Progesterone is an incredibly vital reproductive hormone that's responsible for many aspects of overall health. When it's not doing what it should be, it stands out! Issues like PMS/PMDD, implantation failure, early miscarriage, and postpartum depression can all be due to low progesterone! In order to address these issues at their source, it's best to first learn as much as we can about Progesterone. Today's episode shares a great introduction, including what it is, how it functions, how to tell if it may be low, and the process in diagnosis and treatment. You'll even learn about bioidentical progesterone vs. progestin!
NOTE: This episode makes use of female anatomical terms, and does briefly mention pregnancy loss possibilities.
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Caitlin:
Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started. Welcome back to the Woven Well Podcast. If you're a regular listener, then you know I talk a lot about the benefits of progesterone. It relates to PMS, successful implantation, regular menstrual cycles and more. It's used in cycling women, perimenopausal, pregnant and postpartum women. So if you're a woman, you need to know about progesterone. So I've compiled an overview for you to cover all the things that matter most, what it is, what it does, how to know if it's low, and what to do when there's a progesterone imbalance. Let's start today with what progesterone is and how it shows up in a cycle. Each reproductive cycle for a woman consists of the development and release of an egg. At the start of a new cycle, eggs are recruited to develop. They grow a protective, nourishing follicle around them that produces the hormone estrogen. So this is the dominant hormone in the first part of your cycle. When one egg produces a sufficient amount of this estrogen, the ovary releases the egg from the follicle, and it has the opportunity to meet with a sperm if there happens to be one waiting. But that follicle that grew around the egg, it doesn't just disappear. It transforms into something called a corpus lium, which changes that dominant reproductive hormone from estrogen over to progesterone. This is why progesterone is typically tested after ovulation and can even be used to help pinpoint when ovulation occurs. Remember that progesterone is a hormone, and hormones serve as messengers through the entire body, not just the reproductive system. So progesterone specifically is critical to so many aspects of a woman's life, her menstrual cycles, her ability to get pregnant, but also her overall quality of life. Even things like her mental health. Progesterone is responsible for balancing out the effects of estrogen. So if you've ever heard of estrogen dominance, then you know it's something that you'd like to avoid. The production of progesterone actually balances out the function of estrogen to prevent this from happening. While estrogen contracts the uterus, progesterone relaxes it. While estrogen causes the lining of the uterus to grow, progesterone maintains it. Estrogen develops breast tissue and progesterone normalizes it. Estrogen stimulates brain cells. Ever notice how focused and energized you are around ovulation, but progesterone heals them. Progesterone is fantastic for increasing sleep, relaxation, and reducing anxiety. It even changes the type of cervical mucus that the cervix creates from one that promotes fertility and sperm travel around ovulation to one that creates a thick antibacterial barrier afterwards. Progesterone is amazing. It's also critical to the possibility of implantation, which is when an embryo burrows into the lining of the uterus. If the lining is not first prepared for this implantation by progesterone, it's likely to be unsuccessful. So we need progesterone for so many reasons, but if for nothing else, because it's also the decrease in both progesterone and estrogen at the end of your cycle that signals the uterus to contract and bleed and for you to have a new period. So progesterone plays a critical role for every woman no matter what reproductive season of life you're in. This is why it's truly important to know if it's deficient or lower than it should be. Your first thought may be that you have to get lab work to know if that's the case, and lab work is very helpful, but there are a surprising number of ways that you can confidently suspect low progesterone even before lab work is done. So if you're charting your cervical mucus with the Creighton system, which is what we teach at Woven Natural Fertility Care, then you're able to see lots of signs through your everyday observations. You could have brown bleeding at the end of your period or spotting in the days leading up to the start of your period. You could have a short or changing luteal phase, which is that time between ovulation and your next period. So ideally, this would be somewhere between 12 to 15 days long. So if it's less than that or you see wild fluctuations in the length , then it could be pointing to issues with progesterone production, or you may be experiencing difficulty getting pregnant or staying pregnant. Women with recurrent pregnancy loss or those who cannot seem to get pregnant may be experiencing issues with the lining of the uterus. So if progesterone is not high enough, successful implantation or the long- term success of the pregnancy may be challenged. Even if you have none of these things, you may still be able to suspect low progesterone because you have symptoms before your period that could point to it. Things like breast tenderness, fatigue, headaches, bloating, difficulty sleeping, irritability, or feeling sad or depressed. With progesterone being so important to our overall quality of life, we may have symptoms related to progesterone issues that we didn't even realize. Identifying them really is the first step to getting the diagnosis and treatment that you need. Now, if you're working with an OBGYN or medical provider who is interested in a restorative approach to women's health, one who wants to preserve your reproductive health, then they're going to be really knowledgeable and helpful in the process. They won't just want to know the symptoms, although those are important, but they're going to want to