Low Progesterone

What is low progesterone?

Progesterone is a hormone that plays an important role in your reproductive system. Hormones are chemical messengers that tell your body how to work. In women or people assigned female at birth (AFAB), progesterone supports menstruation and prepares your uterus for pregnancy. If your progesterone levels are low, it can cause irregular menstruation, make it difficult to maintain a pregnancy and affect your overall health.

What does progesterone do in your body?

Some of the functions of progesterone in your body include:

• Thickening the lining of your uterus for implantation (a fertilized egg attaching to your uterus).
• Regulating your menstrual cycle.
• Regulating bleeding during menstruation.
• Supporting a pregnancy once conception occurs.
• Helping improve your mood.
• Supporting thyroid function.

Progesterone's role in pregnancy

Progesterone is critical in supporting a pregnancy because it thickens your uterine lining (called the endometrium). A thick uterine lining helps a fertilized egg implant and grow.

Progesterone is made by your ovaries (with support from your adrenal glands). More specifically, the corpus luteum, the empty follicle in your ovary that releases an egg during ovulation. If an egg is fertilized by sperm at ovulation, human chorionic gonadotropin (HCG) tells the corpus luteum to make more progesterone to support the developing embryo.

Progesterone levels continue to rise during pregnancy. It also suppresses uterine contractions, which helps you avoid preterm labor. Finally, it helps your mammary glands (breasts) prepare for breastfeeding (chestfeeding).

Progesterone's role in menstruation

Progesterone is responsible for thickening your uterine lining to prepare it for pregnancy. If conception doesn’t occur during that menstrual cycle, progesterone levels drop, and you get your period. The blood and discharge you see during your period is your uterine lining breaking down.

How does low progesterone affect my body?

Only your healthcare provider can determine if your progesterone levels need to be checked. Hormones are a complex system in your body. Too little or too much of one hormone causes a chain reaction in the rest of your hormones.

In the case of progesterone, it’s balanced by estrogen. Having low progesterone can lead to having too much estrogen, which can cause symptoms like:

• Weight gain.
• Depression.
• Heavy menstrual bleeding.
• Decreased sex drive.
• Gallbladder issues.

If you’re trying to get pregnant, low progesterone levels could make it hard to maintain a pregnancy.

How does low progesterone affect pregnancy?

Low progesterone affects your body’s ability to create a thick and healthy uterine lining. This lining is what a fertilized egg attaches to. Once it attaches, more progesterone is needed to help grow the embryo into a fetus.

Since progesterone plays an important role in maintaining your uterine lining during pregnancy, low levels can make it hard for you to stay pregnant. You need progesterone levels to stay high until you’re ready to give birth.

If you have low progesterone, you’re at risk for pregnancy complications, such as:

• Ectopic pregnancy.
• Miscarriage.
• Preterm labor.

What are the signs of low progesterone?

Low progesterone can affect your body in several ways and cause unpleasant symptoms in some people.

Symptoms of low progesterone in people who aren’t pregnant include:

• Irregular menstrual periods.
• Headaches.
• Difficulty conceiving.
• Mood changes, anxiety or depression.
• Trouble sleeping.
• Hot flashes.
• Bloating or weight gain.

Some symptoms of low progesterone in pregnant people are:

• Spotting (light bleeding).
• Low blood sugar.
• Breast tenderness.
• Fatigue.
• Miscarriage.

What causes low progesterone?

There are several causes of low progesterone. The most common causes are:

• Anovulation: Ovulation doesn’t occur (your ovary doesn’t release an egg).
• Polycystic ovary syndrome (PCOS): A hormone imbalance that causes missed periods and unpredictable ovulation. PCOS can also cause small cysts to develop on your ovaries.
• High stress: Cortisol is your stress hormone, and too much of it can interfere with your body’s ability to make progesterone.
• Hypothyroidism: A slow or underactive thyroid. It makes it harder for your body to make progesterone.
• Hyperprolactinemia: Your body makes too much prolactin, the hormone responsible for lactation. Prolactin disrupts other sex hormones like progesterone, leading to irregular cycles or loss of your menstrual period.
• Low cholesterol: Low levels of cholesterol can cause low progesterone.
• Perimenopause: The time just before menopause when your hormone levels decline.
• Over-exercising or extreme dieting: This can increase cortisol levels and put stress on your body. It also deprives your body of key nutrients needed to sustain healthy hormone levels.

