The Progesterone Piece
What every woman needs to know about her hormones.
When you think about hormones, what comes to mind?
Testosterone for men. Oestrogen for women.
But here's what most people don't realise: women don't just have ONE dominant hormone. We have TWO.
Oestrogen AND progesterone.
We cycle through two distinct phases every month:
Follicular phase (Oestrogen-dominant, from period to ovulation)
Luteal phase (progesterone-dominant, from ovulation to period)
This is called a biphasic cycle. Two phases. Two hormones working in balance.
But when shit goes wrong - when you're emotional, irritable, can't sleep, rage-crying over nothing - everyone blames OESTROGEN.
"My hormones are fucked." "Must be my estrogen." "Probably oestrogen dominance."
And yes, oestrogen imbalance is real. But what we FORGET is the other half of the equation:
Progesterone.
Progesterone is the peacemaker. The calming force. The emotional buffer.
And it takes A LOT to make it flow and balance out everything else.
Without adequate progesterone, everything falls apart.
What Happens When Progesterone Is Low
When your progesterone is depleted or disrupted, you FEEL it.
Mood and mental health:
Rage, irritability (especially premenstrually, but often all month)
Zero patience - snapping at your kids over nothing
Anxiety (on edge, can't relax, everything feels overwhelming)
Depression, low mood, crying easily
Emotional volatility - fine one minute, losing it the next
Feeling like you used to cope better but now you can't
Sleep:
Insomnia (can't fall asleep, or waking at 2-3am and can't get back)
Restless sleep, vivid dreams, nightmares
Waking unrefreshed even after 8 hours
Menstrual cycle:
Short luteal phase (less than 10-12 days between ovulation and period)
Heavy, painful periods
Severe PMS (mood swings, breast tenderness, bloating, irritability starting 7-10 days before period)
Irregular cycles
Spotting before period starts
Physical symptoms:
Breast tenderness (especially premenstrually)
Water retention, bloating
Headaches, migraines (often around your period)
Low libido
Difficulty getting pregnant or maintaining pregnancy
The feeling: Like you have ZERO buffer left. Like the smallest thing can send you over the edge. Like you're barely holding it together.
That's what low progesterone feels like.
Oestrogen Dominance: When The Balance Is Off
Here's something crucial: your oestrogen levels might look NORMAL on testing.
But if your progesterone is LOW, you end up with oestrogen dominance - not because oestrogen is necessarily high, but because it's high RELATIVE to progesterone.
The RATIO matters.
We need WAY more progesterone than estrogen in the luteal phase for things to work properly.
When that balance is off - when progesterone is too low to balance estrogen - you get:
Heavy periods
Severe PMS
Breast tenderness, fibrocystic breasts
Fibroids, endometriosis
Weight gain (especially hips, thighs, belly)
Mood swings, irritability
I'll dive deeper into oestrogen dominance another day. For now, just know: progesterone is KEY to balancing oestrogen.
Without enough progesterone, oestrogen runs wild.
How Do We Naturally Make Progesterone?
Let's talk about where progesterone actually comes from.
After you ovulate, the follicle that released your egg transforms into something called the corpus luteum (literally "yellow body").
The corpus luteum's job? Produce PROGESTERONE.
For the next 10-14 days (your luteal phase), the corpus luteum pumps out progesterone to:
Prepare the uterine lining for potential pregnancy
Calm your nervous system
Support sleep, mood, and emotional regulation
Balance oestrogen
But here's the catch: you have to OVULATE to make progesterone.
No ovulation = no corpus luteum = no progesterone.
Anovulatory Cycles: When You Bleed But Don't Ovulate
You can have a "period" without actually ovulating.
These are called anovulatory cycles - cycles where you still bleed, but you didn't release an egg, so you didn't form a corpus luteum, so you didn't make progesterone.
You go through the whole month with only oestrogen (no progesterone to balance it).
What anovulatory cycles look like:
Short cycles (bleeding every 21-25 days)
Long cycles (35+ days with unpredictable bleeding)
Very light or very heavy bleeding
No PMS (because there's no progesterone drop to trigger symptoms)
OR severe PMS-like symptoms all month (because estrogen is unopposed)
Why does this happen?