investigate with you further. Is your progesterone starting off normally and then plummeting halfway through your luteal phase? Does your progesterone seem to rise and fall normally, but just not as high as it should be? Are your progesterone levels actually normal or high? But there seems to be a resistance to the hormone itself. This information can help your provider pinpoint the cause of your problem and treat it specifically for you and your experience. Now, a part of that diagnosis process will be having lab work done to test those progesterone levels at a traditional OBGYN. They may suggest that you go in on cycle day 21, but I want to give you a little more context Cycle day 21 is suggested based on the theory that women are most likely to ovulate on day 14 of their cycle. Cycle day 21, then would be seven days later, right in the middle of their luteal phase. So if you do in fact ovulate on cycle day 14, then this is great. But for the 80 to 90% of women who do not ovulate on cycle day 14 most cycles, this won't be nearly as effective. Women with long or regular cycles, for instance, will only be more confused by this number. I wouldn't be surprised if their doctor told them that they may not be ovulating at all. That's because it was too early in their cycle to get an accurate progesterone reading. They may not have even ovulated yet, so they're testing too early. Now, the opposite applies for women with shorter cycles like women in perimenopause who may be ovulating near the end of their periods. They may not even make it to cycle day 21 before starting their next cycles. So instead of guessing, just using this assumption of cycle day 21, learning to identify your own ovulation allows you to know exactly when you should have that progesterone tested at woven natural fertility care. The work behind this podcast, I teach women every week how to chart their cycles to understand when they're fertile and infertile and how to identify possible issues like low progesterone. It's not nearly as difficult as you'd think to figure out when you should test for progesterone, and if you're working with a NaPro provider or restorative women's health provider, that's going to be their preference anyway. They may even ask you to have your progesterone tested 3, 5, 7, and 9 days after ovulation to really get a full picture of hormone production during that time. Again, the more information they have, the better they are able to treat you. Now , when it comes to treating progesterone, there are several approaches, depending on the cause and the problem. The most common is usually the use of bioidentical progesterone called prometrium. So these squishy little tablets can be used orally or vaginally, and they function very differently than artificial versions known as progestins. So that is key. You want this bioidentical progesterone because it's derived from natural sources and it has the same molecular structure as our own progesterone. It binds really easily and creates better results without all the negative side effects of progestins. Progestins are not chemically identical and more so just mimic the effects of true progesterone. Now, as far as side effects for bioidentical progesterone, they're often very minimal. If there are any at all, you may feel sleepy, lightheaded, or dizzy. So doctors usually encourage you to take it at night right before bed. If you still experience symptoms, then they may even suggest that you take it vaginally instead. The key to any progesterone supplementation though is timing. Timing is everything. You don't want to take it every day of your cycle because remember, your progesterone is only naturally produced after ovulation. Instead, you'll want to identify ovulation and then take the progesterone as directed by your doctor before your next cycle begins. Although bioidentical progesterone supplementation has none of the negative side effects of like estrogen supplementation, for instance, there's still going to be women who may prefer not to supplement. That's fine, I get it. If that's you, then you may want to consider some other lifestyle changes that may be able to improve your overall hormone production. Remember, the entire body is interconnected, so doing things like nourishing gut health, reducing stress, regulating your endocrine system, they're going to provide improvement to your reproductive system as well. There may even be some supplements that can help in this process, but of course, ask your doctor about specific recommendations. I mentioned earlier that progesterone is not only important for cycling women, but those who are pregnant, postpartum, and perimenopausal these seasons all have their own issues related to progesterone deficiency. But if you're working with a NaProTechnology doctor, they will know how to time and dose progesterone to support your specific concerns, whether they be early miscarriages, postpartum depression, interuterine growth restriction, or mood swings and hot flashes related to perimenopause. Often these things, whether they be PMS or any of the things I just listed, are assumed to just be a part of being a woman, but they may actually be a sign of progesterone deficiency. Knowledge is important, and this episode is only an overview. There is so much detail that we weren't able to go into, and I'm not a doctor myself, but I do hope that this is a helpful starting place for you as you begin advocating for your needs and getting to the root cause of women's health issues that often go unaddressed. If you're ready to start charting your cycle so that you can learn more about your own progesterone production, why don't you join our upcoming introductory session? It's happening in the next few weeks. It's online, and I would love for you to be there. It's the perfect way to get started and learn how you can be empowered in your own cycle health. Make sure to check out our show notes for a link there. If you enjoyed this episode, please take just one second to write us a five star review. I can't tell you what a difference it makes in spreading this information to other women who need it. I really appreciate it. As always, thanks for listening. As we continue to explore together what it means to be woven well.