The Right Way to Test Progesterone with Your Cycle

testing progesterone

The next time your doctor orders a progesterone test, ask yourself: “When is the right day to do this test?”

Forget “day 21 progesterone.” There’s no reason to test progesterone until you are approximately one week before your period. That will change depending on how long your cycle actually is.

Here’s what need to know about progesterone testing.

The brief window of progesterone

You make progesterone ONLY during the brief 10-14 days following ovulation, which are the 10-14 days before your period. That’s your luteal phase. You cannot expect to see any progesterone before then.

If you have a longer cycle, you will have almost no progesterone for the majority of your menstrual cycle, and that’s normal.

You want to test progesterone when it’s highest, which is about halfway through your luteal phase. In other words, it’s when you are 5-7 days after ovulation and 5-7 days before your period.

If your cycles are regular, it’s easy to know when to test progesterone. Simply identify the date of your next expected period, and then count 7 days before that. For example:

  • 21-day cycle: Test progesterone on approximately day 14
  • 28-day cycle: Test progesterone on approximately day 21
  • 35-day cycle: Test progesterone on approximately day 28

👉 Tip: Day 1 is the first day of proper menstrual flow. Days of pre-period light flow or “spotting” are counted as the final days of your previous cycle.

If your cycles are not regular, it’s harder to know when to test progesterone. The best plan is to detect ovulation and then count 5-7 days.

How to detect ovulation

  • Watch for fertile mucus and twinges in your pelvis. When you see these physical signs of possible ovulation, count 5-7 days, and then have the blood test.
  • Test with LH ovulation test strips. Start testing your urine a few days before you think you’ll ovulate. When you see the double line indicating LH surge, count 5-7 days, and then have the blood test.

👉 Caution: You cannot rely on ovulation test strips if you have PCOS because your LH could be chronically elevated.

  • Chart your basal body temperature (BBT). Using an ovulation thermometer, take your early morning resting temperature. You will see it rise 0.5℃ (0.9℉) after ovulation. When you see your temperature rise, count 5-7 days from the start of the rise, and then have the blood test.

👉 Caution: BBT charting is a great way to confirm ovulation and progesterone, even without a blood test.

Check-in with your actual period

Don’t interpret your progesterone result until your period has actually arrived. Wait for your period, and then ask: “Was the test done within 14 days before my period?

If not, then it is not a valid test and cannot be used to diagnose progesterone deficiency or estrogen dominance.

👉 Tip: If you’re certain you ovulated, but your period does not come within 14 days, you could be pregnant, so do a pregnancy test!

When it’s normal to have no progesterone

There are three situations in which you can expect to have no progesterone so there’s no point testing.

  • Pre-ovulation (follicular phase). And remember: if you have long cycles, your follicular phase is many weeks long—the majority of your cycle.
  • Hormonal birth control.  Almost all types of hormonal birth control switch off progesterone. The only exception is the hormonal IUD (Mirena or Skyla), which permits some ovulation (but not regular ovulation).
  • Post-menopause.  Unless you take body-identical progesterone, you can expect to have no progesterone after menopause. Even if you do take body-identical progesterone (Prometrium or Utrogestan), your serum levels should not exceed the baseline level of 1.8 ng/mL (5.5 nmol/L).

Interpreting your progesterone result

To confirm ovulation: If your serum mid-luteal progesterone is less than 1.8 ng/mL (5.5 nmol/L), it means you did not ovulate. Instead, you had an anovulatory (non-ovulation) cycle.

Anovulatory cycles are common with polycystic ovary syndrome or PCOS. Your strategy is to correct the underlying reason for PCOS, and therefore start to ovulate again. That’s how you’ll make progesterone.

👉 Tip: These reference ranges are for progesterone on a blood test. I don’t recommend saliva or urine to assess progesterone.

To assess optimal progesterone: The optimal range of progesterone is greater than 8 ng/mL or 25 nmol/L, and the higher the better. But don’t worry too much if your result is at the low end of normal. Progesterone fluctuates widely over the course of ninety minutes, so a low-normal reading may simply mean the blood was drawn at a low point.

Ask me in the comments.

Dr Lara Briden

266 thoughts on “The Right Way to Test Progesterone with Your Cycle”

  1. I have irregular cycles and for a few of them I had an lh surge detected with mild bbt rise then 3 days later, I had pink spotting that lasted a day, which had a higher bbt shift. When would 1 dpo be, after the lh surge or after the spotting? I would like to get my progesterone tested to find out if my levels are optimal, but want help figuring this weird sometimes occurring phenomenon! Thanks!

    Reply
  2. Hello thank you so much for taking questions, After my last pregnancy and getting my tubes tied 4 years ago, my periods have become twice as long (3 days days to 7days) I have gone from only having gas and bloating to gas, bloating, severe cramps, pressure in the vaginal area that feels like everything is going to fall out, sciatica now acting up, and feeling so sick like I have the flu not wanting to get out of bed. I was seen the last day of my period (occasional spotting, no pad needed) they tested my TSH it was normal, FSH was 5.1 miu/ml, and progesterone was <0.2 miu/ml. Than they did a pelvic ultrasound and found a hemorrhagic follicle 2.1 in size. I have had 2 before 2 years ago. Now they rechecked my progesterone again it was one day before my period started and I was at 1.6 miu/ml. Now they want to do an endometrial biopsy. No one can give me any answers. Thank you for any help

    Reply
  3. Здравейте Лара,
    От последния преглед доктора ми каза , че нямам овулация и не мога да забременея.
    Ако взимам таблетки прогестерон, това ще предизвика ли овулация?

    Reply
  4. I Can’t seem to find an answer to this question anywhere. I am undergoing fertility treatments and have had several cycles canceled as my baseline progesterone does not drop as low as it should. I’m told it should be under one or close to zero and mine seems to hover around two at baseline. Are you able to explain what could cause high progesterone at baseline, or progesterone that does not drop adequately? I’ve also had very light periods As well as follicular cysts. At the progesterone issue seems to be a consistent problem. Thank you

    Reply
  5. Hey Lara, thanks for sharing all these insights! I am in menopause and after reading your book, I suggested taking progesterone and estrogen to my doctor. I take progestan vaginally and an estrogen spray. Since my maternal grandma died of breast cancer in her 60ies, I thought it would be a good idea to slowly phase them out. Asked my doctor whether my hormone levels should be tested. She refused, saying that a test would only be a snapshot. Is there a way to test and would it make sense to do so? Best regards, Heike

    Reply
  6. Hello Dr Briden!
    My question is re: progesterone testing and the OTC progesterone cream I use, Emerita Pro-Gest.
    I am perimenopausal, and am still having a kind of regular period. It’s getting a little wonky. (Spotting)
    I have Hashimoto’s, but am still in the “lower normal” range. No thyroid drugs needed at this point. But I do have weight gain. Been almost underweight most my life, but things have changed the last 1.5 years.
    I am wanting to test my Progesterone. I think I may prefer to take a pill instead of cream twice a day.

    Do I take a break from the Progesterone cream to test my progesterone? (during the literal phase)

    I am curious if the cream is doing the job, though. Pro and cons of cream vs pill? Of course bio-identical (I forget the current term for that)

    Thank you!!
    Jennifer

    Reply
  7. I am undergoing treatment for IUI and taking Clomid. First cycle day 20 test was 40 and i wasn’t pregnant. This time it was 19. Why would their be such a large variance between the 2. before taking any climid my day 22 test it was 16.
    Thank you!

    Reply
  8. My level today is 30. I’m on day 28. Have been having 35 day cycles since starting chlomid (I haven’t taken anything since Feb but the 35 day cycles have remained)
    I believe this means I have already ovulated.
    When would I have ovulated if my score today is 30?
    My score 7 days ago was 2
    Thanks
    Amanda

    Reply
  9. Looking for advice I had a miscarriage on 18th September on 5th October I had positive test with clear blue ( had had just flashing smileys for 3 days before ) I also used just a strip which was also positive however had my day 21 test Monday 12th ( 7 days later ) and it was very low 3.15 nmol/l Is there a chance I could go on to ovulate this cycle or what ?

    Reply
  10. Hi Lara, I have a question. I had a hormone workup which included progesterone during my last cycle, exactly 7 days before my period and approximately one week after ovulation (perfect timing). My result was 2.19ng/mL. In America, the “normal” levels during luteal phase is supposedly 1.83-23.90ng/mL. (Estradiol was 91.9pg/mL, also supposedly within normal levels, but on the lower end). I just turned 30, have never had normal periods, and I don’t have periods unless I take vitex. Ultrasounds have not shown cysts. I’ve been a mystery to doctors here. Wondering if you have any insight?

    Reply
      • Hi Dr. Briden! Yes, my period came exactly 7 days after.
        Other hormone levels:
        TSH-1.11 uiu/mL
        Testosterone-31.8ng/dL (high end)
        Insulin (14hr fasting)- 14.8mcu/ml
        FSH- 5.9miu/ml
        Prolactin- 8.9ng/ml

        Reply
          • I appreciate your response! It is possible that I’ve been having anovulatory cycles, but it seems unlikely to me. I had anovulatory cycles until I began vitex consistently (I skip it during my period). Though I don’t track my temps, I experience most if not all symptoms of ovulation. I was diagnosed with infertility in my early 20s, then started vitex instead of clomid, and I was pregnant within 6 months, having 3 healthy pregnancies within three years. If I skip vitex, I have no cycle at all, and if I miss a few days, my cycle is delayed the amount of days skipped. It may also be worth mentioning that my mom died of uterine cancer at age 34, so my drs have been hyper vigilant to any irregularities, but I’m an enigma here.

          • Additionally, my Hydroxyprogesterone-17 was 117ng/dl. My ultrasound results confirmed ovulation. One symptom I have had for 15 years is severe hirutism (tried treating with zinc and magnesium for 3 years). I am thinking of requesting a cortisol test.

    • Sydney! Thank you for sharing your story. This situation sounds so similar to me. I’ve been taking maca to try to regulate because while vitex makes my skin SO clear it seems to prolong my cycle very long. I was tinkering around with it in tea so I feel like that could have been the problem. I’m curious- do you take it as a supplement through just the luteal phase or the whole cycle?

      Reply
      • Hi Anastasia! That’s interesting, I haven’t tried a tea form of vitex. I tried powder capsules which didn’t work, so I now take two Gaia brand 500mg liquid capsules daily. I take it throughout my cycle except when I’m on my period, though I often skip a few days here and there. But if I skip a few days, my skin lets me know!

        Reply
  11. Hi Laura! Just stumbled on this post – I had My cd22 progesterone level checked (8dpo) and it was 11. My ob said it’s a good level but from what you are saying it needs to be 25? Does that mean at 11 it can’t sustain implantation?

    Reply
  12. Hi
    I have been trying to conceive for 3 years, I suspect I have pcos but it has never been confirmed. I check my progesterone most months and track my bbt. This month I had my best bbt rise in all my months tracking with 5 high temps after my positive ovulation test so I was certain I ovulated but my progesterone level came back at 23.4 which means I didn’t 🙁 why would I get such a rise if I didn’t ovulate?

