Levels of progesterone are the first to decline in women, usually from around the age of 35 and typically before estrogen. Estrogen levels can wildly fluctuate (highs and lows) throughout perimenopause with an eventual decline.

In a healthy menstrual cycle, progesterone rises after ovulation and peaks around day 21 of a woman’s cycle. Progesterone is our calming hormone. So when we don’t have enough of it, we can feel more anxious and tense ((hello, PMS!). In addition to progesterone keep calm it also reduces inflammation, supports the immune system, protects the heart and breast tissue, and even builds bone.

Symptoms of progesterone deficiency:

• PMS and mood swings
• Anxiety
• Poor sleep
• Heavy or prolonged periods
• Spotting before your period
• Short cycles < 25 days  or long cycles > 35 days
• Headaches
• Recurrent miscarriage
• Fertility challenges

Low progesterone causes an imbalance between estrogen and progesterone, leading to a relative estrogen dominance…meaning this can present similar to estrogen excess (or estrogen dominance).

Symptoms associated with estrogen excess (possibly due to an imbalance between estrogen and progesterone):

• Heavy periods
• Tender breasts, fibrocystic breasts
• Uterine fibroids
• Menstrual migraines
• PMS & mood swings
• Water retention/swelling
• Weight gain (abdomen and hips)
• Bloating

How to support progesterone during perimenopause:

• Vitex– increases progesterone production via an increase in luteinizing hormone. This herb is quite safe and can be really helpful for PMS symptoms!
• Progesterone cream or oral micronized progesterone if indicated. We always recommend testing to determine if you need progesterone. A natural progesterone cream or a pill can be really helpful for perimenopausal related sleep issues.
• Stress management– when our cortisol levels increase, progesterone levels decrease. Finding a sustainable stress management practice is crucial. For me, it’s long walks. For some, its meditation or yoga. Find something that brings you joy. This all really matters when it comes to keeping hormones balanced!
• Blood sugar balance- Elevated blood sugar and insulin can lead to an increase in estrogen levels and progesterone deficiency. To keep blood sugar AND hormones balanced, eat protein and fiber at every meal and snack.
• Evening primrose oil– rich in essential fats (GLA) and thus can help alleviate symptoms associated with low progesterone.
• Cruciferous veggies (broccoli, cauliflower, brussels, etc)- support estrogen detox. In your 40s, estrogen dominance relative to progesterone levels can creep in. Support your liver and gut health with fiber-rich cruciferous veggies to keep estrogen in check. Aim for 2 cups/day.
• Eat foods rich in zinc– supports progesterone production. Zinc-rich foods include oysters, beef pumpkin seeds, lentils, cashews.
• Flax- supports hormone metabolism. Aim for 2 TBSP ground flax daily. Add to smoothies, yogurt, oatmeal, baked goods, salads.
• Avoid endocrine disruptors– these chemicals mimic estrogen and can cause a state of estrogen dominance. Ditch the plastic. Choose non-toxic cleaning products. Avoid parabens in your skincare products. Decline receipts.

Testing: Identifying specific imbalances can be challenging due to symptom overlap, especially with estrogen and progesterone. Specialty hormone testing (urine, blood, saliva) can help pinpoint issues. With a clear diagnosis, you can take targeted steps to restore hormonal balance and unlock a happier, healthier you!

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.