53. Understanding Low Progesterone: Causes and Solutions

Join Dr. Monica Minjeur on Cycle Wisdom as she delves into low progesterone levels. Learn the causes, natural remedies, and when prescription-strength progesterone is necessary. Hear Joanne's inspiring story of overcoming recurrent miscarriages with charting and targeted progesterone treatment. Dr. Minjeur also covers key lifestyle changes to boost progesterone and debunks common misconceptions about hormone treatments. Whether you're struggling with fertility or menstrual irregularities, this episode offers essential insights to support your journey to optimal health. Tune in for practical advice and expert guidance on managing low progesterone naturally.

Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. On today's episode, I'm going to be talking all about low progesterone levels. We'll discuss some specifics as to what actually causes low progesterone and dig into more details about what you can do to help improve your levels more naturally. I will also share crucial details to understanding that not all progesterone is the same and when it's appropriate to take an actual prescription strength progesterone medication from a healthcare professional who understands and knows how to monitor your levels. So let's get started with a story about a past client of mine who we'll call Joanne. Now Joanne came to me because she was having troubles with getting pregnant and carrying to term. She had actually been able to get pregnant four times over the past six years, but all of them ended in miscarriage somewhere between six to eight weeks. She had short cycles and they were happening every 22 to 24 days and she wasn't yet tracking her ovulation, but she knew that this was a little too short. She had heard that some women need progesterone support during their pregnancy so she talked with her OB doctor and that doctor told her that she didn't need progesterone because they don't do that anymore. So Joanne came to see us and we started obviously with charting first. Now what we identified was a few things on her charting before we even did any other medical evaluation. One of the things we were able to pick up that made us suspicious for low progesterone was that she had spotting that started 3 4 days before her actual menstrual flow. The other thing that we identified was that she had a very short luteal phase. So again, that's the time from she ovulates until her menstrual cycle starts. And in Joanne's case, that was only about 7 to 8 days each cycle. Normally, we like that to be somewhere between 12 to 14 days to be optimal. So, we checked some lab work and again, this was timed to where she was at in her cycle. This confirmed the suspicion that Joanne indeed had low luteal phase progesterone levels. And so from a treatment standpoint, we actually started her on progesterone prior to her even getting pregnant. Most often when we're prescribing progesterone, we're going to start it three days after ovulation. And so this is why it's really important to know and understand exactly the day that you're ovulating so that we can time our treatment appropriately. Within a couple of months, Joanne was able to conceive and we measured those progesterone levels throughout her entire pregnancy. There's really important guidelines that we follow when it comes to knowing exactly where the progesterone levels should be at each week of gestation. And so we were able to supplement the progesterone additionally, depending upon what Joanne needed and depending upon where her lab levels were as we checked them throughout her pregnancy. Joanne was able to go on and have that full term pregnancy last until 39 weeks and she delivered a healthy baby girl who was 8 pounds 2 ounces. So, how do I know if I have low progesterone levels without getting my levels actually checked? You know, for most women, as we noted with Joanne, we're going to very commonly see that short luteal phase, right? So the time from when you ovulate until your menstrual cycle begins, that luteal phase, anything that is shorter than 10 days is reason for concern and additional evaluation. We oftentimes will also see that spotting or maybe even very light bleeding prior to the onset of an actual menstrual flow. And if this lasts for two or more days, it does raise suspicion for low progesterone levels. Overall, we also noticed that women that have low progesterone oftentimes will deal with an increase in anxiety or PMS mood related symptoms prior to the onset of their menstrual cycle. Progesterone has a very calming effect, and so if you don't have enough of that progesterone, it can really amp things up and make you a little bit more irritable in that time leading up to the onset of your period starting. Other things that we notice in regards to pregnancy is that some women will have infertility and low progesterone can be a common cause that we find as their reason. Again, if we're seeing that short luteal phase, oftentimes there's not enough time for that fertilized egg to be able to implant before the next menstrual cycle begins. And so that alone can be a cause of infertility. So when we lengthen out that luteal phase, it gives that. fertilized egg time to actually implant. Another common sign that we see can be recurrent miscarriages and in my world one miscarriage is already too many so if we can identify a low progesterone problem prior to getting pregnant