If you’ve been trying to conceive for any length of time (or at least thinking about it for any length of time) you have probably heard of LH strips (AKA OPKs, LH test, ovulation test, luteinizing hormone tests, ovulation predictor kits). LH strips are a pretty standard tool in the TTC communities and are often recommended to help improve odds of getting pregnant in any given cycle. But the way you use LH strips, whether correctly or incorrectly, could make or break your TTC efforts. This article will help you avoid making this common mistake.

What are LH strips?

LH strips are home urine tests that can be used to identify the surge of luteinizing hormone (LH). LH strips, when used correctly, predict ovulation to help couples who are trying to conceive by improving the precision of their efforts. Conception really only is possible during a six-ish day window of the menstrual cycle, corresponding to the five days leading up to and including ovulation, plus the day after. [Learn more about fertility, hormones, and the fertile window in my book, Go with Your Flow.] Contrary to most Sex Ed classes (or what is exemplified in the movie Mean Girls) a single sexual encounter is actually less likely to result in pregnancy then it is to cause it, statistically speaking. 

Knowing this, most cycle tracking apps offer a predicted fertile window to aid users in identifying the days of the month when they are likely to conceive from intercourse. Now, of course, these apps make their predictions based on averages (which ironically do not actually reflect the average woman) that assume a luteal phase length of 14 days, with ovulation occurring approximately mid-cycle.

To give you a few examples:

• For a woman with an average cycle length of 28 days, her app would predict ovulation on day 14, with a 14-day luteal phase thereafter
• A woman with a 35 day cycle would receive a prediction for ovulation on cycle day 21 (again with a 14-day luteal phase)
• A woman with a 24 day cycle would receive a prediction for ovulation on cycle day 10 (based on a 14-day assumed luteal phase)

While any of these scenarios could be true for a given woman, it is also true (and especially important to note) that countless other variations are also possible.

Why

Because not all luteal phases are 14 days in length.

Let’s go back to the “textbook” 28-day cycle for a moment: this woman may have:

• A 14-day luteal phase with ovulation on day 14
• But she just as easily may have a 12-day luteal phase with ovulation on day 16.
• Or even the somewhat atypical 15 (or more) day luteal phase with ovulation on day 13.
• She also could have a less-optimal but still potentially fertile 8-day luteal phase with ovulation on day 20. 

Even within just this 7 day variation, you can see easily that miscalculating the day of ovulation could mean completely missing the entire fertile window. Yikes.

So, instead of relying on the law of averages and missing the important detail of individual biology, scientists have come up with easy, at-home ways for tracking ovulation, based on the hormonal dance that takes place throughout a menstrual cycle. Ergo, LH strips or “ovulation predictor kits.”

How Do LH Strips Work?

In order to understand the lowly LH strip, we first need to understand it’s namesake hormone, LH–or luteinizing hormone.

In a nutshell, luteinizing hormone is a chemical signal sent by the brain to tell the ovary to release an egg.

The menstrual cycle is divided into two parts (which are, as we already learned, not necessarily halves) by ovulation, marking the transition point between the two.

The first part of the cycle, called the follicular phase is all about the development of an ovarian follicle (AKA egg) which bursts open during the event of ovulation. If a sperm is there, ready and waiting, when this occurs, fertilization and subsequent conception could theoretically occur. (Note: It goes without saying that many other factors are involved when determining whether or not pregnancy occurs, but those are beyond the scope of this article.) 

An Overview of Ovulation

During the follicular phase, the brain releases FSH, or follicle stimulating hormone, to facilitate maturation of the egg. As the egg matures, it produces increasing levels of estrogen, which the brain monitors. In addition to thickening and developing the uterine lining to prepare for a possible pregnancy (or period), this rising estrogen level serves as a communication signal to the brain to keep the nervous system in the loop about the status of the egg and it’s development. Once estrogen levels reach a high enough point, the brain then responds with its own signal (LH) to trigger ovulation.

After the follicle releases its egg, it then transforms into a progesterone-producing gland called the corpus luteum, which serves as the namesake for the second part of the cycle: the luteal phase. 

In reality, LH is produced at least a little bit every day of the cycle, even when menstruating. However, the key differentiating factor between “everyday LH” and the LH surge is the tremendous increase in amount of LH being released in any given moment. For younger women, the daily average LH level may be less than 1.0 mIU/mL, though for someone who is perimenopausal, it may fall into the tens-range. With regards to the brain-ovary line of communication, it’s not so much the actual numerical value of LH as much as it is the magnitude of change. To trigger ovulation typically LH levels must rise by a factor of 10, but for some people it is much more than this. It is not uncommon for LH levels to exceed 100 mIU/mL at the peak of the surge.

