By Dr. Shawna Darou, ND
Progesterone is a key hormone for women’s health, having a great influence on your mood, sleep, period flow, bloating, weight and more. It is also important as the hormone that balances out our estrogen levels. Low progesterone can be associated with PMS, endometriosis, uterine fibroids, infertility, early miscarriage, PCOS, heavy periods and perimenopause. It is also associated with the development of breast cancer because of its role in counterbalancing estrogen.
Signs of low progesterone can include:
- Spotting before your period
- Very heavy menstrual flow
- Premenstrual syndrome, especially poor sleep and anxiety
- Difficulty getting pregnant
- Early miscarriage (before 7 weeks)
- Perimenopause symptoms such as mood swings, difficulty sleeping, heavy periods & irregular cycles
What causes low progesterone?
Progesterone is a hormone that naturally declines with age, beginning somewhere in the 30’s and usually being more significant by age 38. This is why we see a much higher rate of estrogen-dominant conditions such as uterine fibroids, breast cysts, heavy menstrual flow and breast cancer through the 40’s.
Progesterone can also decline with prolonged periods of high stress. The reason is that both progesterone and the adrenal stress hormone cortisol share the same precursor hormone called pregnenolone. When you are going through a period of prolonged high stress, your body will use more pregnenolone to keep up with the demand for cortisol. This is also a way your body protects from getting pregnant during a period of high stress.
Progesterone may also appear low in cases of estrogen dominance. What this means is that there is a higher than normal level of estrogen, and not enough progesterone to counterbalance it. In these cases, the actual progesterone level may be normal but there are symptoms of low progesterone. The key here is to support estrogen breakdown and detoxification and reduce exposure to estrogen-mimicking substances like plastics (phthalates, BPA), pesticides, hormones in meat or dairy and other chemicals found in personal care products (such as parabens and DEA).
Testing your hormones:
There are ways to measure progesterone, and especially the balance between estrogen and progesterone. The simplest is to measure both hormones ‘mid-luteal phase’, or approximately 1 week before your next period is due. We can also test the balance between estrogen and progesterone with saliva testing or urine hormone testing.
If your progesterone level is low, how do we treat it?
As a naturopathic doctor, my aim is to treat the root cause whenever possible. This means that our first recommendations will be nutrition, stress reduction and possibly herbal medicines. In some cases where the hormone imbalance or symptoms are extreme, we do have the option of bioidentical progesterone.
Here are the top strategies:
- Nutrition: Increasing fibre in the diet, adding more vegetables, especially the broccoli family of vegetables, and reducing caffeine, alcohol and sugar are some of the basics. Switching to a more organic diet will also reduce exposure to estrogen-mimicking chemicals which can promote estrogen dominance.
- Adrenal gland support: Since low progesterone may be due to the body needing extra cortisol to deal with stress, it is essential to look at stress reduction as a significant treatment for low progesterone.
- Reducing exposure to estrogen-mimicking chemicals: We are exposed to many chemicals through our foods, personal care products and plastics which mimic estrogen and increase our estrogenic load. Switching to organic, choosing natural personal care products and minimizing the use of plastics is an excellent start.
- Supporting estrogen metabolism and detoxification: Estrogen is detoxed in two phases, first through the liver and second through the colon. What this means is that we need to support liver detoxification and also bowel health, to optimize hormone balance.
- Weight loss (if needed): When a woman is overweight, her estrogen levels will be higher since fat cells, especially abdominal fat produces more estrogen in the form of estrone. Weight loss will lower estrogen, and then reduce the relative estrogen dominance.
- Herbs to increase progesterone: The next step may be herbs to increase progesterone, such as Vitex, wild yam, Rehmannia and white peony.
- Bioidentical progesterone: This is usually prescribed as a cream, although in cases of fertility vaginal suppositories are also an option. The benefit of bioidentical progesterone is that it is structurally identical to the progesterone your own body produces, and we can dose it precisely to optimal physiological levels. In cases of hormone imbalance such as endometriosis and perimenopause, this is often the most effective treatment.
As you can tell, progesterone is a very important hormone and it is a key treatment point in many women’s hormone-related health conditions. If you suspect that low progesterone or estrogen dominance with relative low-progesterone may be affecting your health, the first step is testing your hormones to confirm. From there we have many options, ranging from nutrition changes, to improving digestive health, and then with herbal medicine or bioidentical hormones. This is an area of hormone treatment where we can see profound improvements in your overall health, mood and well being.
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