A Pause for Progesterone: Connecting Stress, Hormone & Fertility

What is Progesterone and Why Does It Matter?

🧐 Progesterone is a steroid hormone made in the adrenal glands, two triangular structures that sit on top of our kidneys. While it is less commonly known than estrogen and testosterone, it is absolutely essential to many aspects of our health and deserves our care and attention in any treatment plan involving hormonal imbalance, gut health, mood issues and/or fertility support.

🩸Progesterone is the dominant hormone in the second ½ of the menstrual cycle, from just after ovulation until just before the start of the next period. It is secreted by the corpus luteum, a structure found on the follicle of the ovary that ovulated. About 12-14 days after ovulation the corpus luteum disintegrates and progesterone levels drop which causes the period to start. In people who menstruate, progesterone is responsible for building and maintaining the uterine lining (AKA the endometrium) making it key to fertility and regular menstrual cycles.

⚠️ If progesterone levels are low, the endometrial lining is often too thin for a fertilized egg to implant successfully, which can lead to infertility and/or repeated miscarriages. 

Progesterone is also essential for many other important bodily functions:

🙂 Balanced mood: progesterone interacts with our primary calming neurotransmitter, GABA. When progesterone is low, GABA activity is reduced, leading to increased feelings of agitation, anxiety, irritability, mood swings, and/or sadness and depression (PMID: 37111278, 22906865).

💪Supports bone density to prevent osteoporosis: progesterone binds to receptors on osteoblasts (bone-building cells) signaling them to build more of the bony matrix needed to strengthen our bones and prevent bone loss and fractures. Studies have shown that people with lower progesterone levels experience more bone loss than those with healthy progesterone levels (PMID: PMID: 29962257, 28860416).

🫀Protects cardiovascular health: healthy levels of progesterone reduce blood pressure, improve blood flow by preventing blood vessel constriction, and decrease inflammation in the cardiac muscle and coronary vessels (PMID: 24548847).

☯️ In Chinese medicine, the adrenal glands are considered to be part of the Kidney system. Similarly to the kidneys and adrenals in Western medicine, the Chinese medicine Kidney system is closely involved in hormone balance, growth and development over the lifespan, reproductive health, bone health and stress response. Chinese medicine ascribes additional energetic qualities to the Kidney system. 

😰 The emotion associated with the Kidney system in Chinese medicine is fear, which ties into the fact that the adrenals are responsible for our “fight or flight,” response. Long-term over-activation of the adrenals leads to depletion of Kidney qi, which can cause people to become fearful, anxious, and lacking in motivation since the Kidneys are said to house our Zhi (志, willpower). Anyone who has been stressed for a long period of time can attest to the fact that chronic stress frequently leads to "burnout," characterized by fatigue, low mood and lack of motivation. This is the result of overtaxing the Kidney system for too long and depleting our body's physical and energetic resources.

How High Stress Directly Causes Low Progesterone:

🧱Progesterone is made from the same basic building block as the stress hormone, cortisol. Because our bodies are wired to prioritize our survival, cortisol production will always come before the production of the other steroid hormones, including progesterone and estrogen.

😖 When we experience chronic stress (which can be physical, psychological, emotional or physiological) the majority of the available “building blocks” are used to make cortisol instead of other steroid hormones like progesterone, estrogen and testosterone. 

🥑The basic “building block” used to make all these hormones is cholesterol. This is why eating enough healthy fat is key to hormone balance. Include healthy fats such as avocado, salmon, high EPA/DHA fish oil, nuts/seeds and extra virgin olive oil and/or cold pressed avocado oil in your diet to ensure healthy levels of cholesterol for hormone balance. 

Symptoms of Low Progesterone:

• Irregular menstrual cycles (often very long cycles but may vary)

• Heavy, painful and/or clotty periods

• Spotting before periods

• Mood swings, PMS/PMDD (premenstrual syndrome/premenstrual dysphoric disorder), anxiety, depression, irritability, emotional lability 

• Insomnia around when the period starts

• Headaches and/or migraines around when the period starts

• Low sex drive

• Infertility 

• Repeated pregnancy loss early in pregnancy

• Hair loss/thinning 

• Low energy, fatigue

If you are experiencing these symptoms, you may be suffering from the effects of low progesterone, high cortisol, and/or other hormonal imbalances that are negatively impacting your health.

Treatment Options for Low Progesterone

Western treatment options for low progesterone are typically synthetic progestins, which are the lab-made version of progesterone. These may take the form of hormonal birth control, topical cream, patch, or injection. While the use of synthetic progestins can be helpful temporarily, they do nothing to address the root causes of low progesterone and often come with uncomfortable and disruptive side effects. 

In addition, synthetic progestins do NOT have the same health benefits as natural progesterone. This means that hormones from birth control or hormone replacement therapy are not as beneficial to your health as the progesterone made in your body. 