LH levels may also be high at a baseline in women with PMOS (formerly named PCOS) because of dysregulated estrogen signaling from polycystic ovaries. Both in the case of PCOS/PMOS and perimenopause, these slightly higher baseline LH levels may result in the rupture of more than one follicle at a time leading to a multiples pregnancy. This is why fraternal twins are statistically more common in women of older age and in women who have PCOS/PMOS. 

The Confusion About LH Strip Timing

Because LH starts to rise shortly before the release of the egg, and because conception is most likely if sperm are already ready and waiting in the fallopian tube at the time of ovulation, studies have identified that the most fertile days-–or the days of the cycle on which conception is most likely–-do not correspond to the day of ovulation itself, but rather to the day prior, and even the day before that. This allows sperm to make their way through the reproductive tract, undergo the capacitation process (which basically is just a fancy term for saying the sperm reaches its own peak maturity, which takes about 10 hours), and be ready to greet the egg when she make her arrival. 

To use an LH strip, a woman simply collects a urine sample, dips the test strip in the urine, and then waits a few minutes during which the LH present in her urine reacts with dye and adheres to a small line of antibody printed on the strip. Like a pregnancy test, LH strips also have a control line which is always dark in color. However, the key difference between a pregnancy test and an LH strip is the fact that LH is always present (whereas the pregnancy hormone hCG is not.) So, with an LH strip, a pale pink test line indicates a negative whereas a dark pink test line (which is as dark as, or darker than the control line) indicates a positive. 

But here’s the catch… LH surges for most women last multiple days. (Studies show an average of 4.8 duration.) Typically over this timeframe, the LH levels rise rapidly, peak, and then fall back down to baseline. While the actual length of the LH surge varies from woman to woman, the key factor here when predicting ovulation is to pay attention to the beginning of the LH surge rather than the peak. It’s the dramatic rising nature of LH that triggers ovulation, not the absolute maximum (as we have already discussed that the peak itself can vary in magnitude from woman to woman, as well as throughout a woman’s life, depending on the season of her fertility).

To flush this out a little bit more:

• One woman might have a 4-day LH surge with the peak occurring at the 48-hour mark
• Another woman might have a 1-day LH surge with the peak occurring at the 12 hour mark

Although the day of the peak itself varies in this scenario by over a day and a half, the important thing is that the beginning of the surge falls on the same day for both women. Because ovulation occurs roughly 12 to 36 hours after the start of the surge, both of these women would have ovulation happening on the same day. But for the first woman, her LH surge didn’t peak until after she actually ovulated. 

The real kicker is that this, statistically speaking, is the norm:

Medical researchers have found that for roughly 94% of ovulating women, LH peaked 1.2 days after ovulation already occurred. (Study link)

This means that if you are relying on the peak day, meaning the day that your LH strip is the darkest rather than the first day that you get a positive, and you are timing, your TTC efforts according to this, there is a very good chance that you will not be having sex until after ovulation has come and gone. Which means you aren’t going to get pregnant even if you have a perfectly healthy egg and a perfectly healthy sperm. (Chances of conception on the day after ovulation are 5% or less.)

Now this is an area of confusion that I often see among patients, in my real life conversations, and online. While many LH strips delineate the first positive day as being of highest importance in their instructions, the whole thing gets a little bit confusing because the test strips don’t provide numerical values; they simply use an analog, observation-based indicator. For women who are new to using LH strips, the color gradient can be kind of confusing. 

But let’s say you are among the women who know to count from the day of the first positive test. Well, because of the whole individual variation principle, and because of the variation among test sensitivity on LH strips from different manufacturers, you still might accidentally be missing the start of your LH surge. Here’s why…

How LH Strips Work 

I touched on this a little bit earlier, but to go into a bit more detail:

In an LH strip assay, urine flows across the strip and carries LH molecules toward antibodies attached to colored particles. The LH binds to these color-labeled antibodies, forming pink LH–antibody complexes. These complexes continue moving until they reach the test line, where another set of antibodies captures them. The accumulated colored particles produce the visible test line, with more LH generally producing a darker line. A separate control line confirms that the sample flowed correctly and the assay functioned properly.

