Progesterone is a tiny molecule that plays a big role in the hormonal picture. When levels start to go awry, our health and well-being suffers. Understanding how our hormones affect wellness is not only an important tool for self-care, but this knowledge also gives us the power to advocate for ourselves so we can access the care we deserve. Whether your goal is to regulate your cycle, conceive and carry a healthy pregnancy, reduce the long-term risks associated with hormonal imbalances, or just gain some good, old-fashioned information about how your body was designed, read on!

Hormones throughout Your Cycle

Throughout the female cycle, two hormones tend to be held responsible for triggering key events such as ovulation and the start of a period:

• In the first half of the cycle, estrogen rises and falls, correlating with a hormonal signal from the brain that triggers the release of an egg.
• Following ovulation, the corpus luteum produces progesterone, which is responsible for thickening the uterine lining in anticipating of pregnancy.
• After about seven days, progesterone levels peak and begin to steadily decline; once they drop low enough, the lining starts to shed, signaling the start of a period and another cycle.

When progesterone levels drop too low, or aren’t produced in a functional ratio in comparison to other sex hormones like testosterone and estrogen, our health suffers. Chronically low progesterone can increase risk of osteoporosis, poor blood sugar control and diabetes, breast cancer, depression, anxiety, and other neurocognitive disorders. Low progesterone also leads to symptoms such as:

• Migraines
• Absent or irregular periods
• Bleeding or spotting between periods
• Low libido
• Recurrent miscarriages
• Painful periods
• Insomnia
• Luteal phase defect
• Infertility
• and more…

What Causes Progesterone Deficiency?

The production of progesterone from the ovaries is regulated by the hypothalamic-pituitary-gonadal axis, a delicate web of signals between the brain and reproductive organs. Progesterone deficiency can result from interruptions along the entire axis, whether from a signaling problem at the brain level, or from dysfunction of the ovaries themselves. One of the most common reasons for low progesterone is chronic stress. Elevated stress hormones create a negative feedback loop that interrupts the signaling between the brain and ovaries, decreasing progesterone production. In many cases, especially with women who are over-exercising or under-eating, stress acts on the HPG axis to prevent ovulation altogether. Without ovulation, the corpus luteum doesn’t form, and the main mechanism for producing progesterone during the luteal phase is completely taken out of the picture.

Here are a few other reasons for low progesterone:

• Adrenal dysfunction
• Perimenopause
• Vitamin deficiencies
• PCOS
• Low body fat
• High prolactin (such as in breastfeeding women)
• Calorie or carb-restricted diet
• Too much exercise (especially high-intensity or weight training)
• Use of contraceptives containing synthetic progestins
• Oophorectomy (surgical removal of ovaries)
• Hypothyroidism
• Inflammation
• Estrogen Dominance (creating a relative progesterone deficiency)

What to Do About Progesterone Deficiency

As with any hormonal imbalance, effective treatment starts with identifying the root cause. This is why it’s so important to work with a naturally-minded healthcare provider to review diagnostic tests and lifestyle/history to get to the bottom of the progesterone deficiency. If undereating is the driving force behind low progesterone, for example, no amount of vitamins or supplements will effectively solve the problem. The nutrition (and the relationship with food) needs to be addressed, first!

Note: I explain the details of what is and isn’t normal and how to explore natural treatment options in my book, Go with Your Flow. Click here to learn more.

Once an appropriate diagnosis is made and healing efforts are underway, there are a number of steps that can be taken to help the body natural restore progesterone production, balance out the production of estrogen, and get the hormone levels back to a functional status quo.

Lifestyle

Diet and Exercise: Overdoing it in the gym and under eating are the main forces behind low progesterone. These create a state of allostatic overload, lowering progesterone output or altogether inhibiting ovulation—a condition called hypothalamic amenorrhea. When I’m working with a patient whose history and labs point to progesterone deficiency, the first place I start is with cutting back on exercise, and upping her intake of carbohydrates and fats. Hormones are produced from fat and cholesterol, so adding in foods like eggs, butter, and oily fish are essential. Carbs are also extremely important for women, and we can’t menstruate without them. Low-carb and calorie-restricted diets also affect production of all kinds of other hormones, including thyroid, immune, metabolism, and more.  

Stress: In my clinical experience, the most common cause of hormonal imbalances among women are related to stress. Whether that source of stress is emotional, relational, physical, nutritional, or otherwise, stress management is key. Progesterone and cortisol are both produced from the same hormonal precursor, called pregnenolone. When stress levels are high, the body allocates its resources towards producing cortisol, which means there aren’t many leftovers for producing progesterone. (This is called pregnenolone steal.) The end result is a low progesterone level. Stress also inhibits the HPG axis at the brain level, preventing the LH surge that triggers ovulation. Without ovulation, it’s impossible for progesterone levels to remain high enough for health and fertility.

Sleep: Sleep and stress go hand in hand. When we aren’t sleeping enough, cortisol production goes into overdrive, creating all the problems described above. Lack of sleep also distorts the circadian rhythm, changing the natural patterns of sleep hormones and neurotransmitters that regulate cyclical patterns in the body—everything from the sleep/wake cycle to the menstrual cycle. Lack of sleep also tends come along with over-use of stimulants such as caffeine and nicotine, which create their own subset of hormonal fallout.

