You may already know that your hormones start to shift as you move into and through your 40s. Progesterone is one of first hormones to start changing as you move past late 30s, it starts to decline. You might ask why does progesterone decrease in perimenopause? And this is a really important part of perimenopause physiology to understand and manage.
In this blog, I’ll explain what progesterone is, its role, why it declines, and how to help counteract this for a smoother and happier perimenopause!
WHAT IS PROGESTERONE?
Progesterone is a steroid hormone. ‘Steroid hormone’ refers to a group of hormones derived (made) from cholesterol that act as chemical messengers in the body.
Progesterone converts into a brain hormone called allopregnanolone, which increases the actions of GABA, a calming, anti-anxiety and sleep-supportive brain chemical. Without allopregnanolone, the body’s stress response system can become destabilised.
This can soon result in a reduced ability to cope with stress and issues getting to sleep at night and or staying asleep.
Progesterone is anti-inflammatory, supports cognition, thyroid and metabolism and prevents water retention (‘puffiness’).
Progesterone is the yin to oestrogen’s yang, sheltering the body and breast tissues from the effects of too much oestrogen.
If oestrogen is met with progesterone (i.e. ovulation occurs), perimenopause symptoms are minimised by maintaining balanced hormone levels.
Some studies show that lack of progesterone may lead to irregular and or much heavier periods than normal during perimenopause.
WHY YOU NEED PROGESTERONE: PERIMENOPAUSE SYMPTOMS OF DECLINING PROGESTERONE
The main function of progesterone is to prepare the lining of your uterus (endometrium) to allow a fertilised egg to implant and grow.
Progesterone makes this lining fluffy and hospitable for the egg to settle in, get cosy and grow. If pregnancy does not occur after ovulation, the endometrium sheds, marking day 1 of your bleed and the start of a new cycle. If pregnancy does occur, progesterone levels increase in order to support the pregnancy.
HOWEVER! Progesterone is needed for so much more than just pregnancy.
Your body and brain need this wonderful hormone to:
Prevent oestrogen from being left unopposed (not balanced out by its partner hormone), also known as ‘oestrogen dominance’
Promote a sense of contentment, equilibrium and well-being
Support deep, restful REM sleep
Increase a brain chemical called GABA, which reduces anxiety and promotes calm and relaxation
Support cognition (your brain!) and concentration
Boost metabolism through its thermogenic (raising of body temperature) actions
Help your thyroid gland to make enough thyroid hormone
Help you release excess body fluid (preventing ‘puffiness’)
Protect nerve cells and support healthy blood flow to the brain
Manage emotional symptoms, such as mood swings and irritability, by stabilising hormone levels
When progesterone is low or you didn’t make any one or multiple months, you may experience:
Trouble sleeping / insomnia particularly during the second half of your cycle
Anxiety, particularly heightened during the second half of your cycle
Symptoms of unopposed oestrogen/oestrogen dominance (miserable, heavy periods, clotting, breast pain, mood swings, headaches, rage, fibroid growth, cyst growth)
Feeling more stress-sensitive
Irritability
Migraines just before or during your period
Water retention / ‘puffy’ ankles and hands etc.
Spotting or breakthrough bleeding during the second half of your cycle
Shorter cycles (less than 25 days)
Long or irregular cycles due to less frequent ovulation
HOW YOUR BODY MAKES PROGESTERONE
Oestrogen is made everyday as part of your menstrual cycle, with oestrogen levels ramping up as your body gears up to ovulate just before the midway point of your cycle.
Whether or not one of your ovaries releases an egg (ovulation), that oestrogen will still have been made. Progesterone however, is ONLY made IF you do actually ovulate.
So, ovulation is HOW your body makes progesterone.
During ovulation, a unique little temporary gland is formed, called the corpus luteum. This amazing little gland allows one of your ovaries to release a nice load of progesterone into your system after ovulation.
The corpus luteum forms very quickly and lives for about 11-14 days (the approximate length of the luteal phase of your cycle), where it continues to release progesterone into your system.
Sometimes, you manage to ovulate but the corpus luteum formation is less than optimal, resulting in less than optimal levels of progesterone being made.
NO ovulation means NO progesterone production.
