Early awareness of signs of pregnancy before missed period depends on pattern recognition rather than a single symptom. It’s common to have one of these signs or symptoms at nearly any time throughout the month. However, when many occur at once during your two-week-wait, you should pay attention—though of course you will still need to take a test to confirm.

Symptoms-Related Signs of Pregnancy Before Missed Periods

1. Tender Breasts

Breast tenderness ranks among the most reported signs of pregnancy before missed periods. Rising progesterone and estrogen increase blood flow and glandular activity within breast tissue, leading to fullness, sensitivity, or a heavy sensation. Observation requires no tools, only awareness of changes that differ from a typical premenstrual pattern. In other words, if you don’t normally experience breast tenderness before your period but this month you do, pay attention. It could be pregnancy. Other explanations include luteal phase progesterone surges, high prolactin from stress, caffeine excess, or a new exercise routine.

• Research Brief: 76% of pregnant women experience breast pain or tenderness during the first trimester, whereas research on US women noted that only 69% experience it as a PMS symptom.

2. Mood Changes (Atypical for You)

Mood shifts often appear early among signs of pregnancy before missed period. Neurotransmitter signaling responds quickly to progesterone metabolites, influencing emotional processing, irritability, tearfulness or just a greater overall emotional sensitivity. One good way to identify if changes in mood could be a sign of pregnancy is by tracking mood daily through journaling. Mood changes are common during pregnancy, but if you notice a change in the intensity or type of moods you experience, it could be a sign to pay attention to. Other causes of mood variation include PMS, sleep disruption, blood sugar instability, or psychosocial stress. For most of us, our moods change day-to-day. However, a pattern that feels distinctly different from prior cycles carries more weight.

• Research Brief: A large international study showed that up to 64% of women experience mood changes in the premenstrual period. In contrast, a global study revealed that the prevalence of depression, anxiety and stress in the first trimester averages about 27%. Depending on your individual situation, a lack of mood swings in the premenstrual window when you usually have them may be more of a flag for possible pregnancy.

3. Vivid Dreams

Intensified or unusually vivid dreams frequently accompany signs of pregnancy before missed period. High levels of progesterone alter sleep architecture, increasing REM density and dream recall. Noticing this change involves subjective reporting rather than measurement. Relative accuracy stays low to moderate. Similar dream changes follow melatonin disruption, magnesium deficiency (or supplementation), late-night eating, or anxiety.

• Research Brief: The research here is somewhat limited, so we need to draw some extended lines. But here’s what we know: across both genders, about 54% of people report frequently recalling their dreams. On the other hand, up to 91% of pregnant women report dream recall. This may be due to hormonal reasons, a lack of REM sleep, interrupted sleep, among others.

4. Cramping and Spotting

Mild uterine cramping or light spotting often reflects implantation and ranks among classic signs of pregnancy before missed periods. Implantation typically occurs 6–10 days after ovulation, triggering localized inflammation and capillary disruption. That being said, many women do report cramping or spotting before their periods. “Implantation bleeding” is typically light pink or brown spotting that resolves quickly, and tends not to be bright red. Premenstraul bleeding gets progressively heavier. Cramping when you don’t usually experience it before your period (or during) is certainly something to pay attention to. That being said, women with adenomyosis or endometriosis are more likely to experience cramping during times of the month when they aren’t actively bleeding. Other causes of bleeding include luteal phase spotting from low progesterone, cervical irritation, or ovulation-related bleeding.

• Research Brief: There actually is no research identifying the prevalence of premenstrual cramping, meaning cramping that occurs before your period starts. Regarding spotting, only roughly 6% of women report premenstrual spotting. Notably, this isn’t normal and actually should be evaluated. (More on this in my book, Go with Your Flow.) On the other hand, approximately 25% of pregnant women are reported to experience vaginal bleeding in the first trimester.

At-Home Signs of Pregnancy Before Missed Periods

1. Cervical Position

Cervical height and texture change in response to estrogen and progesterone, making this a useful at-home marker among signs of pregnancy before missed period. During early pregnancy, the cervix tends to feel higher, softer, and more closed. When performing this self-check, make sure you have clean hands and a habit of checking cervical position before the two-week-wait when trying to conceive. Ovulation, arousal, and infection also influence cervical position. Learn more about checking cervical position for fertility or as an early sign of pregnancy in my book, Go with Your Flow.

