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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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 Signs of Pregnancy Before Missed Period: Your Complete Guide appeared first on Dr. Alexandra MacKillop.

If you’re wondering how to naturally increase fertility, the most important thing you should know is that fertility isn’t just about the reproductive organs—it’s a whole-body indicator of health. As a functional medicine doctor, I’ve helped countless patients learn how to naturally increase fertility by addressing imbalances across all systems of the body. If you’re trying to conceive without resorting to pharmaceuticals or IVF, this guide will give you the strategic, root-cause roadmap to reclaim your fertility naturally.

Why Increase Fertility Naturally?

Natural fertility optimization isn’t just about conception—it’s about creating the healthiest possible environment for you and your future child. Couples choose to increase fertility naturally because they want to avoid synthetic hormones, invasive procedures, or expensive treatments that ignore the real cause of the issue. They want to heal, not override, their bodies. IUI, IVF and other fertility treatments can alo be extremely costly, which is another important reason to consider learning how to naturally increase fertility. However, even when pursuing fertility treatments, or perhaps undergoing a process of egg retrieval for egg freezing or a sperm harvesting for sperm freezing, it’s still a good idea to take all possible measures to increase fertility naturally so that the eggs have the best possible chance of success.

Conventional medicine often reduces fertility to a hormone problem. But infertility is a signal—your body is telling you something is off. When we listen, investigate, and treat the underlying dysfunction, the result isn’t just fertility—it’s vitality, balance, and lasting health.

Lifestyle Practices That Harm Fertility

Before we can build fertility, we need to stop destroying it. The modern lifestyle is fertility-toxic. Here’s how:

• Chronic Stress: Activates the HPA axis and shuts down reproductive hormones. Cortisol hijacks your cycle, suppressing ovulation and libido. It also significantly suppresses testosterone production and sperm quality in men.
• Poor Sleep: Disrupts circadian rhythms and hormone production—especially melatonin and progesterone, as well as testosterone in men.
• Toxin Exposure: Pesticides, BPA, phthalates, and heavy metals mimic hormones and disrupt endocrine balance. There is also data out there that exposure to plastics in clothing also act as fertility disruptors, creating changes in electrical and magnetic signaling that negatively impact ovarian function and sperm quality. Look for clothing that is free of plastics, PUFAs, and other synthetics.
• Nutrient-Deficient Diets: Low-fat, high-sugar, or overly restrictive diets destroy hormone production and egg quality. Our ultra-processed modern diet is void of nutrients despite being rich in processed carbohydrates and seed oils. In fact, both simple carbs and seed oils have been proven to negatively impact fertility. Aim to include high-quality animal proteins and fats as well as organic, darkly colored fruits and vegetables like berries and leafy greens. I also recommend a daily carrot salad for hormone balance.
• Overtraining/Under-Eating: Particularly common in driven, Type A women, this leads to hypothalamic amenorrhea, where the brain shuts down ovulation entirely.
• Alcohol, Caffeine, and Smoking: All three impair egg quality, sperm health, and hormone balance. I recommend avoiding all three if you’re TTC.

A note about these lifestyle factors: These foundational elements are pretty universal amongst articles describing methods for how to naturally increase fertility. Because they’re so ubiquitous, it may seem tempting to overlook them in search of something more direct, more exclusive, or more granular. While I do offer such recommendations below, I want you to know that lifestyle is the single most important factor in fertility as well as in health as a whole. It will do you no good to look to supplements or anything else for how to naturally increase fertility while overlooking the lifestyle. There is no supplements, and honestly no drug, that can undo the effects of poor sleep, high stress, toxin exposure, calorie deficits, substance abuse, and a poor diet.

How to Naturally Increase Fertility by Identifying the Root Cause of Fertility Disorders

To truly increase fertility naturally, you must identify why your body isn’t conceiving. Here are the most common root-cause conditions that sabotage fertility:

1. Thyroid Disorders

Low thyroid function (hypothyroidism) decreases progesterone, disrupts ovulation, and increases miscarriage risk. If your TSH is “normal” but you’re still tired, cold, or constipated—get a full thyroid panel. Subclinical hypothyroidism often flies under the radar. Hyperthyroidism, such as seen in Graves’ disease, also negatively impacts fertility. If you’re wondering how to increase fertility naturally, you should start by getting your thyroid thoroughly checked out.

2. PCOS (Polycystic Ovary Syndrome)

PCOS is an insulin-resistance and androgen-dominance issue. It impairs ovulation, leads to cystic ovaries, and causes irregular cycles. You must correct blood sugar dysregulation, reduce inflammation, and support hormone detoxification to restore ovulation.

3. Endometriosis

This inflammatory, estrogen-driven condition causes pelvic pain and infertility by distorting reproductive anatomy and disrupting implantation. Gut health, immune balance, and estrogen metabolism must be addressed aggressively.

4. Hypothalamic Amenorrhea

This is the brain pulling the emergency brake on fertility due to perceived stress or lack of energy availability. It’s common in athletes, perfectionists, and under-eaters. Recovery requires restoring adequate caloric intake, body fat, and nervous system calm.

5. HPA Axis Dysfunction (Adrenal Fatigue)

The hypothalamic-pituitary-adrenal axis controls the stress response. When it’s dysregulated, it suppresses reproductive hormones. You must rewire the stress response through nervous system regulation, sleep, and adrenal support to restore fertility.

How to Naturally Increase Fertility with Supplements

Certain nutrients powerfully support reproductive function. Many of these are key players in my practice for optimizing fertility:

• Myo-Inositol: Improves insulin sensitivity and ovulatory function—especially critical for PCOS.
• CoQ10 (Ubiquinol): Enhances mitochondrial function in eggs and sperm, improving quality and developmental potential.
• Omega-3 Fatty Acids: Reduce inflammation and support hormone production.
• Methylated B Vitamins (especially B9/Folate): Crucial for methylation, egg health, and preventing neural tube defects.
• Magnesium: Calms the nervous system, supports adrenal function, and improves sleep—all essential for fertility.
• Vitamin D3: Regulates hormone production and immune balance. Low levels are directly linked to infertility and miscarriage.

How to Naturally Increase Fertility by Looking at the Whole Body

Your uterus does not operate in a vacuum. Fertility is the result of systemic harmony, not isolated hormonal tweaks. Here’s how the entire body affects your ability to conceive:

Brain & Nervous System

The hypothalamus and pituitary gland orchestrate your reproductive cycle. Chronic stress rewires your brain to shut down reproduction. Nervous system regulation—via breathwork, somatic practices, and trauma healing—is fertility medicine.

Gut Health

The gut regulates nutrient absorption, immune response, and estrogen metabolism. Dysbiosis, leaky gut, or SIBO drive inflammation and hormone imbalance. Heal the gut, and you lay the groundwork for conception.

Liver Function

The liver detoxifies excess estrogen and metabolizes hormones. A sluggish liver leads to estrogen dominance, PMS, and ovulatory issues. Support with cruciferous vegetables, dandelion root, NAC, and targeted herbs.

Blood Flow

Pelvic blood flow is essential for ovarian and uterine health. Sedentary lifestyle, poor circulation, and inflammation impair oxygen and nutrient delivery to reproductive organs. Movement, dry brushing, acupuncture, and castor oil packs all enhance circulation.

