Progesterone Deficiency

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Progesterone is a wonder hormone. We know that it is important with respect to reproduction as it helps maintain a pregnancy, however it is also extremely important for females who are not trying to conceive. Low progesterone has been a phenomenon I have noticed consistently in practice, affecting all ages from teens to menopausal females. But why?

Progesterone is a steroid hormone that originates from pregnenaolone (synthesized from cholesterol). After ovulation, the corpus luteum is formed on the ovary; the corpus luteum produces progesterone, which means a person needs to ovulate in order to have sufficient amounts of this hormone. In a ‘regular’ cycle (28 days with ovulation occurring around day 14), progesterone steadily rises right up until the next period begins. Progesterone deficiency is often reflected by a shortened luteal phase (1). The luteal phase includes the days between ovulation (day 14) and the next period, typically ranging from 12-15 days (1). Progesterone rises during the second half of the cycle to maintain the endometrial lining, or to put it simply, it keeps the period in. Some symptoms that progesterone is low include mid-cycle spotting, heavy periods, sleep disturbances, irregular periods (especially in the luteal phase) and PMS (pre-menstrual syndrome) (2). This may sound familiar for women approaching menopause, as progesterone is the first hormone to decline (3). This is also a common pattern in young women, however they may be experiencing only one or two of these symptoms.

Why is Progesterone Important?

• Balance Estrogen: Estrogen without progesterone leads to symptoms such as fluid retention, uterine fibroids, fibrocystic breasts and headaches associated with the menstrual cycle. Adequate progesterone reduces risk of estrogen-modulated cancers such as breast and endometrial cancer (6)
• Neuromodulatory/neuroprotective. It has been classified a neurosteroid due to it’s role in myelination (7). This becomes increasingly important to address if females in the post-menopausal demographic begin to notice cognitive changes

It is important to note that the synthetic forms of progesterone, progestins, do not behave the same way progesterone does. Therefore they do not carry the same neuroprotective, inflammatory-modulating, sleep-regulating benefits that the true hormone does. Progestins are found in certain oral contraceptive pills (birth control).

Causes for Low Progesterone

• Thyroid: An under-functioning thyroid – whether clinical or subclinical – can disturb progesterone. It was found that a deficiency in T3, the more biologically active thyroid hormone, was significantly correlated with a deficiency in progesterone. Additionally, when T3 was added to luteal cells in vitro, progesterone release was stimulated (8). Therefore if T3 is not adequate, progesterone will likely be inadequate as well.
• High cortisol/stress: Our stress hormone, cortisol, is released when we have a perceived threat. This can be a bear, driving in your car or financial worries. Chronically elevated cortisol can impact progesterone in two ways. For one, it can reduce thyroid function, indirectly impacting progesterone. Secondly, the precursor to progesterone and cortisol are the same: pregnenolone. If our body is under chronic stress and cortisol is being demanded to be released, the hormones will be shunted away from progesterone to cortisol, also know as the ‘cortisol steal’ (9).
• History of under-eating/over-exercising: Regardless of whether a formal Eating Disorder has been diagnosed, individuals can experience menstrual irregularities after periods of energy restriction. Carbohydrate restriction in particular can disrupt the thyroid’s normal functioning, again indirectly leading to progesterone deficiency (10).
• True vs. Relative Progesterone Deficiency: Another extremely common hormone pattern is estrogen excess or dominance. This is a topic unto itself, however it should be touched on as it pertains to progesterone deficiency. If estrogens are not being detoxified properly, (4) it can create an imbalance between the ratio of progesterone to estrogen, leading to symptoms of estrogen dominance and progesterone deficiency.

Naturopathic Approaches

In keeping with the philosophy of Naturopathic Medicine, the root cause must be identified for appropriate treatment. While symptoms can tell a lot about someone’s hormonal picture, there is information that cannot be gleaned by symptoms alone. Lab testing is an extremely useful tool when it comes to hormones and getting the ‘whole picture’. DUTCH (Dried Urine Test for Comprehensive Hormones) breaks down the metabolites of hormone pathways to help identify whether it is a true progesterone deficiency, a relative progesterone deficiency, an adrenal based pathology, PCOS/anovulation, or whether to investigate thyroid further.

Beyond that, some common Naturopathic interventions include:

• Vitex agnus-castus: Vitex is a progestogenic herb useful in certain cases of PCOS and anovulation (11). It is useful to understand two other lab values prior to using Vitex: LH (luteinizing hormone) and FSH (follicle stimulating hormone). Vitex stimulates ovulation and therefore is ideal in someone whose LH is low in comparison to FSH. If LH is high, increasing ovulation would be more harmful than helpful in which case Licorice and Peony and wonderful (10).
• Vitamins and Minerals: Iodine, magnesium, zinc, Vitamin D and B vitamins (10) help with healthy hormone synthesis. Magnesium and B5 are paramount for adrenal function; B6 is necessary for many detoxification pathways to rid the body of excess estrogen; iodine is critical in many tissues in the body, however specifically important for healthy thyroid hormone conversion, and zinc can help to balance testosterone metabolism, which impacts progesterone.Nutrition: Ensure adequate healthy fats and protein for hormone production and sufficient caloric intake for the individual’s energy needs. Depending on the PCOS (polycystic ovarian syndrome) status, carbohydrates for thyroid function OR a paleo-based diet for true insulin-resistant PCOS (10).

• Cruciferous vegetables/DIM: If there is an estrogen dominant hormone picture, gently supporting the liver and gut to eliminate harmful estrogens to rebalance the estrogen:progesterone ratio.
• Adaptogenic herbs: Herbs such as Withania, Rhodiola, Magnolia and Licorice can help re-balance cortisol if progesterone is low due to high stress. As discussed in the section above, high cortisol influences low progesterone.

Conclusion

Progesterone is a key hormone not only for fertility, but also for a female’s overall health. A common pattern for people of all ages is low progesterone, which manifests as mid-cycle spotting, heavy periods, sleep disturbances, irregular periods (especially in the luteal phase) and PMS. The only way to produce adequate amounts of this hormone (if you’re not pregnant or menopausal) is to ovulate. This is a key part of every female’s cycle and is as important as the period itself. Hormone testing is a useful tool to understand the entire hormone picture, as there are many factors that contribute to low progesterone; this can help identify the root cause. There are numerous Naturopathic approaches to correcting a progesterone deficiency and the treatment is unique to each individual based on the underlying mechanism.