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 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 break-down 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
Fatigue
Sluggish metabolism
Foggy thinking
Hair loss
Headaches
Increased blood clotting
Fertility issues
Irregular periods
Insomnia
PMS
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
Endometriosis
PCOS
PMS
Cramps during menses
Blood clotting
Swollen breasts
Fibrocystic breasts
Loss of libido
Obesity
Depression
Water retention
Low thyroid
Facial hair
Hot flashes
Night sweats
Vaginal dryness
Foggy thinking
Memory lapse
Incontinence
Tearful
Depressed
Sleep disturbances
Heart palpitations
Bone loss

Hormone Testing

Hormone testing can be performed by a medical doctor, naturopathic doctor or by an at-home testing service. Testing options range from charting your menstrual cycle to determine the length of your luteal phase, to basal body temperature tracking during your luteal (consistently low BBT may indicate low progesterone production), to taking saliva or blood tests to find out your progesterone levels. The questionnaire above helps 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, steady rise in temperature after ovulation has occurred and progesterone has increased. An irregular or consistently low BBT may indicate low progesterone and luteal phase defect.

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 or by using 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 times 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, day 21 progesterone testing 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 (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 its 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 axis (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.

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 and 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 14 of your 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 14. 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 controlling symptoms within six months. Once the outbreaks of endometriosis are tolerable reduce the usage to day 14 until your menstrual cycle begins.

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…

Summary

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


References:
1. Lee, John, M.D. (2006) Hormone Balance Made Simple. Werner Books: New York, New York.
2. Lee, John, M.D. (1999). What Your Doctor May Not Tell You About Premenopause. Grand Central Life & Style – Hachette Book Group: New York, New York.
3. Hobbs, Christopher, L.Ac. (2003). Vitex The Women’s Herb. Healthy Living Publications: Summertown, Tennessee.
4. Trickey, Ruth. (2003). Women, Hormones, and the Menstrual Cycle. Giffen Press: South Australia.
5. Weed, Susun. (1986). Wise Woman Herbal for the Childbearing Year. Ash Tree Publishing: Woodstock, New York.
6. Schettler, T., M.D., M.P.H.; Solomon, G., M.D., M.P.H.; Kaplan, J., M.E.S.; Valenti, M. (n.d). “Generations at Risk: How Environmental Toxicants May Affect Reproductive Health in California.” California PSR and CALPIRG. Retrieved online at: http://www.psr-la.org/files/generations_at_risk.pdf
7. Dalton, K. (1968). Ante-natal progesterone and intelligence. The British Journal of Psychiatry, 114(516), 1377-1382. doi: 10.1192/bjp.114.516.1377

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  1. i have an irregular cycle and for the past 3 months it has been around 50 days. I am considering using progesterone cream. would i start it on day 14 to mimic a natural cycle?

    • Hi Kristina,

      Progesterone cream supplementation is best utilized only when you have confirmed low progesterone through testing. If you don’t know if you have low progesterone, you could ask your doctor to run a progesterone test. I think you will find our article Use of Progesterone Cream with an Irregular Menstrual Cycle Q&A helpful. There are many other natural remedies that can help the body to regulate the menstrual cycle such as herbs and fertility massage. These are a much gentler, supportive approach. Women who don’t know if they have low progesterone or not shouldn’t supplement with progesterone, even if there is information stating you can regulate your cycle with progesterone cream.

      I hope that helps you!

  2. I don’t ovulate regularly and I have irregular or no periods. I am trying to conceive with clomid however my ovulation is still unpredictable on when or if I will. This cycle, my progesterone was too low to confirm ovulat-tested day 22. Since I don’t know when/if I ovulate or when my period will be, what day should I start progesterone cream? What happens if I use the progesterone after day 14 but I didn’t ovulate or I might ovulate late in my cycle. What happens if I did ovulate but started using the progesterone cream NOT right after ovulation but days after? Is it better than nothing or does it need to be right after ovulation? Just in case I ovulate late, I don’t want to start too early.

    • Hi Jessica,

      Thank you for your questions, they are good ones! If you have confirmed very low progesterone, supplementing with progesterone cream will likely take many, many months to increase your progesterone levels. For an average person with low progesterone, it can take anywhere from 4-12 months of consistent progesterone cream supplementation at a regular dose to get levels up to normal. So, it is highly unlikely if your levels are very low, that you will suppress ovulation with progesterone cream supplementation at first, since you will be working to build up to normal levels. It would be best to try to “create a cycle” by using the progesterone cream consistently at the same time each cycle. Make up your own cycle and stick to it. In the mean time be sure to chart ovulation via BBT or OPK, or another reliable method. We don’t recommend using progesterone cream during the same cycle you are using Clomid without guidance from your doctor.

      We find a handful of herbs helpful in promoting regular ovulation, sometime they can help get the menstrual cycle on track, which makes it easier to figure out when to apply progesterone cream. None of these herbs can be used in the same cycle as use of Clomid. Keep in mind, Clomid can help you achieve pregnancy, but it doesn’t resolve the underlying health issue that is causing your absent and irregular cycles.

      You might find our Use of Progesterone Cream with an Irregular Menstrual Cycle Q&A helpful too!

  3. Hi there,
    I have been tracking my cycles for the past 4 months and I have a pretty consistent 8-10 day luteal phase. As I am trying to get pregnant, I understand that this is likely too short to conceive. I have an appointment scheduled with my obgyn for next month. I have started taking Vitex 3x/day this cycle, and will ovulate in about 5-6 days from today. Should I go ahead and also try the progesterone cream? I have the Emerita brand, but wasn’t sure if I should try the Vitex by itself or go ahead and also use the cream. Thanks for your advice!

    • Dear Lily,

      It is best to determine low progesterone levels through testing before using natural progesterone cream. That said it is known that if progesterone levels do not elevate enough after ovulation, or drop too soon before menstruation begins, a short luteal phase can result. Vitex and progesterone cream are two natural remedies used to support a healthy progesterone rise. Diet, antioxidants and vitamin B6 can also be helpful. Consider learning more in our guide Luteal Phase Defect: Natural Treatment Options.

  4. I used Vitex just for one cycle while trying for my second, I got positive pregnancy results on Day 29. Progesterone is very low ranges between 2-4. Dr just asks to repeat HCG tests to see if pregnancy is progressing fine. HCG was 30 on Day 32 and 56 on Day 33. Dr says its not very reassuring that pregnancy is progressing. I started red spotting on on Day 33. Would the progesterone cream still help. Dr is not giving progesterone supplements yet. Can I still use over the counter natural cream to help support pregnancy. or just wait and watch like the Dr says. It feels disappointing to not try and save it and just wait and watch. Please suggest. Thanks!

    • Dear Dipali,

      It would be best to find a midwife to work with, or ask your doctor to guide you in using progesterone cream. This being said, if it were me, I would want to do everything in my power. I would hate for you to regret just waiting to see what happens if you truly do not want to. This being said, if the pregnancy is not viable, progesterone cream is not going to reverse that.

      If you choose to try progesterone cream, choose a pure progesterone cream such as Emerita Pro-Gest. Here is a guide to Natural Progesterone Cream Use in Pregnancy to help you decide what is best to do for your needs.

      All my best!