If you read my article, How I’m Healing My Own Estrogen Dominance (And Quickly) this month, you’re halfway there in understanding the mechanisms behind your own period problems, luteal phase irritability, swollen breasts, and PMS.
Today, we’re diving into the other half of the equation: low progesterone.
Progesterone doesn’t get the villain arc estrogen does as in no one’s writing thinkpieces about it, and estrogen seems to get all the attention.
But in my practice (and in my DMs, constantly), low progesterone is one of the most common threads running underneath the symptoms women bring me: the insomnia that shows up like clockwork in the luteal phase, the spotting 2+ days before their period even starts, the “I have a period so I must be fine” logic that, I promise you, is not how any of this works.
Here’s the thing about progesterone: it’s doing its job in the background, going unnoticed when it’s abundant and properly metabolized. When it’s too low (and rarely but sometimes too high) relative to estrogen, it gets annoyingly loud.
Progesterone is the female sex hormone responsible for calm, restorative sleep, maintaining the uterine lining, and keeping estrogen from running the luteal show...
When it’s low, your body shows you in about a dozen different ways but most of which get written off as “just PMS” or “just stress” or, my personal favorite, “just being a woman.” Pretend there’s an upside-down happy face emoji sitting here.
Let’s break down exactly what low progesterone looks like, what reliably causes it in women in their 30s and 40s, how to actually confirm you’re ovulating (spoiler: bleeding ≠ ovulating, I was shocked and confused when I learned this myself!), what your labs mean, and what to do about it nutritionally and within your lifestyle choices.
Grab a coffee (single shot, after breakfast, if you’re taking my advice below) and let’s get into it.
First let’s determine if your symptoms are screaming (or whispering) low progesterone or not →
PMS symptoms (irritability, fatigue, headaches, bloating)
Fibrocystic breasts or breast tenderness
Infertility or recurrent miscarriage
Irregular cycles (anovulation = no ovulation → no progesterone)
Spotting between cycles
Spotting 2+ days before bleed starts
Heavy periods or blood clots
Fluid retention: progesterone acts as a diuretic
Weight gain and/or cellulite
Low body temperature (low or irregular basal body temps in luteal phase)
Hypothyroidism (progesterone enhances thyroid hormone function; thyroid hormone makes progesterone receptors more sensitive)
Insomnia (especially in the luteal phase)
Headaches/migraines (especially in the luteal phase)
Pain/inflammation (radiating cramps, joint pain before or during period, feeling flu-like during period i.e. “period flu” from high prostaglandins and estrogen)
Endometriosis, fibroids, and ovarian cysts
Endometriosis and adenomyosis (estrogen-engineered disorders especially at the tissue level even if blood and urinary testing looks “okay”)
Anxiety (progesterone interacts with GABA receptors; GABA is a calming neurotransmitter) or depression
History of under-eating, disordered eating or eating disorders
History of over-exercising
I know - it’s a long list. But progesterone has some important functions in our body even outside of reproduction, and the modern lifestyle most of us grew up believing is “normal” couldn’t be more anti-progesterone.
Constantly dieting, unintentionally (but undercover intentionally) under-eating to control your weight (yet this almost always backfires), working a 9 to 5 (that’s more like an 8 to 7), and constantly going, doing, being and performing to create a sense of self-worth out of worldly values. Fast track to low progesterone, ladies!
Nutrient deficiencies both directly and indirectly can lower progesterone production especially zinc, vitamin C, B vitamins, vitamin A, vitamin E, iron and magnesium
Low cholesterol: low fat intake, mold exposure, chronic dieting can all cause low circulating cholesterol which is the building block of all hormones including progesterone. Total cholesterol < 160 is your red flag but I feel best when mine is between 180 and 200.
Low fat and low carb diets: initiate a starvation response in the body by either lowering total cholesterol (low fat diets) or increasing stress hormone and decreasing thyroid hormone (low carb diets)
Being Underweight: women must have a certain amount of body fat to signal reproduction safety to the endocrine glands. This is usually caused by chronic dieting, over-exercising or under-eating or malabsorption conditions.
Gluten sensitivity: gut and systemic inflammation spiking cortisol and reducing progesterone availability as cortisol is made from progesterone
Chronic stress and HPA axis dysfunction (we can reliably see this on DUTCH testing in my practice) — especially if light environment is poor. Your easy fixes: morning sunlight in bare eyes outside (no screened porch, glasses, contacts) for 10-15 min every morning before phones or indoor lights get turned on. Red lens blue light blockers after sunset. Start with those two shifts!
High prolactin (on bloodwork usually linked to hypothyroidism and estrogen dominance when marginally elevated - I see it in women with PCOS too. Very high prolactin outside of breastfeeding should be evaluated.)
Postpartum or breastfeeding are naturally anovulatory, low progesterone states.