Musculoskeletal System

Tension in the pelvis, scar tissue, or misalignment in the spine can block blood flow and nerve signaling. Bodywork (chiropractic, craniosacral therapy, pelvic floor therapy) helps clear the path for conception.

Lymphatic System

The lymphatic system clears cellular waste and toxins. A stagnant lymph system clogs hormone pathways and raises inflammation. Rebounding, sauna, hydration, and manual lymph drainage support this overlooked detox pathway.

Final Thoughts: Fertility Is a Barometer of Health

To naturally increase fertility, you must stop chasing hormones and start chasing health. When your body feels safe, nourished, and in balance—it will create life. This isn’t theory. I’ve seen it happen over and over with patients who were told their only option was IVF.

Natural fertility is not luck. It’s the result of uncovering root causes, supporting the body as a whole, and restoring biological wisdom. Your body is not broken. It’s communicating.

You just need to learn how to listen—and how to heal.

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 Naturally Increase Fertility appeared first on Dr. Alexandra MacKillop.

Why Women Seek Functional Medicine PCOS Treatment

Many of my patients come to me looking for an alternative to the birth control prescription given to them by their OB/GYN. Others have friends or family with a PCOS diagnosis, and are wondering if that’s the reason for their own irregular and/or painful cycles. Some ladies worry if they’ll ever be able to have children, since PCOS has complicated their fertility, and still more patients come to me out of desperation—they’ve already worked with another “natural doctor” who had put them on an extremely restrictive diet and told them to lose weight. I have even heard of PCOS patients being prescribed gluten-free, dairy-free, low-carb, sulfur-free diets. Functional medicine PCOS treatment offers hope of realistic, sustainable treatment where most other providers give a grim prognosis or simply leave patients feeling overwhelmed.

In this post, we’ll be diving into the details about PCOS: what it is, what it isn’t, how it’s managed by most healthcare providers, functional medicine PCOS treatment strategies, and more. As a starting point, I encourage you to check out my fertility overview post (Female Fertility 101) if you aren’t familiar with the ins and outs of your menstrual cycle. That post lays the groundwork for understanding the status quo of periods, hormones, women’s health, and it’s important to understand these topics before we start talking about with cycles that fall outside of the norm. [Although it’s the most common, it’s not the only period problem faced by women. To learn more about what your period can tell you about your health, check out this post.]

What Is PCOS, and How Is It Diagnosed?

PCOS stands for Polycystic Ovarian Syndrome, one of the most common endocrine and metabolic disorders in women of reproductive age. The syndrome is defined by hormonal imbalances and ovarian dysfunction, and it’s diagnosed only after other causes for the patient’s symptoms have been ruled out (such as hypothalamic amenorrhea). Because of this, many women have to go through a frustratingly long and drawn out process in order to get answers for their health struggles. However, functional medicine PCOS treatment offers faster results because it gets to the root cause.

Functional Medicine PCOS Diagnosis

The name “polycystic ovarian syndrome” is a bit of a misnomer, because although ovarian cysts are common in PCOS patients, they aren’t part of the diagnostic criteria—many women with PCOS don’t have any cysts on their ovaries at all. Rather, a PCOS diagnosis is given when at least two of the three following criteria are met: [Reference]

• Hyperandrogenism (elevated androgen hormones, assessed via lab work)
• Anovulation or oligo-ovulation (absence of ovulation or infrequent ovulation, usually leading to irregular cycle length)
• Polycystic appearance of ovaries (assessed via ultrasound imaging)

The general consensus in the medical community is that a PCOS diagnosis should be given when a woman has either polycystic ovaries and/or irregular cycles in addition to high androgen levels on her blood work. When making the diagnosis, doctors are careful to rule out other causes of high androgens, such as adrenal disorders, thyroid disease, drug-induced androgen excess, and other hormonal disorders, as well as alternative causes for irregular cycles.

Types of PCOS

PCOS patients typically fall into two different categories: insulin resistant, and non-insulin-resistant types. As is the case with most hormonal disorders, more than one level is out of balance. The vast majority of women who suffer from PCOS also present with insulin resistance, glucose intolerance, dyslipidemia, and elevated levels of inflammation. Part of what makes treating PCOS so complex is that these hormonal imbalances feed off of each other: elevated insulin levels trigger a feedback loop via the HPATG axis that leads to further androgen levels, and vise-versa. Apart from the insulin resistance piece, functional medicine PCOS diagnosis further divides PCOS into 4 separate categories which you can read about here.

Symptoms of PCOS

The symptoms experienced by women with PCOS vary because not everyone meets the same diagnostic criteria, and the extent of those experiences can vary too. Some women experience only mild elevations in androgens, and symptoms are consequently lesser. Women who have cysts on their ovaries often experience pain related to the formation and/or rupture of cysts, which are symptoms that wouldn’t be experienced by women who do not have cysts. Likewise, symptoms for women who concomitantly deal with insulin resistance face different symptoms than women who do not.

• Symptoms Related to Excess Androgens
  • Excessive hair growth (face, chest, back, buttocks)
  • Thinning hair
  • Oily skin
  • Cystic acne
• Symptoms Related to Anovulation/Olig-ovulation
  • Long cycles (more than 35 days) or irregular cycle lengths
  • Difficulty conceiving or repeated miscarriages
  • Abnormal uterine bleeding
• Symptoms Related to Polycystic Ovaries
  • Painful periods and/or pelvic pain
  • Sudden, intense abdominal pain resulting from ruptured cysts
• Symptoms Related to Insulin Resistance
  • High blood pressure and/or high cholesterol
  • Fatigue after meals
  • Weight gain, especially in the abdominal area
  • Dark patches of skin, particularly along neck creases, in groin and under breasts (this is called ancanthosis nigricans)
  • Skin tags

Due to the fluctuating hormones, many women also experience generalized symptoms related to hormonal imbalances, which include (but are not limited to): fatigue, insomnia, anxiety, depression, headaches, etc.

Functional Medicine PCOS (Causes and Treatment)

The root cause isn’t really known. The current understanding is that it’s a mixture of genetic predisposition and environmental triggers, but other theories include nutritional conditions in the uterus, prenatal exposure to androgens, insulin resistance on an and more [reference]. Because of this, most treatments focus on managing symptoms—painful periods, irregular cycles, insulin resistance, etc. Hormonal contraceptive use also can induce a reversible type of PCOS, but the symptoms can continue for months or even years (called “post-pill PCOS”).

On a physiological level, we know that elevated androgens and insulin resistance result from dysfunction in the hypothalamic-pituitary-adrenal-thyroid-gonadal axis. In women with PCOS, the pituitary gland releases higher-than-normal levels of luteinizing hormone (LH), which stimulates the ovaries to produce more testosterone than usual. (Ovaries normally produce some testosterone, but problems result when they produce too much.) This over-stimulation of the ovaries by luteinizing hormone also cancels out the mid-cycle LH surge that typically triggers ovulation.