    Reply
  13. Hi there-

    I have recently received my blood results back with my progesterone levels were 10.8nmol/L which was around day 23 of mY cycle. My usual cycle length is 32 ish days.

    My GP said it’s all perfect and I’ve ovulated. Can you confirm this?

    Love my book! Thanks so much Lara

    Reply
  14. I’m in Canada. I was watching an interview you did and you mentioned a form you could take to your Dr to get a natural progesterone. Could you please send that to me?

    Reply
  15. Hello! Some time ago, they removed PdG urine tests from the market, then Proov is now available. You can get in qty of 5, 9 or 18. Would you recommend these for urine testing vs blood tests? I keep being told I should “try progesterone” but I want some proof before messing with hormones.

    Reply
  16. Thank you so much for your article I’ve been trying to wrap my brain around the whole progesterone testing thing and you explained it all in one user friendly article!

    My Dr asked me to do my progesterone test CD21. My temps however indicated that I may have ovulated on CD17 – should I have therefore tested CD24? My results were 28.13 nmol/L 4DPO. I have been asked to re-test next cycle I’m now CD1.

    Reply
  17. Can Vitex be used with an estradiol patch instead of micronised progesterone each month? Would it protect the endometrium just like natural progesterone does? Thank you.

    Reply
  18. Hi Lara. Does this mean taking Vitex during follicular phase is also not good as it raises progesterone therefore might suppress ovulation? I remember reading in one of your articles that Vitex should be taken during the follicular phase. Would you please mind clarifying this? Thank you.

    Reply
  19. Thanks for this interesting post Lara! I’m 16 weeks pregnant My gynaecologist prescribed me to get progesterone and prolactine tests done. What is the minimum level of progesterone and prolactine in 16 weeks pregnant to have a healthy pregnancy?

    Reply
  20. Hi can 200mg progesterone daily for 14 days prevent ovulation or conception in case l do ovulate during the time when l take progesterone? I take them vaginally instead of orally, l hope that is also okay for the sperm to move freely.

    Reply
  21. Dr. Briden,

    Thank you for your reply! Although my doctor did not specifically say it was a dx procedure, I’m assuming that’s what it was (she said it would help “get my periods back on track”). I just finished my round of Prometrium (I asked for that in place of Provera, as you suggested), and I started what I assume is my period today.

    I have read your blog post on PCOS/HA, and I seem to have a mix of symptoms from each category:

    Symptoms I DO have: absent or irregular periods, polycystic ovaries, bleed from progesterone challenge.
    Symptoms I do NOT have: no thin or thick uterine lining (per ultrasound), no hirsutism. I don’t believe I have elevated androgens (no issues with acne or weight gain), and my thyroid fx is normal (per blood test).
    Questionable: LH to FSH ratio (I don’t think I’ve ever had that tested)

    I eat over 2,000 calories/day and get plenty of healthy fats and carbs, so I don’t believe I’m undereating. It feels like a never-ending mystery, and I’m starting to wonder if it’s just the stress of graduate school.

    I greatly appreciate your work and any insight you might have into this!

    Kelly

    Reply
  22. I told my Dr. I get a positive LH test around CD 16 or 17 and she told me to get my progesterone tested on CD 20 (plus or minus a day). Does this sound right?

    Reply
  23. Dr. Briden, I’ve read your Period Repair Manual, as well as several of your blog posts on progesterone/progestins. They’ve been very helpful. However, my doctor is prescribing Provera (a progestin) for my amennorhea (no period for 3 months now). I’ve ruled out androgen-excess and thyroid disease. Is it a mistake to take the Provera to induce a period? From what I understand, taking a progestin could turn off my body’s ability to make progesterone. I’m not undereating, and I started taking Zinc/Magnesium a month ago. I’m just nervous that taking the Provera could set me further back, but I’m also growing more anxious each month my period does not come. Thank you so much for your work- you’ve changed the way I interact with my body. I’m so grateful!

    Reply
    • The most likely situation is that your doctor has prescribed Provera to try to induce a bleed as a diagnostic procedure. Is that correct? Because that’s one way to differentiate between PCOS and hypothalamic amenorrhea. See my blog post Is it PCOS or hypothalamic amenorrhea?

      I think it’s fine to do a short course of Provera for that purpose, but for what it’s worth, a course of progesterone (Prometrium) can do the same thing — but with fewer potential side effects.

      Reply
  24. Hi Lara, I would like to ask you to talk about early menopause. My grandmother was and I am now 33 years old and my endometrium is 3 millimeters, I already have an appointment with my gynecologist to see that subject. More than a year ago I stopped taking hormonal contraceptives and taking them for 16 years could have caused that.
    Thank you

    Reply
  25. Hi Lara,

    I am tracking my cycles (TTC 2.5years) have hx of PCOS and a pituitary adenoma. Cycle length between 30-33 days. Testing progesterone with specialist for fertility- tested day 23 and came back 19.5 nmol/L. Should this be more? Or could I have got it on the rise? I’m going to start tracking bbt from tomorrow so hopefully that will help. Specialist wanting me to start metformin.

    Thanks!

    Reply
  26. If I chart my temperature and do BBT, but my temperature doesn’t spike for 2-3 days after the positive LH test is that normal? Is there something I can do to encourage the progesterone?

    Reply
    • yes, a temperature rise 2-3 days after the LH surge is normal. But it’s not a spike. It’s a rise and then then it should stay high until your period.

      Reply
  27. I had a terrible hair loss issue that began 3 months after I stopped taking Jolivette (progesterone only) birth control for 7+ years, well into menopause. Sure that the issue must have been the instant drop from constant progestin to none, I wanted to supplement it to see if the hair loss stopped.

    After 2 full years from the time I stopped taking the BC and terribly thinning hair, I took the saliva test from the ZRT lab as well, specifically to see my progesterone level (post menopause). (I had used emerita pro-gest cream 2 times prior to taking the test – 10 mg each time.) I was expecting to see a very, very low number being post-menopausal, but the test came back mid-range. I called the lab to ask if the test results had picked up the 2 times I used the topical cream and they said yes – so that wasn’t very helpful in confirming my thoughts.

    After a ton of research I then began a “loading phase” of the cream for 3 months, after which I was going to drop way down. (3 weeks on, 1 week off) By the end of the 3rd month bad side effects appeared and I stopped – not concerned about stopping abruptly because I was 4 days short of my off-week anyway. The side effects all stopped between 2 – 4 days after I stopped.

    Good thing is, my 2 years of continuous hair loss (why I started this) stopped completely after 2 months using the cream.

    Now I will wait at least one full month, take a saliva lab test to see if the number has dropped way down before I even consider using the cream again and then will only use a very, very small amount.

    Reply
  28. Do you recommend the eu natural conception multi vitamins? It contains magnesium, zinc, ashwaganda, vitex and more.

    Reply
  29. My doctor said it was impossible to test testosterone in women because our levels are so low. I was taking testosterone but now only 50mg DHEA.

    Reply
  30. Hello! In your book, you state multiple times that progesterone “thins” the uterine lining. Can you help me understand why you use this action instead of “maintain” or “keep”? I understand you frame progesterone as the balancer of estrogen which thickens the uterine lining. But progesterone is released throughout pregnancy, so if progesterone was continually thinning the uterine lining, how would a pregnancy be maintained? I’m asking as an herbalist working to piece together herbs as contraception. Thank you!

    Reply
  31. What is the best method of checking progesterone levels in menopausal women using bioidentical hormone creams? Saliva or blood or other? Which hormones should be cked with saliva tests and which with blood tests or another form? Thank you for the information

    Reply
  32. Hi, could you offer some advice please? My daughter is 16, started periods at 13, but they have always been very very irregular and usually heavy to very heavy (7-10 days duration) with carping. I am in England, and getting help for this is almost impossible, so trying to sort myself! I suspect progesterone deficiency, but don’t know how to test, as periods can be anywhere from 3 weeks apart to 10 weeks! She has terrible anxiety, depression, food cravings, excessive sleeping (and still always tired), borderline low thyroid, & type 1 diabetes that is being v difficult to control! I’m a bit scared of starting on natural progesterone cream in terms of effect on insulin resistamce/very raised bg among other things. What would you advise please?
    Ruth

    Reply
  33. Good day Lara,

    I had a miscarriage in Feb 2019 and I just started with my 1st period cycle since then. So to test my progesterone levels I will use the Clearblue ovulation Test (Smiley) so it I get the a positive ovulation test then I count 5 -7 days later. As I am sure what my cycle length is at this stage.

    Thank you in advance
    Diane Nel

    Reply
  34. Hi, I’ve been using a biodentical progesterone cream for years now. I had a blood test and my profesterone is too low…I had a saliva test and progesterone is too high. 4,000… I used the cream 12 hours before saliva test.. Please help. Been getting anxiety.
    Thanks
    Alison

    Reply
    • Alison did you ever find an answer to your blood test vs saliva test quandary. I am at a loss of what hormones to ck how. Thanks

      Reply
    • I had a very similar issue, and according to ZRT Lab and DUTCH Lab info – topical progesterone is NOT monitored accurately in blood AT ALL. I had low/normal blood levels at the same time as sky high saliva levels – with *extreme* negative symptoms at the same time. Personally I believe blood monitoring of topical P use leads to very real overdose in some cases.

      Reply
  35. Hi, I have been using bio-identical progesterone cream for 3 cycles. I start using it on day 14 and finish on day 26. The first month I got my period on day 28. The second month day 25, and the third month day 26. Before starting the cream my periods were coming 1-2 weeks late. There is also quite a bit of breast tenderness which I didn’t have much of before using the cream. Is it possible that this 75mg cream is too strong?

    Reply
  36. Post menopause, have all my reproductive organs, all hormones tanked and I felt like death. Began BHRT last August. My Estrogen and Testosterone are via pellets, my Progesterone was oral for the first 12 weeks but began having stomach issues, switched to compounded P cream 30mg at night. My Progesterone levels rose from 0.2 ng to 2.5 ng while on oral, 5 weeks into the cream and I’m back down to 0.3 ng. Waiting to hear from my doctor but would love your feedback. How much cream would you prescribe per day, what is the optimum area to use it for absorption and what’s the best way to test levels if using Progesterone cream? Thanks in advance!

    Reply
  37. Hi Dr Lara,
    Thank you for your posting here. It was very useful information. I am 40 yr old with minor symptoms of mild depression around luteal phase, general GI bloating which has gotten better with several ellimation diets, probiotics, digestive enzymes, other supplements. I have a regular 28 day cycle with 3 days of period. Days 1 and 2 being moderately heavy with tolerable cramping. I avoid NSAIDs most of the time and am fine with the pain so far. Last year, my OBGYN did an ultrasound and results came back with ovarian complicated cysts in both ovaries with low level echoes. The differential diagnosis was endometrioma to versus hemorrhagic follicles. Based on my symptoms and ultrasound findings, my OBGYN diagnosed me with endometriosis and advised laparoscopic surgery. My serum lab results last year TSH 2.71, Estradiol 72.4 Prolactin 28.7 FSH serum 6.9. I declined and did an second ultrasound a year later, the cysts have not changed much but my Obgyn wants to treat the endometriosis and cysts with birth control to stop my period all together. She first prescribed me progestin which I took for a month and my period cramps got worse and my period lasted longer than 3 days with spotting so I stopped it. Reading about all the negative effects of birth control made me feel unsure If this is the right course of treatment. Since then I have been prescribed Prometrium 200mg nightly (not only luteal phase) to do the same thing. She did not see the point of additional testing and did not test progesterone levels. Is it worthwhile to do the Dutch test in my case to see if I need to take the bioidental hormones at this point? I know this is a lot of information but I really don’t know whether I should take the Prometrium or not. Thank you in advance for your advice!

