The Solution Is Nuanced: The Gottfried Protocol for Low Progesterone


Do any of these problems sound familiar?

  • Agitation or PMS
  • Painful or swollen breasts?
  • Irregular cycles, or your monthly cycle is more frequent as you get older?
  • Heavy and/or painful periods?
  • Bloating and/or fluid retention?
  • Ovarian or breast cysts, particularly at night?
  • Itchy or restless legs?
  • Clumsiness or lousy coordination?
  • Cyclic headaches, especially menstrual migraines?
  • Infertility?
  • Miscarriage?

These are common signs of progesterone deficiency, or having too much estrogen relative to progesterone (also known as estrogen dominance). Addressing progesterone deficiency is sometimes more complicated than simply adding more hormone to the equation. There’s nuance that most doctors don’t know about, and it involves progesterone resistance. When you have progesterone resistance, you don’t respond to the addition of progesterone cream or pills.

For instance, PMS is related to a problem with progesterone, but frosting yourself in progesterone cream does not automatically fix the symptoms in all women. Our best science shows that PMS is the result of the poorly synchronized interplay among four entities: progesterone, allopregnenolone (a derivative of progesterone), and in the brain, the GABA and serotonin pathways.1Rapkin AJ., et al. “Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder.” Menopause International 18 (2) (2012): 52-59. It’s a complicated neurohormonal mix that results in progesterone “resistance,” which is why topping off your progesterone may not be the answer. Your body may respond better to a “cure” that addresses upstream causes – including precursors, such as vitamin B6, that help you make serotonin, or perhaps an herb that alters progesterone sensitivity, such as chasteberry, as well as lifestyle techniques to calm your brain.

You can increase your body’s progesterone level naturally in several ways: vitamin C and chasteberry for women who are premenopausal, and over-the-counter progesterone cream or progesterone pills for women who’ve reached menopause. When you’re premenopausal, your ovaries still may be able to produce progesterone, but they need a nudge. Once you’ve had your final period and a year has passed (the official definition of menopause), topical or oral progesterone is the best choice. I suggest tweaking your protocol to adjust to the realities of your life stage, so use these steps as a starting point.

Hand with pen drawing the chemical formula of progesterone

First Step: Targeted Lifestyle Changes and Nutraceuticals

1. Vitamin C is the lone but mighty solution in this arena. It’s the only over-the-counter nutraceutical treatment for low progesterone proven to be effective. At doses of 750 mg/day, vitamin C has been shown to raise progesterone in women with both low progesterone and luteal phase defect.2Henmi H., et al. “Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect.” Fertility and ...continue In a randomized trial, women were randomly assigned to receive either vitamin C or a placebo. Within three menstrual cycles, the group receiving vitamin C saw progesterone levels increase on average from 8 to 13 ng/mL. (Remember, your goal is 10 to 25 ng/mL.)

If you have garden-variety low progesterone – that is, not associated with luteal phase defect – we don’t know if vitamin C will raise your progesterone level. But we’re not talking massive doses here. Taking 750 mg/day is completely safe, even though the recommended daily allowance is an abysmally low 75 to 90 mg/day. Incidentally, a daily dose of 500 to 1,000 mg of vitamin C also helps prevent cancer and stroke, keeps your eyes working well, boosts immunity, and increases longevity. Because it’s water soluble, any excess vitamin C is excreted in your urine. It’s a win/win situation.

2. Hang out with others. Progesterone is another stress-related hormone, and affiliation helps women to calm down. “Closeness” exercises with a partner were shown to raise progesterone in the saliva.3Brown SL., et al. “Social Closeness Increases Salivary Progesterone in Humans.” Horm Behav. 56 (1) (2009): 108–111.

3. Hold the joe. Has your doctor asked you about caffeine? I’m guessing the answer is no, because many American physicians are addicted to caffeine themselves. Sorry to be the bearer of bad news, but one of the first steps I recommend in treating low progesterone is weaning yourself from caffeine. Caffeine boosts energy temporarily by raising cortisol, but as we’ve seen, high cortisol can block progesterone receptors: your daily jolt may be decreasing the ability of your progesterone to bind to its receptor and do its job. While caffeine has not been shown to lower progesterone levels in women who are still having monthly cycles, two studies have linked caffeine with PMS symptoms.4Rossignol AM. “Caffeine-containing beverages and premenstrual syndrome in young women.” American Journal of Public Health 75 (1985): 1335-1337; ...continue

I won’t sentence you to the interim irritability and headaches, though. I have a systematic approach: switching from regular coffee to yerba mate or green tea, and from yerba mate or green tea to decaffeinated green tea, and then to flavorful herbal teas, such as rooibos and fruit teas.

