP and energy production along with cellular hypothyroidism. We already know that hypothyroidism leads to low progesterone, so now you can see how you end up with a stress-thyroid-low progesterone connection.
But what types of stress are we talking about anyway? Almost any type of stressor can impact the adrenal system, whether it is physiologic, a lack of sleep, emotional stress, physical/traumatic, etc. Emotional stress, such as rejection from peers or social stress, seems to impact progesterone more than other types of stress, but regardless of the source stress – the bottom line is that it must be eliminated (if possible). Also, certain supplements can help to augment the effects of reducing stressors and regulate cortisol levels in the body.
7.) Sensitivity to Xenoestrogens or Endocrine Disruptors
This topic doesn’t get nearly enough attention, so it’s worth elaborating on what exactly endocrine disruptors and xenoestrogens are. Endocrine disruptors (also called EDC’s) are chemicals that we are exposed to on a daily basis (whether we realize it or not), that interfere with normal hormone balance in the body.
Below are some of the sources of these chemicals:
- Commercial and processed foods (including things like soy milk)
- Pesticides/fungicides directly on food
- Lipophilic chemicals in industrial agriculture/livestock facilities
- Phyto-estrogens within certain foods
- Synthetic hormones (think oral contraceptives) which are metabolized and recycled in the body
- Cosmetics (make up, hair spray, lotions, etc.)
- Inhalation (hair spray, paint, etc.)
- Storage of EDC’s in adipose (fat) and breast milk
- Embryonic exposure (transferred from mother to child)
- Transfer to child through lactation and breast feeding
Even though we are coming into contact with these chemicals on a daily basis, it seems that EDC’s take time to build up in your system before they start to cause trouble with your hormones. Also, some people seem to tolerate EDC’s better than others. This means that certain people will naturally have lower levels than others, and EDC’s may be playing a big role in some peoples’ health and a smaller role in others.
EDC’s mimic the effects of regular hormones, and block their cellular binding. Another big problem is that they limit lipogenesis (the burning of fat) which then in turn promotes more EDC storage and build up over time. The result is an increase in estrogen, a reduction in progesterone and an increase in overall fat mass.
So how can you get rid of EDC’s? The first step is to try an avoid them at all costs. Next you can increase certain enzymes in your liver that are involved with phase II detoxification pathways by taking supplements such as the ones below.
- Milk thistle + MCM + NAC – Take 2 capsules daily for 2-3 months.
- Calcium D-glucarate – Take up to 2 grams/day for 10-14 days, then take a 1-2 week break.
- Vitamin C (buffered) – At least 2-5/day. If it causes diarrhea, simply lower your dose.
Finally, you should drink plenty of water, and ensure that you’re having proper bowel movements and frequent, deep sweats.
8.) Cellular Progesterone Resistance (As seen in PCOS & Endometriosis)
This is an newer concept that has been shown to at least play some role in patients who have a history of endometriosis and/or PCOS. In this case, your cells become resistant to the effects of progesterone in the presence of high estrogen levels (estrogen dominance).
This is the same thing that occurs in leptin resistance, insulin resistance and thyroid resistance when hormone levels in the body increase and your body responds with a protective mechanism which downregulates receptor activity to certain hormones. This causes a temporary reduction in cellular activity, but usually results in abnormal serum labs that don’t match the symptoms of the patient.
In the same way, progesterone resistance creates a scenario in which serum progesterone levels may be “normal,” but cellular resistance is occurring which creates the symptoms of low progesterone, making a diagnosis difficult.
Progesterone resistance often occurs in patients who ALSO have insulin resistance, higher than normal IGF-1 levels and high estrogen levels. This could be because certain cells may coexpress receptors for insulin, IGF-1, estradiol and progesterone. This means that an increase in ANY one of these hormones may result in the downregulation of progesterone receptors, causing progesterone resistance.
A big problem for women who have progesterone resistance is that it seems like they should take progesterone replacement to help their low progesterone symptoms, however in this case taking progesterone will NOT improve the situation and may actually make your symptoms worse. This finally may explain why some women who take progesterone, even with low levels, experience negative side effects.
The good news is that progesterone resistance can be treated. Studies have shown that metformin actually helps by reversing insulin resistance, which in turn sensitizes your cells to progesterone. The treatment of progesterone resistance should therefore focus on the treatment of any existing hormone resistance syndromes first, and then go to the replacement of progesterone.
Testing your Progesterone
Along with identifying low progesterone symptoms, it’s actually quite easy to find out if you have low progesterone with simple lab tests. Here is an example of a serum lab test of both progesterone and estradiol:
In these serum results we can see that this patient is indeed experiencing low progesterone and estrogen dominance during her cycle. These labs were drawn on day 20 of this patients menstrual cycle, when progesterone should be at its highest during the cycle. You can see that the progesterone level is 0.7 ng/mL, while the estradiol level is 73 pg/mL, suggesting that this patient has low progesterone (but does not determine the underlying cause).
It’s relatively easy to start out with a simple serum progesterone/estradiol ratio, but serum lab testing don’t necessarily work for every individual’s situation. Some people may need more extensive testing such as saliva testing, dried urine testing or estrogen metabolite testing.
Bio-Identical Progesterone Replacement
If you determine from your symptoms and lab results that you have low progesterone, but not progesterone resistance, then you may want to consider supplementing with bio-identical progesterone. Remember that taking progesterone without addressing underlying causes of progesterone resistance may cause your symptoms to get worse. It is best to seek the guidance of your physician when determining what type and how much hormone replacement you should begin with.
Low progesterone symptoms are very common among women in the united states who are both still menstruating and post menopausal. Treating low progesterone symptoms begins with the proper evaluation of both your symptoms and serum lab tests. If your progesterone is low, hormone replacement may give you a significant reduction in symptoms such as bloating, weight gain and depression. However, some women may experience a worsening of symptoms when supplementing with progesterone which should means they should be evaluated for progesterone resistance.