Pituitary Hormones and PCOS

At the same time, the pituitary gland releases lower-than-normal levels of follicle-stimulating-hormone, which prevents eggs from reaching full maturity. When this happens, the follicle does not release the egg (ovulation does not occur, AKA anovulation). The immature egg either dissolves, or remains in the follicle, forming a cyst. Since the follicular remnant after ovulation (called the corpus luteum) is responsible for producing progesterone during the luteal phase, many women experience additional symptoms related to low progesterone levels. (Read more about luteinizing hormone, follicle-stimulating hormone, progesterone, and the luteal phase in this post: Female Fertility 101)

The Birth Control Pill and PCOS

Most OB/GYNs prescribe oral contraceptives as a first line of treatment for PCOS, because the artificial hormones suppress the natural cycling of luteinizing hormone, follicle-stimulating hormone, estrogen, progesterone, and testosterone. The simulated hormonal environment causes the endometrial lining to develop and shed as it would in a natural period, but it take the ovaries out of the equation: no egg matures, no egg is released, and fertility is not possible.

My goal as a functional medicine doctor is to promote the natural fertility of my patients, empowering them to have healthy cycles rather than suppress the normal functioning of their bodies. That being said, sometimes the healthiest thing for a patient and her values is to reduce the pain, control the hormonal dysfunction, and reach a place where she feels that her health is manageable. If that means medication, that’s okay—the most important thing is that she is able to manage her wellbeing according to her values.

Prescription Medications for PCOS

Another medication used in the treatment of PCOS is spironolactone, which is typically used as a diuretic drug for individuals with cardiovascular disease. However, this drug also has a secondary effect of reducing androgen levels in the body, which can be helpful in controlling irregular bleeding, hair growth, and other symptoms of high androgens in women with PCOS. Like birth control pills, using spironolactone targets hormonal pathways of PCOS without addressing the root cause. This is where functional medicine treatment for PCOS can fill a huge gap and meet a huge need.

The third medication that is used in the management of PCOS is metformin, which is a drug typically given to patients with diabetes. Metformin improves insulin resistance, which can be helpful in the treatment of PCOS because of the amplifying effect that insulin plays in the production of testosterone. When insulin sensitivity improves, often testosterone levels follow suit. You can read more about the use of metformin as a fertility drug (and natural alternatives) in this post.

Functional Medicine Treatment for PCOS: Lifestyle & Supplements  

Most of my patients come to me because they are looking to avoid the use of prescription drugs in managing their fertility. If that describes you too, keep reading!

1. Lifestyle Factors for Balancing Hormones: The #1 thing we can do to support hormonal balance is building a foundation for well-being. This means taking nutrition, rest, exercise, stress management, and psychological/emotional health into account. Neglecting even one of these areas can create huge interruptions in the HPATG axis, making symptoms of PCOS and other hormonal disorders so much worse. These lifestyle factors include eating enough (in terms of calories, macronutrients, and micronutrients) as well as eating frequently enough to keep blood sugar stable. It also involves balancing exercise and rest to prevent elevations in cortisol, the stress hormone, which interrupts the production of sex hormones like progesterone. This is part of the reason why stress management, sleep hygiene, and social support are so important.
2. Eating a Diverse Diet:Gut health is a huge topic in the media lately, and research continues to show that the best way to support GI health and microbiological diversity is to eat a varied diet, with many different types of plant foods and fibers. The more restrictive our diet (limiting the types of foods we eat to just a few varieties), the more likely we are to disturb our gut microbiome, which plays a huge role in balancing our hormones. (Did you know that bacteria both produce and metabolize hormones When we disturb our gut microbiome, it affects our bodies ability to make hormones as well as clean out the old, broken down ones.) Gut health also helps modulate blood sugar control, which is an important consideration in insulin-resistant PCOS. Check out this study to learn more about the relationship between PCOS and the gut microbiome.
3. Micronutrient Balance: Research has shown that women with PCOS tend to follow certain patterns of vitamin deficiencies, including vitamin D and B vitamins (especially folic acid). Vitamin D plays an important role in supporting the thickness of the endometrial lining, which is often depleted in women with PCOS due to low progesterone levels. Likewise, B vitamins such as folic acid play an important role in follicular maturation, and supplementing with elvels at 700 μg/day can support successful ovulation. Other nutritional deficiencies have also been identified in the majority of women with PCOS, including calcium, zinc, selenium, and chromium. [Reference] While the best way to prevent nutrient deficiencies such as these is to eat a varied and balanced diet (and avoid restriction of food groups of calories), some women may benefit from using supplements—especially Vitamin D. Studies have also shown that supplementing with omega-3 fatty acids, such as those found in cod liver oil, prevent excess inflammation, help manage dysglycemia, and support hormonal balance in women. [Reference]
4. Evidence-Based Supplements:
   1. Inositol: Inositol is a type of sugar alcohol that has been shown to improve insulin sensitivity, lipid synthesis, hormonal signaling, and maturation of oocytes (female eggs) during the follicular phase. Supplementation of inositol in women with PCOS lowers androgen levels, improves insulin sensitivity, and increases rates of ovulation in women with anovulatory cycles. Supplementation is effective when administered in ratios of 40:1 of myo-inositol to D-chiro-inositol, at levels of 4000 mg per day in conjunction with 400 μg of folic acid.
   2. Alpha-Lipoic Acid: This chemical is a free-radical scavenger, meaning that it prevents premature breakdown of biochemicals and hormones in the blood stream. Studies show that supplementation with alpha-lipoid acid decreases prevalence of ovarian cysts and increases progesterone levels in women with PCOS.
   3. Melatonin:While this hormone is typically thought of as a supplement for promoting sleep, it is not a sleeping pill, but rather a hormone. (There are many reasons to avoid using melatonin as a sleep aid, but that’s a topic for another post.) When used in women with PCOS, supplementation at night has been shown to improve ovulation rates, corpus luteum formation, progesterone levels, and pregnancy rates for those who are trying to conceive. Melatonin supplementation also decreases hirsutism and androgen levels when used at 10 mg/night.
   4. Black Cohosh: As described in this post about fertility drugs, research has shown that dosing 20 mg daily of black cohosh at the beginning of the cycle modulates the LH surge during the follicular phase, improving rates of ovulation. This supplement also results in higher progesterone levels during the luteal phase, improving the thickness of the endometrial lining and supporting a luteal phase that is long enough for implantation and pregnancy in women who are trying to conceive.

Closing thoughts…

As if the symptoms of PCOS 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.

Become a Patient

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Sign Me Up!

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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 Functional Medicine PCOS Treatment appeared first on Dr. Alexandra MacKillop.

Have you heard of estrogen dominance Or maybe, you already know you’re dealing with this hormone imbalance. Excess estrogen (or deficient progesterone) disrupts hormonal balance, triggering symptoms such as weight gain, mood swings, heavy periods, and fatigue. Functional medicine targets root causes with precision, and understanding why you have estrogen dominance is key to treating this condition. Herbs for estrogen dominance play a pivotal role in restoring estrogen balance by supporting detoxification, improving insulin sensitivity, and enhancing progesterone production. Below, I detail clinically supported herbs for estrogen dominance that that effectively address their mechanisms, and recommended dosages.

