How to Interpret Your Progesterone Test

Are you experiencing symptoms of hormonal imbalance? Progesterone may be to blame. High and low levels of progesterone can cause many symptoms in women. Instead of blindly guessing what may be causing symptoms, test! Progesterone testing is an important diagnostic tool in evaluating fertility issues, menstrual irregularities, and menopausal symptoms. Given the natural hormonal fluctuations throughout the menstrual cycle, interpreting female hormonal results can be complex. This article will help readers understand what progesterone test results mean and what they can do to address them.

What Is Progesterone?

Progesterone is a steroid hormone primarily produced by the ovaries in females, although the adrenal glands also synthesize smaller amounts. It plays a crucial role in the female reproductive system, particularly during the menstrual cycle and pregnancy. 

The levels of progesterone in the body undergo cyclical fluctuations during the menstrual cycle. A normal menstrual cycle encompasses four phases: the menstrual phase (days 1-5), the follicular phase (days 6-14), ovulation (day 14), and the luteal phase (days 15-28). After ovulation, typically around day 14 of a 28-day cycle, the remnants of the ruptured follicle (the corpus luteum) secrete progesterone. If fertilization occurs, the corpus luteum continues to secrete progesterone until the placenta takes over. Progesterone facilitates the preparation and maintenance of the uterine lining and inhibits uterine contractions, ensuring an optimal environment for a potential pregnancy. If fertilization does not occur, the corpus luteum degrades, progesterone levels decline, and the uterine lining is shed, beginning a new menstrual cycle. (28) 

Beyond its reproductive functions, progesterone also influences mood. Progesterone and its metabolite allopregnanolone can cross the blood-brain barrier and potentiate the effects of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), leading to a heightened sense of relaxation and tranquility. It is hypothesized that fluctuations in progesterone levels during the menstrual cycle and after pregnancy contribute to mood disorders, such as premenstrual dysphoric disorder (PMDD) and postpartum depression, and emotional symptoms associated with premenstrual syndrome (PMS). 

While progesterone levels are lower in men, it still holds an important role in men's health. Produced in the testes and adrenal glands, progesterone influences sperm development and testosterone synthesis. It also facilitates capacitation, a change sperm undergo that enables them to fertilize an egg. Progesterone receptors in the brain suggest potential involvement in cognitive function, and studies hint at neuroprotective effects. (13, 17) 

Indications for a Progesterone Test

A progesterone test may be recommended in various scenarios to assess hormone levels and gain insights into reproductive and overall health. In women, such testing is commonly advised in the following situations:

Fertility Evaluation

Progesterone levels are crucial in assessing the menstrual cycle and ovulatory function. Testing may be recommended for women experiencing fertility issues to determine if ovulation is occurring and if any hormonal imbalances are contributing to infertility. 

Menstrual Irregularities

Women with irregular menstrual cycles or absent periods may undergo progesterone testing to evaluate ovulatory function and hormonal balance. Symptoms of low progesterone include irregular or missed periods, heavy periods, and mid-cycle spotting. Progesterone testing can provide information about the function of the ovaries and help diagnose conditions such as polycystic ovary syndrome (PCOS), which causes irregular menstrual cycles. 

Monitoring Pregnancy

Progesterone levels are essential for maintaining the uterine lining and supporting early pregnancy. Testing may be done to ensure adequate progesterone levels needed for a viable pregnancy, especially in cases of recurrent miscarriage or other pregnancy complications.

Menopausal Hormone Therapy

Progesterone levels decline as women age and enter menopause. After menopause, progesterone levels fall below 0.5 ng/mL. In women undergoing menopausal hormone replacement therapy (HRT) to treat common symptoms (e.g., hot flashes, night sweats, vaginal dryness, changes in mood, insomnia), progesterone levels may be monitored to ensure safe and effective dosing.

