By Dr. Shawna Darou, ND
Progesterone is a key hormone for women’s health, produced by the corpus luteum, only after ovulation. It has a tremendous influence on your mood (think PMS), sleep, period flow, fertility, and more. It is also important as the hormone that balances out our estrogen levels, keeping us out of an estrogen dominant state.
What is luteal phase defect?
Luteal phase defect is a condition associated with low progesterone levels, or inadequate progesterone secretion from the corpus luteum – this an be either a short luteal phase (less than 11 days) or low progesterone level.
A low progesterone level is defined as a blood measurement taken 5-9 days after ovulation being below 32 nmol/L. Because we sometimes cannot pinpoint ovulation timing, a more precise measurement is measuring progesterone on three consecutive days in the same window 5-9 days after ovulation), where the total is less than 95 nmol/L.
Signs of low progesterone include:
- Spotting before your period
- Menstrual cycles shorter than 26 days
- Very heavy menstrual flow
- Premenstrual syndrome, especially with poor sleep and anxiety
- Difficulty conceiving
- Early miscarriage (before 7 weeks)
- Lots of perimenopause symptoms – mood swings, difficulty sleeping, heavy and difficult periods, irregular cycles.
If you have any of the above, or especially if you ave several of the above signs, the next step is to test your progesterone level to confirm. There are other possible causes for all of the signs above, to please test before treating!
What are the causes of luteal phase defect?
- Both low calorie diets and low fat diets are associated with low progesterone levels.
- Over-exercising will also drop progesterone, especially when combined with a low-calorie diet.
- High stress levels drop progesterone when a mechanism called the “progesterone steal.” Progesterone drops more when there is stress in the first half of the cycle (before ovulation), compared to the second half. Think of this as your body protecting you from pregnancy when stress levels are too high.
- High insulin levels are associated with low progesterone production, in PCOS and otherwise. Nutrition changes to lower insulin often have bring up progesterone dramatically.
- Progesterone levels often drop with age, meaning the peak levels decline through the 40’s, long before estrogen drops. This is why many women experience more shorter cycles, heavier periods, more anxiety and sleep disturbance in the late-40’s especially.
Tips to bring up progesterone levels:
The key is to get to the source where possible and determine the underlying cause. Is it nutritional, weight-related, caused by insulin resistance, or caused by persistent high stress levels.
- Start by addressing stress: This is the most common cause of a short luteal phase and low progesterone. When the body is under stress for too long, there is less progesterone. Are there some causes of stress you can let go of? What are the tools and strategies you can use to reduce your load? Think about meditation, time in nature, restorative exercise, socializing with friends, and prioritizing regular downtime in your week.
- Is this a situation with too little food and too much exercise? Progesterone tends to be low in any prolonged calorie-deficient state. Take an honest look at your exercise routine – is it too much? Low progesterone can be one sign of overtraining.
- Is there insulin resistance of PCOS? Insulin resistance is associated with high intake of carbohydrates and sugars, and carrying extra weight around the mid-section. Reversing insulin resistance with a lower-carbohydrate diet and regular exercise can make a profound impact on the regularity of ovulation and base progesterone levels.
- Are you in perimenopause? Although progesterone naturally does drop with age, in most cases there are other contributing factors such as the three listed above: high stress; over-exercising; or insulin resistance. What this does is amplify the age-related change to a more extreme level. We can often minimize perimenopause symptoms by simply improving nutrition, optimizing exercise and reducing stress.
- Supplements and herbs to support progesterone: Many supplements may be recommended to support optimal progesterone production. These include: vitamin C, Vitamin B6, Vitex (Chasteberry), Black cohosh, and more.
- Using bioidentical progesterone: We may choose to use bioidentical progesterone to reduce symptoms or low progesterone while we are working on underlying causes. For women who are not trying to conceive, topical progesterone creams or oral progesterone capsules are preferred. (Naturopaths can prescribe creams, and refer for oral progesterone). For fertility, progesterone vaginal suppositories are most effective.
If you suspect you may have a luteal phase defect, or know that you have low progesterone or a short cycle, I hope this short article has given you some insight. As discussed above, not only do we need to accurately test your progesterone level, but also determine the underlying cause. Often the progesterone is low for a reason, and by correcting this your ovarian function can return to optimal.
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