    Reply
    • No, it doesn’t have to be a 28-day cycle. Progesterone needs to be tested midway between ovulation and the period — no matter how long the cycle is. So, generally, about 7 days before the next expected period. But if the period comes late, then the result will not be valid. The other way is to track ovulation with temperatures and test 5-7 days after ovulation.

      Reply
  38. Hi Laura, Loved your book. As a practitioner two comments on this page jump out…I am wondering why you don’t use saliva tests to determine mid-luteal progesterone? Also you say Testosterone can’t be tested by saliva (that’s a 2016 comment I believe)…do you still feel the same now?
    I often do both. Thanks

    Reply
    • Hi Brendan,
      For mid-luteal progesterone, I just find serum testing to be simpler and cheaper. But I think saliva testing can also pick up the progesterone peak.
      For testosterone, no I don’t trust saliva testing because I’ve seen some very high salivary testosterone readings in women that do not have high androgens. My understanding is that salivary testosterone can be falsely elevated by the presence of certain bacteria in the mouth microbiome.

      Reply
      • Interesting. You’ve given me something to look into there. The rabbit hole keeps getting deeper!
        Thanks for your reply Lara.
        Brendan

        Reply
        • I wanted to chime in while you are both responding here. I am having the hardest time getting clarification on when to test progesterone if you have irregular, long, cycles and don’t ovulate as often so therefore no luteal phase to go off. On time when I did ovulate, as confirmed through temp, my serum level was 5.6ng/ml. I did another E2/PG saliva test during follicular as I didn’t ovulate, and the ratio was 16.
          I have been prescribed prometrium and told to take 14-28 days after a bleed or during luteal (again I don’t have a luteal to go off). do you have any suggestions about best time to test and also the best time to take prometrium with an irregular cycle?

          Reply
          • Kerrie, how old are you? Because your first step is to figure out why you’re not ovulating regularly and fix that. Do you have PCOS or insulin resistance? Are you eating enough?

            But re: your question when to test progesterone with an irregular cycle… It’s quite difficult! The best thing is using temperatures like you described, and testing 5-7 days after you temperature rise. If you’re not seeing a rise, then there’s no point in testing because there’s no progesterone there anyway.

          • I am 34, have 3 children, I went on the pill right after the birth of my youngest in 2015-2017. Exactly one year ago I stopped the pill and have been trying to get back to normal cycles ever since. My doc suspects PCOS but I have not been tested in any way. I’m unsure about insulin resistance but I had gestational diabetes twice and have a family history of type 2 diabetes but again never tested for this either. Eating is definitely not a problem and I stay very active , I take vitex, DIM, magnesium and a low dose antidepressant that I was prescribed after the birth of my son in 2015. Cycles really tend to last about 45 days or more. I was recently prescribed prometrium but have no idea when to take to get the most help out of it

          • If you had gestational diabetes, then it’s really worth being tested for insulin resistance. The test I use with my patients is the glucose tolerance test WITH insulin. And then, if you discover you have insulin resistance, the treatment is to reverse insulin resistance and that could permit you to ovulate regularly. Read Reverse Insulin Resistance in 4 Easy Steps.

  39. I am pretty lost. My period started at 15. The only disruption was for about 6-9 months when I was 17. My mother took me to obs/gynae who weighed me/did bloods which were normal (not sure what was checked). When I was 21 I went on dianette/Diane 25 for about 3 Years. My periods never came back once I stopped taking it. 3 years ago I had an Transvag USS and the presence of cysts and no period= I was diagnosed with PCOS and out back on the combined OCP to regulate and reduce the risk of endometrial cancer. I asked for an endocrine review- she did bloods and said they were “ok”? and she confirmed my ovarian reserve was ok too. I am normal weight (63kg and 172cm tall). I eat well (lots of cinnamon, porridge, fresh veg, lean meat and fish) and exercise regularly but not excessively. I’m now 29 and so have stopped taking the pill to see if I have some hope of natural conception. It’s been 6 months and no sign of any period. I feel hopeless when I talk with my GP or endocrinologist. Their management plan is OCP for regularity then cross the infertility bridge if it arrives when I’m trying (with clomid or Metformin)
    I’ve just found your website so went out and bought some peony- fingers crossed.
    Any other advice based on that history? Sorry I know that’s a lot to ask so I understand if there’s nothing you can tell me.

    Reply
    • An ultrasound finding absolutely 100% cannot diagnose PCOS. Do you have high testosterone on a blood test? Or significant hirsutism? if not, you could have hypothalamic amenorrhea, which means you need to eat more (even if your body weight is normal). I urge you to read my book Period Repair Manual.

      Reply
      • No I have no hirsuitism. Skin is ok (the odd pimple) and I’m a “healthy” size with a “healthy, normal diet”- I eat plenty so I don’t know if that’s the solution. Thanks, I’ll look into the book

        Reply
  40. Hi there, what if your not mensurating at all? I’ve been told my progesterone is low and also my estrogen hence the no ovulation and periods !

    Reply
    • It’s the no ovulation that comes first, then the low hormones. ie. Lack of ovulation causes low hormones. How old are you? Are you sure you’re eating enough to get a period?

      Reply
      • Thanks for replying! I’m 36 and no I wasn’t Eating enough over the last 5 years i was working out 2 – 3 times a day and I did eat a lot but I had unfortunately cut so many things out it was clean eating gone extreme.. I’m currently working on gaining weight and reducing workouts . I’m still waiting to see the endrochrine specialist.. there’s far more to it but hard to write it all

        Reply
    • What has confused you?
      And yes, progesterone can relieve the symptoms of perimenopause and menopause. I’m a big fan of natural or bioidentical progesterone, but not every woman needs it.

      Reply
      • Thank you. So how would one know if one needs it or not? Is there some information I can read please? I no longer have faith in ANY of the doctors Ive seen nor the naturopaths who arent across your material.

        Reply
        • After menopause, there’s no test to determine if you would benefit from a natural progesterone supplement. There are only symptoms (flushes, mood, sleep, etc), and then the decision to try progesterone to see if helps.

          Reply
  41. This article was so helpful! I couldn’t agree more with the comment about many doctors having little knowledge of the female cycle. I have had to be my own advocate for years now as I work through my concerns for a huge mood crash right after ovulation-menses, and research on my own. I have irregular cycles and have long suspected PMDD when I do ovulate. So when I ovulated this month (confirmed through BBT charting), i jumped at the chance to test my progesterone levels 6-7 days DPO. When i called my doctors office i was told that unless i was trying to get pregnant, i could come in anytime during my cycle to have my progesterone tested. I had to educate the nurse on why it was necessary to test on this particular day and how testing prior to ovulation would do me no good. My problems lie from ovulation-period-my luteal phase. After i was told no, i decided to order a lab test online through LabCorp, walked in, had my blood drawn. My result was 5.6ng/ml. This seems on the lower end (6 days post ovulation), so now i am wondering about the application of progesterone cream during my luteal phase. My question is, do i apply 14 days after i get my period or wait it out until i actually confirm ovulation then apply?

    Reply
    • Just to confirm your low reading, did your period actually come with 7 days after that reading?
      And wow! crazy to be told that a progesterone test could be done on “any day”

      Reply
      • Hi Lara,
        Yes period came exactly 7 days after that reading. I haven’t ovulated again since this time, tried a saliva E2/PG test a few weeks ago and got a E2/pg ratio of 16, the E2 was with normal range of 1.6. I have been prescribed prometrium and was told to start 14 dats after a bleed. I am so confused because I rarely ovulate, I am by no means regular, so I don’t know hoe prometrium helps prior to ovulation.

        Reply
    • Good lord! You had to explain *to them* that the test timing mattered?! I agree that something is very wrong with the medical education around hormones. Have had some disurbing experiences myself – explaining to a doc that progesterone affects GABA receptors! She looked at me like I had two heads!

      Reply
  42. Dear Laura,

    My family has a history of progesterone and thyroid issues. I desperately need to test my progesterone, but I cannot, cannot do one more needle. I keep being told that the blood test is the only sure way. Please help. I cannot do more needles. It’s all I can do to test my thyroid every six months.

    Reply
  43. Lara, I have your Period Repair Manual and on page 82 you mentioned there’s an in-home urine test for progesterone to check the Resources Section. I don’t see any such reference in the Resources Section. Can you advise? I appreciate it.

    Reply
  44. From your article…I think I can feel better. I was just tested for PCOS because I was 8 days late. The test was done the day I got my period and it was .44 ng I really hope I’m readinf your article correctly and it was done at the wrong time.

    Reply
  45. So when do you test if yoir young but had a hyster and dont know where you are in your cycle ? Well I had partial hyster but I have no clue if ovulation is happening still or some or what

    Reply
  46. Hi Lara, Thank you for sharing your wisdom and expertise!! I am 53, was menopausal at 47, and after years of suffering with hairloss, vaginal dryness (have been taking Vagifem for 5 years with minimal relief), migraines, and muscle and joint injuries that refuse to heal, I have started seeing a hormone specialist in Toronto, Canada. He has prescribed natural progesterone cream — 10 mg nightly (off for 5 days per month and I can hardly wait the 5 days to go back on it so it definitely is working). Within a few short weeks, the migraines reduced by 80% – life changing!

    My question is about progesterone levels.I have had 2 blood tests, the first 1.5 weeks after starting the progesterone cream with a result of 1.3 nmol/L, and a second test 8 weeks from beginning with a result of 2.1 nmol/L. Note: I was instructed NOT to stop using the cream for my blood test. The range on my blood report states Follicular and Post-Menopausal ranges <1.7 nmol/L, but you indicate <5.5 nmol/L. That's quite a difference – can you explain why this might be? With my most recent report I am over the recommended 1.7 nmol/L.

    I am hoping to get a correct progesterone:estrogen ratio to curb the hairloss, and am very willing to play the long game as you suggest. I have had the DUTCH test completed to hopefully help determine where my ratio presently sits, but have not yet received my results. W

    Thank you for a terrific blog.

    Patricia

    Reply
  47. Hi Lara,

    I am afraid that I have a short Luteal Phase. I have a 28-30 day cycle and have been using OPK sticks for the past 2 months. I didn’t get the LH surge until day 16 both months and continued to test fertile until day 19. This gives me a 9-10 day LP. I’m thinking of starting progesterone cream and just ordered an at home progesterone test kit. I am currently on day 17 and am testing fertile this morning. I am not exactly sure if I Ovulate today, tomorrow, or the next. When should I test my progesterone level and what level should it be at? I was hoping to test on Thursday (day 20) and if it was low, I start using progesterone cream? I appreciate any insight/advice! Thank you.