4. Skip the zin. While you are abstaining from coffee and nonherbal tea, consider ditching other drinks that can adversely affect your hormonal balance. Alcohol intake is associated with premenstrual anxiety, mood problems, and headache.5Gold EB., et al. “Diet and lifestyle factors associated with premenstrual symptoms in a racially diverse community sample: Study of Women’s ...continue Drinking more than three to six alcoholic servings per week increases risk of breast cancer.6Li C., et al. “Alcohol consumption and risk of postmenopausal breast cancer by subtype: the women’s health initiative observational study.” ...continue If that’s not enough to convince you, consider that alcohol increases belly fat.14Bergmann MM, et al. “The association of lifetime alcohol use with measures of abdominal and general adiposity in a large-scale European cohort.” ...continue This makes sense to me because when you drink a glass of wine, your liver shifts to burning alcohol for fuel instead of burning fat in your body. This sidetracks your fat-burning mechanism and may slow down your rate of fat burning by more than half.

Second Step: Herbal Therapy

There are several herbs worth mentioning, but chasteberry is the most effective and safe. Other botanical therapies that raise progesterone include bladderwrack and saffron.

Chasteberry (Vitex agnus-castus). Also known by several other terms, including chaste tree, chaste tree berry, and vitex, this herb is available as capsules or liquid tincture, and the average dose is 500 to 1,000 mg/day. It is proven to reduce PMS and infertility, presumably by raising progesterone.

Chasteberry, used by the ancient Greeks more than two thousand years ago, restores normal progesterone levels in the body. Most researchers believe that chasteberry increases the release of luteinizing hormone from the pituitary, which raises progesterone and normalizes the second half of the menstrual cycle. The progesterone boost stimulated by chasteberry has been demonstrated in blood- hormone levels, in endometrial biopsies documenting progesterone effect on the uterine lining, and in analysis of vaginal secretions.7Brown DJ. “Vitex-agnus-castus clinical monograph.” Quarterly Review of Natural Medicine (1994): 111-21 Some postulate that chasteberry works by lowering prolactin, another hormone that affects menstrual cycles, while others believe that chasteberry affects dopamine (the brain chemical or neurotransmitter of reward-driven learning, pleasure, and satisfaction), acetyl- choline (the neurotransmitter that governs communication between the nerves and muscles), and/or opioid receptors (located in the brain and organs – these receptors bind to morphine, endorphins, and other similar chemicals).8Wuttke W., et al. “Chasteberry tree (Vitex agnus-castus) — pharmacology and clinical indications.” Phytomedicine 10 (4) (2003): 348-57; ...continue Bottom line? We don’t yet know how it works. In Germany, where integrative medicine is practiced as the standard of care, chasteberry is approved for menstrual irregularity, PMS, and breast pain.9Blumenthal M., et al. “The Complete German E Commission monographs: therapeutic guide to herbal medicine.” Boston: Integrative Medicine ...continue

A Stanford university School of Medicine study shows that in women with low progesterone, fertility rates are higher among those taking chasteberry. After six months of treatment, 32 percent of the women taking chasteberry became pregnant, compared with 10 percent of the group taking a placebo.10Westphal LM., et al. “Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women.” ...continue Unlike with most pharmaceuticals, fewer than 2 percent of the women taking chasteberry have adverse effects. Among this small percentage, the most common complaints are malaise and gastrointestinal complaints, including nausea and diarrhea.

Chasteberry has been proven to help low progesterone in more than sixty years of clinical research, including five randomized trials.11Turner S., et al. “A double-blind clinical trial on a herbal remedy for premenstrual syndrome: A case study.” Complementary Therapies in Medicine ...continue Randomized trials are my gold standard of best evidence. When performed properly, they allow the least amount of bias and demonstrate causation – unlike lesser- quality study approaches, such as observational studies or case- control studies. As we try to find what truly, effectively helps women with hormone imbalances, any kind of bias is the enemy.

