Without proper progesterone production, the uterine lining cannot easily grow to either shed during a normal menstrual period or sustain the health and growth of an embryo. Progesterone a vital hormone for reproductive wellness and female fertility. So, when women learn their progesterone is low they google what they can do about it, often to learn of progesterone cream. Below are several questions about supporting healthy progesterone levels and proper use of natural progesterone cream.

Q1: “I lack progesterone. What should I eat?”

A: Supporting healthy hormonal balance, including progesterone levels, does begin with following a healthy whole food diet, such as the Fertility Diet. Do be sure to eat foods rich in vitamin B6 – wild Alaskan salmon, tuna, bananas, spinach, walnuts, grass-fed beef, cage-free chicken, sweet potatoes, prunes and beans. It may take more than diet to improve progesterone levels naturally, however. So, I think it would be most helpful to refer to our Progesterone Fertility Guide to learn more on reducing exposure to xenohormones, the herb Vitex (Vitex agnus-castus) and natural progesterone cream.

Q2: “I have pcos. It seems that I am stuck in a 14 day cycle. I have a 4-5 day period. Then about the time someone with a normal cycle would ovulate I start my period again. If I start the progesterone cream on day twelve, do you think it would have time to take effect and lengthen my cycle? I am not trying to conceive right now. I’m just trying for a normal cycle.”

A: It may be best to first consider making dietary and lifestyle changes, while enlisting the help of herbs, nutritional supplements and natural therapies first for a minimum of three cycles or so to see how the body responds. We feel it is best to ensure progesterone levels are low prior to using natural progesterone cream. This is done through testing. So, if you can give a natural program for PCOS a try, as we share of in our guide How to Reduce the Damaging Effects of PCOS on Fertility Through Diet and Herbs, that’d be a great start.

All that said, if you are going to try using progesterone cream, theoretically it may work to start the cream on the day after ovulation (or around cycle day 12 if you are not ovulating) and apply it daily until your period starts or for two weeks, whichever comes first. Keep in mind that the cycle days of use may shift as progesterone levels increase and the body works to relearn balance. In general, with dietary and lifestyle changes the body should begin to adjust to progesterone therapy over 3 menstrual cycles or so (it can take longer).

Q3: I’m on month three of the ovarian cyst cleanse. I’ve been struggling with fatigue even when I get TWELVE hours of sleep at night! I’m concerned that the progesterone cream may be the cause. I’ve had a few people tell me their doctor told them to take their progesterone at night because of fatigue (and plenty of other people tell me complete other things haha). Is it an option to do all 40mg in the evening instead of 20/am and 20/pm? Anyone else mentioned this as a possible side effect?

A: (by Certified Herbalist Sarah Abernathy): May I ask if your progesterone was ever tested prior to the cream use? We usually only suggest using it after levels are confirmed low.

Additionally, progesterone can cause fatigue in some women. Using progesterone cream can also temporarily increase estrogen dominance symptoms like fatigue, especially when you first begin it. Tip: Using Maca 500-1,500mg per day may help give you a little more energy if you’re interested in trying it.

For your other question, unfortunately, we do not suggest doubling up on the cream dose. I asked our Senior Herbalist and she explains: “The split dosage ensures optimum progesterone levels are maintained throughout the day. Splitting the dosage ensures 8-12 hours of sustained delivery – which more closely mimics how your body produces progesterone. Using one big dose in the evening risks a full 12 hours of no progesterone absorption.”

Note: If it’s been a few months or more, and fatigue is still an issue, then it is perhaps time to test progesterone levels again to confirm that 40 mg total daily is still needed.

Q4: In terms of application, I know everybody says to apply the cream to your skin but I read this article by Dr. Mercola and can’t help feel convinced that it should be applied via the vagina or rectum? Thoughts?

A: There are differing usage instructions of progesterone cream by different practitioners. We do not suggest using FertilicaTM Natural Progesterone Cream, or Emerita Pro-Gest vaginally or rectally. We follow the usage guidelines of Dr. John Lee and his suggested application is that progesterone cream is best applied to the skin (transdermal application): to the face, neck, upper chest, breasts, inner arms and palms of hands and feet. You will want to work with a qualified practitioner to guide you in vaginal or rectal use. This is best not done on your own.

Q5: Wouldn’t it be easier to just take a progesterone pill?

A: We follow the guidance and expertise of the late Dr. John Lee who recommends a transdermal application of progesterone cream rather than oral progesterone because upwards of 80% to 90% of an oral dose of progesterone can be lost through the liver. This is why progesterone pills taken orally are often prescribed at doses of at least 200 to 400 mg daily. This amount is necessary orally to achieve a physiologic dose of 15 to 24 mg daily. Such high doses create undesirable metabolites and unnecessarily overload the liver. Ultimately, the form of progesterone you use is up to you. Side note: Many women are given oral progesterone supplements in pregnancy and it is fine to take the prescription pills to ensure your pregnancy is safe.

Supporting healthy progesterone levels…
Supporting healthy hormonal balance, including progesterone levels, is important for reproductive wellness. It is always good to ensure you are eating as healthy of a diet as you can, one like the Fertility Diet, moving or exercising regularly to maintain a healthy BMI and then using herbs, nutritional supplements and natural therapies. It is when the body is healthy that natural therapies can be most effective for nourishing the body systems involved in hormonal balance. Eat right, exercise, take your herbs and supplements, and you’ll be setting yourself up for balance and success.

Resources to help you learn more:
Progesterone Fertility Guide
Progesterone Fertility Q&A
Natural Progesterone Cream Use: 10 Things You Should Know
Use of Progesterone Cream with an Irregular Menstrual Cycle Q&A

Elizabeth Willett - M.A., Certified Herbalist

Elizabeth Willett is the Senior Herbalist and Lead Educator at NaturalFertilityInfo.com. She holds a BS in Mass Communications (2000) from Minnesota State University, and a Master of Arts degree (MA, 2010) in Holistic Health Studies with a specialization is herbalism from St. Catherine University in St. Paul, MN. Liz has written over 200 articles on women’s fertility and brings a vast wealth of knowledge and expertise in holistic health and healing to Natural Fertility Info.com