we want to treat that before the pregnancy even begins. So why do we see low progesterone so commonly? You know, lots of people that have observed my practice realize that I prescribe and recommend progesterone a lot. And really what we find is that there's a lot of reasons that your body can struggle with low progesterone. Now, not many of these are going to be anything new or earth shattering that we haven't talked about already, but But a lot of it really goes back to the basics as far as lifestyle choices and modifications that we talk about consistently on this podcast. So one of the big things that we see causing low progesterone is going to be stress. Now again, this can be emotional or psychological stress, but it can also be physical stress. So either eating poor foods or not getting enough sleep or having illness. All of these things are going to increase your cortisol levels and cause troubles as far as downstream with the production of progesterone. Thyroid dysfunction is another very common cause that we see that can cause low progesterone. It's another one of the major hormones responsible for regulating progesterone and can cause some issues with some of the precursors that are needed in order to form enough progesterone. So if you don't have enough thyroid, you don't create enough pregnenolone, and if you don't have enough pregnenolone, it's really difficult to go on and create enough progesterone. Another big area that we see that causes low progesterone in general is an unhealthy follicular ovulation. So this can be from ovulation defects, so maybe I'm not ovulating regularly. Maybe, again, I've got that higher stress situation or maybe I'm dealing with some other underlying condition like polycystic ovary syndrome, which can have along with it some troubles with ovulation. High prolactin levels is another reason that we can see follicular ovulation have struggles and all of these cases lead to less healthy follicular development. Now if we have a follicle that is much smaller before it releases that egg, what happens is that that follicle. goes on to then produce progesterone after the egg is released when it's called the corpus luteum. And so if we don't have a follicle that gets large enough or that is healthy or robust enough, then it is not going to be capable of producing enough progesterone in the luteal phase when we see it happen. Another thing that we pay attention to that can cause low progesterone is endometriosis. We know that the inflammation from this can inhibit some of the follicular development and that can be another cause of low progesterone. Other things that can be setting things off that are not specific to progesterone itself can be estrogen dominance. So you may just have too much estrogen and your progesterone levels may be fine but it may just show up as a relatively low level compared to the high high estrogen levels. So again we've talked about in a past episode where we review estrogen dominance that it can actually be your progesterone levels are normal but you can still have some of these symptoms if you have too much estrogen. Another time that we see progesterone levels decrease is going to be based on your age. So if you starting to go through a perimenopause transition, which again can occur up to 10 years before your periods actually stop happening, we naturally see that your progesterone levels will decrease over time. And then the final category I want to mention today is just medications. And so there are certain different medications that are prescribed for psychiatric conditions, especially things like bipolar or other, um, antipsychotic medications that can cause low progesterone levels, as well as of course, many of the other synthetic hormones that are available on the market in the form of oral contraceptives, IUDs, implants, all of all of these will cause a decrease in your progesterone levels primarily because they're blocking ovulation. So lots of reasons that you can have low progesterone and it can be a little bit overwhelming to figure out, okay, what's causing it? Are there multiple factors that are playing a role? So why is there so much skepticism about treating people with progesterone deficiency? Now, whether you are dealing with a healthcare professional or whether you are a patient yourself who has low progesterone levels, many people don't want to be prescribed anything or take anything related to their hormones because that can get really scary. And a lot of this unfortunately comes from a misunderstanding of how hormones are created and realizing that not all are created equally. So I want to break it down just a little bit here to see if we can get some better understanding. So most of the time when we're talking about artificial or synthetic hormones, those are called progestins. Now the progestins all have an increased side effect risk, primarily going to be an increased risk of breast cancer, Changes in menstrual bleeding as well as breast tenderness. Now progestins are again going to be the artificial form of progesterone that we see primarily in IUDs, in oral contraceptive pills, and in depo shots. They are not considered to be bioidentical. They do not have the same chemical structure as the progesterone that we normally have in our bodies. Because a lot of them also are going to contain estrogen components, you will often see on the package inserts that have estrogen plus