The diagram below shows an average 28 day menstrual cycle (normal cycles range from 24 – 35 days so don’t worry if yours isn’t 28 days!). In the diagram you can see that after ovulation, oestrogen is met with lots of progesterone, which is reflected in the grey line.
Had this person not managed to ovulate, the grey line would have remained flat throughout the entire cycle, creating an oestrogen ‘dominant’ situation, likely resulting in PMS, breast pain, mood swings, headaches and heavy flow, potentially with some clotting. PLUS symptoms of low/no progesterone, which include trouble sleeping, anxiety, irritability and low mood, water retention, and brain fog.
Irregular periods can also be a symptom of declining progesterone, manifesting as changes in cycle predictability, flow, and duration.
If you experience these perimenopause symptoms, it is advisable to consult a doctor to rule out any underlying issues.
NOTE: If you are on the oral contraceptive pill or injection, brain to ovary communication is shut down in order to suppress ovulation, which means you won’t have the natural cycling of hormones shown in the diagram. There’s also no progesterone if you’re on almost any type of hormonal contraception, including the implant and hormonal IUD, because the progestins contained in these meds are NOT the same as progesterone.
It’s possible to track whether or not you’ve ovulated by way of taking your temperature each morning as soon as you wake up (before getting out of bed) and noting it down, known as ‘basal body temperature tracking’.
Once you have a good idea of your baseline morning temperature from day 1 of your cycle through to just before ovulation (the follicular phase), you’ll be able to see if there has been a slight increase in temperature (between about 0.1°C to 0.3°C higher) after your estimated ovulation day.
This would suggest that you did ovulate and therefore make progesterone, this is because progesterone increases body temperature.
WHY DOES PROGESTERONE DECREASE IN PERIMENOPAUSE?
For most women, as they approach late 30s and move into their 40s, one of the first hormonal shifts that starts to occur is a decline in progesterone.
Hopefully by now you can appreciate the significance of this on physical, mental, and emotional wellbeing.
During the menopause transition, also known as perimenopause, hormonal changes occur that lead to irregular menstrual cycles and may manifest symptoms such as hot flashes and vaginal dryness.
So, why does progesterone decrease in perimenopause?
Simply put, because ovulation starts to become harder and harder to achieve as you move past 40. This is due to the change in communication between your brain and your ovaries that starts to occur from mid to late 30s onwards.
The brain no longer talks to the ovaries as loudly, clearly and timely as it did in your 20s and earlier 30s, and your ovaries no longer respond as well as they did before.
The good news is that you can support your body to ovulate more months than it might have done had you not intervened and greatly ease symptoms.
This is the beauty of nutrition and lifestyle habits – you can leverage them to support your body to ovulate despite the fact that is does become harder to achieve after 40.
Isn’t that just great?
6 WAYS TO OPTIMISE PROGESTERONE IN YOUR 40S
Remember, the only way to make progesterone is through (monthly) ovulation.
To achieve ovulation, you need to support health as a whole. You also need to identify any potential obstacles to your ability to ovulate, such as stress, inflammation, thyroid issues, insulin resistance, nutrient deficiencies or under eating.
As said by the wonderful Dr Lara Briden, managing to ovulate is your monthly health report card!
Here Are 6 Ways To Ovulation:
1) Manage Stress And Minimise Its Impact
This is a BIG one because chronic stress is one of the BIGGEST blockers to ovulation. Why? Because your brain is always scanning your environment for any threats to yours or a potential baby’s survival.
The annoying thing is that we can’t just tell our brain that we are not actually trying to become pregnant, we just want to ovulate so we can have progesterone!
The brain also cannot be told that certain day to day stressors are not actually life threatening, such as having too much on your plate, working long hours, financial worries, work or relationship issues, ageing parents, troublesome teenagers, traffic jams, running late, etc.
These stressors are considered a threat by the brain, which results in the signalling to your ovaries to go ahead and ovulate NOT being sent. No ovulation occurs, no progesterone is made.
Now oestrogen is left unopposed and dominates the second half of your cycle, and symptoms ensue and your next period is heavy.
Managing stress effectively can also help alleviate emotional symptoms, improving overall well-being.