2. Increased Basal Body Temperature (BBT)

Sustained elevation in basal body temperature ranks among the most objective signs of pregnancy before missed period. Progesterone raises resting temperature after ovulation; pregnancy maintains that rise beyond 14 days. One of the best ways to identify pregnancy without a urine test is with a sustained temperature past 18 days post-ovulation. This is an extremely accurate predictive method for those who regularly track their cycles with basal body temperature. Fever, alcohol intake, poor sleep, or thyroid imbalance also elevate BBT.

• Check out this post: Basal Body Temperature 101

3. Increased Resting Heart Rate (RHR)

Resting heart rate often climbs early among signs of pregnancy before missed period due to increased metabolic demand and plasma volume expansion. Wearable devices (like a FitBit or Apple Watch) or morning pulse checks with a pulse oximeter are two ways to track RHR and identify changing patterns. A sustained increase of 3–10 beats per minute compared with baseline could be suggestive of early pregnancy. Because heart rate changes rapidly, this method is not as predictive or accurate as BBT. Dehydration, overtraining, illness, or stimulant use also raise RHR.

Lab-Based Signs of Pregnancy Before Missed Periods

Laboratory markers offer higher specificity among signs of pregnancy before missed period, especially when interpreted within clinical context. Of course the best and most accurate measure is with blood test for beta-hCG. However, I’ve accidentally identified pregnancy in patients who weren’t actively trying to get pregnant through these routine hormone blood tests.

1. High Prolactin

Prolactin supports breast development and milk production during early pregnancy. Nonpregnant reference ranges typically fall between 5–20 ng/mL. Early pregnancy often shows levels above 20–30 ng/mL. Prolactin is evaluated through a fasted morning blood test. However, high levels aren’t always a sign of pregnancy; elevated prolactin also appears with pituitary adenomas, hypothyroidism, chronic stress, or certain medications, so correlation matters.

2. Elevated Progesterone

Progesterone sustains the uterine lining and plays a central role in sustaining a pregnancy. Luteal phase values often range from 5–20 ng/mL, though they ideally sit between 12 and 20 ng/mL. Early pregnancy usually maintains levels above 10 ng/mL, often rising toward 20–40 ng/mL within weeks. Serum testing around 7–10 days post-ovulation offers useful insight. Supplement use, ovarian cysts, or timing errors also influence results.

Note: If you know you are pregnant and your progesterone level is lower than 15 ng/mL, this may be a miscarriage risk. Talk to your provider and learn more about ways to boost progesterone for fertility.

3. Rising Estrogen

Estradiol supports placental development and vascular growth, contributing to many signs of pregnancy before missed period. Typical luteal phase values range from 60–250 pg/mL. Early pregnancy often pushes levels above 200–600 pg/mL, with a steady upward trend. Blood testing works best when compared against prior cycle baselines. Estrogen dominance, ovarian hyperstimulation/cysts, or liver clearance issues also raise estradiol levels.

Putting the Signs Together

Of course, no single marker confirms pregnancy before a missed cycle unless that marker is directly testing hCG, the pregnancy hormone. However, a careful eye looking through a functional medicine lens can identify signs of pregnancy before missed periods by evaluating cycle history, nutrition, stress load, and metabolic health. When multiple symptoms, at-home observations, and lab trends align, it can help create hope during the two-week-wait.

If you’re seeking clarity, knowing the how’s and why’s behind these signs of pregnancy before your missed period empowers you to know your own body and understand your physiology on a deeper level. Tracking patterns over several cycles will improve the predictive power of these strategies and help you to know what is, and isn’t normal when deviations pop up. Of course, if you’re concerned about preconception signs and symptoms or anything else concerns you about your health, make an appointment with a trusted healthcare provider so that you don’t have to navigate your journey alone.

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 Signs of Pregnancy Before Missed Period: Your Complete Guide 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.

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

But, that doesn’t mean it’s impossible. Or even unlikely. Quite the opposite, actually.

One of my favorite parts of my job is seeing patients get better, but the icing on the cake is when they have a truly dramatic and objective improvement, such as getting pregnant and delivering a healthy baby after sometimes years of unsuccessfully trying to conceive. Sometimes my pregnant patients have been previously told by other providers, including fertility specialists, that they will never conceive naturally…

As a functional medicine doctor, I’ve had the privilege of seeing women and couples from all walks of life conceive successfully and finally fulfill their dream of become parents, or perhaps become parents a second or third time after things didn’t go as smoothly after the birth of their first child(ren). Yes, this includes couples over 40, too.