As we get started, here are a few key things to keep in mind when it comes to estrogen dominance:

• Estrogen dominance is a condition in which negative symptoms occur because of a high estrogen level in relation to progesterone
• Estrogen dominance may be caused by excess estrogen production, deficient progesterone production or both
• Certain underlying diseases and syndromes increase risk of estrogen dominance, like obesity, PCOS, type 2 diabetes and hypothyroidism
• Even if you have symptoms of estrogen dominance, it doesn’t necessarily mean you have it. It’s essential to test your hormones and understand your diagnosis before using any treatment strategies

Herbs for Estrogen Dominance, Explained

1. DIM (Diindolylmethane): Detoxify Excess Estrogen

DIM is one of the most powerful herbs for treating estrogen dominance. This is a compound derived from cruciferous vegetables, promotes healthy estrogen metabolism by enhancing Phase 1 and Phase 2 liver detoxification pathways. It shifts estrogen breakdown toward beneficial 2-hydroxy metabolites and away from harmful 16-alpha-hydroxy metabolites linked to estrogen dominance and cancer risk. Impaired gut function or excess production of estrogen are key candidates for treatment with DIM.

• Dosage: 100-200 mg daily
• Evidence: A randomized controlled trial found DIM supplementation significantly improved estrogen metabolism in women with estrogen dominance symptoms [2].

2. Calcium D-Glucarate (CDG): Support Estrogen Clearance

CDG inhibits beta-glucuronidase, an enzyme that reverses estrogen conjugation in the gut, preventing reabsorption and facilitating elimination. This reduces circulating estrogen levels, decreasing estrogenic load. Those who eat a diet high in ultra-processed foods and sugar are likely to benefit from supplementation with CDG when high estrogen levels have been documented on labs at any point in the cycle. This could be considered either a food or one of the best herbs for estrogen dominance.

• Dosage: 300-400 mg daily
• Evidence: Clinical studies demonstrate CDG enhances detoxification and lowers estrogen recirculation, supporting hormonal balance.

3. Berberine: Target PCOS and Insulin Resistance

Polycystic Ovary Syndrome (PCOS) drives estrogen dominance via insulin resistance and androgen imbalance. Berberine improves insulin sensitivity, regulates blood glucose, and supports gut microbiota diversity—addressing core PCOS mechanisms. Berberine may also be helpful in those with impaired gut detox pathways due to imbalances in good and bad bacteria, as berberine affects microbiological diversity.

• Dosage: 500 mg twice daily with meals
• Evidence: Multiple randomized trials show berberine’s superiority to metformin in reducing insulin resistance and improving ovulatory function in PCOS patients.

4. Evening Primrose Oil: Boost Progesterone Production

Evening primrose oil supplies gamma-linolenic acid (GLA), a precursor to prostaglandins that stimulate progesterone synthesis. Increased progesterone balances excess estrogen, alleviating symptoms like breast tenderness and PMS. If estrogen dominance and related symptoms are caused by deficient progesterone, meaning there isn’t enough progesterone to balance out otherwise normal estrogen levels, EPO may be the right solution.

• Dosage: 1,000-2,000 mg daily
• Evidence: Clinical reports confirm evening primrose oil’s efficacy in improving luteal phase defects by increasing progesterone.

5. Fish Oil: Modulate Inflammation and Hormonal Balance

Omega-3 fatty acids reduce systemic inflammation and improve insulin sensitivity, indirectly supporting estrogen metabolism and progesterone activity. Inflammation is a major driver of excess production of estrogen in men and women from abdominal fat cells.

• Dosage: 1,000-3,000 mg EPA/DHA daily
• Evidence: Supplementation reduces inflammatory markers and improves hormonal profiles in women with hormonal imbalances.

6. Fenugreek: Support Hormonal Regulation

Fenugreek seeds contain phytoestrogens that modulate estrogen receptor activity and stimulate progesterone production, improving estrogen-to-progesterone ratio.

• Dosage: 500-600 mg daily
• Evidence: Controlled trials indicate fenugreek improves hormonal balance and reduces estrogen dominance symptoms.

7. Fennel Tea: Natural Estrogen Modulator

Fennel contains anethole, which exhibits estrogenic activity that regulates menstrual cycles and reduces estrogen dominance symptoms such as bloating and cramps.

• Dosage: 1-2 cups of fennel tea daily
• Evidence: Clinical use supports fennel’s effectiveness in managing menstrual disorders related to estrogen imbalance.

8. Cinnamon: Improve Insulin Resistance and Hormone Balance

Cinnamon enhances insulin sensitivity and lowers blood glucose, indirectly reducing ovarian androgen production and estrogen dominance, especially in PCOS.

• Dosage: 1-3 grams daily
• Evidence: Studies confirm cinnamon’s role in metabolic and hormonal regulation in women with insulin resistance.

9. Chamomile: Calm Inflammation and Support Progesterone

Chamomile’s anti-inflammatory properties reduce systemic inflammation that disrupts hormone production. It also supports progesterone synthesis through improved adrenal function.

• Dosage: 1-2 cups chamomile tea daily or 300 mg extract
• Evidence: Research validates chamomile’s efficacy in reducing inflammation and improving hormonal balance.

10. CBD Oil: Regulate Endocrine and Stress Response

CBD modulates the endocannabinoid system, which influences hormone regulation and reduces cortisol-driven estrogen dominance. It also supports liver detoxification.

• Dosage: 10-50 mg daily, titrated individually
• Evidence: Emerging studies demonstrate CBD’s role in hormone balance and stress reduction [20].

11. Boron: Enhance Hormonal Balance and Bone Health

Boron increases circulating levels of free testosterone and estrogen metabolites, promoting a favorable hormonal environment and supporting bone density.

• Dosage: 3-6 mg daily
• Evidence: Clinical trials report boron’s capacity to increase steroid hormone levels and improve metabolic health.

12. Black Cohosh: Promote Ovulation and Progesterone Production

Black cohosh exhibits estrogenic effects that stimulate ovulation and improve progesterone synthesis, directly countering estrogen dominance.

• Dosage: 40-80 mg daily standardized extract
• Evidence: Clinical trials validate black cohosh’s role in improving luteal phase and balancing estrogen-progesterone ratio.

13. Adaptogens (Reishi): Balance Stress Hormones and Support Endocrine Health

Reishi mushroom modulates the hypothalamic-pituitary-adrenal axis, reducing cortisol and supporting overall endocrine harmony, which indirectly regulates estrogen dominance.

• Dosage: 1,000-1,500 mg daily
• Evidence: Studies show Reishi’s efficacy in reducing stress-related hormonal imbalance and inflammation.

Functional medicine’s approach to estrogen dominance requires targeted, evidence-based herbal interventions. DIM, CDG, berberine, evening primrose oil, fish oil, and other botanicals address detoxification, insulin resistance, inflammation, and progesterone support. Combining these herbs with lifestyle modifications establishes hormonal balance and improves patient outcomes.

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 Herbs for Estrogen Dominance and Hormonal Balance appeared first on Dr. Alexandra MacKillop.

Please note: When referring to hormonal contraceptives, birth control pills or “the pill” in this post, I am referencing medications containing both estrogen and progesterone analogs (estradiol and progestin).

The menstrual cycle plays a powerful role in women’s health, and not just in terms of fertility. As I often say, our periods tell us way much more about our sense of well-being than whether or not we’re pregnant, and that information is so, so important! If our cycle is out of sync, it’s really important for us to address those concerns early so that the underlying causes–like thyroid, metabolic, adrenal, or other hormone imbalances—don’t worsen and lead to disease.