How to Test Progesterone Levels

Progesterone levels can be measured via blood, saliva, and urine testing methods. Choosing one type of test over another will depend on the patient/provider's preference and what they want to measure. Progesterone is produced after ovulation in premenopausal women. In this population, it is recommended to measure luteal phase-progesterone, around day 21-22 of a 28-day menstrual cycle or about one week after ovulation (7). Hormonal birth control and HRT will influence progesterone test levels. 

Blood Testing

Access Medical Laboratories' serum Progesterone test offers a snapshot into circulating progesterone levels at the time of the blood draw. Very often, progesterone will be measured in concert with other sex hormones, like estradiol, LH, and FSH, so that a more comprehensive hormonal assessment can evaluate the hypothalamic-pituitary-ovarian (HPO) axis and how the various hormones coincide with one another at a certain point in the menstrual cycle. You could order the FSH & LH panel by Access Medical Labs with the Female Serum Hormones Basic Profile by ZRT Laboratory to do this.

Salivary Testing

Salivary testing measures the free, unbound concentration of progesterone available to act on tissues. The Saliva Profile I - female/male by ZRT Laboratory measures progesterone alongside estradiol, testosterone, DHEA, and testosterone for a comprehensive hormonal evaluation. 

Alternatively, you may consider Genova Diagnostics' Rhythm test, which measures hormones over a month to map out hormonal fluctuations throughout the cycle. This type of test is beneficial to better understand the pulsatile rhythm of how progesterone is produced throughout the various menstrual cycle phases in premenopausal and perimenopausal people.

Urinary Testing

The DUTCH Cycle Mapping test by Precision Analytical is a urine test equivalent to the Rhythm test mentioned above. It requires 25-morning urine samples, collected over 25 days, to map the patterns of estrogen and progesterone throughout the menstrual cycle. Disruptions in the normal hormonal secretion patterns at any point during the cycle can contribute to signs and symptoms of hormonal imbalance.

Precision Analytical's DUTCH Complete is a very popular panel amongst functional medicine providers. It is another dried urine test that measures sex and adrenal hormonal metabolites. Assessing progesterone metabolites may benefit patients with mood-related symptoms, given progesterone's role in mood regulation. 

Understanding Your Progesterone Test Results

Serum progesterone is low during the follicular phase. Levels begin to increase just before the onset of the LH surge and then increase to peak 6-8 days after ovulation. (25)

The following are typical ranges for progesterone based on menstrual cycle phase and pregnancy:

• Female (Pre-Ovulation): < 1 ng/mL
• Female (Mid-Cycle): 5-20 ng/mL
• Male: < 1 ng/mL
• Postmenopasual: < 1 ng/mL
• Pregnancy 1st Trimester: 11.2-90 ng/mL
• Pregnancy 2nd Trimester: 25.6-89.4 ng/mL
• Pregnancy 3rd Trimester: 48-300+ ng/mL

Higher-than-normal progesterone levels may indicate pregnancy, ovarian cysts, excessive levels of stress, HRT, and (rarely) ovarian cancer or congenital adrenal hyperplasia (13). 

Lower-than-normal progesterone levels are a causative factor for irregular menstrual cycles, amenorrhea (absence of menstruation), menorrhagia (heavy periods), PMS, mood disorders, and infertility. During pregnancy, progesterone levels < 10 ng/mL at 6-8 weeks signify an abnormal intrauterine or ectopic pregnancy (25). 

Factors Influencing Progesterone Levels

Acknowledging the intra-cycle variability of progesterone levels is crucial for accurately interpreting hormonal assessments and ensuring meaningful insights into reproductive health. Progesterone levels fluctuate significantly throughout the menstrual cycle, reaching their peak during the luteal phase after ovulation. Understanding the expected range of progesterone levels in each phase of the cycle is essential for appropriate interpretation. For instance, higher progesterone levels in the luteal phase are normal and indicate ovulation and readiness for a potential pregnancy. On the other hand, low progesterone levels during this phase may suggest issues with ovulation or luteal phase deficiency, potentially affecting fertility. (25)

Several factors can influence progesterone levels, reflecting the intricate hormonal balance within the body. Stress is a significant contributor; elevated stress levels can lead to increased production of cortisol, a hormone that shares a precursor with progesterone, potentially diverting resources away from progesterone synthesis. Lifestyle factors, such as inadequate sleep, excessive exercise, and poor nutrition, can also impact progesterone levels, as the body's overall health plays a role in hormone production.