    Reply
  48. Hi Dr Lara wonder if you can help. I had 2 progesterone blood tests carried out 48 hours apart, first was 5/6dpo and 2nd was 7/8dpo, first reading 124pmol and 2nd 78 pmol I get strong ovulation anyway but was on mild stimulation this cycle. My question is, is it normal for my progesterone to drop so much within 48hrs, i was worried about a short luteal phase so consultant suggested checking levels, do your levels keep dropping until either implantation occurs or they get so low you start bleeding and if you do get implantation I take it it rescues the corpus luteum which would then continue to produce progesterone. Im just trying to work out if levels naturally start dropping after peak levels reached or if they should maintain at a level until a certain point. My luteal phase can be 9-11 Days. Thank you

    Reply
    • One thing to keep in mind is that progesterone fluctuates in a 90-minute cycle. Seo, there is some natural variability depending on where you were in that 90-minute cycle at the time of the test.

      Reply
      • Hi Dr Lara thank you so much for your response, yes I totally understand my readings could of been higher maybe earlier or later that day i will bear that in mind but do they naturally drop until implantation occurs or would they stabilise and drop much nearer to an impending period, I’m trying to understand if my corpus luteum fails early, my levels even when not on stimulation are normally 70+ but my period arrives quite early normally 9dpo or 10dpo but cramps start day before, so it seems my progesterone falls quite quick…is it natural to have a daily decline from peak until implantation not sure if that’s how it works? Thank you

        Reply
  49. I have been using 12 – 16mgs of Bioidentical Progesterone Cream 25 days per month for 13 years & found it prevented me from requiring a hysterectomy (for heavy bleeding leading to anaemia). Testing with salivary tests, initially i had one excessively high result but when I stopped the cream all my unwanted symptoms returned so we decided it may have been a lab error. I continued with the Progesterone Cream & monitored it by my symptoms (or lack of) keeping a monthly diary until menopause. For the last 4 years I now have symptoms of low oestrogen (vaginal dryness & subsequent burning pain with sex) confirmed with a blood test although I know that is not the most accurate reading. I am attempting to discover the right Bioidentical Oestrogen Cream to alleviate the problem. For just over 2 years I used Oestriol Cream 14 mgs per week vaginally, finding eventually a daily dose worked the best. Then the pharmacy changed the supplier for the base cream & I suffered skin irritation & burning pain with sex returned. The pharmacy tried a different base but the symptoms did not improve. Next I tried Vagifem (Oestradiol) for 7 months which did nothing for my symptoms. For the last 8 months I have been on topical Biest 0.5mgs each night which also has not helped with my symptoms. I will seek further advice but I have read that vaginal application at a lower dose than the topical Biest may help.

    Reply
  50. I had a progesterone blood test at day 21 as I have a 28 day cycle, give or take a day. The reading was 9 nmol/L and my ND here in Canada thought that was pretty low. I have been on Progesterone Cream in my luteal phase for 3 months now. My PMS/PMDD has very much improved, however, I’m now starting to get PMS-like symptoms from Day 5 until ovulation every month that I’ve been on the progesterone (non-stop headache, rheumatic hip joints, pelvic pain, sharp knife pain up my rectum and general tenderness there). Is this something you have seen happen before? Do you recommend low dose of progesterone throughout the follicular phase too? Thanks 🙂

    Reply
  51. Hi Dr. Lara, so happy to have come across your site!! Have been ttc and used an opk for the first time since periods are irregular (6-13 days) and cycles have been in high 30s number of days. However, I’ve gotten “peak” LH readings for 4 days in a row (the test says should only be 2 days). Saw my doctor yesterday and she is doing a test for various hormones such as testosterone, LH, prolactin, progesterone. She said it didn’t matter what day she tests me because she knows the dates of last period. Turns out she tested me on Day 10 of what has been an avg 37 day cycle. From reading info on your site, I’m concerned this cycle test date won’t provide helpful readings (being neither early in cycle or post ovulation). What do you think? should I ask to retest on a different cycle day? Thanks so much for your help!!

    Reply
    • A day 10 test will give you no useful information about progesterone. Or potentially, about LH. I prefer to test LH on day 2 or 3.

      Reply
  52. Hi Lara,

    I recently took a hormone salivary test (Sabre Sciences) that resulted in the following:
    Estradiol 4.83 pg/ml
    Progesterone 111 pg/ml
    Testosterone 10 pg/ml

    I wasn’t instructed to take the test on any particular day, and only recently remembered reading this post about test timing. Unfortunately, looking back, it turns out I tested on day 4 of my cycle (last day of my period). Are my results worth considering? My doctor suggested progesterone cream – hopefully to assist with low mood, low libido, and ongoing hair loss issues. I have had all other tests for thyroid and nutritional deficiencies, nothing alarming.

    I want to try the progesterone cream, but am worried it could do more damage, since I tested on a day when the results would inevitably be low? Would it be dangerous to try the cream and see how I respond?

    Reply
    • A progesterone test done on day 4 is definitely not worth considering.
      That said, progesterone can often be beneficial even if a deficiency has not been established.

      Reply
      • Ok thanks Lara. I think I will try it out and see if I see any stabilization in my symptoms. Should I consider the testosterone results invalid as well? I was surprised they were deemed “low” event though I seem to have classic signs of androgen excess – hair loss, oily scalp and skin, acne.

        Thanks for your input!

        Reply
        • Hi Lara,

          Just following up – I have been using the hormone cream twice a day (it has both progesterone and DHEA I think), and haven’t noticed any new or worsening symptoms. In fact, I think it has helped keep my skin clearer than usual. (I’m already on a no/low gluten dairy and sugar diet, but was still getting breakouts).

          I have been applying it every day – should I switch to a certain time in my cycle, even though I’m not having any issues so far?

          I’m hoping this also helps my hair loss and dramatic texture changes since quitting the Pill – my hair is unbearably brittle, yet also feels caked in grime by the end of the day! What kind of improvement if any can I expect, and how soon, with this kind of treatment?

          Thanks!

          Reply
  53. My progesterone level was tested 10 days before my period. It is at 0.8(ng/mL) and I am aware of that it is just peri. Is this really low? What should the level be at that time of the month? Thanks!

    Reply
  54. I’ve noticed that I’ve been ovulating during alternate cycles. I also have elevated Free testosterone during the anovulatory cycles. Can elevated Free Testosterone impair ovulation or is it the other way round?
    I also have insulin resistance PCOS, so is it possible that my Free Testosterone is elevated only during the theoretical luteal phase immaterial of ovulation?

    Reply
  55. My obgyn did a hormone test on me and marked progesterone day 24. (What does that mean first of all) 2nd . . . I do have pcos. (I’ve had 3 kids prior to having this) then suddenly habe it and am infertile.. .my progesterone level came back as a 0.27 ng/ml (my prolactin was tested also.. and was normal.. don’t know if that matters.. but figured it must if they tested for it in the same test) I was told I have a hormonal imbalance.. yet.. my endocrinologist can’t find one. What am I missing here?

    Reply
  56. Hello, I’m 29 years old, no children. In 2012 it was told to me that I have a 2.5 cm ovarian cyst, most of the doctors said it is endo. It is not growing or bothering me. Beside this, starting one year ago I have light ovulation spotting which lasts up to 6 days. I also have pre-menstrual spotting. I have tested regularly my thyroid and last months also for hormonal imbalance. All my tests are perfect and progesterone was tested exactly as you indicated. In this case it is not clear to me why do I have so many days of spotting? What is wrong with my body? Thank you for your support!

    Reply
  57. Hi! I would like to test my progesteron levels to see if I really do have low progesterone. I have been taking a natural progesterone cream for one cycle. How long should I wait before the test results will be accurate? In a blood test, that is. Thank you!

    Reply
    • If it’s tested at the right time. Was the test 3 to 10 days before your period? If so, then it means you didn’t ovulate that cycle. (or you tested at the wrong time). Please see my book for ways to ovulate.

      Reply
  58. Thanks for this very detailed process! Unfortunately even my sydney-based integrative doctor didn’t know when to test, however I only found out after I’d been on the cream for months. I was tested on the first day of my period, I was given no instruction like your article. I still think I benefited from the cream but am looking to get a proper test again soon with my naturopath. I read your histamine article and that progesterone helps with histamine intolerance too! So amazing! Thanks

    Reply
  59. I took a saliva (4 times throughout the day) estradiol and progesterone test on day 21 of my cycle (28 day cycle). I felt ovulation cramps at day 14-15. My estradiol came back at 1.10 pg/ml (ref range 0.5-5.0) and progesterone came back at 29.82 pg/ml (ref range 127.0-446.0) which put my Pg/E2 ratio at 27.11 (ref range 200-600). Any ideas on what’s going on?

    Reply
  60. I am postmenapausal and had a saliva test done at 3 different times during the day. My progesterone is non-existant, as you state, is perfectly normal, but how do I raise it? Or should I?

    Reply
    • There’s no way to raise your own progesterone after menopause. Some women choose to supplement natural progesterone, which I think is a reasonable thing to do.

      Reply
  61. I love your post. It is hard to find accurate information on progesterone issues online. I recently purchased an at home salivary progesterone test because my OBGYN refuses to test my levels even after 3 miscarriages. I am 31 and have had “regular” peroids my entire life. I menstruate like clockwork every 28 days, but have experienced 5-7 days of breakthrough bleeding the week before my period since I was 15. After two years of charting my cycles (BBT and Mucus), I am positive I ovulate every cycle around days 18-20 which would put me closer to the end of my luteal phase if I waited 7 days to test. Should I test in the middle of my luteal phase or still test 7 days out? I am pretty confident I will never successfully carry a pregnancy without progesterone supplementation, but don’t want to start an OTC cream without first verifying 100% that this is the issue.

    Reply
    • So your luteal phase is only 8-10 days long? That can be a problem for fertility. The solution is to improve your egg quality and therefore the quality of your corpus luteum. That probably means correcting whatever problem is impairing egg quality which could be 1) thyroid, 2) insulin resistance, 3) inflammation, 4) nutrient deficiency. Please see my book for ideas of how to improve your ovulation.

      And in answer to your question, yes, check mid-luteal so in your case about 5 days before your period.

      Reply
  62. I’m 27 years old, I’ve been off BC for 4 months (started when I was 18 to regular my periods). Since being off BCP, I’ve not had a period. After a visit with my doctor last week for my yearly apt., she urged me to go back on BCP. I’m not planning to go on BCP ever again, as my goal is to have natural and regular periods. After my apt., I had an impromptu blood test (no fasting prior) and they said my progesterone levels may be low/ it could be a thyroid issue. I was prescribed medroxyprogesterone and out of desperation I took it for 7 days. After stopping it, I did experience spotting for a few days, but I wouldn’t consider it a period.

