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Progesterone Fertility Guide

Progesterone Fertility Guide

Article Overview

Hormonal Balance is an important factor when it comes to healthy fertility and getting pregnant. Throughout the 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 approximately 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 starts 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
  • 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

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 produce excess estrogen.

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
Excess bleeding during menses
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


Click here to learn about Fertilica™ Natural Progesterone

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. 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 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.

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 (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 allow progesterone dissolve slowly 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.

Click here to learn about Fertilica™ Natural Progesterone Cream

Progesterone use should begin directly after ovulation, which is usually day 14 in the cycle (day 1 is the start of your period), and end 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. Excessively thin women lack both estrogen and 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 using 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 shop for Fertilica™ Natural Progesterone Cream

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

  • Lee, John, M.D. (2006) Hormone Balance Made Simple. Werner Books: New York, New York.
  • 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.
  • Hobbs, Christopher, L.Ac. (2003). Vitex The Women’s Herb. Healthy Living Publications: Summertown, Tennessee.
  • Trickey, Ruth. (2003). Women, Hormones, and the Menstrual Cycle. Giffen Press: South Australia.
  • Weed, Susun. (1986). Wise Woman Herbal for the Childbearing Year. Ash Tree Publishing: Woodstock, New York.
  • 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 from: http://www.psr-la.org/files/generations_at_risk.pdf
  • Dalton, K. (1968). Ante-natal progesterone and intelligence. The British Journal of Psychiatry, 114(516), 1377-1382. doi: 10.1192/bjp.114.516.1377 Retrieved from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/antenatal-progesterone-and-intelligence/070A87B8800351685DDBCDD3177CD453

Hethir Rodriguez - Certified Herbalist, Nutritionist, Birth Doula

Hethir Rodriguez is the Founder and President of Natural Fertility Info.com. She has been a Certified Herbalist for over 19 years, holds a Bachelors degree (BS) in Nutrition Sciences and is a Certified Birth Doula and Massage Therapist specializing in fertility massage. Since founding Natural Fertility Info.com in 2007, Hethir’s research, articles, and guides have been read by over 40,000,000 people, currently averaging at over 1,000,000+ readers per month.  Hethir has dedicated her life to helping provide a source for high quality, research based information and support for those on their journey to becoming parents.

Dr. Kimberly Langdon Cull M.D., OB/GYN
Dr. Kimberly Langdon Cull M.D., OB/GYN

Dr. Kimberly Langdon Cull is a University-trained Obstetrician/Gynecologist with 19-years of clinical experience. She delivered over 2000 babies and specializes in gynecologic diseases such as menstrual disorders, infertility diagnosis and treatment especially pertaining to tubal blockage and polycystic ovarian syndrome (PCOS). Dr. Langdon is the inventor of 6 patent pending medical devices, and attended Ohio State University from 1987-1995 receiving her Medical Doctorate Degree (M.D.) with Honors in Obstetrics and Gynecology.

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  1. Should progesterone cream be used in the same way for menopausal women.

    • Dear Barbara,

      Our site focuses on guiding women who have not yet begun menopause. It would be best to find a resource for guidance that focuses on women in menopause. Dr. John Lee or Dr. Christianne Northrup may be two to look into.

      My best!

  2. HEllo,
    I read on another fertility website to take a break from Vitex for a few days every month. If you have irregular cycles, I read that you take take 5 days off from DAy 1 of your cycle, take Vitex for 25 days, then take 5 days off (depending on when your cycle happens…)

  3. Dear Mrs. Willet,

    I was wondering how long you can use natural progesterone cream safely? (in months)
    Is it possible to get hormone imbalances when you use it for a longer period at a time? I was pointed out by someone that it might be harmful in different ways and can cause illness or negative side effects. So now I am worrying a bit about that. I thought that maybe it might be wise then to take a pause every couple of months when pregnancy does not occur. (I have progesterone deficiency) Thank you so much for answering my question.
    Warm regards,
    Donna

    • Dear Donna,

      What we know is that it can take anywhere from 4-12 months to bring progesterone levels back up in women with very low progesterone levels. In general we suggest its use, while following a holistic natural fertility program, for a minimum of three months, up to 6 months while paying attention to how the body is responding/shifting before making a change to said program. It would also be a good idea to have progesterone levels monitored during this time to know how levels are shifting and if you might need to adjust the dose, or if you can wean off of progesterone cream. Each woman will be different, so the length of safe use for you will likely be different from the length of safe use for me or another.