In the world of fertility, time is of the essence. In today’s day and age, couples are waiting longer to start trying in the first place and, if fertility problems pop up, it really can throw a wrench in a couple’s plans. For this reason, many OB/GYN offices refer patients out for fertility treatments if they don’t successfully conceive after just 6 months of trying. While many couples who don’t have fertility problems naturally conceive without a problem within a year of trying, the setback of an additional 6 months turns into sometimes additional years once the decision to start IVF (after IUI attempts) has been made and finances secured. At some point, they say, a woman just gets “too old.” Or, does she?

I won’t dispute that age is a factor when it comes to fertility. Obviously, natural conception is virtually impossible after menopause. But, menopause aside, 40 is not “too old” to get pregnant despite what many fertility specialists might say.

I’ve seen plenty of women, both patients and otherwise, conceive successfully well into their 40’s. The key difference between women who conceive easily and women who don’t comes down to understanding a few key things about fertility. Let’s dive in…

1. Egg quality isn’t just about age

A woman is born with all the eggs she will have in her lifetime, but not all those eggs are fully mature at the same time. Rather, the primordial, pre-eggs reside in ovaries and ultimately develop and differentiate into mature eggs or “oocytes” over the course of a couple menstrual cycles. This maturation process depends on nutritional quality, hormonal balance, and control of factors that can degrade the quality of the eggs, such as environmental toxins and yes, aging. But biological age and oocyte age are not the same thing. There’s no “hard and fast rule” for what is too old to conceive. I’ve had young women in their 20’s with poor egg quality that we’ve reversed through functional medicine as well as women in their 40’s who have had excellent egg quality. (We measure this with Anti-Mullerian Hormone, or AMH, on blood work.)

Egg quality can be improved, and there are many factors that can help slow down the processes of aging and poor egg quality. The most important factors to improve egg quality are lifestyle-related ones like:

• Stopping smoking
• Reducing or eliminating alcohol
• Sleeping at least 9 hours per night
• Exercising 5 or more days per week
• Eating enough calories and cabohydrates, but also maintaining an ideal body weight
• Controlling insulin resistance (look into a CGM to get a better idea of your body’s glucose control)
• Drinking clean water and avoiding endocrine toxins like plastics, parabens and phthalates
• Managing stress

Egg quality can also be dramatically improved with supplementation techniques like:

• Melatonin
• Zinc
• CoQ10
• Pycnogenol
• Pterostilbene
• NAD

These supplements generate energy for the cells (powering up mitochondria), reduce oxidative stress, scavenge free radicals and help slow down the aging process of cells. A little supplementation can go a very long way, and these are staples in my fertility arsenal for any patient over 40.

2. You need to know what diagnosis you’re working with

“Unexplained infertility” is not a diagnosis. It simply means that the doctors haven’t yet dug deep enough to find an answer and create a treatment plan to solve the problem.

Conditions like hypothalamic amenorrhea (HA) and polycystic ovarian syndrome (PCOS) are hallmark reasons for irregular ovulation and difficulty conceiving. Perimenopause may also cause less frequent ovulation and unpredictable periods, making family planning efforts more challenging. That being said, perimenopause at any age, including over 40, does not prohibit pregnancy. But irregular periods can easily be chalked up to “probably perimenopause” if a proper diagnosis isn’t made. This means you need thorough testing to identify problems like:

• Low FSH/LH, meaning the brain is not signaling to the ovaries to develop an egg, as is the case in hypothalamic amenorrhea (HA)
• Elevated androgen levels, possibly elevated LH despite normal FSH, as is often the case in polycystic ovarian syndrome (PCOS)
• High or unpredictable levels of estradiol, low progesterone, and elevated FSH, as is often the case in perimenopause

But that all isn’t even to mention the impact of thyroid disorders, including hashimoto’s, which often go undiagnosed.

To add more to the list, endometriosis is also a common culprit for fertility disorders, with its abnormal tissue growth and accompanying inflammation that can damage the ovaries. While harder to diagnose than conditions which show up on blood tests (endometriosis requires surgery to formally diagnose, though it may show signs on an MRI), there are still hopeful options, such as excision surgery, anti-inflammatory strategies and even platelet-rich plasma (PRP) injections which all provide next steps for women of any age dealing with infertility.

