Roadmap to Progesterone

how to make progesterone

Progesterone is beneficial because it lightens periods. It also reduces inflammation, regulates immune function, and supports healthy thyroid, brain, bones, and breasts.

Do you make enough progesterone? Are you sure?

The only way to make progesterone is with ovulation and a healthy luteal phase.

What is a luteal phase?

A luteal phase is the approximately 10-14 days between ovulation and the period. It’s named after the corpus luteum, which is the temporary ovarian gland that forms after an egg is released. Having a healthy corpus luteum is the only way to make progesterone.

You can detect your luteal phase by tracking your basal body temperature, which is an under-the-tongue temperature first thing in the morning before you get out of bed. Progesterone increases resting temperature by about 0.3℃ so a luteal phase is higher temperatures for 10-14 days followed by a bleed. If your temperatures go up but you don’t get a bleed, then you’re pregnant. There’s no third option because it’s not possible to ovulate but then not bleed except with the hormonal IUD, uterine ablation, or hysterectomy.

Finally, if your temperatures don’t go up, then it’s an anovulatory cycle and you make no progesterone. Anovulatory cycles are also called hormone imbalance, dysfunctional uterine bleeding, unopposed estrogen, or estrogen dominance (a term I don’t use).

Signs of progesterone deficiency.

Four signs of progesterone deficiency

  • A short luteal phase or no luteal phase, because a healthy luteal phase should be at least 11 days.
  • Low temperatures in the luteal phase, because progesterone raises body temperature.
  • Fertile mucus in the luteal phase, because progesterone dries up fertile mucus.
  • Spotting in the luteal phase, because progesterone helps to hold the uterine lining.

Testing for progesterone deficiency

The best way to test for progesterone is to track basal body temperature. You can also measure progesterone as serum progesterone on a blood test.

Serum progesterone above 4 ng/mL (13 nmol/L) confirms ovulation but ideally, it should be at least 8 ng/mL (25 nmol/L). The more progesterone, the better. It’s not possible to have “too much” progesterone, except in the case of exogenous supplementation (taking progesterone).

Need more progesterone? You can supplement natural progesterone as a cream or a capsule. Or you can make progesterone yourself.

How to make more progesterone

The only way to make progesterone is to consistently ovulate every month and to do that, you need to support overall general health because ovulation is a monthly report card of health.

For example, to be able to ovulate, you need to identify the underlying obstacle to ovulation and correct that. Common obstacles include stress, inflammation, thyroid disease, insulin resistance, nutrient deficiency, and/or undereating.


One hundred days to ovulation

The road to progesterone is long.  It takes one hundred days for ovarian follicles (eggs) to journey all the way to maturity and cross the finish line to ovulation. In other words, it takes one hundred days of being healthy and fully nourished to finally achieve ovulation and progesterone.

That means that there can be a delay of a few months between your health and your period. Your progesterone deficiency now could be telling the story of stress or undereating that started months ago.

Vitex agnus-castus (chasteberry or chaste tree)

Vitex is a herbal medicine that promotes ovulation and therefore can enhance progesterone, but only if you’re fully nourished. Vitex is effective for both progesterone-deficient and progesterone-sensitive conditions such as PMS and PMDD. For more information about PMDD, read Why progesterone is both good and bad for mood.

👉 Tip: Be careful with Vitex if you have PCOS because it can worsen the condition. See my post: The dos and don’ts of Vitex, and join in the conversation.

Roadmap to progesterone

For more information, check out Period Repair Manual.

141 thoughts on “Roadmap to Progesterone”

  1. Hi there, you mention that physical signs of progesterone deficiency can be a short luteal phase, but can you tell me why? Because if there is a luteal phase it means there was ovulation, yes? So, there is progesterone. Is it just that there was not much? So, it doesn’t hold the lining of the endometrium for so long? So, bleed early?

    You also mention low temperatures, fertile mucus and spotting in the luteal phase are signs of low progesterone, but again can you explain this. I understand that these are signs that ovulation didn’t occur but then would there not be a luteal phase? So, what does it mean with a luteal phase? Just that there was ovulation but not much progesterone or an unhealthy corpus luteum? Thanks!

    If there is a short cycle does this not usually mean an anovulatory cycle? So, no luteal phase, but a long follicular phase as no ovulation occurred? And is this a more common sign of progesterone deficiency? And then the breakthrough bleed occurs due to no progesterone holding up the lining?

    But then a long cycle can also mean no ovulation, can’t it? Because no ovulation, there is no bleed. But when the bleed comes, say 40 days later, why is this? What causes the lining to finally shed if there is no progesterone?

    But is it correct that a long cycle can also mean just a long follicular phase but still ovulation? And what causes this? Is it low oestrogen production? or slow production so the peak of oestrogen takes longer to cause ovulation?

    Sorry for all the questions, but I just trying to understand the different scenarios.

    I look forward to your response. Susan

  2. Very informative, thank you! I have a question, I am 49 years old and taking compounded progesterone from day 14-28 to alleviate heavy periods. I started my cycle 4 days early, it lasted seven days, which is not abnormal for me. I am scheduled to start taking progesterone tonight which is day 14, however I started my period again, only six days after completing my cycle, not usual for me. My question is do I still start progesterone given I started my period?

  3. Hi Lara, I’m 61 suffering with hot flushes and lack of sleep. Unfortunately HRT with estrogen didn’t agree with me and drove my histamine symptoms up. I’m wondering is it possible to take micronised progesterone on its own and at what dosage. Hard to find this info anyway!

  4. Hi Lara,

    So to provide some back story, I was on the combination birth control pill for about 7 and 1/2 years. I got a bilateral salpingectomy done in November of 2020 and stopped the combination birth control pill in early December of 2020. My periods have been relatively regular at about 28 days, sometimes coming a day or two earlier or later. However I have been experiencing spotting before my period every cycle. It has varied widely, a couple cycles I started spotting 10 days before my period, others it’s been 7, 5, or only 4 or 3 days before my period. If I have intercourse with my fiancé anytime during the week before my period a light amount of blood appears and makes things kind of a mess.

    I’ve read your book Period Repair Manual and I’m wondering with all the random and inconsistent spotting I’ve been experiencing before my period if my progesterone levels might be low or not quite optimal. I want to boost progesterone naturally, so I’ve been considering starting Vitex. In your book, you say you shouldn’t have to take it longer than 6 months if you’re trying to start your period. I’m wondering one needs to ween themselves off of it when they feel they should stop it? I just want to get my progesterone levels to an optimal level for my body and reduce all the spotting I’ve been experiencing, but I don’t want my body to become dependent on having to take Vitex forever to keep my progesterone level at an optimal.

    Any additional insight into how to properly take Vitex that you can give me, so I can make sure my body doesn’t become dependent on it to help moderate my progesterone level would be greatly appreciated!

    Thank you,

    Cady H.

  5. First I want to thank you for your impeccable work educating women about their cycle and their hormones. You are a wonderful communicator.

    I am 45 years old and 5 years ago I had an endometrial polyp of less than 1 cm surgically removed. The same polyp reappeared 2 years later, in exactly the same place…

    I have no symptoms other than some spotting a week before my period.

