One of the most common patterns of hormone imbalance that I see in my practice treating women is low progesterone. In this article, I’ll explain why progesterone is so important for women’s hormone balance, and some of the common signs that suggest you may have this pattern.

What does progesterone do for you?

Progesterone is the hormone that is produced in the second half of the menstrual cycle, after ovulation occurs. I call progesterone the “calming, cooling hormone.” It’s like the “yin” to estrogen’s “yang”; both are important, and they work best when in balance with one another.

Ovulation is the key event that is required for optimal progesterone levels. After an egg is release from the follicle inside the ovary, the little structure that is left behind is called the corpus luteum. This structure is responsible for producing progesterone.

Progesterone has the following important functions:

• Helps to grow and maintain the lining of the uterus by increasing blood flow and oxygen to this area
• Supporting and regulating your mood, especially in the second half of your menstrual cycle
• Maintaining a regular menstrual cycle length (no less than 21 days, and no longer than 35 days)
• Maintaining a predictable period schedule
• Normalizes period bleeding (not too heavy or too light)
• Calming the mind and mitigating anxiety
• Calming the nervous system and enhancing your capacity to manage stressors
• Supporting quality sleep
• Promoting fertility, implantation and supporting early pregnancy
• Progesterone also appears to have some neuroprotective brain benefits, especially after concussions.

The corpus luteum typically lives for about 10-14 days. If fertilization does not occur, it will disintegrate, progesterone levels will drop, and a period will occur. If fertilization and implantation DO occur, then pregnancy hormones will help to maintain the corpus luteum. This way, progesterone levels are kept elevated in order to support the early stages of pregnancy.

10 signs that you might be low in progesterone

The following signs may indicate low progesterone. These symptoms can also overlap with other hormone concerns, such as thyroid problems, elevated estrogen, or iron deficiency, so it’s important to seek help in evaluating your hormones thoroughly.

1. Irregular or skipped periods.

As I explained above, you need to ovulate in order to produce progesterone. If your period is irregular, unpredictable, or you skip periods, this is a sign that you aren’t ovulating. You should speak to your health care provider if you haven’t had a period in 3 or more months, or if your period comes every 35 days or longer.

2. You experience spotting before your period.

Progesterone helps to maintain the integrity of the uterine lining. A little bit of spotting just before your period is normal, because your progesterone is naturally dropping at this time. But if you are having 2 or more days of spotting before your period “officially arrives”, this may indicate low progesterone.

3. You’re not ovulating (or, you’re not ovulating regularly).

Once again: you must ovulate in order to produce progesterone. No ovulation = low progesterone.

Did you know that just because you are getting a period monthly, doesn’t necessarily mean that you are ovulating every single month? This may seem counterintuitive to point #1, but it’s true. This is why for my fertility patients, I educate about the physical signs of ovulation to watch for, basal body temperature tracking, and the “fertile window.” If you are actively monitoring using BBT or ovulation predictor kits but not getting a rise in temperature or a positive test, then you may not be ovulating.

4. Moodiness: you feel really irritable, anxious, angry, tired or depressed in the day(s) leading up to your period.

Progesterone is calming to the brain. It mitigates anxiety, and helps you manage stressors more effectively. Low progesterone is associated with more aggression and fatigue in the PMS time.

5. Other PMS symptoms: in the days before your period, you feel extra bloated, have breast tenderness, headaches, and/or water retention in your arms and legs.

These physical symptoms of PMS are associated with low progesterone.

6. You have problems getting good quality sleep, especially in the second half of your menstrual cycle or during your PMS phase.

Studies show that women with more severe PMS have decreased parasympathetic brain activity (the “rest and digest” state) in the luteal phase. This contributes to worsened sleep, whether that is difficulty falling asleep or staying asleep. In fact, prescription bioidentical oral progesterone is always given at night, because it makes you sleepy.

7. You get acne breakouts before your period.

Are you in your 30’s and suddenly breaking out like a teenager? You’re not alone. Acne breakouts before the period can, in fact, return later in life! This can be a sign of low progesterone. For more on this specific topic, check out my other article about hormonal acne.  

8. You are in your 40’s.

During a woman’s lifespan, peak progesterone production occurs in the late 20’s and early 30’s. If you’re in your late 30’s and feel like your PMS symptoms are worsening, it may be related to lower progesterone production.

Did you know that symptoms of perimenopause start 7-14 years before menopause? This means that perimenopause can start in the early 40’s, or even earlier. Can you guess the first hormone that tends to decline in perimenopause? If you guessed progesterone, you’re right. This is always one of the first hormone that I discuss supporting for my patients in their 40’s.

9. You have a short luteal phase.

The luteal phase is the second half if your menstrual cycle. It starts the day after ovulation and extends until the last day before your period starts. The luteal phase should ideally be 10-14 days long. If it is 8 days or less, this can indicate progesterone deficiency or a luteal phase defect. This can be a concern for women who are trying to conceive, as they may not be producing enough progesterone to maintain the early stages of pregnancy.

10. You have experienced difficulty conceiving or early pregnancy loss.

As I alluded to in the point above, inadequate progesterone may be one contributing factor to difficulty conceiving or early pregnancy loss. There are many factors that need to be assessed in these cases, so a thorough fertility workup is warranted if you have experienced either of these concerns.

What causes low progesterone?

When I am working with patients on balancing their hormones, we first need to identify their hormone pattern. This can be accomplished in a detailed initial consultation, using my hormone assessment questionnaire, and in some cases, hormone testing.

After identifying your hormone pattern, the next most important question is to ask is WHY?

Why is there a pattern of low progesterone occurring?

I have highlighted that the key event required for optimal progesterone is ovulation. Therefore, if a woman isn’t ovulating regularly, she is much more likely to experience the bothersome symptoms of low progesterone.

There are many reasons why a woman may not ovulate. Simply having a highly stressful month can cause anovulation (missed ovulation). Other women may have conditions that impair or inhibit ovulation. Some underlying causes of low progesterone can include:

• Polycystic Ovarian Syndrome (PCOS)
• Stress
• Over-exercising or overtraining
• Dieting or caloric restriction
• Perimenopause or menopause
• Low estrogen
• Other hormone concerns, such a hypothyroidism or elevated prolactin
• Hypothalamic amenorrhea
• Among others.

If you identify with the list of signs above, know that there are LOTS of ways to help balance your hormones using natural medicine! Once we identify your hormone pattern, and the cause of your hormone pattern, we can go to work on balancing your hormones. In my practice, this involves a combination of foods, herbs, nutrients, acupuncture, or sometimes bioidentical hormone therapy. It also requires a serious conversation about the stressors in your life and how you are coping. Each woman receives a treatment plan that is based on her unique pattern, needs and lifestyle.

Yours in hormone health,

Dr Kathleen Mahannah ND

Dr. Kathleen Mahannah is Naturopathic Doctor licensed by the College of Naturopathic Physicians of British Columbia.  Her practice focusses in women's health and hormone balancing using natural medicine and Hormone Therapy, particularly for women in perimenopause and menopause. Dr. Mahannah completed a Degree in Physical Education and Health from University of Toronto, and Diploma of Exercise Science from Capilano College, before obtaining her Diploma of Naturopathic Medicine. She has been practicing for over 6 years in North Vancouver, BC, Canada. Learn more about Dr. Mahannah here.

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