Tip: the first two cycles after endometriosis excision surgery are often considered the “most fertile” time for women struggling with fertility and endometriosis.

3. You need to know your cycle

Are you ovulating How do you know

If you can’t confidently answer both of those questions, you might be experiencing some important road blocks to fertility in your 40’s which can easily be overcome.

One of the major shortcomings of our sexual education practices in America is that we emphasize birth control and pregnancy prevention, but don’t much dive into how to actually help couples conceive when the time comes. As a result, many women have no idea when to time intimacy in order to facilitate a swift family planning process. (Not all days of the month are equally fertile!)

In fact, most women I’ve spoken to have never heard of the concept of a “most fertile day,” or don’t know what their cervical fluid means. Still more have never even heard of luteinizing hormone, much less learned how to identify its surge.

I recommend that all my patients track their cycles using basal body temperature, or a home fertility tracking strategy such as over-the-counter test strips for urinary LH, or a fertility monitor such as Inito to predict and confirm ovulation. If you know for sure when you’re ovulating, you can streamline your efforts for trying to conceive to max on O-2, which is two days prior to ovulation, the day you most typically will see a positive LH strip (AKA ovulation prediction test kit), experience peak production of egg white cervical mucus (ewcm) and be the most fertile. Sex on this day will result in an abundance of healthy sperm waiting in the fallopian tube for a healthy egg to be released.

4. You need to know your options

If you have tried all the things and are looking to fertility treatments as a next step, don’t forget that alternatives do exist. That’s my bread and butter in functional medicine, which is helping identify the root cause. But, sometimes you just need to make it happen. If you haven’t already, check out my blog post regarding natural alternatives to fertility drugs if you’re looking for ways to avoid Clomid, bromocriptine, letrozole, and other prescriptions.

If you’re over 40 and TTC, it’s not too late for you. There is hope and you have options!

Baby dust!

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 Get Pregnant After 40 (Without Fertility Treatment) appeared first on Dr. Alexandra MacKillop.

But when it comes to fertility, ovulation is the foundation.

PCOS, or polycystic ovarian syndrome, is a common reason for diagnosed “infertility,” which is rising faster than ever in the US. One of the hallmark signs of PCOS is ovulatory dysfunction, meaning that a woman has irregular periods or anovulatory cycles which are menstrual cycles in which ovulation does not take place. Ovulation is crucial for pregnancy because that is the process that actually releases the egg that will eventually become fertilized. If you’re wondering how to get pregnant naturally with PCOS, the first step is to make sure that you are actually ovulating.

Why PCOS Causes Infertility

With PCOS, ovulatory dysfunction makes trying to conceive (TTC) difficult because there are fewer eggs released in any given year. Rather than having a monthly period, many women with PCOS have cycles that stretch more than 35 days, sometimes twice that, and some women don’t have periods at all. PCOS can also get in the way of TTC efforts because it’s associated with insulin resistance, inflammation, and hormone imbalances that affect the quality of the uterine lining, damage the fragile embryos in their earliest stages, and increase the risk of miscarriage. These factors combined can add up to the 6 or 12 months of unsuccessful TTC efforts that lead women over, or under, age 35 (respectively) to be diagnosed with infertility and referred for IVF.

Assisted reproductive technology has been a wonderful gift to families who were otherwise unable to conceive without it. But what if there was a way to get pregnant naturally without having to rely on medications, invasive procedures, and tens of thousands of dollars’ worth of medical appointments

Guess what There is! Read on to find out.

How to Get Pregnant Naturally with PCOS

Getting pregnant naturally with PCOS means addressing the root cause of fertility problems in PCOS. These main issues include: irregular ovulation, inflammation, and problems with egg quality.