    I do plan to get further blood work done, but I’m wondering if progesterone cream would be a good idea and if so, what days during your cycle would you use it; are there any days you should avoid using the cream?

    Again, my periods aren’t irregular so ‘cycle syncing’ is difficult.

    SO appreciate any advice! Thank you for such amazing insight- I can’t wait to take control of my health!

    Reply
    • Meant to also say- I just finished your book and have referenced Chapter 7, but I’m very curious if you think the cream could prove helpful. I’m currently taking vitex, a multi-vitamin, magnesium, zinc, vitamin D, omega 3 fish oil and eat a diet full of healthy fats! I’m starting to eat more meat again as well.

      Reply
  63. Hi,
    I have been TTC for 6months now (which is not long I know) and since being off the pill I have had regular 26-27 day cycles. I had been testing my ovulation with LH strips and was getting varying results for ovulation each month between day 13-16. So this month on day 21 I had a progesterone LH and Oestrogen blood test.
    My results we 0.8nmol/L for progesterone 8.8 IU/L for LH and 591 pmol/L oestrogen.
    I also did not get a positive OT at home this month either.
    This indicates I didn’t ovulate however I am now 4 days late for my period with negative HPT.
    I can usually tell when I ovulate as I get pains but this time I didn’t get them around usual time but had them day 23-24.
    I am confused as I have never missed a period in my life (I’m 28) and have always been regular. I don’t see my Dr for another week but it’s driving me crazy being so unsure.
    We conceived my son after only 3 months.
    Any advice would be appreciated.
    Thank you

    Reply
  64. Hi Lara! Thank you for such an informative blog. Is Day 21 of a 28-day cycle best for testing progesterone even if it’s not fertility I’m concerned about? I’ve asked to have a blood test because I’m concerned about skin/low mood and energy issues before my period. My doctor said I should have the blood work done on day 17 but that seems early to me, because all of my troubles start closer to my period. Thank you for your wisdom. 🙂

    Reply
    • Progesterone should always be tested about 7 days before the period is expected. Or, more accurately about 5-7 days after ovulation. That’s true for fertility and for just wanting to know progesterone levels.

      Reply
  65. I just asked for anprogesterone test, as I have been trying to conceive for 9 months, short luteal phase, get spotting days before period and cervical miscues stays in fertile stage until my period (never dries up). The nurse told me I needed to count the first day I see any blood as day 1, and in using this date she instructed me to come for a blood test before I will ovulate. I tried to explain this to her, but she was firm on this date. I typically ignore spotting and count day 1 as full flow, ovulate on day 18 or 19 and then get period again on day 29. Should I go when she told me to, then call her back when I get a positive ovulation test? I don’t want my test results to be incorrect due to error in the date in instructed to go. Thanks!

    Reply
  66. Sorry, one more follow up question 🙂 Is there ever a reason to supplement with progesterone during the follicular phase? From my researching, it sounds like common situations are menopause and when there is heavy bleeding or migraines present in a premenopausal woman – is this correct?

    Reply
  67. Hi Dr Briden, I have a few questions for you:

    -Could low progesterone cause hair shedding and thinning? If so, how?
    -Could a low dose of bioidentical cream (15mg) given during the follicular phase potentially prevent ovulation in a premenopausal woman (with a higher dose of 30mg given days 15-25)?

    I am 36 years old and had a progesterone level of 2.6ng/ml 5 days before my period. I have been dealing with hair loss, hot flashes, insomnia, no libido, fatigue, mood swings, and long heavy periods (8-12 days) with heavy cramping and lots of spotting before and after (though they come very regularly) ever since I came off of ortho tri-cyclen lo 20 months ago.

    Every doctor was convinced it was my thyroid, but after normal TSH, FT4, FT3, TSI, and hyper and hypo-thyroid antibodies tests every 6 months for the last 3 years, they finally tested my progesterone. I also had high IgG levels to dairy, eggs, gluten, and sugar cane, so I also think those sensitivities are contributing to things and am working with a nutritionist to overhaul my diet while making sure I keep my weight up (I’m pretty lean but with a healthy appetite).

    My Naturopath thinks I need progesterone support on both sides of my cycle given the severity of my symptoms and the hot flashes that I experience throughout the month. My main goal is to support ovulation as much as I can, which is why I was worried about supplementing during the follicular phase.

    Thank you so much!

    Reply
    • Yes, progesterone deficiency can cause hair loss. Progesterone is an important hormone for hair because it inhibits 5-alpha reductase, thereby blocking DHT (androgens) at the hair follicle.

      I don’t like to give progesterone is the follicular phase, but a small amount will probably not suppress ovulation.

      I assume you’re already on magnesium and vitamin B6? Have you read my book? You’re not low-carb, are you?

      Reply
      • Thank you, Dr Briden! Yes, I’ve read your book multiple times and have found it so incredibly helpful.

        I’ve been taking 300mg of Magnesium since discontinuing birth control almost 20 months ago, and haven’t really noticed an impact either way. I just started taking a quality multivitamin this past month recommended by my Naturopath (vs the generic prenatals I was taking) – I’ve really noticed the biggest difference with stronger nails.

        To answer your question, I’m not intentionally low carb, but I can do better in this area – I’ve just lost the taste for a lot of the gentle carbs you recommend after I had baby #3 three years ago. Thank you for the reminder.

        Reply
  68. Hi Lara,
    I’m wondering if an LH and FSH of both 5.5 on day 3 of your cycle is good? And is it possible to have pcos if I have 35 day cycles and regulate each one but high testosterone? Thanks so much!!

    Reply
  69. Good Evening Lara Briden,
    I really need your help, I am a 22 year female that does not have regular periods. I used to have them month to month but now I do not have them at all unless I take birth control…even then those are not real periods. If I don’t take birth control I can go a year without my period. I do consider myself to be some what healthy. I am also at a healthy weight at 5 feet 7 inches weighting at 140 LBS. Please help. I need my real period back! (I have not had a “regular real period” since maybe 18 years old)

    Reply
    • Chapter 7 in my book is all about lack of periods (amenorrhea). The first step, of course, is to see your doctor for blood tests.

      Reply
  70. I’m 35 and I have been trying to conceive for 2 years. Been off birth control pills for almost 4 years. I tried every type of birth control since i was 18 and always had terrible side effects. The last Pill I was on was Yaz and Yasmin which I had breakthrough bleeding with. Since I stopped the pill I continued to have premenstrual spotting 5-7 days before my period. I suffer from adult acne which gets worse at certain times of the month and i get terrible mood swings. My blood tests have been normal. I have been seeing a fertility specialist for 1.5 years now and he took an endometrial biopsy in October 2015 on day 28, 2 days before my period. He diagnosed me with progesterone deficiency. I have been taking femaprin for about 4 months now and I’m not sure if it’s helping me. I also take a prenatal, fish oil and 200mg of coq10. My cycle ranges from 26-30 days, but usually around 28 days. I seem to ovulate around day 12 to 14. I also had a laparoscopy in Dec 2016 and discovered a congenital defect hanging over my fallopian tube and cinching it closed – the defect was removed. The other tube seemed to have a mucous plug but now both tubes are open. I have tried Femara with timed intercourse several times with progesterone suppositories during the two week wait. Then tried with IUI with 4 failed attempts. Now we are going to attempt IVF which I never wanted it to come to. I feel so lost as to what I should do. I always felt like a had some type of hormonal imbalance but feeling like I don’t really have any answers.

    Reply
  71. Hi Dr Briden, I have a few questions for you:

    -Could low progesterone cause hair shedding and thinning?
    -Could a low dose of bioidentical cream (15mg) given during the follicular phase potentially prevent ovulation in a premenopausal woman (with a higher dose of 30mg given days 15-25)?

    I am 36 years old and had a progesterone level of 2.6ng/ml on day 21. I have been dealing with hair loss, hot flashes, insomnia, no libido, fatigue, mood swings, and heavy periods with heavy cramping and lots of spotting before and after (though they come very regularly).

    Every doctor was convinced it was my thyroid, but after normal TSH, FT4, FT3, TSI, and hyper and hypo-thyroid antibodies tests every 6 months for the last 3 years, they finally tested my progesterone. I also had high IgG levels to dairy, eggs, gluten, and sugar cane, so I also think those sensitivities are contributing to things and am working with a nutritionist to overhaul my diet while making sure I keep my weight up (I’m pretty lean but with a healthy appetite).

    My Naturopath thinks I need progesterone support on both sides of my cycle given the severity of my symptoms and the hot flashes that I experience throughout the month. My main goal is to support ovulation as much as I can, which is why I was worried about supplementing during the follicular phase.

    Thank you so much!

    Reply
    • Quick question before I answer: On which day did your period actually come after the day 21 progesterone test?

      Reply
      • My period came 5 days after that progesterone test.

        Also not sure if important, but my mom completed menopause at 40. I’m 36 and have had my FSH and AMH tested and have been told I’m not in menopause, but I’m thinking I could be in perimenopause.

        Reply
        • Hi Dr Briden,

          Just thought I’d check in to see what your thoughts were. Thank you for providing so much information and support around hormonal issues!

          Reply
  72. Dr. Lara, If Prometrium is safe, why are the side effects so extensive with numerous serious side effects? I read through 100 reviews of the drug and within those reviews there were two stroke reports. There were hundreds of reviews, but I couldn’t go through them all. Can you apply the liquid from these pills onto your skin to try to bypass the side effects or at least cut them?

    Reply
    • Those are side effects and reports from progestins generally. Pharma and mainstream medicine do not yet recognize the crucial difference between progestins and progesterone, so they consider prometrium just one more progestin, and therefore list all progestin side effects. In reality, progestin and progesterone have many opposite effects. Click the link above to my “crucial difference” blog post.

      Reply
  73. Dear Lara, do you know if Curcumin actually causes DNA damage? I heard it’s the dose, then I heard it’s the absorption. I am interested in Mireva Curcumin

    Reply
    • The DNA damage effect was observed in vitro (in a petri dish). As far as I am aware, there have been no studies showing DNA damage in animals or humans.

      Reply
  74. So sad ..as I have been searching for help with my hair loss for 3 years dr after dr natropath ect and now I’m so depressed that I see so much scalp I tried ndt thyroid med for low ft3 and lost over half of what I had. That breakage is worse my life is over 😢 It’s never coming back I just know it I’ve fixed my iron worked on adrenals everything I’ve done has only made things worse I’m 48 and hoping to be bald like a middle age man…all in the matter of a a couple years 😢 Hard to get a jump on fixing when no one knows why

    Reply
  75. Dear Dr. Lara,

    I was reading that there are less side effects with transdermal Estrogen. Is the same true with Progesterone? I’m not sure that this information was regarding Bioidentical, but I am inquiring about Bioidentical. Do you have a recommended Progesterone cream when Prometrium isn’t offered? I’m not sure what ingredients to look out for or how to judge a quality cream.

