True to its name, progesterone (literally meaning “pro-gestation”) helps a woman get pregnant and stay pregnant. If your body isn’t making enough, then you might suffer from recurrent miscarriages or not be able to get pregnant in the first place. Although many factors contribute to a woman’s fertility, this article will discuss the importance of progesterone, how to know if you might have low progesterone, and what you can do about it.
如果您正在努力努力，低黄体酮可能是一个贡献因素。从Katie Melville看了这篇文章，了解更多关于孕激素扮演的重要作用以及你可以怀疑低孕酮的重要作用。#functionalmedicine #wellness
The Purposes of Progesterone
Progesterone is important in both a woman’s normal menstrual cycle and during pregnancy. Low progesterone can be associated with repeat miscarriages, infertility,postpartum depression，甚至是低骨质量和更高的心血管风险等条件。（1,2,3,4)
Progesterone in the Luteal Phase
The luteal phase of a women’s cycle begins at ovulation and lasts until the next period begins. Healthy women should have a luteal phase that lasts 11 to 16 days—and progesterone plays an important role in that length. (5)
At ovulation, the dominant follicle releases an egg that slowly travels down the fallopian tube to the uterus, hoping to be fertilized. The now ruptured follicle becomes a tiny, temporary endocrine organ called thecorpus luteum，其分泌包含孕酮的激素，以帮助制备用于胚胎的子宫内膜以连接。如果卵子没有受精，黄体酮下降，引发子宫内膜衬里在月经中脱落。
If the eggisfertilized, the resulting embryo will take approximately seven to 10 days to travel down the fallopian tube and implant into the uterine wall. However, if the corpus luteum doesn’t generate enough progesterone, then the uterine lining sheds too soon, never allowing the embryo to implant well or at all. (6) Without enough progesterone, the woman will experience an apparently normal period and may never know she was pregnant.
Progesterone during Pregnancy
During pregnancy, progesterone serves several functions, including: (8)
- Altering the maternal immune response and suppressing inflammation to prevent the immune system from rejecting the “foreign” tissue
- Reducing uterine contractility to prevent the uterus from expelling the fetus
- Improving the circulation between the mom and fetus
If not enough progesterone is produced by the corpus luteum after implantation, or if not enough progesterone is produced by the placenta after seven to nine weeks, then a miscarriage is likely. Studies have shown that lower progesterone levels during the first trimester were associated with a higher risk of miscarriage. (9,10)
Despite this correlation,measuring progesterone levels during early pregnancy is still not a routine practice in obstetrician-gynecologist offices.
Low Progesterone and Luteal Phase Defect
低孕激素和黄体期缺陷(LPD)often used interchangeably, but that’s not entirely accurate. Although its characterization has evolved over time, LPD is best described as an abnormality in endometrial development that can result in infertility or miscarriage. Common symptoms of LPD include: (11,12)
- A luteal phase (the time from ovulation to the next period) that lasts 10 days or less
- Serum progesterone levels lower than 5 ng/mL at six to eight days after ovulation
- Spotting for several days before a period starts
Low progesterone is probably the most common cause of LPD, but LPD does not always present with low progesterone. In these cases, the corpus luteum could be secreting enough progesterone, but for some reason the endometrium isn’t responding properly to it. In a study comparing endometrial tissue, women with unexplained infertility had fewer progesterone receptors in their endometrium compared to parous women. (13) With fewer progesterone receptors, “normal” progesterone levels still might not be enough to develop a healthy endometrium and sustain a pregnancy.
How Conventional Medicine Gets Progesterone Testing Wrong
If you have a short luteal phase, spotting before a period, or fertility issues, getting your progesterone levels checked seems like a no-brainer place to start. Unfortunately, many medical offices won’t even consider testing a woman’s cyclic hormone levels until after three miscarriages or at least one year of unsuccessfully trying to conceive. And, even if they do agree to run hormone panels, they often will measure progesteroneat the wrong time.
黄体酮应在肺阶段峰值峰值，排卵后大约六到八天。（14）在具有14天的肺阶段的发条28天循环，第21天直接落入肺阶段的中间。这就是为什么第21天是测量患者血清胰岛素的标准标准。但是，很少有女性表现出这些发条周期。For example, if you generally have 32-day cycles and a 12-day luteal phase, your ovulation day is around day 20. Progesterone in this cycle won’t peak until around day 26, and measuring at day 21 won’t be able to tell you if you do or do not have enough progesterone that cycle.