Just like pregnancy test, which come indifferent sensitivity levels (i.e. 6.3 mIU/mL for the First Response Early Result compared to 25 mIU/mL for most standard tests and “internet cheapies”) LH strips can come in different sensitivity levels, generally ranging between 10 and 40 mIU/mL. An LH strip with a lower detection limit. (i.e. 10 mIU/mL) can pick up on lower level levels of LH hormone in the urine and will provide a brighter or darker test line. Meanwhile, an LH strip with a lower sensitivity. (i.e. 40 mIU/mL) will pick up LH in urine only when it has a higher level. Therefore, the same concentration of LH in the same urine sample would show up differently on these two tests: a darker line on the higher sensitivity LH strip (10 mIU/mL) and a lighter line on the lower sensitivity LH strip (40 mIU/mL).

If you are somebody who has a generally lower LH level and a comparatively lower peak, LH strips are going to show up lighter overall than someone who has a generally higher LH level. If you are using a high sensitivity test, this shouldn’t be a problem as it’s going to show test lines of the appropriate darkness and identify the beginning of your surge without issue. Like anyone else, your line will get darker as you reach the peak–but as we have already covered, it is the beginning of the surge that matters the most. This means that for the high sensitivity (10 mIU/mL) LH strip, the test line is equivalent in shade to the control line. But sometime thereafter, the test line would get darker than the control line (around your peak). However, if you were to use a lower sensitivity LH strip (i.e. 40 mIU/mL), your test line might not be dark enough at the start of your surge to indicate a positive test (as identified by a test line of equivalent darkness to the control line) even though, biologically speaking, the LH surge has started. 

In other words, you might not see a positive until you reach the peak of your LH surge which–if you are like the 94% of women in the world, is 1.2 days after ovulation rather than 12 to 36 hours before.

Understanding LH Strips in Real Life

Let’s take a look at this chart made using an Inito fertility monitor, which provides numerical data for all four fertility hormones (LH, estrogen, FSH and PdG, which represents progesterone).

As you can see on this chart, the purple line (LH) has risen dramatically from baseline levels. (This isn’t evident in the photo, but the day prior, the LH level was 0.08 mIU/mL). Having risen to 3.14 mIU/mL, it increased by several orders of magnitude, indicating the beginning of the LH surge. This indicates that ovulation will occur within 12-36 hours.

Now, let’s compare that same test to a standard, analog, over-the-counter LH strip:

The LH strip at the top of this photo was taken on the same day, with the same urine sample as the Inito reading. According to the definition of “positive” being the test line as dark as the control, this test would not be considered positive.

But we know that it is, because of the several days of preceding data identified with the Inito monitor.

Now let’s move on to the next day in this cycle:

On this next day, the Inito fertility monitor identified an LH level of 19.37 mIU/mL (corresponding to the peak of the surge) and the standard, over-the-counter LH strip turned positive (as evidenced by the bottom strip in the photo on the right, where you can also see the old, dried out strip from the day prior for comparison). The Inito identified the start of the LH surge on cycle day 12, whereas the OTC LH strip was negative. In reality, ovulation occurred sometime thereafter, and was likely complete by the time the LH surge reached its peak on day 13. The OTC LH strip did not identify a positive until cycle day 13, but as we know from Inito, ovulation had already likely occurred.

Here’s another example with Inito. In this cycle, the LH surge was identified on cycle day 16, with both the peak and the first positive taking place on the same day. In this case, the standard OTC test strip would be positive too.

Do you see the problem?

In short, standard, over-the-counter LH strips are great if you’re someone with a generally high LH level, but they may miss the start of the surge for women with lower levels (or more dilute urine). Missing the start of the surge by just one day could mean missing the day of ovulation altogether.

Of course, the obvious way around this is to make sure that you’re having intercourse (or, as it’s more commonly referred to on the online forums, “baby dancing”) daily throughout your fertile window. (If you don’t know when that is, I would suggest starting as soon as your period ends and continuing until you’re sure you’ve ovulated, whether via monitoring cervical mucus, basal body temperature, or with a device like Inito.)

Alternatively, you could check the sensitivity of your LH strips.

LH strips come with different sensitivity levels. When in doubt, use a high-sensitivity strip. Here are a few options:

• The Inito Fertility Monitor, which provides numerical data up to two tenths of a decimal (0.01 mIU/mL) for LH, plus the other 3 fertility hormones
• PreMom Quantitative Ovulation Predictor Kit and LH Strips which range from 0-65 mIU/mL
• Clearblue Advanced Digital Ovulation Test, which is sensitive to 40 mIU/mL
• Easy @ Home LH Strips, which observe 25-30 mIU/mL

The Bottom Line on LH Strips

If you’re using LH strips to time conception, don’t wait for the darkest test line to start trying. Pay attention to your month-to-month averages, and make sure you’re TTC well before your LH strips show a positive. View the LH positive as a signal for when you can stop trying (a few days after your positive) rather than a signal to start. Because a standard LH strip may miss the earliest part of your surge, consider testing more frequently as you approach your fertile window, and choose a more sensitive or quantitative test if your strips tend to turn positive late.