    I maintain a healthy weight (maybe a little below what I should be based on my height) I have no insulin resistance or PCOS or any other gynecological pathology. I do daily physical activity, meditation, I eat really conscientiously and in sufficient quantities and I rarely have PMS symptoms, ovulatory pains or heavy periods, but my cycles are a bit erratic from 23-34 days.

    Is the cause of these uterine polyps known, or is there a way to reduce them naturally?

    Thank you very much again from Argentina!

  6. Hello!
    What if you are 60 years old what should your progesterone levels be? In the US they are reluctant to test for hormone levels past menopause. How would you know you were low?

  7. Dr Lara,
    I was excited to try progesterone because of reading about it here and in one of your books. However, after using it for a few months, I have just discovered it is causing me very bad back pain. A bit of googling and I found this is not an uncommon symptom. Do you know why progesterone causes back pain? For me, this side effect is not worth it.

  8. Hi:-) I have an irregular period since I can remember and now after birth none at all without taking progesterone. I have been diagnosed with pcos because of irregular periods but I feel that there is a difference issue. All my hormones are regular except for the fact my lh to fsh is very high(3/1) but I have no high testosterone or any other signs of pcos. Any advice?

  9. Do you ever have clients with both low progesterone and estrogen during the luteal phase? What do you recommend to increase both?

    • if progesterone is below 1.8 ng/mL (5.5 nmol/L), then ovulation did not occur so estrogen is also likely to be low. The strategy is to identify why ovulation is not happening and fix that. See my book Period Repair Manual.

      • Thank you for your comment. What if progesterone levels indicate ovulation occurred, but is just not optimal (like around 9 at day 21)? Thanks!

  10. I am so, so shocked that you recommend stevia!?!??! Other than that, I really agree with a lot of what you have to say about hormones. But please, can we try to help other women out here. Read about Stevia and its dangers in endocrine disruption. I was perfectly balanced for 7 years until I started incorporating slowly more and more stevia into my diet. It took me over a year to figure it out. I stopped ovulating, my period went missing or I continually spotted for weeks on end, I developed extreme anxiety and heart palpitations, I lost my ability to sleep and cope with stress. Look online and you will see tons of women that went through the same thing. Stevia as far as I’m concerned is the devil of all hormone disruptors! And it’s sneaking into everything! If you have hormone issues or PCOS, avoid stevia like the plague, please!!!!!

    • Selma, I would be interested in the kind of stevia you were using. I suspect some forms are better than others and it may not be stevia itself that’s the problem, but certain formulations.

  11. How does a post-menopausal woman with osteoporosis, estrogen driven DCIS and thickening of the endometrium make more progesterone??

    • There’s no way to make progesterone after menopause. (because the only way to make it is to ovulate)
      Persistently high estrogen after menopause is usually down-stream from insulin resistance. Do you have insulin resistance?
      There’s also the option to take body-identical progesterone capsules.

  12. I have a 15 year old nonverbal daughter with a history of anxiety, irritability, sleep and GI issues. She is gluten free, limited dairy and no corn. Life is typically challenging for us but recently it has gotten worse. My daughter’s periods are becoming more regular and with that she is much more uncomfortable and she looks like she is in a lot of pain. Typically the discomfort is very obvious on day one of her period. In addition to pain and discomfort my daughter has thrown up three times since January 2020, each time it is on day one of her period. By the afternoon she is feeling much better and back to her old self.

    In addition to the pain and vomiting, this month I also noticed my daughter was a wreck the week before her period. The anxiety, tears, irritability and anger were so bad that we actually reached out for mental health support and questioned if we were dealing with a mood disorder.

    My daughter has always had a history of sleep issues but I have noticed for a few months now that she goes through episodes were she sleeps every other night, I started noticing that it was worse on nights she had high sugary treats. I question if her sleep is worse prior to her period, something I will pay attention to more closely this month.

    The mental health provider suggested we explore PMDD as a possible cause for what we are seeing. Could this be a possible diagnosis and how can I rule this out or confirm it?

    Why is day 1 of my daughter’s period so bad? Is it due to a change in hormones?

    Thank you for any help you can offer.

    • For a second as I read this, I thought I posted it a year ago and forgot about it. Seriously I have close to the EXACT same situation with my daughter. Did you ever resolve this or at least get a diagnosis?

    • This may be a shot in the dark for you but I thought I’d throw the idea out, just in case. I have had miraculous results with my period from a low oxalate diet. My period pain sounds much like what you described your daughter going through. Low histamine diet helped first (it is lower in oxalates), and then I figured out the oxalate problem and went even lower. There’s a FB group called TLO (Trying Low Oxalates) where you can find more info on how to safely lower oxalates – as well as info on how they can cause behavior issues in some kids.

  13. Hi Lara

    I am a woman of 38. I have always had acne and have tried every conventional treatment including roaccutane, the pill and lately spironolactone. There has always been a side effect that has forced me to stop those meds after a year or two. Acne always comes back and with spiro I have lost half my hair which is very weird considering it usually prevents such a thing . Since stopping spiro last January, I have read your book, which is great. From April on, I have stopped dairy, gluten and sugar altogether and taken zinc and magnesium. Well, acne is better (Say 70% better) but sticks on my chin and jawline. Plus for the first time in 5 months I am very late in my period (2 weeks) for no reason that I can understand. It is usually long (35 days) but quite regular since I quit Spiro (1 year amenorrhea with spiro, regular before spiro, 2 kids with no trouble conceiving). I am not pregnant. I eat healthy with carbs once a day (rice, buckwheat, potatoes, quinoa), eggs but almost no meat. I am not overweight. I take no treatment or pill. I have had blood testing but my physician says everything is ok.TSH is 1.09 mUI/L, FSH is 6.7, LH is 3.9. (follicular phase). Progesterone has been tested at the wrong moment (I tried to suggest otherwise as you recommended but my physician assured me it was OK to test during follicular phase. It’s 0.6 nmol/L). Even if that test is kind of useless, I feel like I have a progesterone issue because when I followed my temperature, the increase was very late (day 28 over 35). This month no increase in temperature so no ovulation I guess? Which might explain the lack of period. Anyway, I am lost. Would you recommend vitex? or natural progesterone? Thank you so much for everything you have done already, though your book and blog. Yours sincerely

  14. How do you test progesterone while you are on it? I take it on days 14 to 26. Can I take it in the evening and test next morning? Just curious if it’s not going to show false high? Like when you test for iron the advice is to stop supplementing 5 days before. Thanks

  15. Hi Dr. Briden! This was a super helpful post; thank you!

    I wonder what you’ll make of my situation. I’m 36, not on any kind of birth control, but a competitive age-group athlete with 15-20 hours of training per week. I’m very diligent about supporting my body for performance in terms of nutrition, sleep, and recovery (3000+ calories most days, with 300+g carbs), and I’m 17-18% body fat (so fairly lean, but not nearly to the degree of most of my competitive peers).

    By almost any indicator, I’m doing a good job. I feel good, I perform well, and my periods themselves are nearly symptomless.

    BUT — for some reason my cycles have shortened (about 12-18 months ago) to a consistent 21-22 days. (This means I spend 2/3 of the time in luteal phase, which is annoying since I always feel/perform better when hormones are lower.) But here’s the really weird part. I track symptoms closely and would have *sworn* I was ovulating — fertile mucus, body temperature change, deeper sleep, increased appetite — it all follows exactly the same pattern each month. Yet when I did a DUTCH test recently, my progesterone was only 3.0 (and the timing was correct, since I got my period 9 days later).

