How to Test Progesterone Levels at Home

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.