    Reply
  76. Hi Lara, I’ve noticed a few of my finger joints get swollen just around ovulation and throughout the second half of my cycle. I am suspecting progesterone deficiency because of other symptoms. Have you ever come across patients who had the same issue with swollen finger joints or should I investigate this separately? It does get worse in the second half of my cycle and I’ve noticed it for about 3 months now. Thank you!

    Reply
  77. Hello, my name is Emily. I have been reading your book, period repair manual. I have found it very helpful so far but I have one question. I have been told by my doctor that I have a progesterone deficiency. I have been tracking my period for about the last year and started taking ovulation tests every month. But I’m noticing that when the test stripes tell me I’m ovulating, my temperature goes down by a full degree instead of going up. Does this mean that the ovulation tests aren’t accurate for me?

    Reply
  78. Hi Laura,
    Thank you for writing a great article! I will be testing my progesterone this cycle and hope you can help with this question. My ovulation normally happens on day 20/21 of a 29 day cycle according to my BBT charting, mucus observation and cervix tracking. With such a short luteal phase should I aim to test right in the middle – around day 25? Is there anything that can be done to lengthen the luteal phase?
    Natalia

    Reply
      • Thank you, Lara. And apologies for misspelling your name above! I have been on AIP for around 6 months (to manage RA) with great success and believe the nutrient density of my diet is second to none. I have added more dietary iodine along with magnesium, zinc and selenium supplement since finding your blog. I have also started taking liquid herbs – Vitex, Peony and Shatawari, under the guidance of a naturopath. Is there any other specific nutrients or herbals that help improve egg quality?

        Love your blog 🙂

        Reply
  79. I am 56 yrs old.. Had complete hysterectomy / oopherectomy at age 28 due to endometriosis. I’ve been on estradiol tabs ever since! ( .5 mg daily)
    My new functional Med Dr wants me on estrogen cream, progesterone capsules, and testosterone cream. At the same time , he’s changed my armour thyroid Med to nature-throid.
    I’m also dealing with onset 18 months ago of an auto immune disease.. Chronic EBV, fibromyalgia , CFS… Etc.!
    What’s your opinion on all the above meds?!
    I’ve opted to address the hashimitos issue and messed up thyroid levels first.
    Thank you.

    Reply
  80. Hello Lara,

    Excellent documentation on PCOS !!! When i was in India , My dermatologist diagnosed me with PCOS on ultrasound as he told me acne is not normal at the age of 30. Blood test showed hormone normal. I have been having regular periods, have few hairs on breasts and couple of hair on my chin. We moved to China & As now my acne is increasing ,im planning to consult a doctor for acne and i dont want to take birth control pills as we are planning for 2nd baby. Please suggest me if i should visit a dermatologist or gynec for acne & PCOS issue and help me to get pregnant .

    Reply
  81. Dear dr Lara, I have question for you. It’s 15 months after comming off birth control pills . During this time no period at all, not event spotting. Yesterday I got some spotting, not real period. Is this a sign that it can regulate on its own ? My ginecologist wants me of cours on BCP again;/// I’m normal weight and don’t have a thyroid problems.

    Reply
  82. Dr. Lara; would it be okay to try Ashwagandha and Rhodiola and Evening Primrose Oil in the morning and Chamomile and Calendula at night?

    Reply
  83. Dr. Lara,

    Sorry if this posts twice. I don’t think my comment registered. I have Hypothyroidism and PCOS with adrenal androgens. I am in a predicament. My doctor will not treat either, only offers me the birth control pill. Ashwagandha seems like it shouldn’t be used long term, so I hesitate trying it. I am wondering if regulating my adrenal androgens would be enough to regulate my thyroid? I am also wondering how long I could use Ashwagandha or if I should use it at all and keep pushing for thyroid medicine or if I should use Ashwagandha and medication since I still need something for my adrenals. My hypothyroidism is mild. However, my adrenal androgens are severe. PS: What is your favorite way to treat severe adrenal androgens? I am wondering if I should try Prometrium.

    Reply
    • I’m curious about this too..I have the hair loss just in that past couple years but it’s a daily difference in the hair how does one address adrenal androgens?

      Reply
  84. Dr. Lara,

    I am not sure what to do in this predicament. I have PCOS with high adrenal androgens and hypothyroid. My doctor won’t treat either, she only offers me the birth control pill. I have a question. My hypothyroid is a priority for me. I am wondering if regulating my adrenal androgens would be enough to regulate my thyroid, since it is only mild hypothyroidism. Even so, I wonder if I should start with Ashwagandha, which seems you shouldn’t use long term or if I should just find a new doctor and try to get Hypothyroid medication. I guess the question is: should I bother with Ashwagandha? Can I use it long term? Or should I use both? Or just the medication?

    Reply
        • It’s intimidating to take Ashwagandha being I have high adrenal androgens and seeing a case report of hirsutism and increase in adrenal androgens in a case report…but at the same time it’s hard to think about taking medication for the rest of my life…not to mention that it has been years and no one will prescribe any. I have no energy at all.

          Reply
          • I’ve seen that case report, but I’m not convinced. I prescribe ashwagandha all the time, and even when adrenal androgens are high.

          • That makes me feel good, to know you’ve used it in scenarios similar to mine without unwanted effects on androgens. What is the difference in sub-clinically and clinically underactive thyroid?

  85. Dear Lara,

    I have PCOS and I have a serious problem with blackheads. I have blackheads all over my nose and chin, around my lips, all over my neck and shoulders and my chest. They are truly out of control. I do not have pimples and my skin is dry. I went to the dermatologist and all they offered was birth control and some salicylic acid (.05 oz tube) that is first of all too small and not enough product for my body (they didn’t care) and really unrealistic for me to rub gel (or anything) over half of my entire body. Any ideas why I have black heads or what to do about it? I have adrenal androgens and IR and addicted to sugar, but trying hard to quit. Inositol did not help me, but caused weight gain. I hope quitting sugar whenever that happens will help, but the problem really needs addressed otherwise in my opinion, because it is such widespread. I will get off sugar. It’s just a bit of a journey. Thank you.

    Reply
  86. Hi Dr. Lara,
    I took progesterone cream for about a year to kick my cycle back in action after stopping BC. It worked like a charm, got my period regularly once a month for a year. I decided to stop using the progesterone cream (I’m 27 and feel like I might be too young to take it and was hoping I could be normal on my own again), and then it took 2 months for me to get my period naturally. Do you think I should go back on Progesterone cream for awhile or keep seeing if my body will adjust on it’s own now? Even though it took two months to get my period.

    Thank you!

    Reply
    • If progesterone was giving you regular periods, it might be because it was correcting an elevated LH (typical of PCOS). Have you had a diagnosis?

      Reply
    • Hi Jess,

      I’m curious how/ when you used the cream? Did you use it consistently until you got a period or did you fluctuate usage? I’m 27 as well and have been off the BCP for 4 months, with no real period yet. Wondering if this would be a good option for me.

      Thank you!

      Reply
  87. Dear Lara,

    I took Yaz for about 6 months to a year in my late teens (around 18-19 years old.) I am now 24. I worry so much of the blood clot side effects. Do you feel I would ne aware or have symptoms by now if I had suffered a clot? What to do?

    Reply
  88. Hi Lara, need some help. I had a baby less than a year ago and am not breastfeeding but my hormones have been a mess. My periods were normal beforehand but now have been over 43 days and in fact I’m on day 50 since my last cycle with no signs of it starting. I had saliva hormone tests done a few months ago (before taking vitex) and last month (after months of vitex). My testosterone doubled and was very high like 100 on saliva test after taking vitex. Then I had my testosterone tested through blood and these were the results: they are all in range (the total testosterone the cut off was 55 so it is right on the edge). Is this a sign of pcos? I know I am not ovulating either and I did ever month before pregnancy. Thyroid is good so idk what else is causing this.
    Testost % Free+Weakly Bound.
    6.7 %

    Testost F+W Bound.
    3.6 ng/dL

    Testosterone Total LC/MS.
    54.0 ng/dL

    Prolactin
    7.6

    SHBG
    89nmol

    Reply
    • That product has 2000 mg myo-inositol and 50 mg d-chiro-inositol. Should be ok. Shame they use synthetic folic acid. Many inositol supplements include folic acid because that combination was used in the clinical trials. But the folic acid does not add to the benefit. It was only there as a general precaution because the trial participants were of child-bearing age.

      Reply
  89. Dear Lara,

    Is it safe to take Ashwagandha, Rhodiola and Fish Oil with Prometrium? I am going to ask my doctor, but I am sure she will not know.

    Reply
  90. Hi dr Briden !
    I desperately need your advice ;/ I stopped taking BCP 8 months ago. Still not period;/ I”ve had ultrasound-my ovaries are not polycistic, but small;/
    I’m also suffering from androgenic alopecia .
    I’ve ordered your book, but it’ll take 3 weeks to get it, because I’m from Poland. I really don’t know what to do…MY ginecologist wants me on BCP again… But I don’t want to do that. on the other hand I’mconcerned because of hair loss. I’ve already lost a half of my hair (i’m not exagerating). Should I take Vitex ?
    I’ve taken Dong Quai but did not help;/

    Please, give me some tip. If I would live in your contry I would go to your clinic without hestitation.

    Thank You in advice
    Ola

    Reply
    • PS. My TSH level is ok, and I’m not insulin-resistant. I have also normal weight. My testosteron is elevated and my estrogen is extremly low;/

      Reply
  91. I have low estrogen and all the symptoms that follows. My naturopath told me that the best way to raise low estrogen levels is by using natural progesteron cream. Is this true?

    Reply
  92. Lara, my gynecologist doesn’t want to prescribe a blood test for progesterone even though I show all the signs of progesterone deficiency. I know you aren’t keen on saliva tests, but I found a saliva test with a reputable lab online that uses 12 saliva samples spread over a month to assess estradiol and progesterone. Do you think it’s worth trying, and is this something you could work with? Thanks

    Reply
    • You could also track basal body temperature, which I think would give a more accurate assessment than saliva test. It’s also a lot cheaper!

      Reply
      • Thanks Lara. Would that be enough to assess if I need to supplement with progesterone cream though? Ideally I’d like to have an idea of my progesterone levels before using the cream, but what do you think?

        Reply
  93. When I spot 4 days after my period could I be low in progesterone then? I also always have breast tenderness pefore my period. I’m not on bcp, and I am 29 y o. I experience heat flashes also, especially during the night, and some acne all the time.

    Reply
  94. Hi Dr. Lara,

    I had a comprehensive hormone test done recently and have been on some supplements since to correct a few imbalances. Not sure if you refer to the same measures, but my testosterone is 11.4 DHEA 118; My progesterone is only 620 even though I have been ovulating consistently for the past 11 months and these periods have been physically painless.

    My testosterone is normal apparently, but since the prog. is so low, could this be making the testosterone higher? I am suffering bad hair loss and sebum production on my scalp. I’m desperately trying to understand the correlation between these different hormones! And how to increase my progesterone naturally? Will I “get more” (?) if I continue to ovulate more each month?

    Reply
    • ***By “get more”, I am wondering if it will just take a few more periods to level out to an optimal level. Or is there such a thing as being just progesterone deficient? I am concerned because I’ve been having consistent periods for a year now, and the levels are still quite low according to my naturo.