    So this would seem to suggest I’m NOT actually ovulating. But if that’s the case, why is everything else on track, and why are the symptoms so cyclical? I thought anovulatory cycles were usually irregular and associated with heavy bleeding, which hasn’t been my experience at all. However, my estrogen was pretty low as well (E1 very low, E2 meh, E3 decent) — could that be playing a role?

    Anyway, I just started Vitex about two weeks ago, and (as you said) I’m prepared to give it a few months to see if it makes a difference. (The only thing I’m noticing so far is that my belly feels bigger!) We shall see.

    Thoughts appreciated! Thanks so much in advance for any advice, as well as for putting out such consistently great content!

  16. I sometime feel nauseous when get up in the morning , I am 48, my GP says that is caused by anxiety, I read
    somewhere to much estrogen cause anxiety, is it true?

  17. Hi Lara,

    I hope you are well?

    Please are you able to offer some advice if possible?

    I’m 29 and have been off birth control for 2 years now and my cycles are on average around 33 days. During my last two cycles, I have had spotting (something that I have never had before) and I’m not too sure why.

    I noticed that before my first spotting- my period prior to this was heavier and longer than normal (8 days as opposed to 4/5) and my last two periods have been heavier too.

    I have spotted around day 18 of my cycle (mid cycle) however when I’ve read up on ovulation bleeds- it says that they typically last for 2 days- but I spot for around 7- it starts off bright red on day 1 and then turns brown/red for the remainder.

    The only changes I’ve made is that I was taking zinc and magnesium post birth control and I stopped this for the last couple of months and am now taking pregnacare conception supplements as I want to try for a baby soon.

    Please are you able to offer any advice as my doctor tells me that what I’m experiencing is ‘normal’ but I’m not convinced. I want to try for a baby soon and want to ensure that I have everything in order to do so.

    Thank you in advance for reading this email.

  18. I’m 52 and had a sustained temp shift starting Day 8 that confirmed the luteal phase. I started spotting on Day 12.

    I assume insufficient estrogen/ovulation, therefore poor progesterone levels causing the bleeding.

    My luteal temps don’t go above 98.0 much anymore, but, still a typical of 97.8 or 97.9.

    Why wouldn’t my temps be lower with bleeding? Is that odd?

    Thanks for all of your peri/menopause work.

      • The temps haven’t gone down- they hang at that 97.8. The period trigger for me is normally 97.7 or 97.6. Today is:

        9th day of bleeding
        13th day of an assumed luteal phase
        Cycle Day 20

        Bleeding is:
        Small quantity bright red on tissue every time
        Liner has brown
        Red in bowl morning only
        It’s been consistent and without the usual menses patterns

        I started using vitex + B6 as soon as I started to bleed. (No idea if it’s doing anything.)

        Thank you.

  19. Ihave found your information of great interest, thank you. I have had a hystrectomy a long time ago and am on Estraderm 50 patches and would like to come off them and get onto progesterone because I am experiencing some strange feelings and feling not too good. I wonder if you would be able to advise me as to how best to come off the patches and onto progesterone. Thank you very much. Keli Flynn Haiyes.

  20. Hello! I just finished your book-thank you!

    I stopped taking my hormonal birth control 6 months ago (after being on it for 8 yrs). The first 3 cycles post pill seemed perfectly normal (28-30 days, regular bleed). But the next 3 cycles were long 38, 42, 45+ (not sure yet….still haven’t gotten my period). With terrible anxiety.I am not pregnant. I am posialso nottive I am ovulating. I’ve been tracking my basal temp but not seeing changes that would indicate ovulation. I DO have changes in my cervical mucus….is that enough to indicate I AM ovulating?

    Is my progesterone low? Do you think it’s PCOS? Not sure what to do.

  21. Hi Dr. Lara,

    I’ve been experiencing pre menstrual spotting roughly 1 week before my period. It’s such a small amount, only noticed with wiping. My temps are generally high in my luteal phase (although I had one temp plummet near my cover line at about 6 dpo once but then shoot right back up the next day higher than before). I’ve had other cycles with no temp plummet and yet still had spotting despite high temps. Can this still indicate insufficient progesterone? Thanks for your time!


  22. Thank you for your response! I plan to start taking natural progesterone (Progon B on Amazon is what was recommended to me, do you have one you favor?) during the second half of my cycle. I’ll see how it goes.

  23. Hi Dr Laura, I have been seeing a naturopathic physician here in the States to treat my endometriosis, which I was recently diagnosed via ultrasound by my ‘traditional’ doctor. I am not on any birth control and haven’t been for years. The naturopathic doctor had me test my progesterone on day 21, even though she knew I have a regular 34-35 day cycle, and when the results came back as low progesterone on day 21, she diagnosed me with high estrogen and low progesterone and started me on a treatment plan for that. After doing my own research and coming across your information, I called her out on this and she says “oh right, well thank you for bringing this to my attention, let’s have you tested on days 3 and 26.” I about to send her an angry email calling her out on this huge oversight, but wanted to see if you had any feedback first since I have come to trust your information and use it as a source of guidance when advocating for my health. Would love to hear your thoughts – is the naturopath I’m seeing a total quack?

    • A few things.

      1) In her defense, most doctors (MDs or NDs) make the mistake of testing “day 21 progesterone.” See my blog post The right way to test progesterone.
      2) For endometriosis, taking natural progesterone or micronized progesterone can be helpful even if your levels are normal (because of the “progesterone resistance” associated with the disease).
      3) Most endometriosis patients have normal hormones because endometriosis is not a hormonal condition. It’s a disease of immune dysfunction. See my blog post Endometriosis? Treat the immune system.

  24. My daughter is on birth control pills due to her Pcos. I’m working towards taking her off of it but in meantime can I add DIM ,Zinc and vitamin C to her regimen while she still is on birth control? Thank you!

  25. 1. “progesterone stimulates thyroid”… I’m going to have my thyroid checked with lab. I’m already on progesterone cream for days 12-24 per my ND, but didn’t have labwork on progesterone. Could the progesterone cream interfere with the thyroid tests?

    2. Ways to track basal temperature. Broda Barnes specified using Mercury thermometer . Do we still need to do that, or what are the possible types of temperature-taking tools we can use? Would like to see your guidelines on taking Basal temps.

    Thank you for your work . It is the most clear,v straightforward, and comprehensive explanation. I’ll be using your works to teach my daughter.

  26. Hello and thank you for he wonderful information.
    I have a question. I’m on the pill ( yaz plus more specifically) and I’ve started taking DIM a month agai after my last period. This month after taking DIM, I did not get my placebo pill period. I’m a little concerned that it might be the DIM interfering with my pill cycle. Do you have any insights on that? And would you recommend I go off the DIM ?

  27. One more question: if I am taking natural progesterone in my faux luteal phase, how will I know if I ever do start ovulating again? (My temperature rises after I start taking the progesterone.) Would it be better to just stay off the progesterone?