Masking the Root Cause

Because of their ability to give us early warning signs about our health, our periods are referred to as our “fifth vital sign” along with heart rate, blood pressure, temperature, and breathing rate. When it comes to our cycles, deviations from the norm often signify an underlying health concern that will intensify, eventually leading to a more serious problem. For example, most chronic illnesses that we see today are either triggered or worsened by stress. Even if a person isn’t experiencing a flare up of their chronic symptoms (or maybe they have a genetic predisposition that hasn’t yet manifested), our bodies can send us warning signals that our stress is reaching a critical level through changes to our menstrual cycles. Stress interrupts the delicate web of signals between our brains and the organs that secrete our hormones (sex hormones, thyroid hormones, metabolic hormones, and more) leading to missing, painful, or irregular cycles. (For more about the details of what your period can tell you about your health, check out this post.)

Birth Control Pills Shut Down Our Natural Hormonal Processes

As I explain in my book, Go with Your Flow, the main event of our menstrual cycle isn’t the bleed, but rather it is ovulation–the release of an egg. The first two weeks of the cycle are all about ramping up the hormonal signals (mainly estrogen) required to mature and release an egg so that your body can become pregnant. After ovulation, progesterone takes over, preparing the uterus to become a suitable environment for a growing baby if the egg meets a sperm along its journey through the fallopian tube. As you learned in sex ed, the egg passes through if it isn’t fertilized, and the uterine lining sheds away. This shedding of menstrual blood–your period–marks day one of the next cycle.

Birth control pills are made up of chemicals that resemble estrogen and progesterone, overriding your body’s natural signaling pathways. Their purpose is to prevent the release of an egg while still allowing your body to “go through the motions” (i.e. by thickening and shedding the uterine lining every 28 days.) While it might seem easier to just not have a period at all, the processes that take place during your cycle are about more than fertility, and shutting them down completely would be very dangerous, leading to osteoporosis, heart disease, and other health problems. So in lieu of completely eliminating your period, the pill shuts off the “main event” of your cycle, aka ovulation, while setting up a carefully curated hormonal environment that mimics a healthy period.

Except it isn’t a healthy menstrual cycle because it isn’t a menstrual cycle at all. It’s just a bleed. Without being able to control their own hormonal fluctuations, our bodes lose their ability to communicate with us about our hormonal health status.

Because of the way that the false periods induced by birth control pills so closely resemble healthy cycles, the pill is often prescribed for reasons other than contraception. Patient suffering from hormonal acne, PMS, painful periods, PCOS, and other women’s health conditions are often given birth control pills because it seems to solve these problems. But the root cause of these issues goes much deeper, and the pill simply masks over the real issue. It’s kind of like breaking your toe and “curing” the problem by chopping off your whole leg. It completely misses the point. Your toe stops hurting, but only because you don’t have one anymore! The same is true of using the pill for non-contraceptive purposes. Your period seems normal but only because you aren’t really having your cycle anymore! As a result, the underlying cause is left to fester, and often returns with a vengeance as soon as you come off the pill.

Health Risks

In addition to masking over our health problems, the pill often outright creates health risks of its own. Here are just a few:

• Infertility: Despite being often marketed as a “fertility drug,” the pill does not support the optimal function of the female body. It actually does the opposite, by shutting off reproductive function and inhibiting ovulation. Unfortunately, many women struggle with fertility problems even after they discontinue use of the pill. It’s not as if ovulation magically starts up again after being chemically prevented. It takes time for the body to re-learn how to secrete hormones in a balanced and functional way. Sometimes, the body can’t reach that place post-pill on its own without medical support.
• Hormone Imbalances: Even if ovulation resumes, many women find that they struggle with metabolic, thyroid, adrenal, or other hormonal imbalances outside of fertility upon coming off the pill. As I describe in this post, our various hormonal systems are all interrelated, so when we so drastically interfere with one aspect of the HPATG axis (as is the case with the pill), other bodily systems can become imbalanced too. Symptoms like fatigue, weight gain, thinning hair, insomnia, and more can all point back to hormonal contraceptive use, or discontinued use.
• Blood Clots: A widely known fact in the medical community that is seldom talked about in a clinical setting is that oral contraceptives containing estrogen or estrogen analogs increase the risk of blood clots forming, even in otherwise healthy women with no underlying conditions. While certain factors increase risk of this phenomenon (smoking, being over 35 years of age, prolonged inactivity, and family history), the likelihood of blood clots goes up dramatically for all women. These blood clots form in deep veins of the body (most often the legs), and if they break off, they can become lodged in the heart (causing a heart attack), lungs (causing a pulmonary embolism) or brain (causing a stroke). This risk is increased even if a woman follows a healthy lifestyle. [Note: Blood clots from using oral contraceptives is often presented as a low risk, but it’s not really that low. Different sources say different things, but it’s typically discussed about as being about 1/1,000, or 0.1%. Let’s add some context…the CDC estimates that 28% of US women are currently using oral contraceptives, which is about 10.6 million women. I’ll let you do the math, but 0.1% of 10.6 million isn’t a small number—and it seems even larger when it’s someone you know. I personally know of three women in from my own personal life (not even counting patients) who experienced this in their twenties.]
• Heart Disease: Long-term exposure to hormonal analogs like those found in the pill act like a biochemical source of stress in the body. These chronic stress exposures alter the metabolism of lipids and carbohydrates in the body, raising blood cholesterol and triglycerides and increasing risk of chronic disease, especially heart disease in women. Once again, this is true even for otherwise healthy individuals.
• Increased risk of some cancers—namely breast and cervical cancer. Breast cancer is the number one most common type of cancer among women, and cervical cancer is the fourth most common type of cancer in women, worldwide.
• Insulin Resistance: One of the ways that oral contraceptives affect metabolism is by increasing blood glucose levels and subsequent insulin secretion. With time, this can increase risk of insulin resistance and the development of metabolic syndrome and/or diabetes.
• Gallbladder and Liver Dysfunction: Part of the role of the liver and gallbladder in our health is to detoxify our bodies from old, broken down hormones, red blood cells, and other waste products. This is a natural and normal process, but sometimes it can become overloaded if the amount of waste buildup is higher than the normal capacity of these organs. Sex hormones like estrogen are one of the major substrates of the liver and gallbladder, and can “clog up” the system leading to low-grade damage. Some women who experience this manifest skin reactions like itching, rashes, or yellowing of the skin (jaundice).

Female Empowerment

It still blows my mind that so many important women’s health topics are still taboo. Sure, sex is a private matter, but healthcare information shouldn’t be limited or kept secret. As women, we deserve to understand our bodies, including the implications of the medical interventions we receive. Ovulation and menstruation are normal and necessary parts of a healthy woman’s body if she is of reproductive age, and these functions (or lack thereof) give us valuable insight into our well-being. They don’t need to be shut off, and we don’t need to be quiet about it.

Our level of understanding of the female body in science doesn’t require us to subdue our femininity in order to allow us to make family planning decisions in accordance with our values. Likewise, we deserve better medicine—safe and effective, individualized treatment plans that address the root cause of symptoms, whether in terms of our reproductive health or otherwise. If the birth control pill fits your goals and values for your life, that’s awesome! I totally support you. But I also want you to know that if it doesn’t, there are other options for you that protect your health and your values, and which allow you to make informed decisions on behalf of both your family and your own body.