Hypothyroidism (an inherently higher estrogen, lower progesterone state — causes include gut infections, low stomach acid, nutrient deficiencies, toxin exposures such as mold, metals, and vaccines, viruses, and emotional stress)
Insulin resistance: often aligns with a high cortisol predominance, shuttling resources away from progesterone production.
The most alarming culprit: you didn’t ovulate that month. Maybe from a combination of the above, or a condition like PCOS, or you had surgery or an illness that disrupted reproductive hormones, or have been starving yourself and over-exercising for bikini season.
Most women I poll don’t actually know if they’re ovulating though, and this is step number one in determining if you are even capable of making adequate progesterone.
First, just because you had a period, does not mean you ovulated that month. Women can still bleed during anovulatory cycles as estrogen is responsible for building up the uterine lining and progesterone is responsible for sustaining it during pregnancy. No progesterone and no pregnancy will still result in a bleed eventually as the uterine lining sheds.
The best way to confirm ovulation is by combining three screenings:
BBT (basal body temp) tracking: I use Natural Cycles to track my overnight BBT to confirm ovulation. I ovulate day 13 or 14, and see a reliable temperature shift in my luteal phase until it drops off around day 27 at the start of my period.
LH test strips: urine luteinizing hormone testing to catch the sharp rise of LH before it drops once ovulation is complete. You do need to test every 12 hours to capture it reliably as the second line must be just as dark or darker than the test line (unlike on pregnancy tests when the second line can be ever so faint, and it’s still a positive pregnancy test).
Ovulation symptoms: such as cervical mucus, libido increase, larger breasts and lips, “feeling prettier”(biology’s way to increase chance of successful reproduction), increase in confidence, extroversion
No, I wish it did! Some women will ovulate and still not make enough progesterone — thus resulting in the low progesterone symptoms above, especially if estrogen is outpacing progesterone in the luteal phase.
Think of ovulation like turning on a faucet. Just because the water starts flowing doesn’t mean the pressure is strong enough.
After ovulation, the ruptured follicle transforms into a temporary endocrine gland called the corpus luteum, which produces progesterone. The healthier that follicle was before ovulation, the healthier the corpus luteum tends to be, and the more progesterone it can produce.
A weak or underdeveloped follicle may still release an egg but produce a less robust corpus luteum, resulting in lower progesterone output (this is common in perimenopause, low nutrient, high stress states).
In other words, the quality of ovulation matters just as much as whether ovulation happened at all.
Many factors influence how much progesterone your corpus luteum can make, including:
Blood sugar regulation and insulin resistance
Chronic stress and elevated cortisol (and eventual cortisol depletion)
Inflammation (systemic, gut, histamine, neuro, lots of possibilities here that require further evaluation, screening and testing in my practice)
Thyroid dysfunction (both hypo and hyperthyroidism → hello, low P)
Nutrient deficiencies (especially cholesterol, zinc, magnesium, vitamin B6, and vitamin C)
Poor follicle development during the first half of the cycle
Advancing age and diminished ovarian reserve (perimenopause)
If you’re experiencing any of the low progesterone symptoms above, I suggest a combination of blood progesterone and urinary hormone analysis (DUTCH or Hormone Zoomer) done on the same day 5 to 7 days post-ovulation.
What your 5 to 7 day post-ovulation progesterone blood level means:
<3 ng/mL → Usually suggests ovulation did not occur.
3–5 ng/mL → Ovulation likely occurred, but progesterone production may be suboptimal.
5–10 ng/mL → Adequate for many women but may be on the lower side if symptoms of progesterone deficiency are present.
10–20 ng/mL → Generally considered a healthy, robust luteal progesterone level in a natural cycle.
>20 ng/mL → Can occur with a very strong corpus luteum, pregnancy, multiple corpora lutea, or progesterone supplementation.
Hormone urinalysis will help you determine if your HPA axis (cortisol disruption) could be contributing to low progesterone, and give us a better idea if you are estrogen dominant in the luteal phase.
We will also get an under-the-hood look at your estrogen metabolism and methylation to spot problems before they have the potential to turn into breast or ovarian cancer or further contribute to inflammatory estrogen-driven conditions such as endometriosis, adenomyosis, uterine fibroids and ovarian cysts.
I run these tests on my clients in my Root & Remedy Functional Women’s Wellness practice. Hop on my waitlist to be notified when I open up more spots.
How many calories am I eating most days? How much protein, fat and carbs? If you’re not even clocking 1,800 calories most days, 100g animal protein, and at least 135g carbs, chances are you found at least part of your problem.
Am I eating breakfast reliably within 30-90 minutes of waking, or am I leaving cortisol unopposed and setting myself up for blood sugar instability the rest of the day?
Do I get outside immediately upon waking for morning sunlight, or do I start scrolling, turning on indoor lights and head straight to the coffee maker?
