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Pcos

I'm Worried my Progesterone Levels are too High

By Dr. Kate Dudek

Measuring progesterone levels is a good way of confirming whether or not ovulation has taken place. One of the main symptoms of PCOS is anovulation, characterised by low progesterone. To diagnose PCOS, most guidelines state that two out of the three main symptoms (anovulation, hyperandrogenism and polycystic ovaries) should be present. A lack of progesterone, in addition to serving as a marker of anovulation, also contributes to higher circulating levels of testosterone, contributing to another of the major symptoms. Boosting low progesterone levels has health benefits (preventing over-exposure of the uterus to oestrogen) and will serve as a natural mood enhancer.

But, what about if progesterone levels are higher than normal?

First, it is worth considering what is ‘normal’? Progesterone levels in the serum naturally fluctuate, not just throughout the menstrual cycle, when they can feasibly go from 0 to 20ng/ml, but also on an hour by hour basis. This makes defining 'normal' challenging. Progesterone is not present at all during the follicular phase of the cycle and will only start to rise after ovulation, reaching a peak 7-5 days before menstruation starts. This peak is often around 8ng/ml, but can be as high as 20ng/ml.
Without fertilisation, progesterone levels fall swiftly back to zero for the start of the next menstrual cycle. If fertilisation does occur, progesterone levels will remain high as the hormone helps to prepare the body for pregnancy. Symptoms of high progesterone include fatigue, bloating, moodiness, breast tenderness and vaginal dryness, these can all be very early signs of pregnancy.
It is not abnormal for progesterone levels to reach 85-90ng/ml during the first and second trimester, dropping to approximately 45ng/ml in the third trimester as the body prepares for birth. Multiple births (twins or triplets) usually give rise to higher than average levels.
So, if your progesterone levels seem high, the first thing to consider is whether or not you might be pregnant.

If pregnancy is not the reason for higher than normal progesterone levels, there are a few other conditions that might lead to high levels of the hormone:
- Ovarian cysts. Some ovarian cysts occur alongside an excess of progesterone, however, which causes which is unclear. Ovarian cysts are usually benign, often form as part of normal menstruation and, unless they rupture, will generally cause few side effects.
- Congenital adrenal hyperplasia. A group of rare inherited conditions that affect the production of hormones, including androgens, by the adrenal glands.
- Ovarian cancer and adrenal cancer. These are both rare and will usually be accompanied by other symptoms such as pain and bleeding.

To conclude, if you have high levels of progesterone, the first thing to do is re-test your levels, taking into account the tendency for fluctuations in readings. Also, bear in mind that having healthy levels of progesterone is generally a good thing; it makes periods lighter, reduces anxiety, is anti-inflammatory and improves the appearance of the skin and hair.

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