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Do I Have to Take Progesterone Supplements if I Have PCOS?

By Dr. Kate Dudek

Progesterone and oestrogen are the two female reproductive hormones; they play an essential role in maintaining normal physiological function.
During a normal menstrual cycle, progesterone levels rise rapidly after ovulation and stay high for approximately 14 days. This is termed the luteal phase of the cycle. Measuring levels of progesterone throughout the cycle is a good way of determining whether or not ovulation has occurred. If blood serum levels of progesterone reach 5ng/ml during the luteal phase then ovulation has occurred. If levels are below 1.8ng/ml then there is no chance that ovulation happened. This is really valuable information for women who are trying to conceive, as without ovulation pregnancy cannot occur. But, even for those not attempting to fall pregnant, knowing whether or not you are ovulating is useful information to have.

Lack of ovulation, accompanied by very low levels of progesterone, is one of the main symptoms of PCOS. Furthermore, low progesterone levels can cause an increase in testosterone levels because one of the hormone’s normal functions is to block the androgen receptors. Testosterone is an androgen and if there is insufficient progesterone available to block its receptor, levels will rise above those normally seen in females, resulting in male-like features such as increased facial hair (hirsutism).

Increasing progesterone levels could, therefore, improve at least two of the main defining characteristics of PCOS. However, it is important to consider the best way of boosting progesterone levels. The preferred method would be to increase the body’s natural supplies. This may mean probing a little deeper into the reasons why you are experiencing PCOS-type symptoms; is it related to insulin resistance, or coming off the pill, or an inflammatory condition, or a side-effect of another condition? Rectifying the cause, may alleviate the symptoms of PCOS, including increasing levels of endogenous progesterone. The next best option is to take a bioidentical version of progesterone, which is as close to the naturally occurring hormone as possible. This is usually available as a cream or a capsule. It can be very useful for menstrual cycle regulation, as well as resolving some of the issues associated with the perimenopause, or menopause, such as sleep disturbances.

Of course you do not have to take a supplement, but if you cannot increase your endogenous progesterone, it may be worth considering. Progesterone has a number of health benefits, not least protecting the uterus from excessive oestrogen exposure, which has been linked to an increased risk of endometrial cancer. Progesterone also improves energy, stabilises mood, reduces the appearance of acne (due to its anti-androgenic properties) and has some anti-inflammatory properties. Incidentally, a heightened immune response is another common symptom of PCOS.

One important fact to bear in mind is that the oral contraceptive pill does not contain progesterone, or even a bioidentical version of the hormone. It contains a synthetically-produced progestogen (also called progestin) and, as such, will not provide all the health benefits of natural progesterone. Whilst newer progestins do have some anti-androgenic properties, there are a number of negative effects which are important to bear in mind before considering using the pill as a treatment option for PCOS. These include increased anxiety and depression, hair loss and a risk of thrombosis. The pill is not a way of supplementing endogenous progesterone production, it is a way of mimicking some of the effects to provide short-term symptomatic relief.

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