In a previous post, I discussed Estrogen Dominance and ways to balance estrogen.
I promised to discuss progesterone balance, as well. After all, it is in essence the balance between the two, estrogen and progesterone, which are at the heart of it. Their balance lay in flux at all times; however, there can be an overall net effect that results in undesirable symptoms.
What is progesterone and where does it come from?
Progesterone comes from the ovaries both before and after menopause, but it is also produced in the brain and the peripheral nerves. Progesterone helps to provide a nice thick lining of the uterus after ovulation. If no egg is implanted, then progesterone levels decline and menstruation occurs.
Progesterone is also brain protective. It produces a sense of calmness, sedation, and anti-anxiety to help produce rejuvenating sleep. Excess progesterone symptoms rarely occur, but when they do, you could feel sleepy, drowsy and depressed. Watch for these symptoms if you are on synthetic or even bioidentical sources of progesterone. However, the more common presentation might be progesterone deficiency. 1
Common progesterone imbalance situations that may occur:
- Low progesterone, Low estrogen (but relatively can still be estrogen dominant with elevated estrogen levels relative to progesterone levels)
- Low progesterone, High estrogen (estrogen dominant)
Possible Signs and Symptoms of Low Progesterone:
- Excess premenstrual symptoms (PMS)
- PMS migraines
- Painful periods
- Irregular or excessively heavy periods
- Cycle less than 21 days
- Endometriosis (Estradiol stimulates the growth and inflammation of endometrial tissue that can grow throughout the organs of the pelvic cavity. Normally balance of progesterone will allow for the enzymatic process of estradiol into estrone—a lesser estrogenic estrogen. Little progesterone is made in endometriotic tissue due to a low level of progesterone receptors in that tissue.)
- See estrogen dominant symptoms
Possible causes of progesterone imbalance:
- Estrogen levels more dominant relative to progesterone levels. You want a ratio progesterone (PG) to estradiol (2E) that is optimally ~300 (PG:2E= 100-500).
- Stress: With endometriosis, and the situation of low progesterone receptors, stress makes this worse by cortisol blocking the receptors, causing more cortisol to be made instead of progesterone.
There is also something considered the “pregnenolone steal,” whereby in the presence of excess cortisol, the body will make more cortisol in lieu of progesterone.
When the body is under duress, the need is for survival, and reproduction takes a back burner. So stress hormones win out. This occurs in women without endometriosis, as well. (see image below)
Low Cholesterol: Eating a low fat diet and/or being on cholesterol lowering medication (Statins), can result in lower cholesterol levels. Cholesterol has gotten a bad rap in the past, but it’s actually vital to the formation of your cells. They have found that for older individuals, lower cholesterol levels are linked to cognitive decline. And as you can see in the image above, it is also vital in production of sex hormones. So lower cholesterol, then no substrate to form pregnenolone and therefore, not enough to produce progesterone (or DHEA, estrogen, testosterone).
Hypothyroidism: Thyroid hormone is essential in forming pregnenolone and thus progesterone.
So you can see there is quite a balancing act going on here, from your sex hormones to your adrenal hormones.
And the solution is going to be individual for you. There is no one size fits all. Because your genetics come into play, as well. But don’t believe for a minute that just because your mom or your grandmother had issues that you are beholden to those outcomes. We know that with epigenetic research, that we do have the capability to alter out genetic outcomes by what we eat, our environment, and our lifestyle.
Solutions for improving the progesterone predicament:
Balance out hypothalamic-pituitary-adrenal (HPA) axis: thyroid and cortisol
a. Get 7-8 hours of good quality sleep per night—pre-sleep hygiene (see post, "Learn to be Still: Understanding Fatigue") + light protein snack before bed
b. Adequate blood sugar balance (See Handout),
c. De-stress and re-set: yoga and diaphragmatic breathing can be beneficial (See Handout)
d. Radical self-care
e. Support nutrient deficiencies
f. Support a healthy gut (probiotics (fermented foods, bone broth), prebiotics, reduce inflammation)
2. Minimize or let go of caffeine.
I know it’s a hard one. But what does caffeine do but causes stress on the HPA axis. Caffeine stimulates production of cortisol, which in turn raises your blood sugar. Go back to the image above—if cortisol is in need, then pregnenelone gets stolen to make cortisol instead of progesterone. If you’re trying to balance your system, it’s best to give it all the advantages you can. There is an alternative called, Capomo which is made from the Maya nut. It tastes and smells similar to coffee without the caffeine. I offer this option to clients to help break away from the coffee kick. Even if you start out with half and half and then break away completely.
