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Progesterone is a hormone produced after ovulation and is crucial for the menstrual cycle, fertility and hormonal balance. During the first part of the cycle, the follicular phase, low progesterone levels are completely normal and should not be interpreted as progesterone deficiency.
Progesterone deficiency instead means that progesterone production is insufficient after ovulation. This can be a low value in the luteal phase or a relative deficiency, where progesterone is not enough to balance the effects of estrogen.
The condition is common, especially in women over 35 and in premenopause, where ovulation becomes more irregular. Progesterone deficiency is also seen in conditions such as PCOS and prolonged stress.
Common symptoms include PMS, mood swings, anxiety, sleep problems, irregular menstruation, breast tenderness, fatigue and reduced fertility. Since progesterone is mainly produced after ovulation, deficiency is often linked to absent or inadequate ovulation.
Progesterone deficiency can in some cases be prevented by stress reduction, good sleep, adequate nutritional intake and treatment of underlying hormonal disorders. Diagnosis is made with a blood test taken at the right part of the cycle, usually in the luteal phase. In cases of severe symptoms, medical treatment may be appropriate after individual assessment.
Progesterone is mainly produced by the corpus luteum in the ovaries after ovulation. During the first part of the menstrual cycle, the so-called follicular phase, progesterone levels are normally very low. This is a physiological condition and should not be interpreted as progesterone deficiency.
Progesterone deficiency instead means that progesterone production is insufficient after ovulation, in relation to the body's needs or in relation to estrogen. This can be an absolute low progesterone value in the luteal phase or a relative progesterone deficiency, where estrogen levels are normal or elevated but progesterone is not enough to balance the effects of estrogen.
Since progesterone is mainly produced after ovulation, progesterone deficiency is often linked to absent, delayed or deficient ovulation.
How common is progesterone deficiency?
There are no exact figures on how many women have progesterone deficiency, as the condition is rarely diagnosed as a separate diagnosis. However, clinical experience and hormonal studies show that progesterone deficiency is common, especially in women aged 35–55.
- Premenopausal women often have low or highly variable progesterone levels.
- Women with anovulation practically always have progesterone deficiency.
- The condition is common in hormonal imbalances such as PCOS.
In clinical practice, progesterone deficiency is one of the most common hormonal findings during hormonal testing in women.
What can lead to progesterone deficiency and can it be prevented?
Progesterone deficiency most often occurs when the body's ovulation does not function optimally. Since progesterone is mainly produced after ovulation, levels are directly affected by factors that disrupt ovarian function or hormonal regulation. In many cases, progesterone deficiency is part of a broader hormonal imbalance.
Causes of progesterone deficiency
- Absence or irregular ovulation, which is common in premenopause but can occur at any fertile age.
- Aging ovaries, where progesterone production often decreases earlier than estrogen production.
- Chronic stress, where elevated cortisol levels can inhibit progesterone synthesis and disrupt ovulation.
- Thyroid disorders that affect the interaction between the brain and the ovaries.
- Nutritional deficiencies, especially deficiencies of vitamin B6, magnesium, and zinc, which are needed for hormone production.
- Use of hormonal contraceptives that suppress the body's own ovulation.
Can progesterone deficiency be prevented?
In some cases, it is possible to reduce the risk of progesterone deficiency by supporting the body's natural hormone regulation. Preventive measures can be especially valuable in premenopause and early signs of hormonal imbalance.
- Prioritize recovery and reduce prolonged physical or mental stress.
- Ensure adequate energy and nutritional intake.
- Treat underlying thyroid disorders or other hormonal conditions.
- Track your menstrual cycle and identify whether you are ovulating regularly.
- Seek medical evaluation if symptoms persist.
In cases of severe or long-term problems, medical treatment with progesterone may be considered after individual assessment and correct hormonal testing.
Which women suffer from progesterone deficiency?
Progesterone deficiency can occur at any fertile age, but the risk increases as ovulation becomes more irregular. Since progesterone is mainly produced after ovulation, the condition is closely linked to how well the ovaries function and how stable the menstrual cycle is.
Women over 35
From the mid-30s, the hormonal reserve of the ovaries begins to gradually decrease. Progesterone is often the first sex hormone to be affected, which means that progesterone levels can drop even though menstruation is still regular and estrogen levels are relatively stable.
Women in the pre-menopause (perimenopause)
In the pre-menopause, ovulation becomes increasingly irregular. Many cycles become anovulatory, which leads to low or absent progesterone production. This can last for several years before menopause and is a common cause of hormonal symptoms even though menstruation has not yet stopped.
Women with PMS or PMDS
PMS and PMDS are often linked to an imbalance between progesterone and estrogen in the luteal phase. Even if progesterone is produced, the level may be insufficient in relation to the effects of estrogen, which can contribute to pronounced psychological and physical symptoms before menstruation.
Women with PCOS
In PCOS, ovulation is often absent or irregular. This means that progesterone production is low or non-existent during large parts of the cycle. Progesterone deficiency in PCOS is therefore common and can contribute to irregular menstruation and reduced fertility.
For women with suspected or diagnosed PCOS, a broad hormonal and metabolic assessment can be valuable. We offer a health check for PCOS where blood samples that may be related to PCOS are analyzed and assessed by a doctor. This can provide a clearer picture of hormonal balance, ovulatory function and any underlying factors that affect symptoms.
Women with fertility problems or repeated early miscarriages
Progesterone is crucial for preparing the uterine lining for implantation and for supporting an early pregnancy. Insufficient progesterone production in the luteal phase can therefore contribute to difficulties in getting pregnant or to early pregnancy losses.
During premenopause, estrogen production often remains relatively stable, while progesterone production decreases significantly. This creates a hormonal imbalance that can be behind many of the symptoms women experience in this phase of life.
Symptoms of progesterone deficiency
Progesterone deficiency can produce a varying symptom picture that affects both the body and the psyche. The extent of the symptoms depends on the degree of progesterone deficiency, the relationship to estrogen levels, and individual factors.
Psychological and neurological symptoms
- Mood swings, irritability, and increased anxiety
- Depressed mood or depressive symptoms, especially in the luteal phase
- Brain fog and reduced stress tolerance
Sleep-related symptoms
- Difficulty falling asleep
- Shallow or restless sleep
- Waking up early without feeling rested
Menstrual-related symptoms
- Short luteal phase
- Irregular menstruation
- Worsened PMS symptoms
Physical symptoms
- Breast tenderness and tension
- Fluid retention and swelling
- Fatigue and lack of energy
Fertility
- Reduced ability to get pregnant
- Increased risk of early miscarriages in pronounced progesterone deficiency
Progesterone deficiency in premenopause and menopause
In premenopause, the number of ovulations gradually decreases, leading to greatly varying and often low progesterone levels. This can occur several years before menopause, sometimes as early as the late 30s or early 40s. The relative progesterone deficiency in combination with residual estrogen production can contribute to symptoms such as sleep problems, anxiety, hot flashes, palpitations and estrogen dominance.
How is progesterone deficiency diagnosed?
Progesterone is measured in a blood test, but the time of sampling is crucial. For menstruating women, the sample should be taken in the luteal phase, approximately 7 days after ovulation. In premenopause, multiple measurements may sometimes be needed for a correct assessment.
Can progesterone deficiency be treated or influenced?
Yes. Treatment is individually tailored depending on symptoms, age and underlying cause:
