Progesterone Fertility Guide

Progesterone Fertility Guide

Article Overview

Hormonal Balance is an important factor when it comes to healthy fertility and getting pregnant. During the course of a menstrual cycle various hormones are working together in a complex symphony to trigger the various components of ovulation and menstruation.

Progesterone is one of these key hormones. After ovulation progesterone production is triggered by Luteinizing Hormone (LH) which stimulates the corpus luteum (the remnant egg sac) in the ovary to produce progesterone. One of the main actions of progesterone with fertility is to help support a developing embryo.

If pregnancy occurs, the production of progesterone from the corpus luteum continues for about 7 weeks (it is then produced by the placenta for the duration of the pregnancy). If pregnancy did not occur, the period begins 14 days after ovulation. When fertilization does not occur the corpus luteum disintegrates, which causes the level of progesterone to fall and the endometrial tissue to disintegrate and shed as menstruation.

Menstrual Cycle

What Does Progesterone Do?

  • Progesterone maintains the lining of the uterus which makes it possible for a fertilized egg to attach and survive
  • Makes cervical mucous accessible by sperm
  • Allows the embryo to survive
  • Prevents immune rejection of the developing baby
  • Allows for full development of the fetus through pregnancy
  • Helps the body use fat for energy during pregnancy
  • Prevents secondary sexual development
  • Increases libido around ovulation
  • Activates osteoblasts to increase new bone formation
  • Protects against endometrial, breast, ovarian and prostate cancer
  • Normalizes blood clotting

Are You Progesterone Deficient or Estrogen Dominate?

Too much estrogen in the body

One of the main reasons women are progesterone deficient is because they have too much estrogen in the body. Estrogen dominance can happen for many reasons:

  • Commercially raised meats and dairy contain large amounts of estrogens, and consuming them can cause hormonal imbalance.
  • Pollution and stress mimic estrogen at the estrogen receptor sites.
  • Eating a large amount of processed soy products can also mimic estrogen.
  • PCOS and endometriosis can also have an estrogen dominate action.

Symptoms of estrogen dominance:

Allergy symptoms like asthma and hives
Breast cancer
Breast tenderness
Decreased sex drive
Depression with agitation and/or anxiety
Dry eyes
Early onset of menstruation
Fat gain, usually around the middles
Sluggish metabolism
Foggy thinking
Hair loss
Increased blood clotting
Fertility issues
Irregular periods
Polycystic ovaries

Not enough progesterone in the body

There are many signs that may show up in the body if you do not have enough progesterone in your system during the correct times of your cycle.

Symptoms of progesterone deficiency:

Recurrent early miscarriage
No period
Not ovulating
Cramps during menses
Blood clotting
Swollen breasts
Fibrocystic breasts
Loss of libido
Water retention
Low thyroid
Facial hair
Hot flashes
Night sweats
Vaginal dryness
Foggy thinking
Memory lapse
Sleep disturbances
Heart palpitations
Bone loss

Hormone Testing

Hormones testing can be diagnosed by a doctor, naturopath or by tests. There are a couple of test options. Tests range from charting your menstrual and basal body temperature, finding out the length of your luteal phase, or taking saliva or blood tests to find out your progesterone levels. The questionnaire above help to point out signs of progesterone deficiency while these tests help to confirm it.

BBT Charting
Basil Body Temperature charting can help to determine the availability of progesterone in the luteal phase. You can learn more about BBT Charting here. There will be a slight rise in temperature after ovulation has occurred and progesterone has increased.

Length of luteal phase
If the date of ovulation is fewer than 11 days before your period, this could suggest luteal phase defects. You can detect ovulation using BBT charting, ovulation detector strip tests.

Saliva Hormonal Testing
Dr. John Lee was very adamant that testing for hormones and progesterone should be done through saliva testing, not blood testing (almost all doctors will test the blood).

You can order an “at home” saliva test that you will take at a certain time during your cycle and then send away to a lab for analysis. They will then mail back the results so you can find out if you have any hormonal imbalances. You can order FDA approved home female hormone tests here.

Blood Hormonal Testing
While Dr. Lee was adamant about getting progesterone testing through saliva, it may be more helpful to work with your doctor to get your progesterone tested so they can explain the test results to you, even if it is a blood test. You most likely will also have other hormones tested at the same time which can give you insights to your entire hormonal profile.

When to Get Your Progesterone Levels Tested
The most appropriate time to measure serum progesterone is mid luteal phase (either 7 days after ovulation, or 7 days prior to expected menses). This is when you’re most likely to catch the peak progesterone level. This day will vary according to a woman’s cycle length however (for example, for a 28 day cycle, a day 21 progesterone is appropriate; but for a 35 day cycle, progesterone would ideally be measured around day 28).

How to Support Progesterone Levels

1. Reduce your exposure to xenohormones

We have become an estrogen dominate society from all of the excess estrogen in our foods and environment.

Reduce your exposure by avoiding these xenohormone producers:

  • Solvents and adhesives
  • Meat from conventionally raised livestock (non-organic)
  • Car exhaust
  • Almost all plastics
  • Petrochemically derived pesticides, herbicides, and fungicides
  • Emulsifiers found in soaps and cosmetics
  • PCD’s from industrial waste

2. Vitex for hormonal balance

Vitex angus castus. Photo by Sten Porse.

Vitex Extract (Chaste Tree Berry) is one of the most powerful herbs for women’s fertility and menstrual health. There are numerous studies and testimonials of Vitex and it’s effects on the body. One of the reasons Vitex is so effective and popular is because of its ability to balance hormones while not containing hormones itself. Vitex supports hormonal balance in the body by having an effect on the hypothalamic-pituitary-ovarian axins (hormonal feedback loop), correcting the problem at the source.

Directions for use
Capsules: 1,000mg a day is the suggested amount to use. Take vitex all month long.

Tincture: 90 drops in water or juice, first thing in the morning. All month long.

However, unlike powerful hormone drugs, vitex works slowly to normalize the body. Maximum benefits are often achieved after 6-12 cycles with vitex.

3. Use Natural Progesterone Cream

Natural progesterone cream can help to supplement your body’s own progesterone levels and lead you back to a state of natural balance.

Natural progesterone cream comes from plant fats and oils called diosgenin which is extracted either from Mexican Wild Yams or soybeans. In the laboratory diosgenin is chemically synthesized into a molecular structure that is identical to real human progesterone.

The United States Pharmacopoeia (USP) denotes a recognized standard of purity and strength. It is sometimes referred to as “human-identical” or “bio-identical” progesterone, which differentiates it from synthetic progestins or progestogens.

How to Use Progesterone Cream

Transdermal application (through the skin) has been found to be one of the most effective ways to use natural progesterone. It is absorbed through the skin into the underlying fat which helps to slowly allow progesterone into the blood. This way of application helps the progesterone to be “time released” into the blood stream. To closely mimic the body’s progesterone cycle, it is best to use progesterone cream twice a day.

How to Use Progesterone Cream for Fertility

Natural progesterone cream is easily and quickly absorbed into the body through the skin (within seconds). So you can apply it essentially anywhere as long as you rotate locations of application.

The best areas for application are places that have capillary blood flow such as:

  • Face
  • Neck
  • Upper Chest
  • Breasts
  • Inner arms
  • Palms of hands and feet

When it comes to dosage, more is not better. Too much progesterone may cause hormonal imbalances, just like too little progesterone can. General suggested dosage is 40mg daily, divided into one 20mg application in the am and one 20mg application in the pm, during the two weeks before your period.

Progesterone use should begin directly after ovulation, which is usually day 14 in the cycle (day 1 is the start of your period), and ending usage once menstruation begins. The best way to know exactly when to begin progesterone cream is to track ovulation with fertility charting. There are several ways to detect ovulation, such as OPK test strips, Ovulation Microscope and Basal Body Temperature (BBT) charting. Once ovulation is detected, progesterone cream would be started the following day.
General application of progesterone cream
What To Do Should You Become Pregnant
Once you become pregnant, stay on the progesterone and contact your healthcare provider. Read below for pregnancy instructions.

Loading Dose
A loading does is useful for women who have had many months or years of anovulatory (no ovulation) cycles, which can create extreme progesterone deficiency. Each cycle that passes without ovulation can increase estrogen dominance as progesterone stores are depleted. Very thin women who have little body fat can become estrogen dominant very easily as there is no fat to store extra progesterone. In either of these situations Dr. John Lee recommends a higher dose of progesterone the first one to two months of progesterone cream use. This helps to replenish the progesterone stored in the fat of the body. After 2-3 months the dose can be lowered to the usual ‘regular’ dosage.

Note: Some progesterone creams come in a squeeze tube, like Emerita Pro-Gest, which uses teaspoons as a measurement for dose. 1/4 teaspoon of Emerita Pro-Gest equals 20mg of progesterone cream. Others, like our Fertilica Natural Progesterone come with a pump. Each pump measures out exactly 20mg of progesterone cream.

Loading dose: 40mg twice a day, one 40mg application in the morning and one 40mg application at night, for a total of 80mg of natural progesterone a day. Apply for two weeks before your period (about day 14 in the cycle), up until menstruation begins.

Regular dose: 20mg twice a day, one 20mg application in the morning and one 20mg application at night, for a total of 40mg of natural progesterone a day. Apply for two weeks before your period (about day 14 in the cycle), up until menstruation begins.

Inducing ovulation using progesterone
Dr. Lee had a number of patients in his practice that had been unable to conceive because they were not ovulating. For two to four months he had them use natural progesterone from days 5 to 26 in the cycle (stopping on day 26 to bring on menstruation).

Using the progesterone prior to ovulation effectively suppressed ovulation. After a few months of this, he had them stop progesterone use. If you still have follicles left, they seem to respond to a few months of suppression with enthusiasm — the successful maturation and release of an egg.

His patients, some of whom had been trying to conceive for years, had very good results conceiving with this method. To learn more about this type of application, please read Dr. Lee’s book What Your Doctor May Not Tell You About Premenopause.

Preventing Miscarriage & Progesterone
Low progesterone during pregnancy can be one cause of recurrent miscarriages. Progesterone is responsible for creating a healthy environment in the womb by maintaining the uterine lining. It also reduces the chances of blood clots and the immune system responding to the fetus as if it was a foreign substance. Progesterone is one of the main pregnancy hormones.

If you feel this might be your situation, talk with your doctor or healthcare practitioner and get your hormone levels tested before using progesterone as well as intermittently to make sure your levels are high enough. Working with a healthcare practitioner is helpful as they can help to monitor your hormonal levels.

Make sure to have at least two bottles on hand, because running out could cause a big drop in progesterone which may cause the menstrual cycle to begin. Contact your doctor or midwife once you become pregnant so they can monitor your progesterone levels during pregnancy.

Progesterone & PCOS
Progesterone cream can help to oppose the estrogen dominance that occurs with PCOS. By using progesterone cream you are able to mimic a natural cycle and help the body to establish its own cycle, including ovulating, again. Dr. John Lee believed that with progesterone cream, changes to the PCOS specific diet and exercise, PCOS could become obsolete.

Progesterone Cream & PCOS

How to use progesterone for PCOS
There are two ways to use progesterone cream for PCOS. The first is the Suppression Cycle. To suppress the cycle one would use progesterone cream on cycle days 7-26. If you do not have a menstrual cycle you would choose a date on your calendar and mark it as day 7. Suppressing the cycle allows the body to rest by stopping the cycle of eggs not being released and estrogen/androgen dominance. Dr. John Lee suggests to use 60-100mg of progesterone cream a day during the suppression cycle and to repeat this for 3-4 months for best results.

Establish a cycle with progesterone cream
To help your body create a cycle including menstruation and ovulation, use progesterone cream on day 12 of cycle and continue until day 26. By stopping on day 26 your progesterone levels will drop, helping to start your menstrual cycle. If your cycle does not start, just treat your cycle like you are having one and start again on day 12. It is best to use a calendar so you can keep track of everything. After 3 or so months it is suggested to take a break for 1 month so you can see if your cycle has jump started itself.

Progesterone Cream & Endometriosis

Progesterone & Endometriosis
If you have endometriosis, Dr. John Lee recommends using progesterone from days 8 to 26 of your cycle, to reduce the effects of estrogen on the body (estrogen stimulates endometrial growth). Take a short week off to refresh your receptor sites. He has had success with this controlling symptoms within six months. Once the outbreaks of endometriosis are tolerable reduce the usage to days 12 till menstrual cycle.

Progesterone Use During Pregnancy

Progesterone Use During Pregnancy
Natural progesterone is safe to use during pregnancy with the consent of your doctor or midwife and may likely prevent many first trimester miscarriages that are due to low progesterone but should be used with caution when nursing as it may stop lactation.

In the first trimester of pregnancy progesterone production is the sole responsibility of the ovaries, but they often fail to produce sufficient levels to maintain the pregnancy. By the second trimester, the placenta itself is responsible for producing progesterone, and it hikes the level of this hormone to 486% higher than the non-pregnant norm.

If you are taking progesterone and get pregnant, you must continue taking progesterone until at least the 16th week. I personally would not stop if I had seriously low levels to begin with. But it is best to work with your health care practitioner if this is the case. They will continuously monitor your levels to make sure they are healthy for pregnancy. Click here to learn more about proper use of natural progesterone cream use in pregnancy…


Healthy progesterone levels are important during conception and pregnancy. You can find out if your levels are where they should be by getting tested. If you do find your levels are low there are many natural ways to promote healthy progesterone levels such as:

1. Reducing Xenohormones
2. Using Vitex
3. Applying progesterone cream

If you become pregnant, continue to use the cream and consult with your doctor or midwife right away.

Progesterone Q&A

Progesterone Q&A

Related Articles

1. Lee, John, M.D. Hormone Balance Made Simple. 2006
2. Lee, John, M.D. What Your Doctor May Not Tell You About Premenopause. 1999
3. Hobbs, Christopher, L.Ac. Vitex The Women’s Herb. 2003
4. Trickey, Ruth. Women, Hormones, and the Menstrual Cycle. 2003
5. Weed, Susun. Herbal for the Childbearing Year. 1986
6. California PSR and CALPIRG. “Generations at Risk” Chemicals and Reproductive Health.PDF
7. The British Journal of Psychiatry (1968) 114: 1377-1382 doi: 10.1192/bjp.114.516.1377


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  1. Hello! I have a question about starting progesterone cream but can’t seem to figure out the answer for my situation. I’ve been tracking bbt for two cycles now and noticed that while I get menstrual bleeding, I have not ovulated either cycle. So, I have bleeding, but no ovulation. How would you go about using progesterone for this situation? I don’t necessarily need to “bring on” a bleeding cycle, but I also don’t know when I would start given that I don’t have a date of ovulation since it doesn’t happen. Also, my cycles aren’t necessarily the same length. The first cycle was 44 days and I’m on day 33 of this cycle with no typical symptoms of getting my period. Help!!

    Thanks in advance!

    • Dear Stacey,

      General suggested use of Fertilica natural progesterone cream is for the two weeks prior to menstruation. To know when to begin using natural progesterone cream, count backwards two weeks (fourteen days) from the first day of your last menstrual period and this cycle day is the day of the current cycle to start using the cream. The cycle day to start natural progesterone cream may change each cycle until they regulate.

      Is this helpful?

  2. Hi! I took a saliva test that relived I have very very low progesterone. I came off birth control at the end of July 2014 and have not had a period since the withdrawl bleed. I was on femaprin for 2 months but now I am on bio-identical progesterone and chaste berry since January and nothing seems to work. I started taking maca as well. All I want is my period back so that my husband and I can conceive and have a baby. I’m not sure what else to do. I have done a detox and cleanse of the liver, kidney, and lymphs. Any suggestions? This is the only thing I stress about!

    • Dear Jackie,

      I am sorry this even has to be a source of stress for you!

      Are you working with a practitioner who suggested the bio-identical progesterone, Vitex (Chastetree berry) and Maca to you? If so, it may be worth reaching out to him to evaluate the doses you are taking/using. While we know natural progesterone cream to be rather fast acting, clinical research shows that Vitex may start working within 10 days, but full benefits may not be experienced until 6 months or longer.

      It may be worth considering the information provided in the article How to Balance Your Hormones After Birth Control as well. We also offer one on one guidance from our fertility herbalist who will evaluate your diet, lifestyle and fertility health concerns to help determine areas that may need to be addressed. This experience is called a Fertility Consultation. This may be helpful!

  3. I am 33 years old and have not been able to have kids. Every time I get pregnant, my progesterone levels are low so they have given me progesterone suppositories, or injections. My pregnancies go as far as 6-9 weeks and then I have a miscarriage. I have tried asking to check my levels of progesterone and to be prescribed progesterone before I get pregnant. I believe that by the time I find out I’m pregnant, get an appointment and get the prescription it’s not enough time to raise my progesterone levels and I end up loosing my pregnancy. I am so frustrated… My first pregnancy was a stillborn at 7 months due to blood clots and since then have had miscarriages. What can you recommend I do? Last year my gynecologist did a progesterone level test and said I may have a deficiency, and told me to contact her as soon as I ovulate, but it was hard to figure out when I ovulate because my periods are very irregular. Now I have not had my period since 3 or 4 months ago.

    • Dear Mabel,

      I am sorry this journey has been nothing less than frustrating and sad for you. I am very sorry for your loss.

      Progesterone levels have proven well supported while trying to conceive by the female fertility herb Vitex and Fertilica Natural Progesterone Cream. Fertilica Vitex is also supportive of hormone balance when menstrual cycle irregularities are present. Both are discussed in this article. There are even FDA-approved home female hormone tests to consider trying.

      Consider also learning more about Systemic Enzyme Therapy to support fertility health as well as the 5 Steps To Decreasing the Chance of Recurrent Miscarriages.

      I hope this is a helpful place to start!

      You may also want to consider a Natural Fertility Consultation. Our email consultations provide you with a personalized written guide and audio recording from a fertility herbalist, explaining the best natural therapies, herbs and nutritional supplements, dietary and lifestyle tips for your unique fertility issues.

      All my best!

  4. Hi,
    I am 40 years old, have PCOS. My period has been irregular due to my low progesterone level. I just started Fertilica progesterone cream this month. I picked my day 12 (on Jan 28) and started having spotting/light bleeding on day 23. Do I need to continue using the cream till day 26 (which will be Feb 11) OR do I need to stop it right away and wait for the new cycle? Need your advice.

    • Dear Julie,

      Spotting when using natural progesterone cream could mean that either the dose is a bit too high for your needs, or that it has been used on the wrong cycle days. Did you continue natural progesterone cream until today, Feb. 11th?

      The other thing to know is that estrogen dominance may become worse when first beginning natural progesterone cream. This can cause concern, but should go away over the menstrual cycle or two as progesterone levels increase. What does this mean though? Our Senior Herbalist Dalene shares that “when first introducing progesterone back into the body after an extended period of progesterone deficiency, the estrogen receptor sites ‘wake up’ (are stimulated), enhancing the action of estrogen for a short period of time. This is a sign that the body is responding well to the progesterone, even though at the beginning it can exacerbate estrogen dominance symptoms one of which is spotting…”

      I hope this is helpful!

    • Hi Elizabeth,
      Yes, I used it till today, and still having light spotting/bleeding. I use 80 mg per day, divided 40 mg each morning and night. Should I reduce it? Also, can I use my 1st day of spotting as 1st day of period? (since I haven’t had period for months prior using fertlica cream). Need help to determine the date for my next cycle.

    • Hello Julie!

      General suggested dosage of Fertilica Natural Progesterone Cream is 40mg daily total, divided into one 20mg application in the am and one 20mg application in the pm, during the two weeks before your period when working to establish a menstrual cycle How to use progesterone for PCOS; Establish a cycle with progesterone cream. This being said, 80mg may be just fine for you.

      It sounds as though this may be a menstrual period given it has lasted now 4 days. It seems that your body has responded to the Fertilica Natural Progesterone Cream. That is great! Cycle day 1 could be considered February 8th then.

      I hope this too is helpful!