3. Minimize or let go of alcohol.
Alcohol puts stress on the liver. Estrogen is detoxed via the liver. If you are trying to balance out your hormones, especially if estrogen dominant, it’s best to not overloaded the liver.
4. Minimize or let go of sugar.
Women with PMS consume 275% more sugar than those without PMS.3 Added dietary sugar stresses the HPA axis. When our system is stressed, cortisol raises blood sugar to give us energy. But elevated cortisol over time leads to overall elevated blood sugars. Sugar is inflammatory, as well, so it’s best to limit it. Remember sugars are found EVERYWHERE. Watch out for hidden sugars under different names like honey, cane sugar, high fructose corn syrup. Look for alternatives like monk fruit and stevia.
a. Vitamin C (brussel sprouts (also benefit of estrogen detox), orange, red pepper, guava, kiwi, strawberries); Supplemental form 750mg/day
b. Saffron 15mg 2x/day or as spice added to food
c. Chasteberry Vitex 500-1000mg/day (I like Pure Encapsulations)
d. Sunflower seeds—add them to your smoothie or eat a handful a day. Sunflower seeds have vitamin B6 and magnesium, which are necessary to form progesterone. May especially want to add them in your diet in the 2 weeks prior to your period, after ovulation.
e. Pumpkin seeds and Sesame seeds—also add them to your smoothie the 2 weeks prior to your period, after ovulation. These contain zinc, which is an aromatase inhibitor, and thus beneficial in reducing estrogen (as well as increasing testosterone and relieving urinary incontinence).
6. Get more light each day, especially during the first 2 weeks prior to your period (luteal phase). Get out in nature.4
7. Enjoy social relationships, especially with your female friends. Social bonding has been shown to increase saliva progesterone levels.5
8. Bioidentical progesterone cream
applied to the inner wrists or inner thighs 1-2x/daily during the last 2 weeks before your period (post-ovulation until menses)—if you still get your period. If you are menopausal or post-menopausal, you can safely apply it daily. Progesterone also has the benefit of improving sleep. (Pro-gest cream by Emerita or Phytogest Cream by Kevala). They are usually formulated into a 20mg pump. You can also talk to your doctor about other alternatives, but just make sure you ask for bioidentical forumlas.
It's a delicate balance and you have to find out what works for you. It's best to have your hormone levels tested so you can work from there. Contact your integrative ObGyn or Functional Medicine Practitioner for proper testing.
If you found this article helpful, please share it. If it left you with more questions, please feel free to contact Tianna to see how we can begin to work together to help you improve that progesterone predicament and bring you back to balance......so you can sleep better, feel more in control of your moods and normalize your period (if you're still having one).
1. Northrup, C. (2006). The Wisdom of Menopause: Creating Physical and Emotional Health and Healing During the Change. New York, NY: Bantam Books
2. Bulun SE, Cheng YH, Pavone ME, et al. “17Beta-hydroxysteroid dehydrogenase-deficiency and progesterone resistance in endometriosis.” Seminars in Reproductive Medicine. Jan;28(1) (2010): 44-50. doi: 10.1055/s-0029-1242992.
3. Abraham GE. “Nutritional factors in the etiology of premenstrual tension syndromes.” Journal of Reproductive Medicine 28(1983): 446-64.
4. Lam RW, Carter D, Misri S et al. “A controlled study of light therapy in women with late luteal phase dysphoric disorder.” Psychiatry Research (1999) 86 (3): 185-92.
5. Brown SL, Fredrickson BL, Wirth MM, et al. “Social closeness increases salivary progesterone in humans.” Hormones and Behavior. Jun;56(1) (2009): 108-11. doi:10.1016/j.yhbeh.2009.03.022. Epub 2009 Apr 9.
6. Drummond, J. (n.d.). EVIDENCE-BASED NUTRITION AND WELLNESS COACHING STRATEGIES FOR Women's Pelvic and Sexual Health: The HPA Axis and Natural Hormone Balance; 2015 [Scholarly project].
7. Kresser, C. (n.d.). Functional and Evolutionary Approach in Practice: Clinician’s Thyroid Disorders; 2016[Scholarly project].