Here are some of my favourite ways to manage and reduce your physiological stress response each day:
Regular deep breathing exercises such as the 4:6 or 4-7-8 techniques done for 3 minutes morning and night
Mindful walks in nature or any kind of green space or woodland, even just 10 minutes
Gentle yoga, Tai Chi, or Qigong, even just 10 minutes
Saying or writing some things you are grateful in your day and or your life as a whole, morning and night
Yoga Nidra (also called non-sleep deep rest) lying down meditations
5 – 10 minutes lying on the floor with your legs resting up the wall whilst focusing on your breath
Baths in epsom salts
2) Support Your Thyroid Health
Look out for a future blog specifically on this and this is a whole other topic in itself but for now, know that you should be keeping an eye on important thyroid function markers such as T4, T3, TSH and the 2 main thyroid antibodies; anti-thyroid peroxidase (TPOAb), anti-thyroglobulin antibody (TgAb).
Monitoring these markers is crucial as thyroid function significantly impacts hormone levels, which in turn affect various bodily functions, including menstruation and mood regulation.
Conventional thyroid testing only looks at TSH and T4, which doesn’t provide the full picture so you would need to go private for a more comprehensive panel.
I use Genova Diagnostics with my clients and for a DIY version I recommend Medichecks. Thyroid issues can block ovulation and or drive symptoms of oestrogen dominance including PMS and heavy and painful periods.
3) Prevent Or Reverse Insulin Resistance
For a deeper dive into insulin resistance and why it matters, you can click here.
Essentially, managing insulin resistance comes down to eating a blood sugar balancing diet with optimal protein, healthy fats, colourful vegetables and ‘complex’ or slow-release carbohydrates, in a healthy serving size.
Avoiding snacking, fasting for 12-16 hours overnight and lifting weights are also helpful. Insulin resistance can affect hormone levels, blocking ovulation and driving PMS symptoms and heavy, painful periods.
4) Eat A Nourishing Balanced Diet With ENOUGH Food (calories)
What’s important to appreciate is that perimenopause is NOT a time for low calorie diets and restriction.
Now more than ever we should be eating a nourishing diet made up of quality proteins (every meal, minimum 30g protein per meal, preferably including all animal proteins), nutrient-dense, slow-release carbohydrates, healthy fats and colourful vegetables.
The formation of the corpus luteum demands a lot of energy (food/calories) from three well rounded, nutrient-rich meals. Optimal protein, healthy fats, quality carbohydrates, and nutrients such as cholesterol, B-vitamins, coQ10, vitamin D, iodine, magnesium, selenium and zinc are essential for a healthy corpus luteum.
5) Identify And Address Potential Underlying Issues / Dig Deeper
Another reason for progesterone decrease in perimenopause can be unaddressed chronic inflammation, which can block ovulation and or prevent optimal corpus luteum formation.
It’s important to identify and address potential sources of persistent, low-grade inflammation and their impact on hormone levels, such as:
An autoimmune condition, including Hashimoto’s (thyroid autoimmunity)
Unknown sensitivity to cow’s milk or gluten
Gut intestinal permeability (also known as ‘leaky gut’)
Insulin resistance and or type 2 diabetes
Gut infections (pathogenic bacteria, parasites, yeast, dysbiosis, H.Pylori)
Viral infections
6) Try Supplementing With Vitex
Consider taking Vitex (also called chaste tree, chasteberry, or agnus castus). Vitex is a herbal medicine prepared from the berries of the Mediterranean tree Vitex agnus-castus.
It has been shown to support/modulate the brain’s production of luteinising hormone (LH), while mildly inhibiting follicle stimulating hormone (FSH), which supports the ovulatory process and helps balance hormone levels.
Additionally, vitex may have calming effects on the nervous system, which is also great for supporting ovulation, and it can relieve symptoms such as breast pain, water retention, and irritability.
Some tips for how to use Vitex:
The brain will be most receptive to Vitex in the morning, so take it as part of your morning routine.
Because Vitex works promotes ovulation, you should start taking it early in the follicular phase, say around day 6 of your cycle, and then continue taking it daily until day 1 of your next period. Take a break until day 6, repeating each month. This 5 day break helps to prevent its effects from attenuating.
You may need to use it for 3-6 months whilst you work on all of the other points I’ve talked about here. Then you could trial some time without it and see how you go. vitex is most effective for up to 6 months.