Certain medications may interfere with progesterone synthesis or metabolism. For instance, hormonal contraceptives containing synthetic hormones can suppress natural progesterone production. Conversely, hormone replacement therapies or fertility treatments may introduce exogenous progesterone, raising levels. 

Additionally, medical conditions can cause HPO dysfunction, leading to hormonal imbalances and irregular menstrual cycles. These conditions may include PCOS, hypothyroidism, hyperprolactinemia, low cholesterol, (peri)menopause, and obesity.

It's crucial to recognize the interconnectedness of these factors and their potential cumulative effects on progesterone levels. Understanding these influences helps healthcare providers assess and address hormonal imbalances, whether for fertility concerns, menstrual irregularities, or overall reproductive health.

Next Steps After Progesterone Testing

Following a progesterone test, the next steps depend on the specific context and purpose of the testing. For fertility assessments, menstrual irregularities, or hormonal imbalances, healthcare providers may consider various actions.

Additional tests may be recommended to validate and complement progesterone results. This could include tests for other reproductive hormones, thyroid function, or imaging studies to assess ovarian health. Complementary tests to hormone panels include:

• Thyroid Panel by BostonHeart Diagnostics
• Micronutrient Test by SpectraCell Laboratories
• Hemoglobin A1c by BostonHeart Diagnostics
• Prolactin by BostonHeart Diagnostics
• Lipid Panel by Access Medical Labs

If fertility is a concern, providers may suggest regular cycle monitoring to track hormonal fluctuations and identify the timing of ovulation. This can involve additional blood tests, ultrasound examinations, or fertility awareness methods like monitoring cervical mucus and basal body temperature (BBT).

Lifestyle factors, such as stress management, adequate sleep, and a balanced diet, can significantly influence hormonal balance. Depending on the individual's circumstances, healthcare providers may recommend lifestyle modifications to support reproductive health. (13, 24, 28) 

In cases of infertility, personalized treatment plans may be devised. This could involve medications to stimulate ovulation, hormonal therapies to correct imbalances, or assisted reproductive technologies (ART) like in vitro fertilization (IVF).

For individuals experiencing symptoms related to hormonal deficiencies, such as irregular menstrual cycles or menopausal symptoms, hormone replacement therapy may be considered. This can involve supplementing with progesterone or a combination of hormones to restore balance. Alternatively, botanical remedies, such as Vitex agnus-castus (chaste tree), may be recommended as natural alternatives to boost progesterone levels. (13) 

The importance of personalized care cannot be overstated, especially in fertility treatments or hormonal therapies. Each individual's response to hormonal interventions can vary, and considering the unique aspects of their reproductive health is crucial. Tailoring treatment plans based on progesterone test results and a comprehensive understanding of the individual's medical history and goals enhances the likelihood of successful outcomes and minimizes potential risks or side effects.

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Interpreting Your Progesterone Test: Key Takeaways

Understanding and interpreting progesterone test results are integral to gaining insights into reproductive health, fertility, and hormonal balance. The dynamic nature of progesterone levels throughout the menstrual cycle underscores the importance of considering results within a broader health context. Recognizing hormonal variability, tailoring interpretations to individual circumstances, and acknowledging the potential influence of lifestyle factors contribute to a more accurate assessment. To navigate this complex landscape, I encourage you to seek professional guidance from functional healthcare providers who can offer personalized interpretation and devise comprehensive treatment plans that align with individual health goals and considerations.