Third Step: Bioidentical Pills

You might need to augment your progesterone with a bioidentical pill, cream, troche, or vaginal suppository. Pills work remarkably well if insomnia is your main symptom. The FDA has approved Prometrium, which is bioidentical, micronized progesterone: natural progesterone that has been broken down – micronized – to enable your body to metabolize it more easily. Taken orally, it is identical to the progesterone you’ve always made while cycling. It is a somnolent, which means do not operate heavy machinery. More to the point, it helps you sleep restoratively.

A word of caution: use Prometrium, not Provera (medroxyprogesterone acetate), the most common progestin, or synthetic form, of progesterone. Many physicians prescribe progestins to patients suffering from irregular periods, fibroids, and/or heavy bleeding. But progestins cause terrible mood problems. In my opinion, it should not be used. Though the words frequently are used interchangeably by physicians and the media, progesterone and progestins are different biochemically, which means they have very different effects on the body. In study after study, Provera has been shown to increase the risk for breast cancer, depression, weight gain, blood clots, and cardiovascular disease (stroke and heart attacks). In the best evidence of progestins and heart disease, women aged forty-five to sixty-four were randomly assigned to receive Provera, Prometrium, or a placebo. Provera was shown to reduce HDL, your good cholesterol (and we need all the HDL we can get). Prometrium did less harm to HDL.12PEPI Writing Group. “Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal ...continue

Prometrium has been shown to be safe. One study, of more than eighty thousand women followed for eight years, showed no increased risk of breast cancer when using Prometrium.13Fournier A., et al. “Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study.” ...continue An important point about progesterone is that one of its main security jobs is to protect the endometrial lining from overgrowth, precancer (hyperplasia), and cancer. The only bioidentical progesterone shown to prevent buildup in the uterine lining is Prometrium.

Prometrium, taken in 100 mg or 200 mg tablets, can do anything progestins can do, but probably better and more safely. (Occasionally, women need higher doses to correct estrogen dominance, or for improved sleep.) The only contraindication is a peanut allergy, because Prometrium is suspended in peanut oil in a soft-gel sphere. Women with peanut allergies might consider compounding natural progesterone in another base oil, which would have to be ordered by a physician who’s comfortable working with a compounding pharmacy.

Bottom line: make sure your doctor prescribes bioidentical progesterone, NOT progestins, for you. The only situation in which progestins might be appropriate is for incarcerated sex offenders, because progestins removes sex drive in both men and women. Seriously!

For more Gottfried Protocols for natural hormone balancing, buy my first book, The Hormone Cure, right here.


 Meet your Hormonal Charlie’s Angels

Remember Charlie’s Angels – Sabrina, Jill, and Kelly, the TV trio of crime-fighting, bad-guy-busting women with brains, brawn, and physical agility? Seeing the three of them working in sync was poetry. It was empowering. So it is with your hormonal system. When the hormones work together, the team is powerful, graceful, and effective.

Bear with me as I pursue this analogy. Sabrina is cortisol. She stands up to Charlie more than the other angels do, and she’s less inclined to manipulate men with her feminine wiles. She’s the smart angel, the no-nonsense, strategic-thinking one. Just as Sabrina is the one who rescues the “angel in danger,” cortisol, coursing through your bloodstream, alerts your nervous system to threats, whether it’s an imminent car accident or a toddler heading toward a wall socket. Cortisol helps you respond to the scary effects of your everyday ad- ventures by regulating the levels of other hormones, such as thyroid and estrogen.

Jill is thyroid. She is the sporty angel, lithe, athletic, and ad- venturous. Thyroid keeps you energetic, slender, and happy; it is the Jill of hormones. Without enough thyroid, you feel fatigued, gain weight, go through life in a low mood . . . and libido? Fagettabout it.

Kelly is estrogen. She is the sensitive angel: soft and voluptuous, but also street-wise and tough. She can be powerful and in control one minute, a seductress the next. This is like estrogen, which keeps you flush with serotonin, the feel-good neurotransmitter. Estrogen keeps your orgasms toe-curling, your mood stable, your joints lubricated, your sleep and appetite right, your face relatively wrinkle-free. Estrogen keeps the other angels, cortisol and thyroid, in balance.