  4. Hi! Thanks for the great article!

    I’m just about to embark on my next Embryo Transfer. I haven’t ovulated yet but am thinking of taking the cream after ovulation. Although, I did progesterone testing on my last two cycles, the first with a level of 16ml and last month at 17ml. Is my body already producing enough to sustain a health pregnancy without the cream? Or will taking a little bit “extra” be beneficial in some way?
    Side note: I do have PCOS with long cycles. However, when I ovulate, my progesterone blood levels are in the normal range.

    • Dear Alexandra,

      I can’t support using progesterone cream with normal progesterone levels or during this time without your doctor knowing and guiding you. Please talk to your doctor or at least his nurse before starting progesterone cream during this time.

      We share other ways to prepare for embryo transfer in our guide 5 Steps to Preparing for a Frozen Embryo Transfer should that be helpful!

      My best!

  5. Hello,
    I bleed from the day after my LH surge till I get my (heavy) period. The first two days after my LH surge are moderate bleeding (I need to wear a panty liner and there are small clots, no pain). I’ve been taking vitex for 6 mo. due to no or late LH surge, now I have a normal LH surge (day 14), but lots of spotting after. I feel that this is due to low progesterone. I have regular cycles, 26-28 days, but I’m not convinced that I’m ovulating. I read that Vitex can increase your estrogen and that I should probably take break from it. Any advice on what to do about vitex? Progesterone cream? (I worked nights as an RN for 2.5 yrs, I think thats what messed up my hormones)

    • Dear Emily,

      Vitex is known to help the body increase LH production and stimulate the formation of the corpus luteum. The corpus luteum is responsible for the secretion of progesterone. We know it to be best taken consistently for 6-12 months for optimal effect. That said, there may be more to consider, such as progesterone cream, dietary and lifestyle changes, a whole food multivitamin, omega-3s and B vitamins (a B complex maybe). Maybe our guide Mid-Cycle Spotting – Should You Be Concerned? will share some helpful tips/info as well. I do hope so!

  6. Hello, I have PCOS and started to take progesterone cream on day 12 of my cycle. Today is day 21 and I started bleeding and cramping a little. I’m not sure if it is a period or just spotting, but should I continue taking the progesterone cream until day 26 ? Can you tell me what should I do if it is just spotting, and what should I do if it is a period ? Thanks a lot.

    • Dear Sarah,

      If this is just spotting, progesterone cream can be continued as instructed. If menstruation starts, progesterone cream is best stopped and started again as instructed. It is okay that the start date of the cream shifts should this be menstruation. It may until the body shows regularity and balance again.

      It’s great that you’ve seem some shifting already!

  7. I have stage 4 endometriosis diagnosed via laparoscopy.We have been ttc for 17 months and then took a break as my docter have put me on Visanne(dienogest).I started bleeding on 20 march and got a positive HCG test on 1 April and the next three days negative HCG test? My docter says the bleeding is from my body that is still “settling” from the Visanne. We have tried Vitex, OPK, BBT, Charting and everything to conceive with no luck.I have endometriosis on my ovary and pelvic wall lines.I don’t know if I ovulate.My doctor said my tubes are fine after my lap but never tested if they are blocked or not. 6 months after excision surgery i had an endometrioma back again.Any ideas on to conceiving?

  8. If you increase your potential to have progesterone can you start ovulating again? Thanks

  9. I have spotting for 3-5 days prior to day 1 of my cycle. I have been told by my RE that I have low progesterone, though I still don’t know why, and have been struggling with infertility for almost 3 years. As we gear up for our 3rd round of IVF, we’ve been ttc naturally. I had left over Crinone progesterone suppositories that I began 3 days after ovulation twice a day (last cycle). Unfortunately, I ran out after 4 days and thought I had more but didn’t. My menses started soon after I stopped and was about 3 days early. I’m trying to find a progesterone cream that could help me conceive. I’m confused though by the cream containing soy. I thought I’m suposed to avoid soy?

    • Dear Anna,

      Processes, GMO soy (not so much fermented soy or non-GMO whole edamame sparingly) is best avoided when battling infertility. Regarding bio-idential progesterone creams however, there is a substance called diosgenin in soybeans and wild yams that is extracted and then modified in a the laboratory to create the progesterone found in progesterone creams. It is no longer the soybean or mexican wild yam, as a whole plant, but rather just one chemical part of the plant. Only the diosgenin from the soy would be converted to bio-identical progesterone and there would be no trace of it’s other chemical make-up such as the phytoestrogen content or isoflavones that you will most often read about related to female fertility.

  10. Dear Elizabeth,
    Thank you so much for your wonderfull work. What can you advice when you have Endometriosis and PCOS and want to get pregnant?

    Jacqueline

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