Fortunately, there are many holistic treatment options and lifestyle changes that are highly effective to support healthy progesterone levels without relying on synthetic hormones. 

🌿 How to Support Healthy Progesterone Levels Naturally: 

🥬 Diet: prioritize protein and fiber-rich, nutrient-dense foods. Literally, this means eat the protein and vegetables on your plate FIRST before going for carbohydrates. Aim for 20-30 grams of protein at each meal to ensure that your blood sugar is stable. Not eating enough protein and nutrient-dense food will cause blood sugar to spike and drop too dramatically, leading to increased cortisol production, fatigue, unstable mood, insulin resistance and poor digestion/gut health.  

🧘‍♀️Stress management is crucial, as explained above. Yoga, tai chi, qi gong, meditation, therapy, breathwork, journaling, and spending time in nature (no screens!) are all excellent options to help regulate your nervous system and shift your hormone metabolism away from high cortisol production and toward healthy progesterone balance.

😌 Reset and Restore with Acupuncture: Acupuncture is highly effective for achieving hormone balance and healthy progesterone levels. Modern studies demonstrate that acupuncture can help regulate the hypothalamic-pituitary-adrenal (HPA) axis, the system that controls our reproductive hormones (PMID: 38955651, 39851439). Acupuncture has been shown to influence the release of both FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which in turn promotes ovulation and regular menstrual cycles (PMID:  37600702). Acupuncture also works to reduce stress and regulate the autonomic nervous system by increasing parasympathetic “rest and digest” activity, the opposite of “fight or flight” (PMID: 24761151). Incorporating acupuncture into treatment plans involving hormone imbalance typically yields clinical results much more quickly and efficiently than other interventions alone. 

😴 Ensure you are getting 8-9 hours of sleep a night. There is no substitute for adequate amounts of high-quality sleep. Try to be asleep by 11 pm at the latest. Build a bedtime routine by getting in the habit of shutting off all screens for the hour prior to bedtime, dimming lights, meditating, and perhaps having a soothing cup of herbal tea (chamomile, Sleepytime Tea, etc) to ease your body and mind into rest mode before bedtime. 

💊 Consider targeted supplementation: specific supplements that are supportive of healthy progesterone levels include Vitamins C, D, B6, healthy fats (think high EPA/DHA fish oil, avocado, seeds/nuts, salmon) and vitex. Adaptogenic herbs that help the body to better manage the oxidative effects of high stress are also helpful to balance cortisol.

🌸 Support Progesterone Production with Customized Herbal Medicine: Chinese herbal medicine is highly effective in supporting healthy progesterone levels and hormone balance when used as prescribed by a licensed and experienced herbalist. Chinese herbal medicines known to support progesterone levels include Xu Duan (Dipsacus asperoides, 续断), Tu Si Zi (Semen cuscutae, 菟絲子) and Man Jing Zi (Viticis fructus, 蔓荊子). I offer customized and individualized herbal formulas tailored to my clients’ specific needs and challenges as well as recommendations for patented Chinese herbal formulas. To book an herbal, dietary or lifestyle consult with me, click HERE. 

☕️ Be mindful of alcohol and caffeine intake: both alcohol and caffeine further stress the adrenal glands (where progesterone is made), leading to dysregulation of the HPA axis (hypothalamic-pituitary-adrenal axis). This produces hormone imbalances and increased inflammation. At the very least, be sure to eat something with protein either before or at the same time as caffeine in the morning to prevent excessive cortisol production.  

🤸Exercise and Movement: Moving your body every day benefits circulation, mood, hormone balance and gut health. In cases of low progesterone, high intensity exercise (running, HIIT, strenuous weight training) are often too much for the nervous system and can increase cortisol production, which negatively impacts progesterone levels. Choose lower intensity exercises such as Pilates, walking, yin yoga, or Tai Chi to reap the benefits of exercise without pushing your body into overdrive.

🚫Reduce exposure to synthetic chemicals and plastics known to disrupt our hormones. Eliminate as much plastic from your personal care products and food storage as possible. Opt for glass, ceramic, wooden or stainless steel utensils, cooking & storage items wherever possible. Choose non-toxic cleaning and personal care products whenever possible.

If you feel like your self care practices and routines already incorporate all of the above but you continue to struggle with symptoms of low progesterone and/or high stress, you will benefit from more individualized support! This is a great reason to work with me so we can figure out the root cause of your symptoms and develop a customized treatment plan tailored to your specific needs and challenges.

I specialize in working directly with clients who are committed to transforming their health and provide direct, individualized, compassionate support integrating the best resources from both Chinese medicine and modern science.

Need to ask more questions before booking an appointment? Book a FREE 15 minute discovery call to discuss your specific needs, challenges and health goals and determine how we can best support you in treatment. 

Happy healing!