Progesterone has a reciprocal relationship with sleep deprivation. Since one of the roles of progesterone is to create a feeling of calm and relaxation, low progesterone can feed forward into insomnia symptoms, furthering the degree of sleep disruption and deprivation. Targeting issues like insomnia at their root cause is essential for true health and healing.

For more information about lifestyle methods for balancing hormones, checkout this post: 5 Ways to Balance Your Hormones, Naturally

Supplements

Progesterone Cream: Progesterone cream is a supplemental form of progesterone that is applied as a lotion to the skin and absorbed into the blood stream. Just like a pill, progesterone cream supplements the existing amount of progesterone produced by the body, but does not address the root cause behind the progesterone deficiency. However, progesterone cream can be a helpful temporary step for women who are suffering from extremely painful periods, or who are experiencing fertility struggles due to low progesterone.

Vitamin D: Vitamin D really is more appropriately classified as a hormone than a vitamin. Like other hormones, it is derived from cholesterol and circulates throughout the body, communicating with almost every organ system. Vitamin D also plays a regulatory role in the production of sex hormones. Because of our largely indoor lives and the risk of skin cancer from UV exposure, most Americans are deficient in vitamin D. In my clinic, I test every patient’s vitamin D levels so that I can safely prescribe supplements to restore functional vitamin D levels and hormonal balance.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4507331/Vitamin B6: In women suffering from a luteal phase defect (a luteal phase that lasts 11 days or fewer, which is a consequence of low progesterone), supplementation with vitamin B6 has been proven to extend the length of the luteal phase. This helps correct for associated fertility struggles, in which the fertilized egg doesn’t have sufficient time to implant in the endometrial lining before menstruation begins—an event triggered when progesterone levels dip.

DHEA: Like cortisol, testosterone is produced from the same precursor as progesterone: pregnenolone. When cortisol levels or testosterone levels are high, progesterone production tends to suffer. DHEA is an intermediate between pregnenolone and testosterone, so supplementing with DHEA in women who are suffering from low progesterone because of elevated testosterone can reduce the consumption of pregnenolone for testosterone production. That leaves more available for progesterone production. DHEA can also cross-react with the pathway for progesterone production, elevating levels even in women whose deficiency is not the result of hyperandrogenism.

Vitex: Naturally occurring iridoids and flavonoids present in Vitex mimic the role of the corpus luteum, acting on the ovaries to stimulate the production of progesterone. In this study, Vitex was dosed at levels of 20 mg tablets daily.

Closing thoughts…

As if the symptoms of progesterone deficiency aren’t difficult enough, the journey towards a diagnosis to explain the symptoms, and finding a treatment strategy that works for you in the context of your own life can add enormous loads of stress to an already challenging life experience. There is a whirlwind of information out there, which only adds to the confusion and frustration of trying to manage your health. It can be a lonely and scary place, but I want you to know that you’re not alone. Consider making an appointment with a functional medicine doctor who can deliver personalized care and help you achieve your health goals.

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 Natural Treatment for Progesterone Deficiency appeared first on Dr. Alexandra MacKillop.

Reasons for Fertility Drugs

The main reason for fertility struggles among women is ovulatory dysfunction. This means that throughout the menstrual cycle, the body struggles to mature and release a healthy egg at the correct time in relation to the hormonal fluctuations that naturally occur during a woman’s cycle.

Ovulation (and everything leading up to it)

During the first half of the cycle (the follicular phase), the pituitary gland releases luteinizing hormone. This hormone acts on the ovaries to produce estrogen, which allows ovarian follicles to mature so they can eventually release an egg. As the follicle continues to ripen and approaches ovulation, the estrogen level suddenly surges upward, and then drops very quickly. This estrogen surge/drop communicates to the pituitary gland that it is time for ovulation. The pituitary gland responds by creating a surge of its own—this time, luteinizing hormone (LH). When the ovaries receive this intense LH signal from the pituitary gland, the follicle bursts open and the egg is released—ovulation has occurred.

Because fertility struggles so often result from ovulation dysfunction, most fertility drugs target these hormonal pathways that lead up to ovulation. Here’s a list of the most common fertility drugs, why they’re used, how they work, and the natural approaches you might choose to use instead.

[As always, the information shared on this website is for educational purposes only. It is not intended to diagnose, manage, or treat any disease. Always speak with your own doctor before starting something new.]

The Most Common Fertility Drugs & Natural Alternatives

1. Clomiphene Citrate (Clomid)

Clomiphene citrate (Clomid) is the first line treatment for women with ovulatory dysfunction, as its main action is to trigger ovulation by intercepting the LH/estrogen feedback loop at the level of the pituitary gland. Once in the blood stream, the drug mimics the positive feedback given by estrogen, as it binds to estrogen receptors in the pituitary gland. This amplifies the LH surge released by the pituitary gland, giving a strong signal to the ovary that it’s time to release the egg. For some women, this results in ovulation, conception, implantation, and pregnancy. But for others, it doesn’t. One of the main reasons for this is that in addition to triggering an LH surge, clomiphene citrate limits the thickness of the endometrial lining, making implantation less likely to be successful.