progesterone, things like increased risk of blood clots and cancers. And oftentimes that's where I think many women and healthcare professionals get a little nervous about hormones because we do have all of these increased side effects that we worry about. But again, these are with the synthetic hormones. So, in contrast, if we look at actual bioidentical progesterone, which is chemically the same as what your body naturally produces, we're going to talk about much fewer risk factors. Now we do see some side effects with these medications and most commonly we talk about headache, dizziness. fatigue, and some mood changes. Now again, as you remember, we talk about progesterone being kind of this calming hormone, so we expect to see those things. When you're looking at progesterone that is bioidentical, this is going to be available from your regular pharmacies as micronized progesterone or prometrium, and it may actually say just plain progesterone. Those are all the bioidentical versions. You can also get compounded versions of these medications from a reputable compounding pharmacy, and they are typically utilizing just the micronized progesterone to put into their different pills, capsules, suppositories, and creams. So, again, a lot of this confusion, I think, comes from a story about a recent medication that was pulled from the market. So, this is the story about, um, a medication called Hydroxyprogesterone Caproate, um, and the brand name for this was Makina. Now, because it has the word progesterone in it, a lot of people think that it is the same as having problems with the bioidentical progesterone, but it is very, very different. different as far as the actual synthesis and what that looks like. So this hydroxy progesterone caproate was brought to market and it was approved in 2011 by the FDA as a means to reduce preterm birth before 37 weeks gestation. Now it was originally marketed just for women who had already had troubles with a preterm birth in the past. And one condition of this. This kind of fast tracked approval from the FDA was that the drug company was required to complete additional studies over the next few years, proving their theory that it actually would decrease the risk of preterm birth. Now, unfortunately, the medication over time did not show statistically significant improvement in follow up clinical trials. And so the FDA actually withdrew approval from the market of the medication Mekina in the year 2023. Now unfortunately, what happened is a lot of the headlines that came out said progesterone is not actually helpful for treatment of preterm birth, but they didn't do that. differentiate hydroxyprogesterone caproate versus bioidentical progesterone. And what we know is that bioidentical progesterone does have a significant track record and many, many studies over the past 50 years that show that it does reduce the risk of miscarriage and preterm birth. But again, it has to be the bioidentical version. So I think that's why there's a lot of skepticism and it's why Joanne's doctor said, hey, we don't do that anymore when it comes to treatment with progesterone and why you may have some pushback from healthcare professionals because this was so recently in the news and the FDA discussions. So, what are some ways that you can fix your progesterone levels naturally? Now this does come with some work on your behalf and again, we're going to go back to a lot of the basics we talk about when it comes to lifestyle modifications. So the number one thing we're going to talk about is sleep, making sure that at a minimum you're getting eight hours of sleep per night, eight to nine is even more optimal, but knowing that we need to be getting that deep restful sleep in order for all of our hormones to function more properly. The other thing we pay attention to is overall stress reduction. So decreasing your cortisol levels can have a huge impact on your progesterone dysfunction. If you're looking for more ways to reduce your stress levels, go back to check out my episode all about stress reduction and how that can improve your hormone levels. Exercise, again, we're talking at about a minimum of 30 minutes of walking daily. We don't want to have exercise that is too intense because again, it can raise those cortisol levels, but being able to get that regular exercise can really help to improve your overall health and wellbeing, which again is going to make a big improvement when it comes to your hormone levels. There are also lots of studies done showing that lower progesterone levels are correlated with an increased body mass index. So anything we can do to help maintain a healthy weight can also help to improve your progesterone levels. And then the final category I'm going to talk about is all about food. Now I am a big fan of any place that we can incorporate appropriate foods into your diet to help from a vitamin level. I would much rather do that as opposed to just giving you a bunch of supplements. So let's talk a little bit about the particular food groups that have been shown to help with progesterone levels. Now many of these are going to be important because they help with creating the precursors or the building blocks in order to help improve those progesterone levels. One of the big areas we talk about is vitamin C. So we want to aim for getting at least 750 milligrams of vitamin C daily. My favorite way to get this is going to be through citrus