When and How to Supplement Progesterone

I was asked the other day about when and how to supplement progesterone – should it be taken all month long, or just for part of the month? And what about progesterone-building herbs? All month long or just part of the month? I thought I’d explain how I recommend doing it in case anyone else had that same question.

The thing to remember is that progesterone levels is a pre-menopausal woman fluctuate throughout the month. In the first half of the menstrual cycle, called the follicular phase, progesterone levels are quite low. Estrogen levels start low and build in that first half, causing a spike in luteinizing hormone (LH), and subsequently ovulation.

After ovulation is when progesterone peaks. It is supposed to stay high for the entire 2nd half of the cycle, as it maintains the uterine lining and prepares the body for a fertilized egg to implant. I say supposed to because falling levels in the luteal phase are the root of many hormone imbalances. Progesterone levels drop quite abruptly if no fertilized egg appears, and then menses begins to shed the lining that is not needed to support a growing embryo.

So … when I give a woman actual progesterone (bio-identical of course), I just give it in the 2nd half of the cycle. I do this because I’m trying to mimic the natural cycles as closely as possible. Progesterone is not designed to be high in the first half of the cycle, and creating that artificially may throw off natural ovulation patterns. I typically start progesterone cream or sublingual troches a couple of days after ovulation, and stop it just before menses. For a woman with a 28 day cycle, I’ll typically give progesterone on days 16-27. That can be adjusted +/- a day or two for women with shorter or longer cycles.

Having said that, sometimes I use herbs to support progesterone levels. My favorite is Vitex Agnus-castus, or Chaste tree. That is a herb that works on the pituitary – the gland that directs the thyroid, adrenals and ovaries to produce their respective hormones. Vitex works by encouraging the body’s own production of progesterone, not by providing progesterone directly. I dose Vitex consistently, all month long, not just in the second half of the menstrual cycle. Vitex takes a while to regulate – can be 2-3 cycles. Because we’re supporting the body’s natural production, we want that consistent dosing, knowing that the body’s natural wisdom is higher production in the 2nd half of the cycle. In my opinion, Vitex doesn’t cause a significant enough “starting rise” and “stopping fall” to truly mimic the normal cycles. It is more of a slow and steady regulator over time.

That’s how I do it in pre- and peri-menopausal women. In post-menopausal women, I would usually dose either options – the USP progesterone, and/or the herbs, all month long. Because again, post menopause there aren’t the same natural cycles, so we’re again working with what the body is doing on its own.

Progesterone support, whether through hormone creams, capsules or troches; or through herbs, can help women with regulating cycles, reducing PMS, balancing estrogen dominance and PCOS. How it is given and dosed is an individual consideration, but my rule of thumb is always to give Vitex all month long as a progesterone regulator, and if dosing actual progesterone hormone, use it in the luteal phase only.