      Thanks!

      Reply
  95. I could really use your help. I took a saliva hormone test in June and my testosterone was 58 and took one now and it is 107 (I know blood test is the way to measure it but still it’s a huge jump!) and also my cortisol in the morning jumped up to 110! And my DHEAS went from 5.6 to 22.7. My estrogen and progesterone are low too. I have a period ever 43 days (they were 32 days before pregnancy) am now 7 months postpartum and I’m scared. Idk what is happening. I took vitex combo with peony and licorice for 3 months could vitex have caused this increase in testosterone, cortisol and DHEAS!?

    Reply
    • That kind of random fluctuation on saliva test is quite common. That’s the main reason most doctors don’t use saliva test.
      Are you currently breastfeeding? Because that could explain your long cycles. Also, did your doctor test your thyroid?

      Reply
      • Hi Lara, I just saw your reply to this post! So maybe I should have my hormones tested through blood? I am not breastfeeding for 7 months. I had normal 32 days cycles before her and now I don’t. Is it possible to develop pcos after baby? Because I’m starting to think that’s what happened. And I’m shocked licorice and peony haven’t lowered my testosterone at all in 3 months unless vitex was counteracting them.

        Reply
          • Ok Thanks! I will start on the thyroid medication again and see if my periods go back to normal length! The thyroid meds just make my acne worse which frustrates me 🙁 is daysy a good way to tell if you are ovulating? I just purchased one!

  96. Hi. I have a question. I’m 48 in per meno I believe I have monthly cycles I tested on nov 29 and my period started on the first but my nov period was the 7-11 mybquestion is. Did I test at the correct time?

    Reply
    • If your period came 2 days after the test, then no, it wasn’t the correct time. Progesterone would normally be quite low by then.

      Reply
  97. Dear Lara,

    Is it fine to take vitamin D3 without vitamin K? Can’t we just get the K in our diets? It’s very hard to find the K in a multi. Thanks.

    Reply
  98. Hi Lara –

    Over the years, I’ve been testing for progesterone on the 3rd day of my period per doctor’s instruction (gynecologists). This last time it was higher than normal, per lab ranges.
    I don’t see that you mention testing it on this day, either here or on the book.
    I also don’t see mention of having higher-than-normal levels during the follicular phase, what is represented as a line on the graph – is there a minimum base-line and is there a maximum as well?
    I wonder if you could elucidate these points a bit further.

    Thank you –

    Reply
    • I cannot think of any reason to ever test progesterone on day 3.

      If it was higher than normal, it may be because you were not yet at the start of your cycle. Do you experience days of premenstrual spotting before your first full flow day? Those are the final days of your luteal phase of the cycle before. Day 1 of a cycle is the first day of proper heavy flow.

      Reply
      • Hmm… I’ve been instructed do the hormones tests (progesterone, LH, FSH, estradiol) at the beginning of my period by gynecologists and family doctors for years now (?) (!)

        My first day usually has a weaker flow – the second day it’s when it’s at its heaviest.
        But it’s a flow, not spotting. So I consider that my first day. Correct?

        I’m shooting for mid-luteal phase estrogen test now, a bit tricky with irregular cycles. I’m following your instructions on how to do this and we’ll see how it goes.

        Thank you –

        Reply
  99. Hi! I’m 30 and suffering from low estrogen. I repetedly get bladder infections. What is best a progesterone cream og an estrogen cream? I’ve read that using estrogen cream will help with my vaginal dryness and also my bladder problems. But am I too young to use a estrogen cream?

    Reply
    • You shouldn’t need an estrogen supplement at 30. Do you ovulate regularly? You don’t use a condom with spermicide, do you? Spermicide is a common cause of bladder infections.

      Reply
      • Yes I ovulate regularly, but I have cloths in my menstrual blood and tender breasts before period. Is’nt this typical estrogen excess? Could bladder infections be caused by excess estrogen? No I don’t use condoms, ever. Not bcp either.

        Reply
  100. Hi Dr. Lara,

    I had my progesterone tested via a comprehensive hormone test with my naturo. It is very low in the 600s range, versus the 1400 recommended. (Not sure if that is a similar measurement you use, or if that has any meaning for you!). My estrogen is also a little high, and my naturo has me on some supplements and a hormone tincture to help balance out.

    While my estrogen and prog. are definitely out of whack, my testosterone levels are completely normal….however, sebum overdrive and oiliness on scalp/skin are the two main post-pill issues I’m dealing with. Even though my testosterone/androgens seem “normal”, could they seem elevated or abnormal due to the other out of whack hormones and whatever interplay is happening between the three?

    Would love to hear your thoughts!

    Also, I’ve had regular periods for the 11 months I’ve been off the pill, so I know I am making natural progesterone. How long does it take to get back to pre-Pill progesterone levels?

    Reply
  101. Lara,

    Will Progesterone supplementation decrease your body’s own Progesterone or might your body stop making it’s own and become dependent? Also, is there any side effects and/or risks of blood clots and cancer with Prometrium? Thanks

    Reply
  102. Hi Lara, this is very timely.
    I went to my obgyn suspecting progesterone deficiency, after reading your book. I’m 36, and started having shorter cycles (25 days instead of 27), big blood clots, spotting for a week before my period, sore breasts in my luteal phase (as well as irritability). He said it does sound like progesterone deficiency but said the testing is useless. So he prescribed tranexamic acid to reduce the blood flow just to try, and progesterone capsules (0.5mg) to take during the last 10 days of my cycle. And see what works. Do you think it’s safe to take or should I get tested? Where I live (Europe) they don’t seem to have the progesterone cream. I’ve also been taking Vitex for ovulation pain for quite a while. So far I’ve been successful using herbal remedies such as Vitex or Rhodiola/magnesium, and healthy diet/lifestyle to reduce inflammation, so I’m not too keen starting medications. The blood clots are annoying/worrying, but my periods aren’t very heavy either. Many thanks

    Reply
      • No. Surgestone is not progesterone. It is the progestin “promegestone”.
        Can you access Prometrium (bioidentical progesterone) in your country?

        Reply
        • Thanks for clarifying, as I know now that there is a huge difference between progestin and natural progesterone! It doesn’t look like Prometrium is available in France but I could see there are different brands with the same dosage (100mg), including generic types. I’m not sure I can get a prescription though. Do you think it’s safe to try a progesterone cream (that I can order from trustworthy supplements brands, such as Source Naturals or Now Foods) without getting my progesterone tested? Thank you very much

          Reply
          • Yes, I’m pretty sure micronised progesterone is available in France. I’ve had patients from there who had been prescribed it.

  103. Hi Lara,
    I’m hoping you can help me out, I’m at my wit’s end after seeing so many naturopaths to no avail. They all have told me to do bioidentical progesterone cream. I’ve been taking the progesterone cream for a full year and I thought I was getting a period but it turns out it was just a bleed each month, I really wasn’t ovulating. After stopping the progesterone I haven’t had a period again since.

    I’ve had my blood work done twice in the last year. Once my LH was 1.5 and another time it was 20.1 And my progesterone was .73 and 1.34.

    I’m basically trying to decide if I should do Licorice and Peony, or Vitex. I’m nervous to try Vitex based on what you’ve warned about it. Do you have a recommendation between the two?

    Thank you!!

    Reply
    • Vitex has been my answer to the same problem. I was bleeding heavily with clots for almost 40 days and this magical herb fixed my progesterone deficiency. I have fuller boobs now without the pain, normal 4 day bleeding each month, no big ball clots and I’m high on the dopamine it releases. It was my sanity saver.

      I chimed in because I can see me a few months back, at my wits end.

      What’s worrying you about Vitex?

      My sister went on Vitex for 3 weeks and that was enough time to fix all her problems. They say this stuff takes a while to work but Ive witnessed otherwise.

      Reply
      • Thanks so much for chiming in and sharing your experience. The only reason I was worried is because Dr. Lara mentions if your LH is high you shouldn’t take it. I’m not sure if my LH would be considered high or not. I’m thinking I’ll give it a go though based on your experience! After your sister went off it did her cycle stay regular? That’s part of what I’m trying to decide too is how long I should take it (i.e. if I get my period should I keep taking it or stop it right away…) Thanks again 🙂

        Reply
        • There’s a Naturopath by the name of Fiona who chimed in to Lara’s blogpost on Vitex and answered some questions surrounding several studies on Vitex and LH (see below). I would personally take Vitex even if my LH was a bit based on her answer alone.

          Fiona McCulloch says

          November 30, 2016 at 2:01 am

          Thank you so much for mentioning my book Dr. Briden! I love your work and your book, recommend it frequently. A must for all women.

          I was always perplexed by Vitex and by the conflicting information on it’s hormonal action in studies. As a pretty significant part of my practice is fertility oriented, I noticed its clinical actions didn’t quite match up with some of the research (which was conflicting, at best anyway).

          Clinically what i noticed was that it seemed to help “kick back in” those who have irregular cycles where there is a miscommunication between pituitary and ovarian hormones (in particular where this is the root of the issue) – but I noticed that it ALSO has a significant effect on hormonal mood issues like PMS. So I took a pretty deep dive into the research and read through every study since things that don’t make sense to me cause me to become obsessed ? What i found was that in fact in research, its effects on female hormones (directly) are very minimal. The effects on hormones appear to come secondarily due to effects on the brain.

          It’s clear that vitex acts on the dopaminergic neurons which has been known for quite some time – it’s the one consistent mechanism we’ve seen in the literature. It has the ability to lower prolactin (in a mild way, not to the level of bromocriptine) – and this happens through effects on the dopamine system.

          Thinking of its effect on mood – interestingly, the newer mechanism I found for vitex (which seems consistent in research) is related to its actions on the opioidergic centers of the brain. It can actually increase beta opioid levels quite significantly – even increasing levels 105% in one study. This effect appears to be consistent in numerous studies which is different from the effects we see on hormones (some studies show it raises LH, others show it lowers LH, some show no effect – basically inconsistent – in the end it depends into what system you are placing it).

          Interestingly, the opioidergic system inhibits the hypothalamic-pituitary-adrenal axis, reducing its negative effects on LH and FSH. It can slow down the pulsing of GnRH (in PCOS there is often fast pulsing of GnRH resulting in a disruption of the normal pattern required to stimulate cyclical FSH and LH production and hence ovulation.

          Over time, I learned to use vitex in the following way from clinical experience treating thousands of women and seeing patterns emerge – and knowing the above information a picture of why this works is a bit more clear.

          – it’s very helpful for hypothalamic amenorrhea, because often the HPA axis has downregulated GnRH. However the cause of hypothalamic amenorrhea (ie nutritional/stress) must be addressed first.

          -in a woman with moderately regular cycles who can identify ovulation – it can be used in the luteal phase only – to inhibit pulsation of GnRH and allow FSH to take predominance over LH at the beginning of the next cycle. I find in this way it can be beneficial for fertility.

