There are several ways to get an accurate assessment of progesterone levels. Naturopathic physicians offer all 3 types of progesterone tests and can help to determine which is the best based on the health picture of an individual and the desired outcomes.
What Is Progesterone?
The 2 most important hormones which control women’s menstrual cycles are estrogen and progesterone. Estrogen levels typically peak during menstrual flow and start to lower around ovulation or mid-cycle. This is called the follicular phase and typically lasts 10-14 days, with Day 1 being the first day of menstrual bleeding. The luteal phase (approximately Day 12-28) of cycling starts around ovulation, or mid-cycle, and lasts until the day before menstruation begins. During the luteal phase, progesterone levels rise and ready the uterus for implantation and pregnancy. If pregnancy doesn’t occur, progesterone levels drop and menstruation along with the follicular phase begins again.
Aside from the physiological changes of the ovaries and uterus during the menstrual cycle, estrogen and progesterone have multiple other roles that maintain well-being both physically and mentally. Having healthy, sufficient amounts of progesterone can support becoming pregnant, prevent mood swings, anxiety, insomnia, headaches, acne, cramps and pain with periods and even help with weight management.
Why Get A Progesterone Test?
Testing hormone levels can help to identify imbalances such as low or high amounts and the ratio between the different sex hormones. If low progesterone is determined or estrogen is too high relative to the amount of progesterone as in estrogen dominance, this can be tested and treated.
Once progesterone hormone levels are identified, treatment to re-balance levels can be initiated. Magnesium, Vitamin B6, Omega 3s, and Evening Primrose Oil are natural supplements that can be used to both improve low progesterone levels and to harmonize estrogen. Sometimes herbs such as Chaste Tree or bio-identical progesterone are used to optimize luteal progesterone levels.
Women suffering from premenstrual syndrome can experience mood swings involving anger, sadness and irritability as a result of low progesterone or estrogen dominance. Physical symptoms vary with cramps, heavy menstrual flow, shorter cycles, acne and sleep disruptions. These symptoms can occur from shortly after ovulation and last for up to 10 or more days until menstruation begins.
Increasing progesterone production with supplements, herbs and bio-identical progesterone will vastly improve PMS symptoms and possibly prevent entirely. Sometimes it can be enough to support production in a natural way and these supplements can be stopped after a new pattern is established. Other times, determining the cause of lower progesterone and addressing it directly may yield more long-term improvements. For women approaching peri-menopause, it can be normal to have less natural progesterone production and can benefit greatly with the use of bio-identical progesterone.
Women trying to conceive in their late 30s and into their 40s may benefit when using progesterone to become pregnant and to maintain pregnancy when tested progesterone levels are low. Progesterone levels during pregnancy can go up to levels more than 10 times during non-pregnant cycles. Many fertility clinics advise the use of progesterone to women who test low on a blood test.
What Is A Progesterone Test Like?
There are 3 ways to test progesterone – blood, saliva and urine. Each offers its own unique value to determining underlying hormone imbalances. Progesterone levels are typically tested around Day 21 of a woman’s menstrual cycle, no matter which type of body fluid is being tested.
Blood (serum) progesterone is best collected on Day 21 of the cycle. Day 1 is considered the first day of full flow of a period and thus it is best to plan the Day 21 test date once Day 1 for that specific cycle has occurred. The test can be completed at any time of the day. This test will give the absolute value of serum progesterone which can show low, healthy and high levels as results. For women without periods, this test can be performed on any day of the month.
Saliva progesterone is also a valid way to test progesterone. Saliva is used either by spitting into a testing container or by placing an absorbent cotton roll into the mouth until saturated. Usually this test is done around Day 21 and analyzes several sex hormones at the same time such as progesterone, estrogen, testosterone, DHEA and cortisol. With full hormone results, comparisons between levels can be identified and show better detail than serum progesterone. For example, if there is an estrogen elevation relative to progesterone a serum might show normal progesterone yet saliva identifies low progesterone when compared to estrogen. This would be missed with a blood test and progesterone therapy would not be initiated. Saliva testing is used for baseline and to assess response to hormone therapy and treatments. Women on hormone therapy should test their salivary hormones every 6-12 months in order to be provided with safe and effective doses. Saliva testing can be used on women with or without a menstrual cycle and is performed at home.