Most importantly, don’t put all your timing eggs in one hormonal basket: combine LH testing with cervical mucus, cycle patterns, or another method of confirming ovulation. The goal isn’t to perfectly predict the moment the egg is released, but to make sure sperm are already there waiting when it happens.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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The post Are You Using LH Strips Wrong? appeared first on Dr. Alexandra MacKillop.

Progesterone is quite the buzz word these days. Whether you’re in perimenopause and considering hormone replacement therapy (HRT), you’re newly pregnant and having levels tested, or you’re experiencing some menstrual irregularities attributed to imbalances between estrogen and progesterone, the term has likely come up for you. But, what is progesterone What does it do for the body How do you know if you have enough of it How can you test progesterone levels at home Read on to find answers to all these questions and more.

What is progesterone and how can you test progesterone levels at home?

Progesterone is a hormone primarily produced by the ovaries in women, particularly after ovulation during the second half of the menstrual cycle. After ovulation, a gland called the corpus luteum forms which secretes progesterone. If you don’t ovulate, you can’t make progesterone because you won’t have a corpus lutem. You need progesterone because it plays a crucial role in regulating the body’s functions, including:

1. Menstrual Cycle: Progesterone helps prepare the uterine lining for potential implantation of a fertilized egg. It also prevents the uterine lining from getting too thick or shedding too quickly.
2. Pregnancy: If pregnancy occurs, progesterone helps maintain the uterine lining, supporting the developing embryo. This is where progesterone gets its name from: pro-gest(ation)
3. Breast Development: It also protects breast tissue from too much estrogen and prepares the breasts for milk production during pregnancy.

In addition to its role in female reproductive health, progesterone is involved in other bodily functions, including mood regulation, sleep and maintaining bone density. (Because it’s so important, and because many providers don’t test levels in office, it’s helpful to know how to test progesterone levels at home.) It is also used in hormone replacement therapy and in various contraceptive methods. Let’s take a closer look:

Progesterone and Brain Health

Progesterone significantly affects the brain and mood due to its influence on neurotransmitters and brain function. Here are some key ways it affects mood:

1. Neurotransmitter Modulation: Progesterone enhances the effects of certain neurotransmitters, such as gamma-aminobutyric acid (GABA), which has calming effects and reduces anxiety.
2. Mood Regulation: Changes in progesterone levels during the menstrual cycle lead to mood fluctuations. Higher levels in the luteal phase (after ovulation) contributes to feelings of calmness, while lower levels pre-menstruation correlates with mood swings or premenstrual syndrome (PMS).
3. Anxiety and Depression: Studies show that progesterone protects against anxiety and depression, though the relationship varies from person to person. I describe estrogen as an “energizing” hormone, which motivates and gets you going. But all that energy, when not balanced by the cool, calming effects of progesterone, becomes anxiety and irritability. Knowing how to test progesterone levels at home is helpful when struggling with premenstrual symptoms like depression or anxiety. If you can track your levels, you can anticipate better how to support your mood.
4. Neuroprotection: Progesterone may have neuroprotective properties, potentially supporting brain health and cognitive function. Maintainin healthy progesterone levels throughout life decreases risk of brain fog and neurodegeneration.
5. Sleep Quality: Progesterone is also linked to improved sleep quality, which subsequently boosts mood. Insomnia is a problem for many perimenopausal women, and the most common prescription is estrogen hormone replacement therapy. However, progesterone actually is much more effective at improving sleep both in perimenopause and at other times of life.

Progesterone and Metabolism

Progesterone affects metabolism and blood sugar control in several ways:

1. Cortisol Interaction: Progesterone interacts with cortisol, the stress hormone. High levels of cortisol affect blood sugar levels and metabolism, and progesterone helps moderate some of these effects.
2. Reproductive Health: In women with polycystic ovary syndrome (PCOS) or other hormonal imbalances, therapeutic strategies that increase progesterone also help regulate menstrual cycles and improve metabolic outcomes. In many cases, low progesterone levels in early pregnancy can lead to miscarriage, which is why it’s helpful to know how to track progesterone levels at home (so you can advocate for yourself in a healthcare provider’s office!)

