Low Progesterone — Causes, Symptoms & Solutions

What Is Low Progesterone?

Low progesterone is a hormonal imbalance in which the body's progesterone levels are below the recommended threshold, which can lead to health problems such as menstrual irregularities, sleep disorders, weight gain, emotional imbalance, or PMS. [1]

Progesterone in Women

Progesterone is a female sex hormone that is primarily produced by the corpus luteum in women. [2] The corpus luteum is a structure that forms in the ovary from the ruptured follicle after ovulation. Follicles (small sacs of fluid) are not to be confused with oocytes (immature eggs). [3]

A well-functioning corpus luteum is crucial for maintaining progesterone levels in the second half of a menstrual cycle. The corpus luteum reaches its maximum size about nine days after ovulation.

After this, luteolysis (the structural and functional degradation of the corpus luteum) begins, resulting in less estrogen and progesterone production. This drop in hormones leads to the breakdown of the uterine lining and triggers menstruation.

Low progesterone can, for example, lead to spotting and intermenstrual bleeding, as the uterine lining is not sufficiently stabilized, and premature shedding can occur. This often occurs in the second half of the menstrual cycle, when progesterone levels should normally rise.

In women, progesterone is also produced by the ovaries, the adrenal glands, and the placenta during pregnancy. However, progesterone plays a central role not only in the female body during the menstrual cycle but also in preparing the body for pregnancy and in maintaining pregnancy. [2]

Progesterone During Pregnancy

The hormone progesterone plays a crucial role in pregnancy and the implantation of a fertilized egg in the uterine lining. [1]

The hormone prepares the uterine lining by thickening it and creating a nutrient-rich environment. These changes are necessary for the fertilized egg to implant and grow successfully.

Without sufficient progesterone levels, the uterine lining would not provide the optimal conditions, reducing the chances of successful implantation and early pregnancy. A low progesterone level can, therefore, lead to miscarriages and an unfulfilled desire to have children. [1]

Progesterone in Men

In men, progesterone is mainly produced in the testicles and adrenal glands. It plays an important role in sperm production and regulating the male hormone balance.  [4]

Progesterone in Both Sexes

Although progesterone is categorized as a female sex hormone, it is produced in both the male and female body, where it also fulfills gender-unspecific functions.

For example, progesterone has a calming effect on the central nervous system and helps regulate body temperature. [2] It supports the formation of healthy sleep patterns and acts as a natural diuretic, helping to remove excess water from the body.

Progesterone also plays a role in strengthening bone structure by promoting the formation of bone substances.

A balanced ratio of progesterone and estrogen is crucial for your overall well-being and health since imbalances can lead to a variety of health problems, both physical and emotional. Low progesterone is increasingly recognized and understood today, making it possible to take targeted measures to improve your quality of life and health.

Women, in particular, are more likely to suffer from low progesterone. This can be caused by factors such as stress, unhealthy diet, aging, and hormonal imbalances.

PMS Is a Result of Low Progesterone

Progesterone deficiency is closely linked to premenstrual syndrome (PMS), as low progesterone levels in the second half of the menstrual cycle disrupt hormonal balance. [5]

This can lead to high estrogen, which is known as estrogen dominance.

This imbalance can cause a variety of PMS symptoms, such as irritability, mood swings, sleep disturbances, breast tenderness, and water retention.

Balanced progesterone levels help alleviate these low progesterone symptoms and promote well-being.

What Are the Causes of Low Progesterone?

Low progesterone is often caused by a lack of ovulation, which can be caused by menopause, luteal insufficiency, stress, or hormonal contraceptives.

But low progesterone can have various causes:

• Menopause and Perimenopause

During perimenopause and menopause, your hormone levels drop, primarily progesterone, as the ovaries become less active and ovulation occurs less frequently or not at all (anovulation). [1]

Let us take a closer look at this:

The perimenopause, also known as the transitional phase to the menopause, can begin at around 38 years of age, or earlier in rare cases. It can take several years to reach menopause. During this time, the production of progesterone decreases, which can lead to various symptoms and health effects.

During perimenopause, progesterone levels often fall faster than estrogen levels, leading to a relative excess of estrogen. This condition is known as "estrogen dominance." So it is not too much oestrogen per se, but the hormone balance is no longer correct due to the lack of progesterone.

Common symptoms of low progesterone in perimenopause and menopause include irregular menstrual cycles, heavier or longer menstrual bleeding, breast tenderness, mood swings, sleep disturbances, and weight gain. Many women also report increased anxiety, depression, and a general deterioration in well-being. These symptoms can have a significant impact on quality of life. [1]

During menopause, which is officially defined as the absence of menstruation for twelve consecutive months, progesterone levels remain low. This can increase the risk of certain health problems, such as osteoporosis and cardiovascular disease. This is because progesterone has a protective effect on the bones and heart, and its deficiency can therefore, have long-term health effects. [1] [2]

• Corpus Luteum Insufficiency (Luteal Insufficiency)

  Corpus luteum insufficiency is when the corpus luteum, which produces progesterone after ovulation, does not function adequately. This leads to lower progesterone levels and can cause you to have menstrual irregularities, low progesterone symptoms, and difficulty maintaining a pregnancy. [6]

• A Lot of Stress

  Chronic stress increases the production of cortisol, a stress hormone that can negatively affect progesterone production. High cortisol levels can inhibit the conversion of pregnenolone into progesterone, leading to a lack of progesterone in your body. [1]