  28. I just finished your book, I loved it! My husband and I have been trying for a baby for over a year. We have been tested, but after reading I don’t feel like completely tested. I started taking birth control around 14 for acne, I went off years ago and then back on due to horrific symptoms. I have been off for almost 1.5 years now. I have been started on Clomide, which has been unsuccessful twice. I just finished my third dose yesterday.
    I am 31 one and have cystic acne, my mother, grandmother, and aunt all have hypothyroid. I continually get test and everyone says its fine. My last one was 3.43 uIU.
    My periods are regular and 24 days I take ovulation tests and it says I ovulate on day 14. I just started taking my temperature every morning. I take a prenatal which I was given by my acupuncturist, within the prenatal it has several of the natural minerals that you talk about. I also take a probiotic and follow a very strict no dairy or gluten diet. I for sure eat enough calories too. I am worried that I don’t have enough progesterone to have a healthy ovulation if I am ovulating at all. I don’t know where to start with some of the other supplements that were talked about in your book. Any advice would be so helpful.
    Thank you

  29. Please help! I was on hormonal birth control for years (not realizing how harmful it was). First it was the combo pill and then I had to switch to the progestin only pill because of migraines. I am 42 years old (almost 43) and have now been off all hormonal birth control for almost 2 years, but something doesn’t seem right. I do get a period every month, but they are all over the place. The time between periods ranges anywhere from 20-31 days. Sometimes I bleed for 3 days. Sometimes I bleed for 5 days. Then after the regular period bleeding, I have spotting that lingers for 3-4 days. On occasion, I spot between periods. I was diagnosed with uterine fibroids recently, which might be contributing to the spotting. I also have thinning hair (I used to have very thick hair). I have sleep disturbances; I fall asleep easily, but I wake up in the middle of the night and then I toss and turn and have a hard time getting back to sleep. I also am cold a lot of the time, particularly my hands and feet. My doctor tested my thyroid, which “supposedly” is normal. Although I’m not convinced that conventional doctors are testing correctly for thyroid issues. I take a high quality multivitamin, which includes zinc, selenium, iodine, b-vitamins, vitamin D, vitamin C, etc. I have just recently started supplementing with magnesium. I try to eat pretty healthy and I do yoga regularly to help with stress. Based on what I’m describing, is there something else I can try? Perhaps a progesterone cream?

  30. My cycles are finally normal in length and temperatures show ovulation. But I haven’t seen fertile cervical mucus the last two months. This post talks about fertile mucus into the luteal phase, but what’s wrong if I don’t see it before ovulation? There’s been some days of very slight tackiness, but nothing stretchy.

  31. Hello! Whenever I apply my progesterone cream, I have an increase in cervical mucus (clear, stretchy) the next day or later in the day, depending on when applied. After I read your note that progesterone should dry it up, it made me confused. Does this mean I’m not taking enough? I do feel the increase is probably only for a few days to a week and not the whole luteal phase, but I can’t be positive from memory.

  32. Hello Dr. Briden! I am 55 years old, 7 months without periods, having horrible hair loss, depression, anxiety and mild night sweating and hot flashes. I checked all hormones and my progesteron level is 0.19 and estrogen is 10. My question is Can Prometrium that you suggest help with these symptoms or I have to take something to balance progesteron and estrogen? Thank you in advance. Viktoriya

  33. Hi Dr. Briden! Love your work! I have a semi-quick question: Do you recommend taking a progesterone supplement in the luteal phase (my OB-GYN has me on 200mg vaginal capsules) while I work with a functional medicine doctor to address adrenal fatigue, hypothyroidism, insulin resistance, and chronic inflammation? I’m 27 years old and I know I’m not ovulating (hence the functional medicine doctor). I have noticed a difference in my cycles with the progesterone capsules (more regular periods and MUCH less spotting) but I’m worried my body will become dependent on the supplement, or that it will be converted to testosterone or cortisol (both of which are already high). Would love to hear your thoughts!

    • First, a clarification: If you’re not ovulating, you do not have a luteal phase. You’re having anovulatory cycles, and yes, it can be helpful to use “cyclic progesterone” like you’re doing to mimic a luteal phase and possibly work to stimulate ovulation in the subsequent cycle.

      In answer to your question, no, progesterone capsules don’t cause dependency or convert to testosterone or cortisol.

      BUT. you do also want to figure out why you’re not ovulating (insulin? thyroid? under-eating? vegan diet?) and work to fix that. So, then you can start to ovulate and not need the progesterone. Have you read Period Repair Manual?

      • Thank you for your reply! My functional medicine doctor is convinced it’s because of I struggle with hyperadrenalism, hypothyroidism, and insulin resistance. (Most likely all as a result of an eating disorder I had in high school.) Now I eat an anti-inflammatory diet as much as I can (most similar to the Paleo diet), but I still am failing to ovulate. I have not read your book yet, but I definitely want to get my hands on it! I need all the help I can get. 🙂

          • I believe I am, but the tough part is that even when I eat healthy carbs like sweet potatoes, white potatoes, or rice, my blood sugar skyrockets (I’ve had readings as high as 180 after eating white potatoes). So I try not to eat too many carbs for that reason. (I’m definitely not perfect, however, and can’t always resist the bread basket at restaurants—but I usually try to keep gluten at a minimum.) Anyway, it makes it hard being insulin resistant with an underactive thyroid, because it seems my body both needs and hates carbs.

          • I am getting a monthly period, I’m just not ovulating (no follicles are growing). My doctor suspects I’m insulin resistant because my postprandial glucose and insulin tend to go higher than they should (insulin was in the 30s the last time I ate a bit of white rice), but she’s going to have me do a glucose tolerance test in January to make sure.

          • what units are you using for insulin? In mIU/L, 30 postprandial is not high.

            And when you say “no follicles are growing,” do you mean visible on ultrasound? It might be worth tracking your temperatures or doing a progesterone blood test one week before your period.

          • I’m sorry, I was mistaken. Insulin was 18.6 uIU/mL about an hour and a half after lunch with BG at 136. My fasting blood glucose has been consistently in the high 90s or low 100s as well. :-/

            My OB-GYN told me there were no follicles detected on an ultrasound on Day 11 or 13 of my cycle. I just started tracking my temperature a few days ago with the app Natural Cycles, so I’m definitely curious! As for ovulation, I’m looking for a sharp rise in temperature, correct?

          • That is not high insulin in that context.
            Keep in mind that insulin is not inherently bad. We need a certain amount of insulin to build muscle and to be able to ovulate.

  34. Please help me. Progesterone is not my happy calming hormone. It makes me psychotic, makes me blackout, makes me rage, and want to kill myself. I’m on lupron which has mostly shut my progesterone down, but not all the way. Does ANYONE know what kind of drugs or herbs can STOP progesterone?????? Thank you. And please please please help…

    • Yes, progesterone sensitivity like you describe is definitely a thing! But my understanding is that it’s sensitivity to the ups and downs of progesterone (so encompassing progesterone withdrawal symptoms). My approach with my patients is to support GABA with magnesium and vitamin B6 and at the same time, stabilize hormone receptors with iodine and by reducing chronic inflammation (which usually involves avoiding dairy and other inflammatory foods).

  35. Hello Dr. Briden, I just listened to your podcast with Eileen Laird and am checking out your blog. I am 57, had a hysterectomy at 40 but kept my ovaries, and have been using bio-identical estrogen patches (Minivelle) for about 5 years. I have never supplemented progesterone. Your article recommends progesterone for peri-menopausal women. Is it something a menopausal woman should try? I’m sure I’m menopausal now.