Censorship of these conversations limits a woman’s access to essential information about her sense of well-being. Sexual health isn’t gross or weird, and it shouldn’t be hush-hush. In fact, every single person on earth is only here because of the function of a woman’s reproductive system. The female body is amazing, and each of us should have the privilege of understanding it on a personal level, especially when making the very personal decision about whether or not to use hormonal contraceptives.

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 Risk of Blood Clots and Other Dangers of Hormonal Birth Control 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.

In this post, we’ll explore the most important foods to avoid for each type of PCOS from a functional medicine perspective, while also offering evidence-based supplements and beneficial foods to help balance your hormones naturally.

Types of PCOS

1. Adrenal PCOS

Adrenal PCOS is driven by excess androgen production from the adrenal glands. This type of PCOS is typically associated with high stress levels, poor adrenal function, and imbalances in cortisol. Women with adrenal PCOS may experience symptoms such as excess body hair (hirsutism), scalp hair thinning, acne, and irregular periods.

Foods to Avoid for Adrenal PCOS

• Caffeine: Excessive caffeine can stimulate cortisol production, exacerbating adrenal stress. It’s best to avoid caffeinated beverages like coffee and energy drinks.
• Refined Sugars: Refined sugars and processed carbs cause blood sugar spikes and crashes, which can lead to further cortisol imbalances.
• Alcohol: Alcohol places additional stress on the liver, impairing its ability to detoxify and regulate hormones.
• Processed Foods: These often contain trans fats and additives that may disrupt hormone function and contribute to inflammation.

Beneficial Foods for Adrenal PCOS

• Adaptogenic Herbs: Foods like ashwagandha, maca root, and holy basil can help regulate cortisol levels and support adrenal health.
• Healthy Fats: Avocados, olive oil, and omega-3-rich foods (like salmon and flaxseeds) nourish the adrenals and promote hormone balance.
• Leafy Greens: Rich in magnesium, spinach, kale, and Swiss chard help calm the nervous system and reduce stress.

Supplements for Adrenal PCOS

• Ashwagandha: Known for its adaptogenic properties, ashwagandha can help lower cortisol and support adrenal function.
• Vitamin C: High-dose vitamin C can reduce cortisol levels and improve adrenal function.
• B Vitamins: B5 and B6 are especially helpful for adrenal support and stress management.

2. Post-Pill PCOS

Women with post-pill PCOS develop symptoms of PCOS after discontinuing birth control pills. The synthetic hormones in birth control pills can suppress natural hormone production, and once the pill is stopped, the body may take time to rebalance itself. Common symptoms include acne, hair thinning, and irregular cycles.

Foods to Avoid for Post-Pill PCOS

• Soy: While soy is a good source of plant-based protein, it can interfere with estrogen levels and disrupt hormonal balance, particularly in women who have just stopped taking the pill.
• Dairy: Some women find that dairy exacerbates acne and hormonal imbalance due to its potential to increase androgens.
• Refined Grains: White bread, pasta, and other refined grains can spike blood sugar, which in turn elevates insulin levels and can worsen hormonal imbalances.

Beneficial Foods for Post-Pill PCOS

• Cruciferous Vegetables: Broccoli, cauliflower, and Brussels sprouts help the body detox excess estrogen and promote hormone balance.
• Flaxseeds: Rich in lignans, flaxseeds help balance estrogen levels by supporting estrogen metabolism.
• High-Fiber Foods: Fiber-rich foods like oats, quinoa, and chia seeds can help regulate insulin levels and improve digestive health.

Supplements for Post-Pill PCOS

• Inositol: A combination of myo-inositol and D-chiro-inositol can help improve ovarian function and regulate insulin.
• Zinc: Zinc supports healthy skin and can reduce acne related to hormonal imbalances.
• DIM (Diindolylmethane): Found in cruciferous vegetables, DIM supports the body’s ability to detoxify estrogen and may help with hormonal acne.

3. Inflammatory PCOS

Inflammatory PCOS is marked by chronic low-grade inflammation throughout the body. This type of PCOS is often associated with symptoms like weight gain, acne, fatigue, and insulin resistance. Chronic inflammation can exacerbate the symptoms of PCOS and interfere with hormone regulation.

Foods to Avoid for Inflammatory PCOS

• Fried Foods: High in trans fats, fried foods can increase inflammation in the body and contribute to insulin resistance.
• Sugar-Sweetened Beverages: Sodas, energy drinks, and even sugary fruit juices can spike blood sugar and increase inflammation.
• Processed Meats: Bacon, sausages, and hot dogs are often high in inflammatory omega-6 fatty acids and preservatives.
• Artificial Sweeteners: These can disrupt gut microbiota and promote inflammation.

Beneficial Foods for Inflammatory PCOS

• Turmeric: Contains curcumin, a potent anti-inflammatory compound that can help reduce inflammation in the body.
• Berries: Blueberries, strawberries, and raspberries are packed with antioxidants that reduce oxidative stress and inflammation.
• Omega-3 Fatty Acids: Fatty fish like salmon, sardines, and mackerel are rich in omega-3s, which help reduce inflammation.

Supplements for Inflammatory PCOS

• Curcumin (Turmeric): An anti-inflammatory powerhouse that can help reduce systemic inflammation and improve ovarian function.
• Omega-3 Fatty Acids: Supplements like fish oil can significantly reduce inflammation and support overall hormone balance.
• Vitamin D: Low levels of vitamin D have been associated with inflammation and insulin resistance in PCOS.

4. Insulin-Resistant PCOS

Insulin resistance is one of the most common underlying factors in PCOS. When the body becomes resistant to insulin, it leads to higher levels of circulating insulin, which can worsen hormonal imbalances, increase androgen production, and contribute to weight gain, fatigue, and acne.

Foods to Avoid for Insulin-Resistant PCOS

• High Glycemic Index Foods: Foods that spike blood sugar, such as white bread, pastries, and sugary cereals, should be avoided.
• Trans Fats: Found in many packaged snacks and fried foods, trans fats can worsen insulin resistance and increase inflammation.
• Refined Grains: These foods cause rapid spikes in blood sugar and insulin levels, exacerbating insulin resistance.

Beneficial Foods for Insulin-Resistant PCOS

• Low-Glycemic Index Foods: Non-starchy vegetables, legumes, and whole grains help stabilize blood sugar levels and improve insulin sensitivity.
• Magnesium-Rich Foods: Spinach, pumpkin seeds, and almonds are great sources of magnesium, which can help improve insulin sensitivity.
• Cinnamon: Known for its ability to improve insulin sensitivity, cinnamon can be added to smoothies or oatmeal.

Supplements for Insulin-Resistant PCOS

• Berberine: An herbal supplement that has been shown to improve insulin sensitivity and regulate blood sugar.
• Magnesium: Magnesium supplementation can help improve insulin sensitivity and reduce the risk of developing type 2 diabetes.
• Alpha-Lipoic Acid: A potent antioxidant that can enhance insulin sensitivity and improve metabolic function.

Personalizing Your Diet for PCOS

Whether you have adrenal, post-pill, inflammatory, or insulin-resistant PCOS, a functional medicine approach focuses on addressing the root causes of your hormonal imbalance through diet, lifestyle, and targeted supplementation. By avoiding inflammatory foods, refined sugars, and processed carbs, and by incorporating hormone-balancing foods, you can help mitigate the symptoms of PCOS and support long-term health.