Natural Alternative: Clomid dosing typically begins on the second day of the cycle (anywhere from day 2 to day 5) and continues for 5 days. In place of Clomid, 20 mg daily doses of black cohosh (Cimicifuga racimosa extract) can be used daily for 10 days beginning on cycle day 2. In addition to triggering an LH surge, black cohosh results in higher progesterone levels during the luteal phase, subsequently improving the thickness of the endometrial lining.

Read more about natural alternatives to Clomid…

2. Letrozole

Letrozole functions similarly to Clomid, by stimulating the pituitary gland to create a surge of luteinizing hormone. However, Letrozole is different from Clomid in the way it brings about this LH surge. Instead of binding to estrogen receptors like Clomid, Letrozole artificially creates an estrogen drop by blocking the enzyme that produces estrogen (aromatase). For this reason, Letrozole is considered an aromatase inhibitor. In women who suffer from elevated estrogen levels (or estrogen toxicity), Letrozole can artificially balance hormones long enough to allow ovulation to take place.

Natural Alternative: Instead of using a prescription drug, some women prefer to use natural means for reducing estrogen levels. In addition to lifestyle behaviors like a balanced diet and moderate exercise, diindolylmethane and calcium-d-glucarate can be used to promote estrogen detoxification.

Diindolylmethane (DIM) inhibits aromatase, preventing excess production of estrogen when dosed at 100-400 mg daily, with 200 mg being most common.

Calcium-D-Glucarate promotes estrogen metabolism and excretion, and prevents absorption of exogenous estrogens and estrogen-like hormones when dosed at 1500-3000 mg daily.

Read more about other natural alternatives to Letrozole…

3. Metformin

In women with insulin resistance, (a common associated manifestation of PCOS,) the pancreas produces larger than normal levels of insulin. Insulin acts on ovarian follicles during the maturation process, causing them to respond to luteinizing hormone too early, preventing ovulation. Although Metformin is typically considered to be a drug for diabetes, it can be used to treat ovulatory dysfunction triggered by insulin resistance. Many patients want to avoid the use of Metformin due to side effects, such as loose stools, nausea, and vitamin deficiencies. Others don’t feel comfortable using prescription drugs. Whatever your reasoning, these natural alternatives may be a better option for you.

Natural Alternative: Lifestyle behaviors are the #1 way to improve insulin resistance (moderate exercise, managing stress, dietary methods for blood sugar control) but in the case of PCOS, insulin resistance is triggered by hormones. Lifestyle behaviors are still highest on the list, but sometimes they aren’t enough.

• Berberine doses of up to 1500 mg a day (three 500 mg doses with meals) have been shown to improve blood sugar control and insulin resistance as well as or better than Metformin.
• Myo-Inositol prevents the effects of insulin on the ovaries, supporting healthy maturation of follicles and subsequent ovulation. Myo-Inositol is dosed at 4000 mg daily, along with 400 μg of folic acid, taken with meals.

4. Bromocriptine

Another important hormone in the pathway leading to ovulation is prolactin. This hormone is typically credited for stimulating the production of breast milk, so levels are expected to be elevated in late pregnancy and during the postpartum period. Prolactin levels normally remain elevated for as long as a woman is breastfeeding. But sometimes, they stay elevated even after weaning. This is called hyperprolactinemia, and sometimes women struggle with it even if they’ve never been pregnant. (In some cases, elevated prolactin may be the result of a pituitary tumor or other pathology, so you should speak with your doctor if you have concerns about this.)

When prolactin levels are high, they communicate with the pituitary gland, inhibiting the production of luteinizing hormone. (As we discussed earlier, luteinizing hormone stimulates ovulation.) In the postpartum period, this makes sense–getting pregnant isn’t the best idea if you’ve just had a baby. But most women eventually want to have more children! So, doctors prescribe Bromocriptine to inhibit the production of prolactin in patients with hyperprolactinemia.

Natural Alternative: Vitex (Chasteberry, Chastetree, Agnus-Castus) fruit extract has been proven as an effective option for managing a variety of fertility concerns, including ovulation dysfunction resulting from latent hyperprolactinemia. Dosage typically ranges from 20-40 mg daily for 2-3 menstrual cycles. Vitex should not be used for longer than this.

To sum things up…

Trying to conceive can be an overwhelming and deeply emotional journey, especially when ovulation doesn’t occur as expected and medical interventions feel stressful or unsustainable. The good news is that natural alternatives for fertility drugs do exist, targeting the same hormonal pathways involved with common fertility drugs like Clomid, Letrozole, Metformin, and Bromocriptine. Whether dealing with ovulatory dysfunction linked to estrogen imbalance, insulin resistance, or elevated prolactin, you have options, including natural ones. Ultimately, you are the one in charge of your fertility journey, and when you know your options, only then are you empowered to make decisions that align with your body, values, and health needs.

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

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

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Want more Grab a copy of my new book, The Postpartum Check-In !

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 Natural Alternatives to Fertility Drugs appeared first on Dr. Alexandra MacKillop.