Progesterone and Thyroid Function

Progesterone affects thyroid function in several ways, largely due to its interactions with thyroid hormones and the overall hormonal balance in the body. Here are some key points:

1. Thyroid Hormone Regulation: Progesterone changes how and when the body makes thyroid hormone, influencing metabolism. It also helps support the synthesis of thyroid hormones and enhances their effects.
2. Binding Proteins: Progesterone affects the levels of thyroid-binding globulin (TBG), a protein that binds thyroid hormones in the blood. Increased levels of TBG can lead to higher total thyroid hormone levels, and increased metabolic rate/response.
3. Metabolic Rate: Progesterone benefits metabolic rate, partly by influencing thyroid hormone activity. This dramatically impacts energy levels and weight management.
4. Hormonal Balance: In women, fluctuations in progesterone during the menstrual cycle influences thyroid function. For example, low progesterone levels are associated with conditions like hypothyroidism and infertility.

Progesterone, Adrenal Function and Cortisol

Progesterone has several effects on adrenal function and cortisol levels, primarily through its interactions with the endocrine system. Here are the key points:

1. Stress Response: Progesterone helps modulate the body’s response to stress. It has a calming effect and counterbalances some of the stimulating effects of cortisol and estrogen.
2. Hormonal Balance: The relationship between progesterone, cortisol, and other hormones is complex. High cortisol levels can lead to a decrease in progesterone, contributing to hormonal imbalances that can affect mood, energy levels, and overall health.

Does the birth control pill have progesterone?

Progestins, the synthetic versions of progesterone used in many forms of birth control, differ from natural progesterone in several key ways:

1. Chemical Structure: Progestins are chemically modified molecules of testosterone that have been changed to interact with the human brain and ovaries. Although they are chemically similar, they are not exactly the same.
2. Hormonal Activity: While progestins mimic some of the actions of natural progesterone, they can have varying degrees of activity on progesterone receptors and other hormone receptors (like androgen and glucocorticoid receptors). This leads to side effects that are not typically associated with natural progesterone. The progestins in birth control contribute to insulin resistance, thyroid disorders and depression whereas natural progesterone prevents those things.
3. Side Effects: The side effects of progestins differ from those of natural progesterone due to their altered hormonal activity. Many experience mood changes, weight gain, or acne with artificial progestins, while these effects don’t occur with natural progesterone.
4. Impact on Menstrual Cycle: Progestins can affect the menstrual cycle in ways that natural progesterone does not, such as altering bleeding patterns, causing lighter or more irregular periods, or even stopping menstruation altogether in some users.

The biggest takeaway is that using artificial progestins, by design, prevents your body from producing its own progesterone. If you have progestins, you can’t have progesterone, and you’re therefore automatically progesterone deficient. In this case, it won’t be helpful to test progesterone levels at home.

How to Test Progesterone Levels

The first and most important thing is to determine if you’re ovulating. If you aren’t ovulating, you can’t make progesterone because you won’t have the corpus luteum gland we discussed earlier. It is impossible to “test” progesterone levels at home if you’re not ovulating because you will not have any meaningful level of progesterone in your body. That means that if you’re using oral ceontraceptives like the birth control pill, or other forms of hormonal drugs like the implant, the Nuva Ring, or certain types of IUD, you aren’t ovulating and subsequently are progesterone deficient.

However, other health conditions may also cause low progesterone because of anovulation, like thyroid disorders, hypothalamic amenorrhea (stress-induced anovulation and lack of periods), and PCOS to name a few. If you aren’t having ovulatory periods at least every month, you are likely deficient in progesterone.

1. How to Track Progesterone Levels at Home with Ovulation

To track your progesterone levels at home, you first need to find out if you’re ovulating and when. The most straightforward way to know if you’re ovulating is to track your cycle using basal body temperature. I wrote a blog post all about how to do this which you can access here. You also can track ovulation using prediction methods, such as urinary LH testing or tracking cervical fluid, though it’s important to note that these methods do not confirm ovulation. Rather, they predict when (generally) in your cycle you may be close to ovulation.

When tracking ovulation, mark the following…

• The day before your basal body temperature rises above baseline
• The day after you have a positive LH test strip
• The day before your cervical fluid transitions from watery/ewcm (egg white cervical mucus) to a thick, dry, gluey texture

2. How to Track Progesterone Levels at Home with Luteal Phase

Once you have identified the day of ovulation, the next step in learning how to track your progesterone levels at home is calculating your average luteal phase length. The luteal phase is calculated from the total cycle length (i.e. 28 days) minus the day of ovulation (i.e. day 14). In the example just given, a 28-day cycle minus ovulation day of CD 14 would be a 14-day luteal phase, which is optimal.

