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Hormone series Part 2: cortisol and progesterone

Bits of Wisdom

“Progesterone is warming, calming, anti-inflammatory and sleep-promoting. It’s definitely a hormone that you want on board for overall health and wellness. Yet so many women suffer from low progesterone or other hormone imbalances that impact progesterone’s benefits. Why is that?”


“Progesterone is the hormone star of the second half of a woman’s cycle.”


“As a functional medicine clinician, I’m always seeking the root cause by asking why. It’s not enough for me to know that progesterone is low, I want to know what causes low progesterone and which reason applies to you.”


“Ever wonder why stress impacts your cycle or your fertility? Here’s why: the body will always choose survival over reproduction.”



Progesterone & Cortisol: The Dynamic Duo Of Wellbeing 


Today’s topic is for the ladies: progesterone. Progesterone is warming, calming, anti-inflammatory and sleep-promoting. It’s definitely a hormone that you want on board for overall health and wellness. Yet so many women suffer from low progesterone or other hormone imbalances that impact progesterone’s benefits. Why is that and what is the root cause?


In Part 1 of my hormone series, we talked all about cortisol, your steroid stress hormone produced in the adrenal glands. Today, we will build upon that foundation and talk more in depth about progesterone. As you’ll see all the hormones are connected; progesterone connects to cortisol, but also to thyroid hormone, insulin and estrogen. I’ll be leading you through it all, piece by piece, so let’s dive in!


In this article, you will learn:


What Is Progesterone?


Let’s start with the basic questions: 


Progesterone, like cortisol, is a steroid hormone that the body makes from cholesterol. It is the hormone star of the second half of a woman’s cycle after she has ovulated. 


The first half of the cycle is dominated by estrogen, which thickens the uterine lining, preparing the body for ovulation. After ovulation, the corpus luteum, which is a temporary organ (part of the ovary), releases progesterone. So the answer to the question, where is progesterone produced is: the corpus luteum. (Remember that cortisol is produced in the cortex of the adrenal glands).


Progesterone’s job is to maintain the uterine lining and then to maintain a pregnancy, should your egg be fertilized during that cycle. If an egg isn’t fertilized, progesterone levels drop, triggering menstruation.


The main point here is that you must ovulate in order to produce progesterone - there is no other way.


Low Progesterone Symptoms


The most common imbalance with progesterone is low progesterone levels. Symptoms of low progesterone include:



Sounds like no fun! Yet, as a woman, you’ve likely experienced these symptoms at one point or another in your life. Of course many of these symptoms can have other causes as well, it’s important to consider the role that progesterone function plays. 


As a functional medicine clinician, I’m always seeking the root cause by asking, “why?” It’s not enough for me to know that progesterone is low; I want to know what causes low progesterone and which reason applies to you. 


Here are some causes of low progesterone:



When I work with women on hormone balance, it’s important for us to take a complete view. The testing that I do in my practice looks at a wide range of hormones and factors. For testing progesterone, specifically, I offer both luteal phase blood testing and Dutch (urine) testing. Each test has purpose. 


Progesterone And Cortisol Connection


Now that you understand the basics of progesterone, let’s talk about the progesterone and cortisol relationship. Have you ever wondered why stress impacts your cycle or your fertility? Here’s why: the body will always choose survival over reproduction


If you really like this topic than you may have heard of a concept called the “pregnenalone steal.” The idea is that because both cortisol and progesterone are made from a pre-hormone called pregnenalone, under stress, pregnenalone diverts away from progesterone in order to make more cortisol. Sounds interesting, but I have to break it to you that this idea is outdated. The regulation actually happens upstream, in the brain!


When we talked about cortisol in my previous article, we talked about the HPA-axis: hypothalamus-pituitary-adrenal axis. When we talk about progesterone, we can think of a HPO-axis: hypothalamus-pituitary-ovary. 


A major role of the hypothalamus is to interpret signals about the environment. When the hypothalamus perceives stress, it signals the pituitary gland to affect hormone production. Under stress, the brain will actually down-regulate reproduction by reducing FSH (follicle stimulating hormone) and LH (luteinizing hormone), both of which are critical for a normal cycle, ovulation and progesterone production. 


It's the hypothalamus signaling the pituitary that also signals to the adrenals to ramp up cortisol production. Although it might seem like progesterone and cortisol levels have an inverse relationship, it’s the brain running the show. 


We aren’t really talking about the adrenals affecting the ovaries, it’s more of a top-down whole body approach coming from the brain. It’s designed for your protection. Having a baby during a famine doesn’t make sense to the body. In our modern world the body will have the same response to anything stressful: undereating, inflammation, emotional stress, lack of sleep, an injury, work stress, lack of intra and inter – personal time, and anything the hypothalamus perceives as stress. 


How To Increase Progesterone


Once you’ve determined, with the help of your provider, that progesterone is indeed low, it’s important to work on the root cause in order to balance hormones and support progesterone producing. In this sense, the answer to how to naturally increase progesterone, may be different for each woman. 