    Thanks for all the great information you provide.

  36. Your book has helped me out so much already! I am 29 years old and spent 10 years on hormonal birth control, 7 of those were with Mirena IUD. I finally got it removed 1 year ago, and I know my body is trying to level out from all those years still, and thankfully I’ve learned a lot from taking a FAM class and tracking my BBT and cervical fluid every month.

    When I initially got my Mirena, it seemed my cycles stabilized fairly quickly (for the first 9 months). My challenge lies in the last 3 cycles. I have been having 6-8 day periods with a couple days of spotting afterwards. Then, a few days later I’ll begin spotting again during my follicular phase for many days. The first cycle was 7 days of spotting pre-ovulation, the second was 3 days of spotting pre-ov, and right now I’m on day 5 of spotting pre-ovulation.

    The spotting will stop 3 days or so before I ovulate, so I know it isn’t ovulation spotting. I have still confirmed ovulation each month and had a consistent 13 day luteal phase. I do not experience spotting during my luteal phase.

    Am I not producing enough estrogen? or is this a progesterone issue? I am very slender and tall, so I know my baseline stores for estrogen are lower. On blood tests, everything looks “normal” with thyroid and other levels according to my doctor.

    I want to supplement, but I know some supplements lower estrogen, and I’m not sure what I need. 🙁 Help, please!

    • Did you check with your doctor? There can be other non-hormonal reasons for spotting.
      And re: estrogen. If you’re ovulating, then you’re making enough estrogen.

      • I realized I typo’d above. It should say “when I initially got my Mirena OUT;” it’s long gone.

        Unfortunately my doctors haven’t been any help, they check my blood and everything looks perfect. Then they suggest going back on birth control to regulate….ugh, good natural providers are hard to come by here.

        I did begin to religiously take 300mg of magnesium a day (I was taking it on and off but I got serious about it and haven’t missed a dose). Within 48 hours of starting that, the spotting stopped and I ovulated with some of the most consistent temps I’ve ever had. I’m not sure if it’s coincidence, but I’m going to stay on this and see how my next cycle goes. I have previously been vitamin D deficient and taking high quantities and I recently read that depletes magnesium levels….whoops.

  37. Hi,
    Is it possible to ovulate and not see a temperature rise at all for the rest of the cycle? Would that indicate low progesterone? I had a progesterone blood test done on CD21 and the doctor said it showed I ovulated but 14 days later I still have the same temps as pre-ov and no period and negative preg test. I have seen a temp rise in some of my other cycles but not all so I know the thermometer works. Thanks!

  38. I´ve been devouring your excellent website but still have a couple of questions.

    I´´m 47 and have been suffering terrible migranes for about 5 years. I reduced sugar and bread but still eat carbs and generally have a good diet. I´ve been managing my migranes with progesterone cream which I use from day 14-27 or so. I apply more on when I get the migranes. Getting more sleep and cutting sugar def reduces the severity.

    Some months I still spot several days before my period and my periods are still super heavy and they come between 21-32 days.

    During ovultion I get a migrane and progesterone helps BUT this is usually day 7-9 – is this too early to be using progesterone cream? I think it is ovulation as I get the pinching cramp and clear mucus.

    Do you think my progesterone dostage is too low if I´m still struggling with the migranes and heavy periods?

    Many thanks

  39. Hi Lara, My cycle is the same every month and has been for several years now. I track it religiously in my period app. However, always on day 4-5 of my cycle, horrific anxiety and depression start until ovulation is finished. Then I get a break until I’m about to start my period again. I’m wondering what this could be as I am definitely ovulating each month. Also, I know general advice is to use progesterone days 14-28 of my cycle but during this time I have the least amount of anxiety and depression, so would i then use progesterone at the beginning of my cycle instead? Thanks for reading. Love all your great info!

      • Thanks, I will check it out. I also was wondering if there could be a link between PMDD and caffeine intake. I see how the months I drink more coffee than usual, I am much much worse. What is your opinion on coffee and hormones?

  40. Hi Lara,
    I have an average 23 day cycle and had a positive ovulation test result on day 16 of this cycle. I rang my doctor this morning to book a mid luteal blood test and they have booked it for day 23 which is 7 days after the positive ovulation test result and also the day before I would be due my next period.
    I’m interested to see if you think this is appropriate given the proximity to the start of my next cycle?
    Thanks in advance,

    • The luteal phase should be at least 10 days long, so unless you have a short luteal phase (which you might want address), then I expect your next period is going to come later than usual this month.

  41. Thank you for this post (and all of your others!)! Could you comment on what you would classify as low temperatures in the luteal phase? How low is too low?

  42. I have just recently found your blog and am trying to learn as much as possible. I am 50, peri menopausal and have always had very regular periods, up until a few months ago. The two months it carried on most of the month with a few days break here and there. Also experiencing severe ovulation pain for a year, a few days each month. Some small cysts and larger fibroid too.
    I just visited a naturopath who suggested some supplements and a tincture with Vitex and a couple other things to try and regulate hormones. My family doctor suggested Provera 10mg for 10 days. Any suggestions? I’d much rather explore the natural route . Many thanks😊

  43. Hi Lara, I’ve been having regular menstrual cycles. But, because of insulin resistance, I cut sugar completely. I’ve also stayed off dairy and gluten over the last few weeks. I’ve always had symptoms of androgen excess (hairloss, hirsutism and acne) but that never showed up in my blood work up (Free Testosterone, DHEAS, Androstenedione) until now. My recent test results are however different. Progesterone around the 21st day was .13 ng/ml, whereas just a month ago, I had ovulated and my 21st day Progesterone was 16 ng/ml. My SHBG is also very low 58.05 nmol/L and my Free Testosterone is high at 4.4 pg/ml whereas it was just around 1.05pg/ml in the previous test. The only change that has happened between my previous normal test results and the current results are the cutting of sugar, dairy and gluten from my diet. I’ve also been supplementing Zinc for ~20 days. Could Zinc elevate Free Testosterone to such an extent? I came off the pill in Feb but I never experienced disrupted cycles in these 6 months and my Androgen levels were always within limits. What could be the possible reasons behind this surge of Free Testosterone and the extremely low Progesterone on my 21st day? I’ve been having regular 26 day cycles. I really want to bring down the levels, but do not want to get on the pill again at any cost. Please help.

    • Zinc is a testosterone booster. It can elevate the levels of testosterone. It sounds like your body is clearing the excess testosterone through converting it to DHT via 5alpha reductase pathway. Maybe cut out the zinc, and add 1 teaspoon of Reishi Mushrooms, Inositol and D-Chiro Inositol Inositol 3000mg and D-Chiro 85mg a day, 2 cups of spearmint tea in teh evening as it is sedative like and 3 cups of green tea a day 2 hours after a meal so it does not inhibit iron absorption.

  44. Good morning Lara.
    Would it have any sense to take vitex in the perimenopause and menopause? And natural progesterone?
    Thank you for your help, I love your blog, your make easy to understand very complicated issues!!

  45. Hi Dr. Lara. I’ve read both your blogs and your book. Thank you for what you’ve been doing for women like me across the globe.

    I have a few questions about my test results that I’m a bit anxious about.