A short luteal phase, which is less than 10 days long, is a sign of progesterone deficiency.

However, tracking luteal phase at home also helps you to know when the optimal day to test progesterone levels is, whether using a urinary hormone test at home or you are visiting a lab facility to have a progesterone blood draw. The optimal day to test progesterone levels is 5 to 7 days before your next period. Obviously, if you have no idea how long your luteal phase is, you don’t know when to predict that optimal 5-to-7-day period. This is why it’s important to track cycle length, day of ovulation, and luteal phase length for several cycles before tracking progesterone levels at home. Testing on the wrong day might give results that make it seem like you have a less-than-optimal level of progesterone.

Basal body temperature charts can also give indication of progesterone levels. While they are an indirect measure, if you have an elevation of your body temperature above baseline that is less than 0.5 degrees Fahrenheit, it may be a sign of low progesterone levels.

3. How to Track Progesterone Levels at Home with Luteal Phase

After the corpus luteum makes progesterone, the body breaks it down into a progesterone metabolite called Pregnanediol Glucuronide (PdG) which can be measured in urine, similarly to urinary LH test strips. While it is not exactly the same as progesterone, it reflects progesterone production and levels in the body.

PdG test strips can be purchased inexpensively over the counter, such as Easy @ Home, Proov and Inito (a comprehensive fertility hormone testing system that also includes estradiol, LH and FSH levels). Using urinary PdG, a level of 5 ug/mL indicates successful ovulaiton, which is roughly equivalent to a serum progesterone level of 10 ng/mL. The optimal levels for urinary PdG and blood serum progesterone would then be 7.5 ug/mL (urinary) and 15 ug/mL (serum) respectively.

How to Track Progesterone Levels at Home with Signs and Symptoms of Progesterone Deficiency

While clinical symptoms don’t confirm progesterone deficiency, they may serve as a clue that you are low on progesterone and should consider starting to test your progsterone levels at home. These include:

• Irregular Menstrual Cycles: Changes in cycle length, missed periods, or very light or heavy menstrual bleeding.
• PMS Symptoms: Increased premenstrual syndrome (PMS) symptoms, such as mood swings, irritability, and bloating.
• Mood Changes: Anxiety, depression, or mood swings that are more pronounced around the menstrual cycle.
• Sleep Issues: Difficulty sleeping or insomnia.
• Hot Flashes: Symptoms resembling those of menopause, including hot flashes and night sweats.
• Weight Gain: Unexplained weight gain or difficulty losing weight, often due to changes in metabolism.
• Low Libido: Decreased sexual desire or changes in sexual function.
• Fatigue: Increased fatigue or low energy levels.
• Breast Changes: Tenderness or changes in breast tissue, including fibrocystic changes.
• Hair Loss or Thinning: Changes in hair growth, including thinning hair or hair loss.

Perimenopause

One of the hallmarks of perimenopause is a shortening luteal phase length, shorter menstrual cycles and less progesterone. Estrogen also takes off on a roller coaster ride. You can diagnose perimenopause with an elevated FSH level in combination with a normal or increased LH level, or with increased LH and FSH in combination with having had a menstrual period in the last 12 months. Being age 40 or above is also a good sign that your progesterone levels are changing.

Test for Progesterone with Lab Testing

Of course, the only way to know for sure that you have low progesterone levels (provided that you are ovulating) is to test them. A progesterone level of at least 4.44 ng/mL (this may vary slightly depending on the lab) is required to confirm ovulation. However, what we care most about is the peak progesterone level achieved in the luteal phase. Because normal luteal phases typically range from 10-14 days, you need to test your progesterone level between 5 and 7 days before the start of your next period.