The midpoint of the luteal phase differs from woman to woman and even from cycle to cycle in the same woman. The best way to correctly estimate ovulation day is to track your cycles with an effectivefertility awareness-based method（FABM) of birth control. By tracking basal body temperature, cervical mucus, and even urine hormone metabolite levels, FABMs empower women to understand their body’s signs of health and fertility.在造型的毛坯中，根据您使用的Fabm在您的循环中识别“峰值”一天，21天的孕酮测试最好是六到七天，无论落在您的Fabm。
How to Measure Your Progesterone at Home
As an alternative to serum testing that requires doctor visits and lab orders, you can now measure progesterone levels at home withProov test strips. Instead of measuring progesterone, these U.S. Food and Drug Administration-approved kits measure pregnanediol-3-glucuronide (PdG), a urine metabolite of progesterone that correlates well with serum progesterone levels. (15)
类似于妊娠试验，Proov应该用第一次尿液进行。与妊娠试验不同，当出现测试线时，Proov测试是正面的测试线disappears. Positive indicates sufficient progesterone. If you have enough progesterone post-ovulation, then you should get a positive progesterone test on days 7, 8, 9, and 10 after the peak day as determined through an FABM.
如果你从未得到一个积极的阅读,然后开启t not be ovulating at all. Progesterone rises only after a successful ovulation. If you get a positive reading on some of the days 7 through 10 but not all 4, that indicates that your body isn’t producing enough progesterone after ovulation.
You Have Low Progesterone—Now What?
If you are having trouble getting pregnant和have confirmed low progesterone, a bioidentical progesterone supplement may help—but not always. When hormone levels are out of balance, it’s likely that other underlying issues exist and it’s important to address those issues.
Working with aFunctional Medicinepractitioner could help identify any other health problems that could be contributing to infertility, such as:
- Hypothalamus–pituitary–adrenal (HPA)-axis dysfunction, from stress, sleep trouble, or something else (16,17,18)
- Hypothyroidism, which affects women disproportionately
- Hyperinsulinemia, which can coincide withpolycystic ovary syndrome（19,20)
- Inadequate nutrition, which can prevent pregnancy or put the fetus at risk
Often, the conventional medical approach to infertility doesn’t take underlying conditions like these into account. Functional Medicine, however, is a systems-based approach to care that’s focused on uncovering and treating the root cause of any condition so patients can truly愈合. If you’re a licensed medical practitioner and are looking for a better way to help your patients, Functional Medicine training may be the right path forward for you.Find out how the ADAPT Practitioner Training Program can help you embrace an investigative, holistic, patient-centered approach to healthcare.
Bioidentical Progesterone Supplementation
If low progesterone is the only discernible issue, then bioidentical supplementation may be a good option, often given as a vaginal suppository. Bioidentical progesterone is routinely used in artificial reproductive technology and is generally considered safe for both the mom and fetus. (21重要的是,bioidentical progesterone is not the same as the synthetic progesterones like progestins found in hormonal birth control pills, which are associated with many more side effects, including weight gain, headache, acne, and possibly even side effects to the fetus. (22)
Studies show that bioidentical progesterone supplementation can help women with a history of recurrent miscarriagewhen taken early enough in the pregnancy.在具有无法解释的经常性流产的女性中，与安慰剂相比，怀孕五到六周开始的黄体酮补充不会产生更好的妊娠结果。（23) But if a woman has low progesterone, waiting until six weeks into the pregnancy may be too late. Progesterone helps build up the endometrium to allow an embryo to implant, and helps sustain a pregnancy after implantation. At six weeks pregnant, implantation has happened weeks ago, possibly into an already progesterone-depleted uterus.
However, when women with a history of recurrent miscarriage began progesterone supplementation just three days after ovulation instead of waiting until after a positive pregnancy test, pregnancy outcomes were improved versus placebo.（24) When taken early, progesterone levels are replete well before implantation, preparing the endometrium for implantation and the body for pregnancy.
Be Your Own Health Advocate
If you’ve taken an at-home progesterone test and discovered that your progesterone doesn’t rise enough after ovulation, take that information to your doctor. Start a conversation about your concerns, and come prepared. Show them the studies where progesterone supplementation, when taken early enough, has helped, and discuss whether it can be an option for you.成为自己的健康倡导者。