    I menstruate regularly and my Progesterone result around my 21st day was 16.36 ng/ml. Aren’t these sufficient indicators of having ovulated?

    What I’m really worried about is my FSH/LH ratio. My FSH is 9.98 mIU/ml whereas my LH is around 4.54 mIU/ml. I understand my FSH is still within range although extremely close to the higher limit. The ratio being ~2 bothers me about my ovarian reserve. I’m only 26 years old. What could be the reason for my elevated FSH and how do I bring it to a healthier 1:1 ratio with my LH.

    I do not have any of the bloodwork criteria mentioned in your book as indicators of PCOS. (Free Testosterone 1.05 pg/ml, Andostenedione and DHEAS within range, fasting insulin ~9.28 mIU/ml) but had visual symptoms of androgen excess and was put on Ayurvedic medicine. Could this incorrect diagnosis and medication have elevated my FSH? I also have a Zinc deficiency (My levels were 55.4 Microgrm/dl) for which I’m taking about 22 mg of elemental Zinc daily.

    Hope to hear from you. 

  46. I have a painful period (debilitating for a couple of days). I have got fibroids and discovered the matter in the last month or so. Is it OK to take progesterone products to relieve the pain? What is the best natural progesterone tablet or cream? I am 42 and I have regular periods.

  47. I am 42 and recently had 1 month long period.. Bleeding was small but didnt stop. But vitex 40 mg stopped it next day, thank God! But I still have painful breasts.. Should i increase or decrease the dosage? Thank you for wonderful posts!

  48. Hi Dr. Briden,
    Thank you for all of the helpful information you’ve provided here and in your book! I have a question about supplementing progesterone. Long story short, I used to make very little (according to a saliva test). I supplemented for a couple of years with cream, and then out of curiosity, I retested myself a couple of years later. I used no cream for that month, and did a saliva test on day 21. When my results came back, my progesterone was in the normal range. I assumed I was making enough on my own and decided to discontinue the cream. However, about eight months later (five months ago), my old symptoms started to return (horrible cramps, hormonal acne like crazy). I’ve restarted the cream and it seems to be helping, although my cycles are always shorter when I use the cream (about 24 days vs. 28). I’m curious, is it possible there was some kind of residual progesterone in my system that gave me a false normal range when I retested? Is there any danger in supplementing with the cream even if I’m making “enough?”

  49. Hi- I really appreciated this post and your post on Vitex. You mentioned to only use Vitex for about 6 months and then maintain the results with diet and supplements. Which supplements do you recommend for daily use?

  50. Thank you for all this amazing information!
    Although I have not finished reading your book, my situation seems pretty different from what you discuss.
    After I gave birth about 17 months ago, I went on Norenthidrone for 1 year. About 2 and a half months after getting off, my period came back. It lasted 8 days, and then came back about a week later. This repeated itself 4 or 5 times already. Each period is light, lasts 8-10 days, and the next one starts again 3-7 days later. How can I get my cycles back to normal?
    My background- I’ve always been mostly normal- periods 6-7 days, every 32-35 days although an occasional wacky month, no PMS, no pain. I miscarried my first pregnancy and a progesterone test came back at post-menopausal levels (although reading your article on testing, I may very well have tested early since my cycles were longer). My dr prescribed Clomid and I conceived after 4 months on it and gave birth to healthy twins. Despite my cycles not normalizing postpartum (I was not on any form of hormonal birth control), I conceived naturally for my 3rd pregnancy. Now suddenly after 1 year on the mini pill, my body is completely messed up!
    Any advice?

  51. Dr Briden,

    I’ve had great success raising my progesterone by following your advice (especially the magnesium.) My progesterone went from 14 on the pill to 174 off the pill. I still have a ways to go but it is getting better. That 174 was in my luteal phase so I’m told it is a tad low but hopefully it’ll get better.

    • Hello again,

      I feel silly but I definitely interpreted my results wrong. Progesterome was 174 ng/dl so that would be 1.74 ng/ml? Which would be very low for the luteal phase, right?

      Could explain why I’m in a lot of pain right now.


  52. Hi Lara,

    I just wanted to share some information. I have been commenting and following your blog for two years now. your posts are what inspired me to go off birth control. It is a GOOD thing I did. I had been having so many symptoms- hair loss, eye pain, rheumatoid arthritic pain, insomnia, muscle loss, acne, food sensitivities, the list goes on and on, and no doctor could figure out what was going on. Conventional medicine does not approach things holistically, and no one could put together my symptoms. It turns out I was on Doxycycline for many many years (over 5) for acne. I stopped in July 2014, and a few months later is when all of my symptoms began to progress. My recent integrative family doctor believed it was all related to inflammation, and I was put on something called LDN or Low Dose Naltroxene. I have now been on the medication for 3 months. Along that time, I found out I had crohn’s disease. I had stopped the pill around July 2015, and did not have a cycle until just recently. I believe the LDN has lowered my chronic inflammation that did not respond to zinc, magnesium and cutting gluten and sugar. It was much more serious long term inflammation according to my doctor, and I believe LDN has helped me to finally ovulate!! I just wanted to thank you for your blog, and helping me to be investigative into my symptoms, and finally have a cycle without fake hormones! It had been 8 years on OCPs. I think that it also contributed to gut issues, thank goodness I am off.

  53. Hello Dr. Briden,
    Just discovered your blog and am absorbed in all your articles, and very impressed. I’m 37 and have been TTC for close to 2-years without any conception. Testing for myself and husband has been normal until last week when my progesterone blood test indicated I was at 1.25 on day 21/22 of luteral cycle. First time tested. I do think I was not eating as well as I should and I had stopped taking my prenatal vitamins for a few months. Suggestions? My doctor plans to order Clomid but I wonder if I should take a supplement of selenium, magnesium, zinc? I did re-up my Multi-Vitamin, Vit C, and thought about adding Vit B12. I eat mostly vegetarian diet but occasionally with consume chicken or tuna. Thank you for your assistance.

    • Hi Sarah, my issue is very similar to yours. I too am 37, TTC for over a year now without success and have low progesterone which is causing me to not ovulate. Did clomid help you? Or did you try something else?

  54. First of all, thank you for such an informative website! I have read your book, and am still looking for a little bit of insight. When I was in my 20’s I was diagnosed with Endometriosis and was then told by my doctor that I needed to be on birth control to control the symptoms. I didn’t know any better, and stayed on it for way too long (approx 12 yrs). It has been about 15 months since I quit using birth control. I’m 36 and I chart every month, my cycles are average length, I get all of the changes we expect to see throughout the month, except my period isn’t normal. It is light, lasts about a day and is brown discharge basically. Would VItex be good for a “jumpstart”? I lead a very healthy lifestyle already, so I feel like my body just needs a nudge. Thanks for reading.

    • Light flow can mean a number of different things including anovulatory cycles or lowish estrogen. Are you pretty certain you’re ovulating? (ie. temperature rise on charting). Low estrogen can be from vegetarian diet, excess soy or smoking. Do any of those apply?