What does low progesterone mean for men?

Men or people assigned male at birth (AMAB) don’t require as much progesterone as women or people AFAB. However, low levels of progesterone can still affect their bodies. Some signs of low progesterone in men are:

• Depression, mood swings or anxiety.
• Low sex drive.
• Erectile dysfunction.
• Loss of muscle mass.
• Fatigue and trouble concentrating.

How is low progesterone diagnosed?

A blood test (a PGSN or progesterone test) diagnoses low progesterone. Progesterone levels fluctuate, and there’s a wide range of acceptable levels. Your healthcare provider may measure your progesterone levels if you’re trying to conceive and have issues with ovulation or regular menstruation.

What should my progesterone levels be?

Progesterone levels fluctuate during your menstrual cycle and are affected by your age and whether or not you’re pregnant.

In the follicular phase of your cycle (the first half of your cycle), progesterone levels are low. You can expect levels of less than 2 nanograms per milliliter (ng/mL) of blood.

At ovulation, progesterone rises, and its levels peak about one week after ovulation (during the luteal phase of your cycle). Your progesterone levels may rise to around 20 ng/mL. If you’re not pregnant, progesterone levels drop, and you can expect to get your period within a few days.

If you’ve conceived that menstrual cycle, progesterone levels continue to increase. During the first trimester of pregnancy (up until the 13th week of pregnancy), progesterone levels can be as high as 90 ng/mL. By the time you enter your third trimester, progesterone levels may be as high as 300 ng/mL. Progesterone levels are higher if you’re expecting multiples.

Like other reproductive hormones, progesterone levels decrease as you age and enter menopause. After menopause, your progesterone levels may fall below .5 ng/mL.

How can I check my progesterone levels at home?

You can’t check progesterone levels at home. Only your healthcare provider can check your progesterone levels using a blood test.

How is low progesterone treated?

There are several ways your healthcare provider can treat low progesterone depending on your symptoms and goals. For example, if you’re trying to get pregnant, progesterone may be needed to thicken your uterine lining. During menopause, you may need progesterone (and estrogen) to help reduce your symptoms.

Progesterone is available in a few different forms:

• Cream or gel suppositories: These come with an applicator similar to a tampon. You insert the applicator into your vagina and push the applicator to release the medication into your vagina.
• Pills: Progesterone pills that can be taken orally (swallowed).
• Injections: Progesterone can be given as a shot (injected into your skin) to help maintain your uterine lining during pregnancy or IVF treatment.

Progesterone supplements are low-risk; however, each treatment has side effects and risks. Talk to your healthcare provider to make sure you understand the risks and benefits of progesterone treatment.

How can I increase my progesterone levels naturally?

Some of the following options are safe and may help increase progesterone levels:

• Eating a healthy diet rich in vitamin C, zinc, magnesium and vitamin B.
• Getting enough sleep (eight hours is ideal).
• Reducing your stress levels and finding ways to stay calm.
• Exercising.

When should I see my healthcare provider?

Contact your healthcare provider if you have any of the following symptoms:

• An irregular menstrual cycle.
• Vaginal bleeding between periods.
• Headaches or migraines.
• Depression, anxiety or other mood changes.

Symptoms of low progesterone are similar to other conditions, so it’s important to talk to your healthcare provider for an accurate diagnosis.

A note from Cleveland Clinic

Progesterone is an important hormone in your body. It helps regulate menstruation and supports a pregnancy. Low levels of progesterone can cause irregular menstrual periods, spotting and headaches, and could affect your ability to get pregnant. Speak with your healthcare provider if you notice symptoms of low progesterone. They may want to run blood tests, especially if you’re trying to conceive. There are many treatments for low progesterone that you can discuss with your provider.