Here Alex O'Connor, a fertility acupuncture specialist, from Essex Fertility in her Explaining the Unexplained series tells us all about low progesterone and what we can do about it.
What is progesterone?
Progesterone is one of the key hormones of the menstrual cycle, it is the counterbalance to oestrogen. Oestrogen grows and thickens the uterus lining, while progesterone matures it and thins it ready for implantation. Oestrogen suppresses the activity of the thyroid gland, while progesterone boosts it. Progesterone also helps to reduce inflammation and calms the nervous system.
Progesterone governs the luteal phase of a menstrual cycle; the luteal phase is the time after ovulation and before the period. Progesterone is secreted from the corpus luteum which develops on the site of a ruptured follicle after the egg has been released. If the corpus luteum is strong and healthy, the luteal phase should last between 12-14 days before the corpus luteum fizzles out and progesterone level falls which triggers a bleed. Alternatively an implanting embryo triggers the release of HCG which encourages the corpus luteum to continue to secrete progesterone so a bleed is not triggered. It is the rising HCG level that produces a positive pregnancy test.
If your progesterone is low you may notice some of the following symptoms: PMT, premenstrual spotting, prolonged bleed and or a particularly heavy bleed.
The article 'Are You Ovulating?' contains a lot of information about how and when to test your progesterone levels - to read that article, go here.
What is a luteal phase defect?
Some women have low progesterone levels at the end of their cycle, this is sometimes referred to as a 'luteal phase defect'. When there is a luteal phase defect, the corpus luteum dies away too early and the fall in progesterone triggers a bleed which will usually end any attempted pregnancy.
There are various possible reasons for this:
- the corpus luteum may not be able to generate sufficient progesterone
- maybe there is a sub-clinical thyroid issue which can hamper the way the body responds to progesterone
- maybe the prolactin level is too high, hampering communication between the thyroid and the corpus luteum
- maybe circulation in and around the ovary is sub-optimal, slowing the supply of nutrients to the corpus luteum and hampering communication between the corpus luteum and the thyroid
Is a progesterone supplement the solution?
If you consider the list of possible causes of a low progesterone given above, you will understand why simply supplementing progesterone is not really the answer to improving your fertility. A progesterone supplement will not improve egg quality, thyroid health, prolactin levels or blood supply in and around the ovary. The main benefit of a progesterone supplement would be that your progesterone level would probably normalise, but you would not necessarily be any more fertile.
Is Vitex the solution?
If you are worried about low progesterone levels, you may have come across Vitex. Vitex is a native Mediterranean herb, also known as 'chasteberry' or agnus-castus. Vitex is only for use by women, it is thought to be harmful for sperm production in men; indeed the term 'chasteberry' comes from a time when it was used to curb sexual urges of soldiers in medieval times!
Vitex can be very effective for some women but can be counter-productive for other women, causing their cycle to shorten or the bleed to become extremely light so it is not suitable for everyone. While it can increase progesterone levels in the second half of the cycle, it can interfere with the way the egg matures in the first half of the cycle so I would recommend you seek the advice of a qualified herbalist before you take it to make sure it is the right thing for you. If you have a history of depression or you have a tendency to a low mood at the end of the month then it may not a good idea to take Vitex because it also has an effect on dopamine levels; if you do decide take it, be careful that it does not worsen these symptoms.
So how do you improve your progesterone level?
If you want more progesterone, the first place to start is with the egg. A combination of diet, supplements and acupuncture is usually all that is necessary to improve the vitality and strength of the maturing follicle, meaning that it is stronger and able to produce more progesterone. If progesterone stays persistently low, then I would suggest investigating thyroid function and prolactin levels to see whether there is something lurking there that could be causing the problem.
High stress levels can contribute to a high prolactin level which can in turn lead to a lower progesterone level. High stress levels are characterised by high cortisol levels - both progesterone and cortisol are derived from the same building block, a substance called 'pregnenolone'; if the body is producing excessive amounts of cortisol it may have less pregnenolone available to generate progesterone. If you suspect you have a luteal phase defect, it is definitely time to look to make improvements to your diet and reduce stress by actively pursuing wellness and relaxation activities such as meditation, yoga, walking etc.
So what can you do about low progesterone?
Acupuncture can be a very good therapy for low progesterone issues, it works by boosting vitality and circulation in and around the ovaries which can result in a stronger ovulation and a stronger corpus luteum. This would is shown in several different ways - your cycle would lengthen, your 21 day progesterone blood tests would show a higher progesterone level, and if you chart your basal body temperature you would see steadier, higher temperatures through the luteal phase of your cycle.
I would recommend working with a Fertility Support Trained Acupuncturist who would be able to work with you to investigate what is happening and treat you to restore regular ovulation. We work in a particularly integrated way, blending western medicine diagnostics with ancient acupuncture knowledge to restore and rebalance your cycle and improve your fertility.
Read more about Alex and Essex Fertility here.