      • Charting my temps is the one thing I haven’t been doing, so I am not certain I am ovulating (my guess is I am not). I am seeing a functional med doc and have done the saliva hormone tests. I am low estrogen and very low progesterone, testosterone is average. Cortisol levels good. I am gluten free, but other than that I try to have a good balanced diet that is similar to Paleo with lots of good protein, fat, veg. I was prescribed a progesterone cream and Xymogen MedCaps but both make me feel worse (heart palpitations mainly). I know I need the progesterone but it makes me feel terrible 🙁

        • You need to ovulate. As I explain in my book, it’s the main goalpost for menstrual/hormonal health. Until you ovulate, you can’t make estrogen or progesterone. You say you’re eating Paleo… Are you eating rice and potato? If not, then please start to. Did you see my posts: Are you eating enough to get a period? , or Have you lost your period to a low carb diet?
          Just to be clear, I support a Paleo-approach. I’m presenting for the Ancestral Health Society next month. But some versions of Paleo are too low carb for women.

          • Yes, I do eat rice and potatoes. The main things I try to avoid or limit is sugar, dairy, and gluten. I don’t know why it never occurred to me to start recording temps, I guess it is all the foggy brain I have lately. I feel like treating this has become a full time job (over a year now). Thanks for your help, it is appreciated.

  55. Should peony and liquorice be taken together as one supplement, or is it fine if they are two separate supplements?

    • They’re usually given as one supplement or together in a liquid mix, but yes, it should be okay to take them separately, but remember licorice can raise blood pressure. It’s better to take it under the care of naturopathic doctor or herbalist, or at least check with your doctor.

  56. Hi Dr Briden, I have a question. If one had low progesterone, could their endometrial lining show up as ” on the thicker side of normal for where they are in their cycle” on a pelvic ultrasound? Mine was 10mm thick 6 days after the end of my period (or if spotting is considered a ‘day,’ then two days after my period).

    Background: Stopped ortho tri-cyclen lo in 7/2015. Average cycle has been 27 days since then. Had normal, albeit heavy, periods prior to taking birth control. 1st 3 months post pill were more normal. Since then, I have had spotting pre and post period most months (ranging from one to many days of spotting). I have also had issues with hair loss, dry/brittle hair, and anxiety/hot flashes/insomnia/heavy bloating prior to periods. Along with my regular vitamins, I have been supplementing with zinc and magnesium the whole time. I have also had my thyroid tested a few times (including T3 and T4 antibodies), iron, D3, celiac, and ANA – all normal.

    I asked my OB about low progesterone, and she said that’s not important unless you are TTC and suggested birth control (sigh). She wants to do an endometrial biopsy, so I am weighing the benefits/risks of that, but just wanted to give my body a chance first (though she said almost a year off of birth control is long enough of a chance). My next step is a naturopath, but was just curious about your take on low progesterone as it relates to endometrial lining (maybe I had an anovulatory cycle that month??)

    Also – do you offer “virtual” consultations, where your time and advice would be compensated? If so, I would definitely be interested! Thank you.

    • Duh, should have also mentioned that I had my progesterone tested 5 days before my period (or 3 days if spotting”counts”). It was 2.6 ng/mL.

  57. Hi, Lara, I was wondering, is it possible to have a progesterone imbalance and still have a near text book cycle? I have a 29-30 day cycle with no PMS, cramps, etc—all relatively uneventful. However, while ttc#3 at age 33 , I have recently had two early miscarriages in the past 4 months. Logically, I believe it is probably “bad luck,” but I hate having to wait for a potential 3rd loss for my doctor to see if I have developed a progesterone issue.

    I would appreciate any thoughts, or is there a section in your book that addresses this? Thanks!!

    • After menopause, both the ovaries and adrenal still make a small baseline amount of progesterone. But it will never be the amount that pre-menopausal women can make. Fortunately, our post-menopausal bodies recalibrate themselves to a lower baseline level of progesterone.

      We can also use natural progesterone cream.

  58. Hi Dr. briden,
    How much Selenium should I be taking since I have very low progesterone (17 yr old)?
    I’m going to buy magnesium and iodine because my multi-vitamin doesn’t have enough.

  59. Hi Dr. Lara, I read your book and I loved it, but I still wasn´t able to identify my problem/treatment.
    After stopping the pill, I was having irregular periods, so a doctor put me on micronized progesterone (200mg – 15 to 25th day of cycle). My periods got regular and I was having no PMS at all, but I got a lot of cystic acne around my chin. I was put on Spiro for 3 months and the acne cleared out; once I stopped the acne was back again. I stopped taking progesterone for the last 2 months, but I still get cystic acne on my chin (worsen on PMS) and my PMS (irritability) is back. Could you please clear out what´s going on?? I´ve seen a couples of doctors, none could help me! Should I take DIM and Magnesium?

  60. Hello Dr. Briden,
    I’m wondering if you do phone or video consultations? We’ve just moved to an area where I’ve found very little in the way of naturopathy. Long story short, I’ve read your wonderful book (I mean READ it, including taking notes and looking up things I didn’t understand), as well as many others on reproductive health, and I’m stumped. As best I can figure, I do ovulate but make almost no progesterone (confirmed with ovulation tests and saliva tests for est & pro a couple of years ago). I’ve been using a bioidentical cream for quite a while, but I’d like to heal the actual issue if possible. I have a history of reproductive health issues in my family. My story is too long to tell here, but I’d be happy to pay for your time. Thank you, Jennifer

  61. Hi Lara, thanks for this wonderful blog and your period repair manual. It’s helping my daughters and I navigate the whole cycle issue 🙂 I have a question re progesterone cream. I get migraine headaches during my bleed and have a mid cycle blood test hormone count of 1 progesterone next to 800 oestrogen. I’m a very healthy, nutritionally diligent 46 year old. My naturopath and I have tried a year of vitex and other herbs, TCM and now pyrolluria treatment (recent discovery). The latter seems to have helped the most with other symptoms and even the migraines/headaches mid cycle, but as the migraines have come back with a vengeance (after two months of significant reduction) I’m feeling a little defeated and like progesterone cream is the only thing left. My naturopath (who is wonderful) has recommended Life-Flo Living Natural Progesta-Care. Do you know the product and in your opinion is it as natural as it appears? In your opinion is there a better alternative?

    • Hi Cordie, thanks for your comment and feedback about my book. That brand of progesterone cream you mention looks pretty standard. I checked it, and it delivers 20 mg progesterone per dose, which is the low dose that I describe in the bio-identical hormone section in Chapter 10.

      Just a note about testing. You say you tested mid-cycle. That would be ovulation, and you would expect your progesterone to be low at that time. The best time to test progesterone is about one week after ovulation (one week before your period).

      • Thanks Lara, that’s great to know about this brand of progesterone, I’ll go ahead with it. And thanks for the advice about test timing. I’ll talk to my practitioners about that for my next test. I’m really keen to get to the bottom of these migraines. I read most of chapter 10 last night and I think there might be some other things I need to be more sure of (gut health e.g.) Thanks again!

  62. I was glad to read this. I have a friend being pressured to take progesterone (a supposedly very natural type – progest-e) she is young and healthy and now pregnant (20+ wks). She doesn’t want to take it and I don’t think she needs it. Are there any side effects to taking progesterone when you don’t need it? Can it ever interfere with your body’s making progesterone itself?

    • It would be unusual to need progesterone at 20 weeks because by then the placenta makes a huge amount. But if her OBGYN wants her to take it, then she probably should. (but Progest-E does not sound like something an OBGYN would prescribe….)