• Polycystic Ovary Syndrome (PCOS)

  If you have PCOS, you often have irregular ovulation or no ovulation at all (anovulation), which can lead to low progesterone levels. PCOS is a common hormonal disorder that is also characterized by insulin resistance and elevated androgen levels. [1]

• Dietary and Lifestyle Habits

  An unbalanced diet, too few healthy fats and vitamins (especially vitamin B6 and magnesium), and excessive alcohol and caffeine consumption can affect your hormone production. Dieting, fasting, or excessive exercise can also affect your hormone levels. [1]

• Overweight and Obesity

  Being overweight can lead to a hormonal imbalance by increasing the production of estrogen and thus disrupting the ratio of estrogen to progesterone. [7]

These potential and multiple causes of low progesterone show how important it is for you to maintain a healthy lifestyle and a balanced diet to keep your hormones in balance.

What Are the Symptoms of Low Progesterone?

• Irregular menstrual cycles: Low progesterone levels can disrupt the menstrual cycle, as progesterone is crucial for regulating the second half of the cycle and preparing the uterine lining for a possible pregnancy. [1]
• Heavy menstrual bleeding: With low progesterone, the uterine lining may not be fully shed, which can lead to thickening and, as a result, heavier bleeding.
• Premenstrual syndrome (PMS): Low progesterone levels can lead to an imbalance between progesterone and estrogen, which promotes symptoms of PMS such as mood swings, irritability, and sleep disturbances. [5]
• Breast tenderness and sensitivity: Low progesterone can cause estrogen dominance, which leads to water retention and swelling in the breast tissue.
• Weight gain, especially in the abdominal area: An imbalance of hormones can slow down your metabolism and cause your body to store fat, especially in the abdominal area.
• Headaches or migraines: Hormonal fluctuations, especially the ratio of progesterone to estrogen, can trigger migraines and headaches. [1]
• Decreased libido: Progesterone acts as a precursor for other sex hormones; a deficiency can disrupt the balance and lead to a decrease in sexual desire. [8]
• Hot flushes and night sweats: Low progesterone levels can affect your body's thermoregulation, leading to hot flushes and night sweats. [1]
• Depression and anxiety: Progesterone has calming and mood-stabilizing properties; a deficiency can, therefore, contribute to increased feelings of anxiety and depression. [1]
• Fatigue and exhaustion: Low progesterone levels can disrupt the sleep cycle and impair your body's ability to recover and store energy, potentially leading to chronic fatigue and sleep problems. [1]
• Erectile dysfunction in men: Low progesterone levels can lead to erectile dysfunction in men, as progesterone serves as a precursor for other important sex hormones, such as testosterone. An imbalance can impair sexual function and negatively affect libido and the ability to maintain an erection. [1]

How Is Low Progesterone Diagnosed?

Low progesterone is usually diagnosed with a blood test called the serum progesterone test. This special blood test measures the progesterone level in your blood serum. It is typically carried out about a week after ovulation in women, i.e. around the 21st day of a 28-day menstrual cycle.

This timing for women when taking blood samples is important as progesterone levels are highest in the middle of the luteal phase, allowing for a more accurate diagnosis. This is because progesterone levels fluctuate during your menstrual cycle and are affected by your age and whether you are pregnant.

Progesterone levels are low in the follicular phase of your cycle (the first half of your cycle). You can expect levels of less than 2 nanograms per millilitre (ng/mL) of blood. [1]

Progesterone rises during ovulation, and its levels peak about a week after ovulation (during the luteal phase of your cycle). Your progesterone levels can rise to around 20 ng/mL.

If you are not pregnant, progesterone levels will drop again, and you can expect to get your period within a few days.

In men, a smaller amount of progesterone is produced, which is not further converted into testosterone. The normal values for men in blood serum are 0.13-0.97 ng/ml. [4]

What Helps With Low Progesterone?

If you're wondering what to do about low progesterone, these methods may be able to help:

Hormone Therapy

A common treatment for low progesterone is hormone replacement therapy, the intake of bioidentical progesterone (progestin), which your healthcare provider can prescribe. These hormones can be used as a cream, gel, tablet or vaginal suppository to balance your progesterone levels. [1]

Lifestyle Changes

Stress reduction is crucial, as chronic stress increases your cortisol levels and inhibits progesterone production. Yoga, meditation, and regular exercise can help lower your stress levels. [1]

A Healthy Diet

Ensure you eat a balanced diet rich in vitamins and minerals. Vitamin B6, magnesium and zinc, in particular, are important for hormone production. Foods such as green leafy vegetables, nuts, seeds and whole grains can help take in high amounts of these nutrients. [1]

Avoid Xenoestrogens

Artificial estrogens (xenoestrogens) are present in many plastics, cosmetics and pesticides. Those can disrupt your hormone balance. Try to avoid products that contain phthalates or parabens and choose organic foods when possible. [9]

Exercise Regularly

Moderate physical activity not only helps to reduce stress but also supports your hormone balance. However, don't overdo it, as excessive exercise can also cause hormonal imbalance. [1]

Natural Supplements

Some women find that herbal supplements such as monk's pepper (Vitex agnus-castus) help increase progesterone levels naturally and relieve their low progesterone symptoms. However, talk to your doctor first before taking any supplements. [10]

Weight Management

A healthy body weight can help stabilize your hormonal balance. Being overweight or underweight can affect your progesterone levels, so it's important to maintain a healthy BMI.