fruits, like oranges and grapefruit, kiwis. you can also get it through bell peppers, broccoli, and kale. Now I would caution against just taking a vitamin C supplement on a regular basis because we know that vitamin C, when taken daily, can actually dry up your mucus cycles a bit. So especially if you're trying to identify ovulation or get pregnant, a vitamin C supplement can kind of offset that. So again, another great reason to try and get it just through your food sources. Other vitamins that are responsible for helping with good progesterone levels include zinc, magnesium, and vitamin B. So especially vitamin B6 we'll talk a lot about. So that's going to be through foods like chickpeas, so think about hummus, tuna, spinach, bananas, and lean red meat and lean proteins. Other good ways to get that source of zinc and magnesium are going to be through legumes, so beans, nuts, and whole grains. One of the other things that's really important, for the production of progesterone that you're getting omega 3s in your diet, so that's going to be shellfish, olive oil, or sometimes just taking a supplement, and then good sources of dietary cholesterol, so eggs, cheese, and then most sources of meat are going to have dietary cholesterol. In particular, cholesterol and omega 3 are the building blocks that your body needs in order to synthesize that pregnenolone, which goes on to produce progesterone. So, you know, cholesterol containing foods oftentimes will get a bad rap, but we do need them in some quantities in order to have good precursors as those building blocks for the rest of our hormones. So what about over the counter products? You know, I've heard that there's lots of supplements or progesterone cream that can actually help. So one thing as far as caution is I always tell people that supplements do not have enough research behind them to confirm that they actually increase levels of progesterone or that they're effective at this. One of the main ones that we hear a lot about in our practice is Vitex or Chase Treeberry. Now, although this can increase your progesterone levels mildly, it can also decrease your estrogen levels. And depending upon where your estrogen levels are, that may not be a good thing. The other thing we know about Vitex is that it can actually increase or decrease prolactin depending upon the dose. And so anything that goes on and starts messing with other hormone levels always creates a bit of skepticism for me Because I don't want to be throwing off other hormone levels just to try and possibly bump the level of progesterone slightly The other big one that we often hear about is over the counter progesterone creams. So if you are getting anything that does not require a prescription, this is likely going to be something that contains wild yam extract. Now, this does not contain actual progesterone. It does contain the steroid precursor called diosgenin. Now diastenin does not actually bind to progesterone receptors, it does not increase the levels of progesterone in your bloodstream, and in many studies it has actually been shown to be ineffective for the treatment of menopause symptoms or PMS. So, while a lot of people want to try these products, they don't have great efficacy as far as absorption, as far as actually increasing the levels. And although they may help with mild symptoms of PMS, if you are somebody who is struggling with significantly decreased levels, or if we are seeing major changes in your menstrual cycle, whether that's a shortened luteal phase, or that bleeding ahead of time, that is not going to be enough in order to help boost your levels. So, those are the cases where we should consider prescription strength progesterone instead. And again, this is going to need to be prescribed by a healthcare professional who understands the safety as well as monitoring of those progesterone levels long term. Again, we are always promoting the bioidentical progesterone because we know it is safe long term. It is safe to take with pregnancy, it is safe to take during breastfeeding, and it is safe safe to take during menopause and this prescription strength progesterone comes in many different formats, but all of them actually will improve your blood levels more quickly. Again, we're timing this to your cycle. So we're only giving it to you when you are actually having that luteal phase when progesterone naturally would be increasing during your cycle. What we find is that prescription strength progesterone will improve anxiety and PMS symptoms. It will also lengthen out your luteal phase and should decrease that bleeding that you're seeing before the menstrual cycle. Imagine if your progesterone deficiency could be identified and you were able to work to correct it through lifestyle changes that we've discussed here today. You now have a better idea of where to get started and know when it's appropriate to use prescriptions under the guidance of a qualified healthcare professional to improve your health and promote fertility. If you're ready to work with our elite team of healthcare professionals, go to our website, radiantclinic. com, to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in person appointments in the Cedar Rapids, Iowa Or can arrange for a telehealth visit. If you live in the state of Iowa, Illinois, and now Minnesota. Thank you so much for listening to this episode. 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