  63. I had suffered a miscarriage at 12 weeks in December. I believe there is retained tissue. My ob/gyn did nothing. Primary doc is aloof. My cycle has not returned and no one will help. I need to know if vitex or fenugreek would help to pass any tissue. If not what can I try. The physicians are idiots or just don’t care. Please advise.

  64. Dear Lara,
    I did find a farming cooperative in New York state that makes a 50/50 peony licorice tincture. I’ve been taking it for about two months now. It slowed the sebum production in my scalp and slowed the acne/chin hair, but my scalp hair is still falling out at a high rate. I’ve also been extremely bloated since starting it. My fatigue has also increased considerably. I don’t know if it’s the herbs, or something else. My thyroid has always tested normal, but hasn’t been checked in a while. Can peony/licorice affect the thyroid? I cut the dose way back, but when I tried stopping it, my hair loss increased considerably. How long is it safe to take this? I’ve read that licorice should not be taken long term. No one that I’ve seen here in the states seems to know a lot about these herbs. Thank you.

  65. Dear Lara;

    My niece who thought had PCOS, was now diagnosed with LO-CAH. Can she use natural progesterone because she has all PCOS symptoms and what are some alternatives she can use instead of the nasty steroids? Will licorice or tribulus help? Thank you so much.

  66. Dear Lara, You’ve mentioned selenium as being super important to the formation of the corpus luteum and therefore, I assume, the luteal phase. It is possible, or even sensible, to test for a selenium deficiency to see if that was a factor?

    • Hi Pauline, great question. Yes, selenium is a hugely important nutrient for progesterone, thyroid and total hormonal health. Deficiency is common, and it’s only going to get worse due to a world-wide decline of selenium in soils and in our food supply. That said, not everyone is deficient, but it is impossible to predict based on diet, because selenium varies so much depending on where the food was grown. I do not routinely test for deficiency because I am not yet convinced how do so accurately. Most of our selenium is incorporated into proteins, and so will not show up in the serum. ‘Red cell selenium’ is possibly our best option, although urine testing may also be an option. I would love to hear from someone who has further information on selenium-testing.

      I regularly prescribe selenium, but I generally stay below 150mcg per day, because it can be toxic at higher dose (>400mcg). I use the safer form selenomethionine.

      • Dear Lara,

        First I want to say thank you for this site! Second, you are absolutely right about selenium it works perfectly in a low dose. I am 46, was very ill with Ebstein Bar virus. I was having symptoms for 6 months while working. I ovulated once and had a period during that time. Needless to say, I wore myself out. Then I started taking low iodine and selenium, now I’m regular again. I have also been taking Femminessence peri, what do you think of that product, would love to know? All my best, Britton

  67. Hi Lara,
    I’ve been trying to induce ovulation for about 5 months now with myo-inositol. I’ve ovulated once in those 5 months. The inositol has succeeded in bringing a period every month, but they are inovulatory cycles. I’m very progesterone deficient and have normal estrogen. I’m 43 and wonder if I’m too old to ovulate regularly. I’ve tried natural progesterone cream – 20mg. It gives me symptoms of elevated testosterone – oily, itchy, burning scalp; hair loss; acne. Vitex produced similar symptoms. There seems to be no relief for me. Is there something else I could try to resume ovulation at my age?

    • Myo-inositol or D-chiro-inositol improve insulin-signalling, so they will only work if insulin resistance is the reason that you are not ovulating. Other treatments for insulin resistance include magnesium (I call magnesium the ‘natural Metformin’), sugar-elimination, exercise and some interesting herbs including berberine extract. Please consult a clinician for individualised advice and dose.

      Most women should still be able to ovulate fairly regularly at 43, but it does vary woman to woman. You can use a day 3 FSH test to gauge how close you are to menopause. I also recommend that women ask their mothers and older sisters how old they were when their periods stopped. Age of menopause seems to be genetically programmed to a large degree.

      If you had side effects from Vitex, then you may have elevated LH (luteinizing hormone), which is consistent with insulin resistance and PCOS, and in which case ‘Peony and Licorice combination’ is a better herbal strategy for encouraging ovulation. But unfortunately, I know from previous communication with readers that the traditional herbal formula ‘Peony and Licorice’ is not widely available outside of Australia.

      I really need to write a detailed post about PCOS treatment…. Coming soon… 🙂

  68. Greetings Lara, folllowing on from the above post – what about peri-menopausal women who have had a history of breast cancer and its ‘suggested’ (the jury remains out on this) that they take no hormones at all ! Any feedback or suggestions on this much appreciated – taking into account of course there is no gluten issues etc (healthy diet) within this mix! Many thanks Also – no hot flushes -as you would be aware the peri versus the actual menopause is quite a different phase – often far more uncomfortable and difficult. I never know when I will bleed – can be 3 months between now or even 4. The significance of the adrenal health is the exhaustion that often accompanies this ‘rite of passage’ .. any ideas much appreciated.

    • The main feature of perimenopause is that the ovaries keep trying to ovulate – so they still make estrogen, but they don’t always succeed – so they often don’t make progesterone. This results in relatively high estrogen compared to progesterone. In the early years of perimenopause, many women can still have some ovulatory cycles, so it is still worth trying to promote ovulation (with Vitex, selenium etc).

      With regard to progesterone use after breast cancer, yes the jury is still out. Certainly, some women do use it, because there is evidence that it is safe and may even protect against breast cancer. But there are also concerns that progesterone might promote breast cancer when used at higher doses (although I have to wonder if that effect could be from the fact that at higher dose progesterone converts to estrogens)

      One more thought about post-breast cancer: Iodine is very important. Please see my Iodine protects Breasts post.

  69. What about women who are menopausal? These hot flashes are horrible & interfere with sleep. I eat gluten free and organic as much as possible. I take supplements SAME, magnesium, zinc, turmeric, alpha lipoic with cinnamon.

    • Menopausal women cannot make ovarian progesterone, but they can make a small amount of adrenal progesterone (so adrenal health is paramount after menopause). Many menopausal women benefit from natural progesterone, which has been shown to be effective for hot flashes even when its used alone without estrogen.

      • When the hot flashes (night sweats) created a living hell for me at 51 years of age, (waking every 20 minutes or so, not fun) I started with a compounded bio identical progesterone cream as I could no longer get the natural progesterone I had used during perimenopause (I live in Canada). This helped, but not enough, so I added EstroGel. I am now weaning off EstroGel four years later, and am wondering about whether to keep the progesterone or not. The hot flashes are back, but I am determined to see this out, so far, not unbearable, but just started this journey about 2 weeks ago. what are your thoughts?

        • Progesterone can be continued longer term after menopause, but it should be used carefully. The key to safe use is: 1) keep the dose as low as possible, 2) allow hormone receptors to down-regulate by taking regular breaks (I recommend at least 5 days off the hormones every month), and 3) monitor your progesterone and estrogen levels with 24 hour urine test and/or saliva test. (progesterone converts to estrogen).
          Also, you need to be sure that you are metabolising and clearing hormones properly. This requires adequate thyroid health, good intestinal flora, good methylation pathways, and adequate iodine intake (iodine down-regulates estrogen receptors and protects breasts). Please consult your clinician for individualised dose and testing advice.


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