Stress. Undereating. Overexercising. PCOS. Thyroid dysfunction. Perimenopause.
When your body doesn't feel SAFE or RESOURCED, it skips ovulation.
Because ovulation (and the progesterone that follows) is expensive. It requires energy, nutrients, and a regulated nervous system.
If your body thinks you're in survival mode, it says: "Not now. We can't afford to ovulate this month."
And you lose your progesterone.
The Cortisol Steal: Why Stress Destroys Progesterone
Even if you ARE ovulating, stress can still tank your progesterone.
Here's how:
Both cortisol (stress hormone) and progesterone are made from the same precursor: pregnenolone.
The pathway: Cholesterol → Pregnenolone → Progesterone OR Cholesterol → Pregnenolone → Cortisol
When you're stressed, your body prioritizes SURVIVAL (cortisol) over REPRODUCTION (progesterone).
Pregnenolone gets shunted toward making cortisol instead of progesterone.
This is called the pregnenolone steal or cortisol steal.
What this means:
The more stressed you are, the more cortisol you need
The more cortisol you make, the less progesterone you produce
Over months and years of chronic stress, your progesterone reserves become DEPLETED
By the end of the year, after running on stress since January with no real break, your progesterone is gone.
And you're running on cortisol fumes.
What Do We Need To Make Progesterone?
Your body needs specific building blocks to produce progesterone:
Vitamins:
Vitamin B6 - cofactor for progesterone production, supports neurotransmitter production
Vitamin C - supports adrenal glands (which produce pregnenolone), antioxidant support
Vitamin E - supports corpus luteum function and progesterone production
Minerals:
Magnesium - essential for progesterone production, calms nervous system, supports sleep
Zinc - cofactor for hormone production, supports ovulation (you need to ovulate to make progesterone)
Macros:
Healthy fats - cholesterol is the precursor to ALL steroid hormones including progesterone. Your body needs adequate healthy fats to make hormones (avocado, olive oil, coconut oil, grass-fed butter, fatty fish, nuts, seeds, eggs, meat).
Protein - provides amino acids needed for hormone production and regulation
Carbohydrates - support thyroid function and insulin sensitivity, both of which affect ovulation and progesterone production
If you're undereating, over-restricting, or cutting out entire food groups, your body doesn't have the resources to make progesterone.
How To Rebuild Progesterone
Restoring progesterone isn't just about supplementation. You need to address WHY it's depleted and give your body what it needs to make it again.
1. Manage Stress and Regulate Cortisol
This is THE foundational piece.
You can't out-supplement chronic stress. If your body is constantly making cortisol, it will keep stealing from progesterone.
How to regulate cortisol:
Nervous system regulation (daily practices):
Long exhales (6 count in, 8 count out, 5-10 minutes daily)
Humming (activates vagus nerve)
Cold water on face (30 seconds, resets nervous system)
Walking (gentle movement, not intense exercise)
Co-regulation (time with calm people, physical touch)
Herbal Adaptogens (support stress response):
Withania (Ashwagandha) - if wired, anxious, can't wind down
Rhodiola - if exhausted but need to function
Holy basil/Tulsi if burnt out, overwhelmed
Boundaries:
What needs to STOP (obligations, commitments, overgiving)
What needs to be added (rest, support, pleasure)
Where you need to say NO
2. Fill Nutritional Depletions
Give your body the building blocks it needs:
Magnesium glycinate
Vitamin B6
Vitamin C
Zinc
Vitamin E
Always under practitioner supervision for individualised dosing and compounding.
Seed cycling:
Follicular phase (day 1 to ovulation): 1 tbsp ground flax + 1 tbsp ground pumpkin seeds daily
Luteal phase (ovulation to period): 1 tbsp ground sesame + 1 tbsp ground sunflower seeds daily
Eat adequate:
Healthy fats (don't fear cholesterol - your body needs it)
Protein at every meal
Complex carbs high in fibre (support thyroid and insulin, both affect ovulation)
3. Help Your Body Feel Safe To Be Fertile and Vitalistic
This is the deeper piece.
Your body won't prioritize reproduction (ovulation, progesterone) if it doesn't feel SAFE.