To bust the bad guys—depression, slow metabolism, lack of energy – you need your hormonal angels working in sync. That’s absolutely pivotal for a feeling that all is right with the world. Get each in the proper proportion, and you will feel more balanced and aligned. Each hormone is important, useful, and essential on its own. But when they work together at the height of their individual powers, magic happens. Health. Happiness. Vitality. Libidic lusciousness.

 

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About Sara Gottfried MD
Sara Gottfried, MD is the New York Times bestselling author of The Hormone Cure and The Hormone Reset Diet. After graduating from Harvard Medical School and MIT, Dr. Gottfried completed her residency at the University of California at San Francisco. She is a board-certified gynecologist who teaches natural hormone balancing in her novel online programs so that women can lose weight, detoxify, and slow down aging. Dr. Gottfried lives in Berkeley, CA with her husband and two daughters.

References   [ + ]

1. Rapkin AJ., et al. “Pathophysiology of premenstrual syndrome and premenstrual dysphoric disorder.” Menopause International 18 (2) (2012): 52-59.
2. Henmi H., et al. “Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect.” Fertility and Sterility 80 (2) (2003): 459-461.
3. Brown SL., et al. “Social Closeness Increases Salivary Progesterone in Humans.” Horm Behav. 56 (1) (2009): 108–111.
4. Rossignol AM. “Caffeine-containing beverages and premenstrual syndrome in young women.” American Journal of Public Health 75 (1985): 1335-1337; Rossignol AM., et al. “Tea and premenstrual syndrome in the People’s Republic of China.” American Journal of Public Health 79 (1989): 66-67.
5. Gold EB., et al. “Diet and lifestyle factors associated with premenstrual symptoms in a racially diverse community sample: Study of Women’s Health Across the Nation (SWAN).” Journal of Women’s Health 16 (5) (2007): 641-56.
6. Li C., et al. “Alcohol consumption and risk of postmenopausal breast cancer by subtype: the women’s health initiative observational study.” Journal of the National Cancer Institute 102 (18) (2010):1422-31; Chen WY., et al. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk.” Journal of the American Medical Association 306 (17) (2011): 1884-90.
7. Brown DJ. “Vitex-agnus-castus clinical monograph.” Quarterly Review of Natural Medicine (1994): 111-21
8. Wuttke W., et al. “Chasteberry tree (Vitex agnus-castus) — pharmacology and clinical indications.” Phytomedicine 10 (4) (2003): 348-57; Natural Medicines Comprehensive Database. Accessed 7/1/12. http://naturaldatabase.therapeuticresearch.com/
9. Blumenthal M., et al. “The Complete German E Commission monographs: therapeutic guide to herbal medicine.” Boston: Integrative Medicine Communications (1998): 108; Halaska M., et al. “Treatment of cyclical mastalgia with a solution containing a Vitex agnus castus extract: results of a placebo-controlled double-blind study.” Breast 8 (4) (1999): 175-81.
10. Westphal LM., et al. “Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women.” Clinical and Experimental Obstetrics and Gynecology 33 (4) (2006): 205-8.
11. Turner S., et al. “A double-blind clinical trial on a herbal remedy for premenstrual syndrome: A case study.” Complementary Therapies in Medicine 1 (1993): 73-77; Lauritzen CH., et al. “Treatment of premenstrual tension syndrome with Vitex agnus-castus. Controlled, double-blind study versus pyridoxine.” Phytomedicine 4 (1997): 183-189; Schellenberg R. “Treatment for the premenstrual syndrome with agnus castus fruit extract: propective, randomized, placebo-controlled study.” British Medical Journal 322 (2001): 134-137; Westphal LM., et al. “Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women.” Clinical and Experimental Obstetrics and Gynecology 33 (4) (2006): 205-8; Zamani M., et al. “Therapeutic effect of Vitex agnus castus in patients with premenstrual syndrome.” Acta Medica Iranica 2012;50(2):101-6.
12. PEPI Writing Group. “Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial.” The Journal of the American Medical Association 273 (3) (1995): 199-208.
13. Fournier A., et al. “Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study.” Breast Cancer Research and Treatment 107 (1) (2008): 103-11. Erratum in Breast Cancer Research and Treatment 107 (2) (2008): 307-8.
14. Bergmann MM, et al. “The association of lifetime alcohol use with measures of abdominal and general adiposity in a large-scale European cohort.” European Journal of Clinical Nutrition 65 (10) (2011): 1079-87. doi: 10.1038/ejcn.2011.70.