Remember that everyone’s experience with PCOS is unique, so it’s important to work with a functional medicine practitioner or healthcare provider to customize your diet and supplement plan for optimal results.

By understanding the type of PCOS you’re dealing with and adjusting your diet accordingly, you can reclaim your health, balance your hormones, and feel empowered to manage your symptoms effectively.

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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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.

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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.

Progesterone plays a crucial role in maintaining healthy menstrual cycles by regulating the various hormonal changes that occur throughout the cycle. After ovulation, the ovaries produce progesterone, which prepares the uterine lining for potential implantation of a fertilized egg. This hormone promotes the thickening of the endometrium, ensuring it is nutrient-rich and conducive to supporting early pregnancy. If fertilization does not occur, progesterone levels decline, triggering the shedding of the uterine lining during menstruation. This hormonal balance is essential for a regular menstrual cycle; insufficient progesterone can lead to irregularities, such as heavy or missed periods, and can contribute to symptoms of premenstrual syndrome (PMS). Additionally, adequate progesterone levels help to stabilize mood and prevent excessive estrogen, reducing the risk of conditions like endometriosis and uterine fibroids. Thus, maintaining appropriate progesterone levels is vital for reproductive health, emotional well-being, and the overall regularity of menstrual cycles.

Herbal Strategies

Herbal remedies can be a gentle way to support hormonal balance and enhance progesterone production. Below are some herbs known for their progesterone-supporting properties. Please be aware that not all herbs are appropriate for all women, and it’s not safe to use all herbs when you are trying to become pregnant. The most straightforward way to correct the problem of low progesterone/progesterone deficiency is by having a thorough laboratory workup from a licensed functional medicine doctor. Please make sure to discuss any herbal strategy with a functional medicine doctor before starting them for yourself.

Vitex (Chaste Tree)

• Mechanism: Vitex affects the pituitary gland, stimulating the production of luteinizing hormone (LH), which can promote progesterone secretion through ovulation. One of the primary reasons that I use vitex in my practice is in cases where women concomitantly have hypothyroidism, hyperprolactinemia (a common reason for the prescription Cabergoline) or are over 40.
• Dosage: Commonly taken as a tincture or capsule, typically in doses of 400–1000 mg per day.
• Considerations: May take several months to show effects; I usually start my patients on vitex for 3 months, and we don’t use it longer than 6 months except in rare cases.

Maca Root

• Mechanism: An adaptogen that helps balance hormones by supporting adrenal function and improving overall endocrine health. One of the plus sides of this herb is that it is a medical food as well as a supplement, and may be safe to take when breastfeeding (check with your healthcare provider!) I myself took it after the birth of my first child because of intense anxiety, and it helped a lot! For this same reason, it’s also one of the adaptogens I’m more likely to recommend when TTC because it doesn’t carry the same risks as others, such as ashwagandha.
• Dosage: Usually available in powder form, with a typical dosage of 1.5–3 grams daily.
• Considerations: Can be added to smoothies or baked goods; start with a lower dose to assess tolerance.

Dong Quai

• Mechanism: Known as “female ginseng,” it may help balance estrogen and progesterone levels by acting as a phyto-estrogen. Women who are perimenopausal are particularly likely to benefit from the effects of this herb.
• Dosage: Commonly taken in capsule or tincture form, with typical doses ranging from 300–600 mg.
• Considerations: Should be used cautiously, especially by women with certain health conditions or who are pregnant.

Black Cohosh

• Mechanism: Traditionally used to alleviate menopausal symptoms; black cohosh is beneficial because it can likewise act like a natural alternative to the drug Clomid, triggering ovulation in women who otherwise might not be ovulating. Without ovulation, you can’t make progesterone, so although black cohosh is a phytoestrogen, it helps improve overall progesterone balance. Anovulatory periods are always estrogen-dominant.
• Dosage: Commonly available as a tincture or tablet, with dosages around 20–40 mg per day.
• Considerations: Not recommended for long-term use; consult a healthcare provider for guidance.

Red Clover

• Mechanism: Contains phytoestrogens that can help balance hormones and support progesterone levels. Similar to black cohosh, red clover can help improve ovulation rates.
• Dosage: Available as a tea, capsule, or tincture, with a typical dosage of 40–80 mg per day.
• Considerations: May interact with some medications; consult a healthcare provider.

Lifestyle Strategies

In addition to herbal remedies, certain lifestyle changes can support hormone balance and increase progesterone production.

Nutrition

1. Balanced Diet
   • Focus on whole, nutrient-dense foods rich in vitamins and minerals.
   • Include healthy fats (avocados, nuts, seeds) that support hormone production.
   • I always recommend that patients include animal products in their diets, especially fish (including whole fish such as sardines)
   • Make sure that you are eating enough calories and macronutrients overall. In my experience, women need at least 100-125 grams of carbohydrates per day to ovulate.
2. Incorporate Zinc and Magnesium
   • Foods rich in zinc (pumpkin seeds, shellfish) and magnesium (leafy greens, dark chocolate) support hormone balance and promote ovulation.
   • Consider supplementation if dietary intake is insufficient.
3. Limit Sugar and Processed Foods
   • High sugar and processed foods can lead to insulin resistance, negatively affecting hormone balance by promoting insulin resistance, which negatively impacts metabolism and ovulation. Insulin resistance changes ovarian function, which can be reversed easily within 90 days using a whole food diet
   • Aim to reduce refined sugars and prioritize whole foods

Stress Management

• Mindfulness and Meditation: Practice mindfulness techniques to reduce stress, which can help regulate cortisol levels and support progesterone balance.
• Yoga and Breathing Exercises: Incorporate regular yoga or deep breathing exercises to promote relaxation and hormonal balance.

Regular Exercise

• Balanced Physical Activity: Engage in moderate exercise, such as walking, swimming, or cycling, to maintain a healthy weight and support hormonal health. The best kind of exercise is always the type you enjoy doing.
• Avoid Overtraining: Excessive exercise can lead to hormonal imbalances; prioritize rest and recovery.

Sleep Hygiene

• Quality Sleep: Aim for 7-9 hours of quality sleep per night to support hormonal regulation.
• Sleep Environment: Create a relaxing bedtime routine and a comfortable sleep environment to improve sleep quality.

Healthy Weight Management

• Maintaining a Healthy Weight: Excess body fat can lead to higher estrogen and insulin levels, both of which can disrupt ovulation and production of progesterone. At the same time, being underweight may lead to anovulation and subsequently the near absence of progesterone production.
• Balanced Caloric Intake: Focus on a diet that supports a healthy weight through balanced caloric intake and nutrient-rich foods. Make sure you are eating enough protein, fat, carbohydrate and overall calories in optimal proportions. Avoid skipping meals or prolonged fasting. If you choose to follow time-restricted eating, consider an earlier eating window (i.e. 9 am – 3 pm) instead of a later one (i.e. 1 pm – 7 pm).