However, in addition to addressing your own root causes, here are some things that are helpful for increasing progesterone:


  1. Eat a nourishing diet. It’s important to be well-nourished and not under eat to support a healthy cycle. In addition, progesterone is made from cholesterol so including some in the diet can be helpful. 


  1. Include zinc-rich foods in your diet. Zinc helps to stimulate FSH to support ovulation that triggers progesterone production. Foods high in zinc include oysters, grass-fed beef, pastured egg yolks, pumpkin seeds and Brazil nuts. 



  1. Add in magnesium. Magnesium is relaxing and calming, and supports adrenal health and fertility. It also happens to be one of my favorite supplements that most women benefit from. 


  1. Don’t forget vitamin B6. Vitamin B6 helps the body develop the corpus luteum and it balances estrogen and progesterone levels. I often recommend a B-complex to help support hormone balance, hormone detoxification and stress. This one I like:


Vital Nutrients Vitamin B6 


  1. Manage stress. Often times stress and HPA-axis dysfunction plays a role in hormone imbalance. In fact, this is a very common root cause I see in my practice. Use all of your self-care tools, meditate, relax and decompress in order for your brain to send strong signals to your ovaries (via FSH and LH). 


  1. Try vitex. Vitex, or chaste tree berry, is an herbal remedy with a long history of use for female cycle support and has been shown to increase progesterone levels. Vitex is a slow acting herb and you have to be willing to make a commitment to take it for about 6 months to see changes in symptoms or cycles. I prefer the tincture as it is more potent and more easily absorbed. Start out with 60 drops a day but you can work up to 90 after taking it for 90 days. More than this and you run the chance of disrupting your hormones rather than supporting them. I usually advise breaking during your period, you can do this cycle for up to a year then give yourself a break for a few months. 


*Don’t take on birth control, fertility drugs, or if you have PCOS or a history of depression. 



Progesterone FAQs


I receive a lot of questions from my patients about progesterone and chances are, you might have some of the same questions. Here is a rundown of the common ones. 


Q: Does progesterone cause weight gain? 

A: Weight gain is more often related to high estrogen or cortisol levels. Natural progesterone, produced by your body, is helpful for weight maintenance, but progesterone taken as hormone replacement sometimes has weight gain as a side effect. At higher levels, progesterone can cause insulin resistance. So if you are trending towards insulin resistance it’s important to work with a provider who understands bio - identical progesterone dosing.  Avoid synthetic progestins.


Q:  What is progesterone used for?

A: In my practice, I use bioidentical hormone replacement therapy for peri-menopause, menopause and other women’s health issues depending on the needs of each individual woman. When used appropriately, bioidentical progesterone is safe and effective


Q: Why take progesterone at night? And does progesterone make you tired?

A: Since progesterone is calming and relaxing, and also increases the function of the relaxing GABA neurotransmitter, taking progesterone at night helps to promote peaceful and deep sleep. It may make you feel tired and ready for bed. 


Q: Does progesterone cause acne?

A: Acne is more often related to excess insulin or testosterone, as in the case of PCOS. Acne may have other root causes as well. I often see gut imbalances or food sensitivities contributing. 


Q: How common is low progesterone?

It’s hard to say exactly how prevalent low progesterone is, especially because many women who experience symptoms of low progesterone might simply brush them off as getting older or think that discomfort or pre-menstrual symptoms are “normal.” I will say that low progesterone is quite common in my patient population and is often coupled with other hormones out of balance. 


Q: How to lower progesterone?

Although it’s most common to have low progesterone, some women may have high progesterone. The first thing to check in this case is if you are pregnant as progesterone levels dramatically rise during pregnancy. In the absence of pregnancy, elevated progesterone may or not be an issue, but can certainly be supported by balancing other hormones, especially estrogen, and supporting liver detoxification. 


Q: How does cortisol affect estrogen?

I’m so glad you asked! Be sure to keep following this hormone series to have all of your questions answered. We will dive into estrogen shortly! The short of it is that under stress, you might experience estrogen dominance. Both elevated cortisol and elevated cholesterol contribute to weight gain and leave you feeling lousy. It’s a pattern that we definitely want to address. 


By now you should be an expert on both progesterone and cortisol! My hope is that this article helps you to understand your body – and all of the connections within – just a little more and helps you on your wellness path. Talking about hormones is one of my favorite things and I’d love to talk with you about your hormones at my clinic: The Fork Functional Medicine



References
  1. Briden, Lara. (2017). Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. Second Edition. 
  2. van Die, M. D., Burger, H. G., Teede, H. J., & Bone, K. M. (2013). Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta medica, 79(7), 562–575. Abstract: https://pubmed.ncbi.nlm.nih.gov/23136064/ 
  3. Lieberman, A., & Curtis, L. (2017). In Defense of Progesterone: A Review of the Literature. Alternative therapies in health and medicine, 23(6), 24–32. Abstract: https://pubmed.ncbi.nlm.nih.gov/29055286/ 

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