          – in women with PCOS – ***who have already worked on insulin resistance** (note, this a MUST or it won’t work well at all) it can be done in the luteal phase – or in those with very long cycles it can be done full cycle until some degree of regularity has been achieved.

          Some studies to check out for any hormone geeks out there interested in this. ? sorry if this was too much information!!!

          cheers,

          Fiona

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993511/
          https://www.ncbi.nlm.nih.gov/pubmed/27435374
          https://www.ncbi.nlm.nih.gov/pubmed/16439081
          https://www.ncbi.nlm.nih.gov/pubmed/9990091

          My sister’s period returned within 3 days of stopping Vitex.

          If you get your period, just stop it for 5 days (that means you are not taking it while you are bleeding) and restart it on day 6. If you don’t get your periods and you have been on it for 25 days, stop it for 5 days. Don’t be too serious with Vitex, half the reason you are low in progesterone is because you’re likely stressed physically /mentally/ emotionally. Consider Vitex as your big sister who has your back.

          If your low carb diet did this to you, then google Gentle Carbs on Lara’s blog. It will give you the answers you’re seeking.

          Vitex is also amazing for PMS. I don’t PMS anymore! I also take magnesium, B6 and occasionally zinc (not often as it’s an antagonist to iron and I’m low in iron from all that bleeding I experienced for almost 40 days)

          If you’re trying to conceive, grab Lara’s book (it’s helped so many of my friends) and maybe book an appointment if you can afford it.

          Reply
    • It would be unusual for low dose progesterone cream to induce a withdrawal bleed. Are you sure you weren’t ovulating with any of those cycles?
      Has anything else changed since you stopped the progesterone that could explain your lack of periods now?

      Reply
      • Hi Dr. Lara,
        Thank you for taking the time to respond!

        Stress could possibly explain it. But to be honest I’ve gone 2 full months without taking Progesterone cream now and have had 0 spotting or sign of period. So I really think I wasn’t ovulating at all when taking it. Not to mention when I was taking it for the last year, my periods would only be about 3 days long.
        (Before I started taking the progesterone cream I went 14 months without any period at all, after stopping the pill. So I really haven’t had a normal period since before taking the pill).

        I think I may try Vitex unless you would recommend trying the cream again. I just am very suspicious that my progesterone is really low and needs some other sort of aid besides the cream if it hasn’t made a difference after a full year.

        Thank you again!

        Reply
        • Low-dose progesterone can suppress LH, and therefore promote ovulation, and therefore lead to a real period. That is common with PCOS may have been what was happening with you.

          Have you had a diagnosis as to why you are not having periods? That’s your first step: Figure out why you’re not ovulating. Please see Chapter 7 of my book.

          Reply
  104. I have been suffering from horrible insomnia that came on over night. I went to my OBGYN and she put me on the low dose patch of HRT progesterone/estridiol… it did not help with my sleep and made me feel worse. I recently went to an endocrinologist and had my estrogen levels tested . I was not on any HRT at the time. Levels read Esterone 33pg/ml, Estridiol 34pg/ml, Estriol <0.10 I was told to me was that my estrogen was low. I also am having difficulty gaining weighThe. I do supplement with magnesium bisglycinate 200mg when I wake up in the middle of the night. I have started Emerita progesterone cream 20 mg x2 a day mornings and evening with 7 days off. Can you suggest any other options for the insomnia ….I am post menopausal.

    Reply
    • Did your insomnia begin with the onset of menopause?

      Usually, low-dose estradiol HRT is very helpful for post-menopausal sleep. (See In Defense of Estrogen. No hormone more powerful for mood and sleep.) If you felt worse on it, it was probably from the progestin they gave you (which was probably not progesterone). Please read The Crucial Difference Between Progesterone and Progestins.

      Might be worth finding a doctor who can prescribe low dose estradiol (as Estradot) combined with bioidentical progesterone (as Prometrium). I always recommend a monthly break from both hormones. I’ll try to write a post about it in future.

      Reply
  105. Hello Dr. Lara. Can you talk about the problems with excess progesterone and how that might show up clinically? Also, can you address how synthetic progestins vs bioidentical progestins may effect a woman in excess? Thank you for sharing your expertise!

    Reply
  106. Hi Lara,
    Great information! I recently had my progesterone level tested on day 21 of my cycle and it was 93.1! From all of the reading I have done that seems abnormally high. Do you think I should be concerned at all with that number? Any reasons why it would be that high? Thanks!
    Vanessa

    Reply
  107. Dear Lara,

    I have had BV for around 3 months with no antibiotics, because I could not tolerate the Flagyl. I started getting black tar like discharge yesterday and my period ended a week prior. It is enough to wear a panty liner. I started taking Jarrow Fem-Dophilus once a day about a month ago, but cannot get remission though I think it helps. I heard if I can get the vaginal PH right the infection will clear. I think I am going to try taking the Probiotic 2-3 times a day to see if that helps and start taking 500mg of Curcumin. Someone suggested Multi-Gyn Actigel, but it is not sold in the US. Do you know of a comparable product available in the US? I also heard low Progesterone (which I have) effects vaginal PH & I should try a Progesterone cream. Is that true? Do you have any other suggestions I could use? I’m so miserable. I can’t tolerate essential oils, so Oregano oil is out. Do you think I could try inserting a Fem Dophilus cap in my vagina to directly influence the bacteria? I just feel very raw inside and am bleeding, so not sure I should insert anything. Do not have a doctor and urgent care wont do anything but give Flagyl and tell me find a way to take it even though I reacted badly with extreme GERDS that caused vomiting and sore esophagus for weeks. Thank you for reading.

    Reply
  108. Hi again dear Lara,

    In my recent cycle, I experienced severe breasts pain 2-3days after ovulation day. Would this be caused by the sudden increase in progesterone? I do not experience sore breasts at any other times during my cycle.

    Thank you!

    Reply
  109. Lara
    I have pcos and conceived through fertility drugs and am 6 weeks post partum. They want me to take the mini pill but I’ve read your book and am wanting to try to avoid birth control and to fix myself naturally. I’m currently breastfeeding and supplemeting with formula. I never could figure out if I had post pill pcos or insulin resistant so don’t know the best protocol based off your book to try and if I should wait until I stop breastfeeding. Do you do paid consultations?

    Reply
    • Were you ever assessed for insulin resistance? For example, did you have a glucose tolerance test during your pregnancy? Please send me a private message.

      Reply
  110. Dear Lara, do you think a mid-luteal progesterone reading of 63.3nmol/L is optimal? However, my BBT only rises a maximum of 0.3C as compared to pre-ovulation temperatures. Do you think I am progesterone deficient? Many thanks.

    Reply
    • 63 is a great reading! And 0.3C is fine. Are you using a proper ovulation thermometer? What matters most is the consistency of temperatures through the luteal phase.

      Reply
  111. Hi Lara

    I track my cycles by measuring BBT and cervical fluid as well as LH texts. I know I ovulate but my temperature spike is not as high as 0.5*C the day after I ovulate, and some months it doesn’t get as high as 0.5*C even by the end of my luteal phase.

    Does this mean I have low progesterone? (I’ve had a blood test and it was 31 nmol/L which is above 25 so it should be enough?)

    Thanks
    Lauren

    Reply
    • Other factors affect temperature rise including thyroid and stress hormones. If you’re achieving 0.3C rise, that is probably enough.

      Reply
  112. Dear Lara. 1-2 weeks before my period I always get bloated in my face. It actually gets bigger, and I feel nasty… Why do you think this is? And is there any supplements I can take during these weeks to avoid this? I already take magnesium and zinc every night before I go to bed. Been doing this some months cause I accationally get som acne, and these supplements help. I’ve also added 180 mg DIM (2 weeks ago). Could dim be the reason my face gets fuller?

    Reply
  113. Thank you Lara for your fantastic blogs! There is something I still can’t get. I have had very heavy (but regular) periods for quite a few years now (I’m 46). The specialist wants to put me on the mini pill before the last resort of hysterectomy, as we’ve tried the rest. Having read your blogs, I can’t bring myself to do one or the other. It just doesn’t feel right. So for the last few months, I’ve created a chart and written in it daily, mainly about criterias that I feel are changing hugely along a 28 day cycle. What came out is that the feeling of anger/frustration appears in the second half of my cycle, around day 17 to 19, and fluctuates but stays fairly high (along with the desire to overeat) until day 1 of my period, when it drops sharply and stays low again until around day 17. So which means that during the first half of my cycle, I feel peace, and the second half, something feels in overdrive, angry and frustrated, restless. How can it make sense? Does it mean there is no progesterone produced around the time of ovulation, and that instead, the level of oestrogen rises even more after ovulation? Does it make sense to you? Many many thanks in advance if you can see any logic in it and a way forward.
    Caroline

    Reply
    • That’s a pretty classic perimenopausal PMS picture. It’s from the combination of 1) estrogen excess, 2) progesterone deficiency, and 3) inflammation that I outline in my PMS post and in Chapter 8 of my book.

      Re: your estrogen-excess heavy periods, did you see my Heavy Period post? What works for many of my perimenopausal patients is a combination of: 1) dairy-free diet, 2) turmeric, and 3) micronised progesterone capsules. Or as a last resort for heavy periods, you can consider Mirena IUD.

      Reply
      • Thank you very VERY much for your response and your time Lara! I’ve already tried the Mirena and had it removed after a month as it was a catastrophe (heavier bleeding than before as well as other symptoms). So I will get on with what you’re advising! Many thanks!! Caroline

        Reply
  114. As always a very interesting post!
    With menopause, taking the natural progesterone cream (0,20 – 0,30mg/day with a stop of 7 days per month) and reading in one of your previous posts that overdose is the only kind of progesterone excess that ever occurs, I am wondering now which is the best and simple way to monitor progesterone value (saliva, blood or what else?) and also what is the best value to reach and to keep.
    Thank you very much!

    Reply
    • The 7 day break is a test of its own. I ask my patients to observe how they feel during the days off. If it has been the right dose, they will be missing progesterone, and ready to go back on. If it has been excessive, then they start to feel better off the progesterone. That’s a sign to use less. But did you say you’re using only 0.2 mg of hormone per day (in say, 1 gram of cream)? That is a minuscule dose. Standard dose is 20 mg.

      Reply
      • Thank you very much for your response. Yes, I think I have made a mistake by saying 0,20mg. As a matter of fact I take one tea spoon of cream which is about 3 gr of 10%progesterone so it shoud be 30 mg of progesterone. I have to pay more attention during the days off, because I cannot see much difference, but in case I want to test would it be better a blood or saliva test?
        Thank you again for your help!

        Reply
  115. Great post, wish my doctor had done this! Is there any way to differentiate pcos from other imbalances? I think I have low progesterone (based on symptoms) and keep being told I “might have pcos”. So frustrating! Is it okay to test while taking vitex? Or will this make it inaccurate?

    Reply
    • It’s fine to test progesterone when on Vitex.
      I discuss testing panel for PCOS in Chapter 7 of my book: insulin, androgens, prolactin, thyroid, zinc etc.

      Reply

I welcome your comment!

Send this to a friend