What makes your body feel unsafe:
Chronic stress (physical, emotional, mental)
Undereating or restricting
Overexercising
Lack of sleep
Constant sympathetic activation FIGHT OR FLIGHT (always "on," never resting)
What makes your body feel safe:
Adequate nourishment
Regulated nervous system
Rest and sleep
Boundaries and support
Feeling resourced (not constantly depleted)
When your body feels safe, it can AFFORD to ovulate. It can AFFORD to make progesterone.
A healthy menstrual cycle is the 5th vital sign of health.
We don't just cycle to have babies. We cycle because it's a sign our body is THRIVING, not just surviving.
What Else Does Progesterone Do?
Progesterone isn't just about your cycle. It has effects throughout your entire body:
Brain and nervous system:
Neuroprotective (protects brain cells from damage)
Supports myelin (protective sheath around nerves)
Activates GABA receptors (calming neurotransmitter)
Anti-anxiety, mood-stabilizing
Supports cognitive function and memory
Sleep:
Promotes sleep by calming nervous system
Regulates circadian rhythm
Helps you fall asleep AND stay asleep
Anti-inflammatory:
Reduces inflammation throughout the body and brain
Supports immune regulation
Metabolic:
Supports thyroid function
Affects insulin sensitivity
Influences body composition
Bone health:
Stimulates bone formation (works with oestrogen to maintain bone density)
Progesterone is ESSENTIAL for overall health - not just reproductive health.
PMDD: When The Brain Can't Respond To Progesterone Properly
Some women have severe mood symptoms in the luteal phase that go beyond normal PMS. This is called PMDD (Premenstrual Dysphoric Disorder).
PMDD isn't about low progesterone levels. It's about how the BRAIN responds to the normal rise and fall of progesterone.
Specifically, it's a dysregulation of GABA receptors in the brain - the receptors that progesterone activates to create its calming effect.
In PMDD, when progesterone rises after ovulation, the brain's GABA system doesn't respond properly. Instead of feeling calm, women with PMDD experience:
Severe depression, hopelessness
Intense anxiety, panic
Rage, irritability
Suicidal thoughts (in severe cases)
Physical symptoms (fatigue, brain fog, insomnia)
This is a neurobiological condition, not just "bad PMS."
Treatment is different than treating low progesterone - I'll dive deeper into PMDD another day. But it's important to know: if your luteal phase symptoms are SEVERE and debilitating, it might be PMDD, not just low progesterone.
How To Test Progesterone
If you suspect low progesterone, testing confirms it.
Serum Progesterone (Blood Test)
When: Day 21 of a 28-day cycle (or 7 days post-ovulation if your cycle isn't 28 days)
Why day 21: Progesterone peaks about 7 days after ovulation
Note: "Normal" lab ranges are often too broad - you want OPTIMAL, not just "within range"
DUTCH Test (Dried Urine Test for Comprehensive Hormones)
My preferred test
Shows progesterone metabolites (how your body breaks down and clears progesterone)
Shows cortisol rhythm (4 time points throughout the day) - helps identify the cortisol steal
Shows oestrogen metabolites and the progesterone:estrogen ratio
Gives the FULL hormone picture
Why I LOVE Symptom Tracking
Even without testing, track:
Luteal phase length (days between ovulation and period - should be 12-14 days)
PMS symptoms (severity, when they start)
Sleep quality through the month
Mood patterns
If your luteal phase is short (<10 days) or you have severe PMS, low progesterone is likely.
Medical Treatment: Progestins vs. Progesterone
When progesterone is clinically low, medical treatment might be needed.
But it's crucial to understand the difference between synthetic progestins and bioidentical progesterone.
Synthetic Progestins
These are synthetic compounds that mimic some progesterone effects but are NOT identical to what your body makes.