Urine progesterone testing is completed along with multiple other steroid hormones. This is the most comprehensive way to evaluate the full sex hormone and adrenal (stress) hormone picture. Urine can be evaluated for multiple hormone levels and the metabolites, or breakdown products. These fine details provide further insight into how the body processes and uses hormones along with the levels of each. For a menstruating woman, this test is usually completed between Day 19-21 of the cycle, however this window moves depending on the average cycle length. For a menopausal woman or those without cycles, it can be performed any day of the month. Urine testing is recommended before starting bioidentical hormone replacements so that risk assessments can be made. The test uses 4 urine samples at different times of the day to better evaluate levels, and is completed at home.
Is a Progesterone Test Painful?
No. Serum levels of progesterone involve a visit to the lab for a simple blood draw. Saliva and urine testing are completed at home and are easy, pain-free ways to evaluate progesterone and other hormones.
Preparing For A Progesterone Test
Blood progesterone testing can be done at any time of the day without restrictions to food, water or activity. However, it must be done on Day 21 of the cycle. This test is completed at the lab and results are usually back within a few days. If it is unclear which calendar day correlates to Day 21, it is advised to reach out to your doctor for clarification so that the most useful results are achieved.
Saliva progesterone testing is completed with one sample during the day. No food should be consumed during the hour before the test. If a woman is cycling, this test is usually performed on Day 21, but it can be altered in cycles that are shorter or longer than 28 days. For women without periods, the test can be completed on any day. There are specific instructions for proper preparation for women using bioidentical hormone replacement therapies that are required for optimal results.
Urine hormone and progesterone testing will require a bit of planning. Sample dates will be individually calculated for cycling women but usually between Day 19-21. Those without a menstrual cycle can collect the samples any day. It is suggested to perform this test on a typical day and some supplements are to be avoided prior to collection. Sampling takes place at dinner time, bedtime, first morning urine and the last is 2 hours after waking.
Common Progesterone Test Results
Depending on serum, saliva or urine, different analyses can be made. Serum is helpful to look at strictly the amount of progesterone present while urine and saliva allows for comparison with estrogen. Relative progesterone levels provide a better understanding of health.
Levels of progesterone that lay under the reference range are considered low. Sometimes progesterone can be in the normal range but not optimal and this is when it helps to have a knowledgeable physician provide an evaluation. Reference range isn’t always the healthiest, it is important to look at the details. Low progesterone can be replaced with bioidentical progesterone or herbal alternative.
Progesterone levels that are considered healthy usually fall in the upper half of the range. There are specific values to look for when assessing components to healthy fertility and this is achieved with testing.
Not commonly seen with testing, but it is possible to have elevated progesterone levels. This is often due to difficulties processing and eliminating hormones in the liver and not an actual over-production of progesterone. Treatment usually supports liver detox and digestion.
Tips To Improve Progesterone Health
Aside from replacing deficient progesterone levels with herbs or bioidentical progesterone, some vitamins, minerals and dietary choices can be supportive. Progesterone and cortisol are made from the same precursor hormone and this can cause imbalance in times of stress. Women might experience more PMS or shorter cycles in times of high stress and this can be tied back to overproduction of cortisol at the expense of progesterone.
Women that have shorter menstrual cycles and signs of low progesterone, may find relief when focusing on stress-lowering activities and balance. Walking, meditation, journaling and relaxing all help to lower stress and this supports progesterone production. Sometimes cortisol balance can also be helped with supplements and healthier diet choices.
Hormones are eliminated via liver breakdown and into the digestive system. Constipation can cause hormones to be reabsorbed back into circulation and raise the overall levels. This often creates further imbalances between estrogen and progesterone. Hydration, fibre and improving the gut flora will improve hormone balance.
Scheduling Your Progesterone Test
In order to decide which type of progesterone test to do, it is highly recommended to speak with a physician well-trained in hormones. Factors such as age, symptoms and costs of tests may play into the decision as well as the desired outcomes for health balance.