Improving Ovulation in PCOS

The first key step in improving ovulation rates in PCOS is figuring out if and when you are ovulating. You can do this in two ways:

1. Blood Tests: In most ovulatory cycles, progesterone levels are highest on day 21. This is because ovulation usually takes place around 2 weeks before a period starts, and in a “normal” monthly cycle, ovulation would take place somewhere around day 13-16. After ovulation, the ovary starts producing progesterone, but does not do this if it doesn’t release an egg. So, to confirm if a woman is “ovulating on time,” we can run a blood test to measure the progesterone levels in her blood and if they’re in the correct range, we know she ovulated “on time.” If a woman has long but regular cycles, meaning they come after the same number of days, we would run this test one week before her expected period.
2. Tracking BBT: If a woman has irregular cycles, it is difficult to predict when to test “day 21 progesterone” or to complete that progesterone test at the correct time. Plus, the progesterone test doesn’t tell us when she ovulated necessarily, only if she ovulated and when, within a general range, that may have taken place. Instead, a woman can track her period using fluctuations in body temperature that give very specific information about the timing of ovulation. Learn how to do this here: Basal Body Temperature 101

Once you know if and when you’re ovulating, it’s time to take steps to make it more regular! Here are a few key ways to do this:

1. Reduce Stress: Stress is a major driver of adrenal dysfunction, which drives androgen production and worsens the hormone imbalances associated with PCOS. Stress also messes with blood sugar and lowers progesterone levels which can make the uterine environment unfavorable for pregnancy.
2. Consider Androgen Blockers: In the traditional medical model, spironolactone and the birth control pill are prescribed to reduce androgens because these hormones are responsible for many of the problems seen with PCOS. However, spironolactone isn’t safe when TTC, the birth control pill defeats the whole purpose, and neither allows our bodies to naturally get back into balance. Instead, natural herbs like red reishi, Chinese peony, green tea extract and black cohosh reduce androgens and improve ovulation rates. Be careful though; many of these herbs are not safe to take during pregnancy and you can be pregnant for up to a week before a pregnancy test shows positive. I recommend working with a functional medicine doctor if you’re using herbal medicines for this reason.
3. Take Melatonin: Disruptions in the circadian rhythm lead to cortisol and DHEA imbalances, which circle back to point #1 in terms of their hormone-disrupting effect. Short-term melatonin use helps regulate the stress cycle, but has also been shown to improve ovulation rates in PCOS and reduce inflammation.

Reduce Inflammation

Inflammation is caused when the immune system gets triggered by foreign invaders or toxic chemicals. Some of these toxic chemicals come from the body’s own metabolic processes (i.e. “waste products”) but others are caused by lifestyle factors. Here’s how you can lower your own inflammatory load:

1. Take Melatonin: It made it to this list too! Melatonin is just that powerful. If you look back up at point #3 above, you can see that melatonin reduces inflammation in PCOS sufferers in addition to increasing likelihood of ovulation.
2. Eat an Antioxidant-Rich Diet: The more colorful the food, the better! That doesn’t mean that white foods aren’t allowed, it just means that you can amp up your antioxidant load without needing to rely on more supplements. My favorite ways to get antioxidants every day is by eating organic beets, blueberries, arugula and raw walnuts. Better yet, I combine all of these into a salad, topped generously with extra virgin olive oil and balsamic vinegar.
3. Consider Curcumin and Vitex: Similar to melatonin, curcumin and vitex reduce inflammation and improve ovulatory outcomes. I usually have my patients take all three when they are TTC.

Work on Your Egg Quality

From a nutritional perspective, it’s pretty simple: eating eggs improves egg quality! Go figure, right That’s because eggs are an excellent source of zinc, B vitamins and choline, all of which are essential for egg quality and developing of a growing baby. Here’s an easy, non-supplement way to improve your own egg quality: eat two eggs per day! The additional protein is also valuable for keeping blood sugar balanced and reducing inflammation from insulin.

1. Eat 2 Eggs Per Day: see above for details!
2. Check out my blog post all about Fertility Supplements for Egg Quality

In closing…

If you have been told that IVF is your only option, remember that there may be meaningful steps you can take first to support your body naturally. Learning how to get pregnant naturally with PCOS starts with restoring ovulation, lowering inflammation, and improving egg quality, which are the true foundations of fertility. While assisted reproductive technology has helped countless families, it is not the only path for every woman. By identifying whether you are ovulating, addressing stress and blood sugar balance, reducing inflammation, and nourishing your body with targeted nutrition and supportive therapies, you may be able to create a healthier environment for conception. With the right testing, guidance, and a root-cause approach, many women with PCOS can optimize their fertility and move toward pregnancy with greater confidence and clarity.

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.

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