If you have regular menstrual cycles and track ovulation with basal body temperature, you know exactly when you’ll reach the midpoint of your luteal phase. If you don’t know when you ovulate, look at the average length of your menstrual cycles. If your cycles are between 24 and 28 days long, I’d recommend scheduling a blood draw 5 days before your next expected period. If they are 29 days or longer, I’d recommend scheduling a blood draw to be 7 days before your next expected period. Note that this isn’t a perfect algorithm; it’s possible to have a 14-day luteal phase in a 24-day cycle and a 10-day luteal phase in a 33-day cycle. However, particularly in the case of perimenopause, a short cycle is more likely to be accompanied by a relatively shorter luteal phase. The target is at least 15.0 ng/mL at the peak progesterone production, however higher is always better. (Note: non-pregnant cycles rarely exceed 28 ng/mL)

Not having enough progesterone leads to a range of health risks and complications, particularly in women. Symptoms include irregular periods, heavy bleeding, or amenorrhea (the absence of menstruation). This hormonal imbalance also exacerbates premenstrual syndrome (PMS) symptoms, leading to heightened mood swings, anxiety, and irritability. Additionally, progesterone deficiency is associated with an increased risk of endometrial hyperplasia, a condition where the uterine lining becomes too thick, potentially raising the risk of endometrial cancer. It also affects bone health, as progesterone plays a role in maintaining bone density; low levels may contribute to osteoporosis over time. Furthermore, inadequate progesterone leads to fertility issues, as it is essential for preparing the uterine lining for implantation of a fertilized egg. Overall, a lack of progesterone significantly impacts physical and emotional well-being, so if you are concerned about your progetserone levels, be sure to seek care from a functional medicine physician.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

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Sign Me Up!

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Test Progesterone Levels at Home appeared first on Dr. Alexandra MacKillop.

One of the most common stories I hear from my patients when they come to me for functional medicine treatment is that they primary care doctor told them they were “fine.” In some cases, their doctors even ran a blood panel, reviewed the test results, and proudly told the patient that nothing was wrong. The problem is, for these patients, that wasn’t good news.

That’s because they didn’t feel like everything was “fine.” Quite the opposite, actually! These patients had made appointments with their doctors (and often waited a long time to see them) because they were dealing with troubling, debilitating symptoms. From fatigue and brain fog to digestive distress, and more. Seeing a healthcare provider only to be told there is no diagnosis feels dismissive, invalidating, and frustrating because no answers means no treatment; and no treatment means they need to keep feeling bad.

The Problem With Traditional Medicine and PCPs

The traditional medical model sets us up for failure in these cases. If a PCP exhausts his or her tools for screening a patient, that patient is left in the dark to figure things out on their own, or to find another model for medical care. That’s where functional medicine comes into play.

Functional medicine’s goal is to identify the root cause of disease. That means understanding the patterns of breakdown in bodily systems that lead to devlopment of disease. Diagnosing disease, for the most part, is not that hard. You simply need to run the right tests and conduct the right clinical exams. In some cases, doctors do a bad job of this, but that phenomenon isn’t simply a consequent of traditional medicine. (There are good doctors and bad doctors everywhere!) But where a given disease process isn’t obvious, we need to also recognize that underlying processes which will one day result in clinical disease, create pathological symptoms in the mean time.

Take blood sugar problems, for example. Type 2 Diabetes is a disease in which the pancreas fails to produce enough insulin, and the body’s cells fail to respond effectively to insulin, enough to keep blood sugar levels from rising dangerously. In this disease, the high blood sugar levels cause poor blood circulation, organ damage, vision problems, nerve pain and loss of sensation, low energy and weight gain. However, before Type 2 Diabetes develops, we see prediabetes. Before prediabetes, we see insulin resistance. Before insulin resistance, we see patterns of abnormal blood glucose spikes and drops. Where traditional medicine says “You’re good! You’re not diabetic!” in thise early stages, functional medicine recognizes the red flag that those early pathological states are, and validates the fact that patients in those early disease states still experience symptoms worth addressing.

But we need to be able to clinically diagnose those early disease states, because the feeling of rising-and-falling blood sugar are similar to the early stages of subclinical hypothyroidism, perimenopause, allergies, anxiety, and so many other things. In the absence of accurate test results, it’s easy to tell a middle-aged woman that her symptoms are “probably” due to aging and perimenopause, for example, or a a young adult with chronic allergies that the other symptoms are “probably” just part of those allergies. “Allergies are bad this year!”

But “probably” is not a diagnosis. “Probably” doesn’t help anyone.

Functional Medicine Tests to The Rescue

With the blood sugar example outlined earlier, in order to understand whether a non-diabetic patient is dealing with prediabetes, or insulin resistance, or poor blood sugar control, or a problem entirely separate from metabolic dysfunction, we need to run testing to identify what’s going on.

To do that, functional medicine doctors use two types of testing: more comprehensive standardized tests, and specialized functional medicine tests.