Examples:
Levonorgestrel (in Mirena IUD, Plan B, some birth control pills)
Norethisterone (in some birth control pills, HRT)
Medroxyprogesterone acetate/Provera (in Depo-Provera injection, some HRT)
Drospirenone (in Yaz, Yasmin birth control)
The "mini pill" (progestin-only pill):
Contains only synthetic progestin, no oestrogen
Works by thickening cervical mucus (prevents sperm entry) and sometimes suppresses ovulation
Can help with heavy bleeding, endometriosis pain, PCOS
BUT: suppresses your natural cycle (you don't ovulate, so you don't make your own progesterone)
Side effects can include: mood changes, irregular bleeding, acne, weight gain
Problems with synthetic progestins:
NOT identical to natural progesterone
Can have androgenic effects (acne, hair growth, mood issues)
Don't provide the same neuroprotective, calming benefits as bioidentical progesterone
Suppress your natural hormone production
Progestins have their place (contraception, managing severe bleeding or pain), but they're not the same as supporting your body's natural progesterone production.
Bioidentical Micronized Progesterone
This is my preference for progesterone replacement when needed.
Bioidentical progesterone is molecularly IDENTICAL to the progesterone your body makes.
Forms:
Oral micronized progesterone (Prometrium, Utrogestan) - capsules taken at night
Progesterone cream - topical application
Progesterone suppositories - vaginal or rectal
Benefits:
Identical to your body's progesterone
Calming, supports sleep (especially oral form)
Neuroprotective
Supports mood without the side effects of synthetic progestins
Can be used cyclically (mimicking natural luteal phase) or continuously depending on needs
When it's needed:
Progesterone levels very low despite lifestyle/supplement support
Severe PMS, insomnia, anxiety not responding to other interventions
Perimenopause (progesterone declines before estrogen does)
Supporting fertility or early pregnancy
Managing heavy or irregular bleeding
Important:
Work with a practitioner who understands bioidentical hormones
Dosing and timing matter (usually luteal phase dosing, or daily in perimenopause/menopause)
You STILL need to address the root cause (stress, nutrition, nervous system) - bioidentical progesterone is support, not a cure
Herbs and Supplements That Work On Progesterone Pathways
Beyond direct progesterone supplementation, certain herbs and nutrients support the PATHWAYS that produce progesterone:
Vitex/Chasteberry (Vitex agnus-castus):
Works on the pituitary to support healthy LH (luteinizing hormone) which triggers ovulation
Supports corpus luteum function and progesterone production
Can lengthen short luteal phases
Takes 3-6 months to see full effect
Don't use if on hormonal birth control or in early pregnancy without practitioner guidance
Peony and Licorice:
Traditional combination for hormonal balance
Supports healthy oestrogen:progesterone ratio
Peony can lower androgens (helpful in PCOS)
Licorice supports cortisol regulation
Use under practitioner guidance (licorice can raise blood pressure)
Maca root:
Adaptogenic herb that supports overall hormone balance
Works on hypothalamus and pituitary (not directly on ovaries)
Can support regular ovulation
Takes 2-3 months to see effects
L-theanine:
Amino acid that supports GABA production
Calming without sedation
Supports progesterone's calming effects
Always work with a practitioner when using herbs and supplements - they can interact with medications and aren't appropriate for everyone.
I always prescribe practitioner quality herbs and supplements for all my clients who require support.
The Bigger Picture
If you've been rage-crying, can't sleep, snapping at your kids, feeling like you're barely holding it together - you're not broken.
Your progesterone is depleted.
And your body is trying to tell you something.
You've been running on stress for too long. Giving too much. Holding too much. Trying to do it all.
And your body can't keep up.
Progesterone depletion is the SIGNAL.
The solution isn't just supplements (though they help).
The solution is:
Managing stress and regulating cortisol (so your body stops stealing from progesterone)
Filling nutritional depletions (giving your body what it needs to MAKE progesterone)
Helping your body feel SAFE (so it can afford to ovulate and produce progesterone)
Supporting the nervous system (so progesterone's calming effects can actually work)
Using bioidentical progesterone when needed (as support, not a band-aid)
A healthy menstrual cycle is a sign your body is THRIVING.
When progesterone is adequate, you feel calm, grounded, able to cope.
You deserve that.
Ready For Clinical Support?
If you're tired of just surviving and ready to actually HEAL - book a connection call.
We'll talk about:
What's happening in YOUR body specifically
Whether testing (DUTCH, serum progesterone, HTMA) makes sense
Clinical protocols tailored to your unique pattern
How to support progesterone production AND address the root cause