Am I over-exercising or under-exercising? Most women do one or the other - there aren’t many women with a healthy relationship with exercise. A good rule of thumb: 5 to 7 45-minute walks a week plus two to three 30 to 45-minute weight-bearing exercise sessions per week (bodyweight, pilates, reformer pilates, weight lifting) is a sweet spot for healthy thyroid, cortisol, and insulin sensitivity.
Have I been reaching for alcohol, sugar, and packaged snacks more often? These filler foods give us a false sense of energy or emotional security yet can contribute to inflammation, insulin resistance and potentially low progesterone.
How do I handle emotional stress? Do I stew? Reach for processed carbs? Disassociate by scrolling? Call a friend? Go for a walk? Stress is inevitable — how we manage and respond to it matters more especially for our progesterone production. If one stressful incident sends you reeling for days, chances are your HPA axis and nervous system need a whole lot more support.
Do I have healthy boundaries in my relationships, or do I let people walk all over me? Criticize me? Am I a people pleaser who over-extends herself? Our relationships, in my experience, directly impact our ability to produce adequate hormone as cortisol-driven stress allocates resources away from reproduction efforts.
Everyone wants to know what supplement to take or cleanse to do when usually the answer is hiding in their diet, lifestyle and relationships. Let’s explore the right way to approach low progesterone: nutrition-first.
Low progesterone in pre-menopausal women (and even early perimenopausal women) almost always has a nutritional deficiency component caused by under-eating, low stomach acid, poor diet, gut infections or medications.
Here’s a short list of what to try first:
Eliminate gluten: yes, I’m one of those people that doesn’t think anyone should be eating modern gluten, especially women with autoimmunity, insulin resistance, PCOS, hypothyroidism, gut issues and estrogen dominance. Why? Because it adds an unnecessary inflammatory burden on the gut and liver which inevitably impact hormones for many women.
Increase vitamin-C rich produce: citrus, bell peppers, broccoli, tropical fruits, and berries are all excellent sources of vitamin C. Aim for 500mg/day — 1 cup raw bell pepper, 2 kiwi, 1 cup strawberries, and 1 cup broccoli. Yes, we should be eating this much produce per day (and more), and no 99% of women are not.
Reduce caffeine: caffeine works against progesterone in two ways — it increases cortisol and adrenaline (why it’s considered “pro metabolic” ironically) and can increase estrogen levels indirectly. I do just 1 shot espresso (single shot) with cashew or whole milk, collagen, and a teaspoon organic maple with or after breakfast to reduce this anti-progesterone effect.
Don’t go high fat but don’t go low fat: we need a moderate amount of fat (aim for 60 grams if you eat 1,800 cals/day as a barometer) to make enough cholesterol for healthy hormone production but high fat diets (80-90g+ a day) can be inflammatory and estrogenic for many women especially when paired with high carbohydrates.
Ensure you absorb your fats: pale, greasy, or floating stools? You didn’t. Take a lipase-based digestive enzyme to help while you fix the root cause (bile!)
Get your carbs from seasonal fruits, veggies and legumes, mostly: simple carbs like most grains spike blood sugar, cortisol and insulin even if paired with protein since most Americans are metabolically unhealthy. Stick mostly with produce for carbs (even leafy greens count).
I do 2 cups produce with breakfast, lunch and dinner each for a total of 6 cups minimum a day. I aim for 40 different produce items per week (a lot easier than it sounds!)
Do not undereat: one of the fastest tracks to low progesterone is under-eating as it signals starvation and famine to the reproductive system.
Signs you are under-eating include: low blood sugar, “barely eating but not losing weight”, skipping meals, waking up hungry during the night, insomnia, missed periods, poor exercise recovery, low libido, hair loss, low testosterone and premature aging.
Prioritize foods high in vitamin B6: sunflower seeds, walnuts, poultry, chickpeas, bananas.
Prioritize foods high in zinc: beef, oysters, pumpkin seeds, sesame seeds, chickpeas.
Prioritize foods high in magnesium: leafy greens, nuts and seeds (pumpkin seeds, almonds), beans/lentils, avocados, bananas, figs, dark chocolate.
Aim for 30g fiber/day: from fruits, vegetables, nuts, seeds, and beans/legumes. Fiber promotes the excretion of excess estrogen by lowering beta glucuronidase (we test this through the GI Map or Gut Zoomer)
Ditch alcohol: it’s inflammatory, estrogenic, disrupts sleep, raises cortisol, and clogs up your liver.
There are no health benefits to alcohol that outweigh its effects on the body, in my researched opinion. More often than not, it is an emotional crutch and a strategy for avoiding personal and relational problems.
Focus on your diet above all else, but if you need to lean on supplemental nutritional support as well, here are some supplements to research and make a bioindividual decision:
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