Increasing progesterone naturally involves a multifaceted approach that combines herbal remedies with lifestyle changes. By focusing on a balanced diet, stress management, regular exercise, and proper sleep, women can support their hormonal health effectively. It is essential to consult with a healthcare provider before starting any new supplement or herbal regimen, especially if you have existing health conditions or are pregnant, and to make sure that you have an accurate diagnosis. With the right strategies, you can achieve better hormonal balance and overall well-being that last a lifetime.

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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The post Herbal Supplements for Low Progesterone appeared first on Dr. Alexandra MacKillop.

The Mirena Crash is a type of hormonal imbalance occurring as an IUD’s hormones wear off, or when it is suddenly removed, leading to various physical and emotional symptoms. In this post, we’ll explore what the Mirena Crash is, how the Mirena IUD works, the benefits of natural progesterone, and natural treatment options for the Mirena Crash. First and foremost, the best way to prevent a Mirena Crash is to not get an IUD in the first place; but if you already have one, don’t fret! In this post, I’ll explain everything you need to know.

What is the Mirena Crash?

The Mirena IUD is a popular contraceptive device that releases a synthetic form of progesterone called levonorgestrel. This is not the same as real progesterone, does not behave exactly like real progesterone, and consequently lacks the benefits of real progesterone. It also comes with some significant risks. Really, all IUDs have these synthetic progestins, so the term “Mirena Crash” really should be “IUD Crash.” But that doesn’t even fully encompass the full scope of the problem, either, because all forms of hormonal contraceptives run the risk of causing major problems to the body’s systems. (Read: Natural Alternatives to the Birth Control Pill) However, for the sake of this trending topic, we’ll keep calling it “Mirena Crash” in this post.

While some women experience a smooth transition off the IUD, many don’t. This term describes the withdrawal symptoms that can occur after the hormones in the device run out (the Mirena is approved in the US to last up to 8 years for pregnancy prevention) or after the device is removed. This hormonal crash often involves symptoms like mood swings, anxiety, fatigue, hair loss, weight gain and other manifestations of hormonal imbalances. The severity of these symptoms can varies but the common denominator is that people who experience the hormonal reverberations of using these endocrine-disrupting contraceptives feel awful. Why Well, it all comes down to how the Mirena and other IUDs work.

How Does the Mirena IUD Work?

The Mirena IUD works primarily by releasing levonorgestrel directly into the uterus. Here’s how it functions:

1. Thickens Cervical Mucus: This makes it more difficult for sperm to enter the uterus.
2. Thins the Uterine Lining: A thinner lining reduces the chances of implantation if an egg is fertilized. You should be aware that this means that IUDs prevent the implantation of fertilized eggs, which may be a moral concern for some.
3. Inhibits Ovulation: Although this is not its primary function, the hormonal release can prevent ovulation in some women: around 55% of cycles in the first year of use, but that number drops to around 25% after 4 years. [Source: FDA Insert]

Hormonal IUDs also run the risk of systemic side effects, even though they’re often advertised as locally-acting. While the pregnancy-prevention effects are locally-induced (read: changes in cervical fluid and endometrial lining thickness) the hormones enter the blood stream and affect organs all the way up to the brain, which is how they interfere with ovulation, and how they cause a hormonal crash after they’re suddenly removed.

With an IUD in place, the levonorgestrel tricks the brain into supressing hormone production. When the hormone in the IUD wears off or the device is removed, you’d think that this hormonal suppression resolves. Well, not always, and certainly not immediately. It can take months for the body to come back into balance. What’s more, because the Mirena is the longest-acting contraceptive device approved for women, it’s usually administered to women who would like to prevent pregnancy for a long time. This group typically reflects women who are done having children. By the time they have the device removed, they’re often well into perimenopause, when hormones have already begun shifting. When you take a situation of hormonal suppression as seen with the IUD, then create a crash by suddenly withdrawing the drugs, and then the return of hormones looks like perimenopause (which sometimes includes debilitating hormonal imbalances all of its own) it’s no wonder that women feel terrible. It’s no wonder we’ve started talking about it on social media. It’s no wonder that women with IUDs are both scared of the Mirena and scared of having it removed.

So, what’s to be done Enter: natural progesterone.

Levonorgestrel and other progestins are not the same as the progesterone our bodies make. Our bodies need progesterone to function properly. The fake progestins in IUDs and other hormonal contraceptives trick our bodies into not making progesterone anymore. Then, when the IUD is removed, there’s still no progesterone around. If removal takes place during perimenopause, progesterone may never come back. Fortunately, the marvels of modern medicine (read: functional medicine) have made a way to bring that back.

The Benefits of Natural Progesterone for the Mirena Crash

Natural progesterone, which can be found in supplements derived from plants like wild yam, or administered through bioidentical hormone replacement therapy, offers several benefits, especially for those experiencing hormonal symptoms like the Mirena Crash. Some of the advantages include:

1. Regulating Menstrual Cycles: Natural progesterone balances estrogen levels, leading to more regular cycles and eliminating estrogen dominance.
2. Improving Mood and Reducing Anxiety: Because the brain has abundant hormone receptors for progesterone, natural progesterone travels straight there and does what it was meant to do all along for our mood, our sleep, stress regulation and more.
3. Supporting Sleep: Progesterone keeps you cool, calm and collected, partly because it helps you sleep better.
4. Bone and Breast Health: Adequate progesterone levels are important for maintaining bone density and preventing breast cancer, as well as numerous other cancers of the female reproductive tract.

Incorporating natural progesterone is especially beneficial for women transitioning off hormonal birth control, and who are on the estrogen roller coaster ride of perimenopause.

How Can the Mirena Crash Be Treated Naturally?

If you’re experiencing the Mirena Crash, there are several natural approaches you can consider to alleviate symptoms. Of course, always talk with your doctor about trying something new:

1. Dietary Changes:
   • Whole Foods: Emphasize a diet rich in fruits, vegetables, whole grains, and healthy fats. Foods high in fiber and omega-3 fatty acids can support hormonal balance.
   • Limit Sugar and Caffeine: Reducing sugar and caffeine can help stabilize energy levels and mood.
2. Herbal Supplements:
   • Vitex (Chaste Tree Berry): Known for its ability to support hormonal balance, Vitex helps regulate the menstrual cycle and reduce symptoms associated with low progesterone and the Mirena Crash.
   • Maca Root: This adaptogen can help balance hormones and increase energy levels.
3. Stress Management Techniques:
   • Mindfulness and Meditation: Practicing mindfulness can help reduces anxiety and improves emotional well-being.
   • Yoga and Exercise: Regular physical activity helps balance hormones and improve mood.
4. Natural Progesterone Creams or Oil:
   • Consider using natural progesterone creams under the guidance of a functional medicine doctor to help manage symptoms. Progesterone cream does come with side effects and is not appropriate or needed for all women.
5. Adequate Sleep:
   • Prioritize sleep hygiene by maintaining a regular sleep schedule and create a relaxing bedtime routine to enhance recovery.

Navigating the Mirena Crash can be challenging, but understanding its causes and implementing natural strategies significantly eases the transition. Whether through dietary adjustments, herbal supplements, or lifestyle changes, there are numerous ways to support your body during this time. Always consult with a healthcare professional before making significant changes to your health routine, especially when it involves hormonal treatments. By taking proactive steps, you can regain balance and well-being after the Mirena IUD.

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 Survive The Mirena Crash appeared first on Dr. Alexandra MacKillop.