Comprehensive Standardized Tests

In this discussion, “standardized tests” refers to testing that a traditional medical provider could and may actually run, but typically doesn’t. As an example, about 50% of PCPs that I co-manage care with run vitamin D tests on patients as part of an annual screening and the other 50% do not. My husband’s primary care doctor ran it without him even asking and mine did not put the order in until I directly asked. Some others flat out refuse even though it’s completely reasonable for them to do so.

Similarly, with the topic of metabolic health, PCP’s could run fasting insulin levels in addition to hA1c, fasting glucose and triglycerides. In the realm of cardiovascular health, a PCP could easily test LDL Particle Number in addition to LDL levels on a cholesterol panel. It’s not typical but it is definitely possible.

Here are some other examples of comprehensive testing that could be run in a standard medical office:

• Fasting insulin in addition to hA1c, fasting glucose and triglycerides
• A full thyroid panel instead of just TSH
• Inflammatory markers, like hs-CRP and sedimentation rate
• Cycle-specific testing of estradiol, testosterone, progesterone and DHEA levels
• Ferritin, serum iron, % saturation and TIBC in addition to a CBC
• Vitamin B12, folate, zinc, magnesium and vitamin D levels

The Cost of Testing

Because these tests are available through traditional labs, they are often able to be covered by traditional health insurance, provided they are used correctly and coded for correctly. In some cases, however, you should be aware that insurance companies may refuse to pay for certain tests to be used as screening. So, if a provider orders them for you, as with all testing and procedures, you should call your insurance company first to know what you might be expected to pay.

The reason most primary care doctors don’t run these comprehensive tests is because it’s not the easy, standard model. It’s more complicated to code for these tests, and more comprehensive follow-up is necessary. Unfortunately the way our current medical system is built, doctors just don’t have time for those things. The average doctor’s appointment is less than 20 minutes, and patients typically see their doctors less than once per year. It’s an overburdened and broken system for sure. That’s why we need not only functional medicine doctors to fill gaps, but a reform of the system to provide better care in general.

Functional Medicine Specialty Testing

Beyond the comprehensive testing that’s available through traditional labs, functional medicine doctors sometimes run tests that are not available through the traditional medical model. Additional training and enrollment in laboratory services is required for these higher-level tests. These tests are at the cutting edge of medical testing, and they don’t necessarily lead to diagnosis of a clinical disease, like Type 2 Diabetes, for example. However, they help identify some of the earlier disease processes that lead to both current symptoms and future development of disease.

Here’s an example: there is no medical diagnosis in the traditional model for a deficiency of beneficial bacteria in the human body. However, we all know just how important probiotics are for human health, and the problems that are caused when we wipe them out (like from overuse of antibiotics.) We know that bacterial imbalances cause severe digestive distress, and also that they create a breeding ground for new infection (C. diff for example.) Functional medicine offers stool testing to identify bacterial imbalances which both create risk of future disease as well as present-day symptoms.

Here are some other examples of “above-and-beyond” testing in functional medicine:

• Salivary and urinary hormone metabolite testing
• Microbiome testing
• Intestinal markers of digestive enzyme activity, inflammation, and short-chain fatty acids
• Cardiovascular markers like LPA PLA2, lipoprotein(a), omega-3 levels and more
• Comprehensive heavy metal testing
• Mold testing
• Organic Acids Testing
• SIBO Testing
• Continuous Glucose Monitoring

…and so much more

Cost of Testing

Because these tests are highly specialized and on the cutting edge of medical advancement, most insurance companies will not pay for them. While some testing panels may include elements that would be covered by traditional insurance, such as occult blood in stool or 17-hydroxypregnenolone, for example, the laboratories themselves do not contract with insurance companies and therefore it is not possible to have coverage for them. The cost of individual tests that may have coverage outside of the panel are negligible when run as a full panel, which offers much greater value than trying to piece together individual tests a-la-carte and not having the full picture. The primary value of these tests, of course, comes from their ability to explain symptoms where traditional labs fall short.

The beauty of functional medicine tests is that they provide a way of diagnosing and describing a person’s symptoms and health status with objective, medical data, creating the possibility of creating a treatment plan as a next step. When doctors and patients understand the health condition at play, the suffering person can finally find healing.

Because, I think we can all agree that if a person is experiencing symptoms, they aren’t “fine.” If the lab tests come back normal, it means the right lab tests haven’t been run yet. And until a diagnosis is made, that person is going to keep on feeling terrible and potentially create lasting health problems in the long run. But functional medicine offers the solutions needed to meet patients where they are and help them restore their health before it is too late.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post What Are Functional Medicine Tests and How Can They Help Your Health? appeared first on Dr. Alexandra MacKillop.