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Progesterone Fertility Q&A

Posted Feb 22 2010 10:04pm 1 Comment

Q: How should you use progesterone if you are trying to conceive?
The basic rule is to follow the instructions on the bottle. You want to mimic your natural cycle as much as possible.

For most uses you would begin to use progesterone by using this calculation Figure out the first day of your period. Subtract two weeks. That day would be the first day you start using the progesterone cream.

Dr. Lee suggests 15 to 30mg (20mg is generally the optimal) of cream during the two weeks before your period, stopping a day or two before the expected period.

Example: An average cycle length is 28 - 30 days. In this case you would begin using progesterone on day 12 of your cycle, counting the first day of your period as day 1. If your cycle is shorter or longer than the given example you would start two weeks before day one of when your period is due. If you have no period at all then you would choose a date and work from there.

Q: I have found out that my progesterone is low. What does this mean to my reproductive health?
When saliva hormonal tests show low progesterone levels, that could indicate that you have not ovulated or that you are not producing the proper amount of progesterone after ovulation - which is called luteal insufficiency. The correct amount of progesterone after ovulation is very important for maintaining a healthy pregnancy.

In a study published in the Lancet, a group of 18 regularly cycling women, average age 29, seven of them (39%) were found to not be ovulating and were not producing progesterone.

Q: If someone has PCOS and/or doesn’t have a regular menstrual cycle, how do they know what days to take the progesterone on?
In cases where your cycle is an 18 or 32 day cycle, starting on day 12 or 14 would not be good. To figure out when would be the best time for you to start and end your progesterone use get out a calendar…

Figure out what day 1 is of your cycle (this is when your next period is due). This is based on what your cycle is. What is normal for you. Then count backwards two weeks. That is when you start using the progesterone cream.

This works because despite the length of a cycle, the days between ovulation and day 1 of the period is consistently two weeks.

Q: Does progesterone cream benefit those of us with PCOS, without a regular cycle? Or are we better off just taking Vitex and/or Maca?
A: With PCOS progesterone supplementation can help to make a big difference with PCOS. It can seem confusing when you should use it since usage is based on a menstrual cycle. In this case choosing your own cycle can help to establish a pattern. Mimicking a general cycle is best. Following the same suggested usage as someone who has a cycle, just choose your own and mark it on the calendar.

Vitex works great in conjunction with progesterone cream. Vitex is working on the the underlying imbalance (which takes some time) while the progesterone helps in the current cycles.

Q: If I have an irregular cycle and don’t menstruate sometimes, how should I use progesterone cream?

A: Figure out what day 1 is of your cycle (this is when your next period is due). This is based on what your cycle is. What is normal for you. Then count backwards two weeks. That is when you start using the progesterone cream.

If you do not menstruate at all then you may want to check out our article on bringing your period back and talk with your health care provider to find out what the imbalance may be.

Q: I know that I am ovulating. Do I still need progesterone? Could my progesterone levels still be low?
Depending on what your fertility issues have been in the past. Many women ovulate and then have a drop in progesterone levels after ovulation (the luteal phase). This may be the cause of recurrent miscarriages or the inability to get pregnant. One way to tell if this is happening is to start fertility charting.

Fertility charting or Basil Body Temperature charting can help to determine the availability of progesterone in the luteal phase. You can learn more about BBT Charting here. There will be a slight rise in temperature after ovulation has occurred and progesterone has increased and stay increased until the period is about to begin. It will then drop. If you are pregnant the temperature will stay at its increased amount.

Q: Is it possible to conceive if I have low progesterone levels?

A: It is possible to conceive with low progesterone, but may be more difficult. It may be hard to maintain a pregnancy if you have low progesterone. Please read the answer to the question before this one.

Q: How do I know if I have low progesterone?
There are a couple of different ways to find out if you have low progesterone.
Hormones testing can be administered by a doctor, naturopath or through labs online. There are a couple of test options. Tests range from charting you menstrual and basal body temperature, finding out the length of your luteal phase, or taking saliva tests to find out your progesterone levels. This preogesterone questionnaire on this page can help to point out signs of progesterone deficiency while these tests help to confirm it.

BBT Charting
Basil Body Temperature charting can help to determine the availability of progesterone in the luteal phase. You can learn more about BBT Charting here . There will be a slight rise in temperature after ovulation has occurred and progesterone has increased.

Length of luteal phase
If the date of ovulation is fewer than 11 days before your period, this could suggest luteal phase defects. You can detect ovulation using BBT charting, ovulation detector strip tests.

Saliva Hormone Testing
Dr. John Lee was very adamant that testing for hormones and progesterone should be done through saliva testing, not blood testing (almost all doctors will test the blood). This is because a blood test may not show an accurate picture of available hormones. Most of the time the hormones in your body are not usable. They are tightly bound to proteins in the blood stream. Only 1-2% are bio available at a time to enter the tissues of the body. Blood tests measure only the total level of hormones in the bloodstream. Dr. Lee suggests saliva testing is more accurate because of the saliva glad being the one of the tissues that bio-available hormones enter.

You can order an “at home” saliva test that you will take at a certain time during your cycle and then send away to a lab for analysis. They will then mail back the results so you can find out if you have any hormonal imbalances.

Q: Can I have both low progesterone and low estrogen?
Yes. This sometimes shows up as a luteal phase defect.

Q: What is the difference between natural progesterone cream and progesterone that is prescribed by a doctor?
Natural progesterone cream contains “bioidentical hormones”. These are hormones that are identical to the ones in your body. Most of the progesterone prescribed by doctors has been molecularly altered to created a kind of “pseudo-hormone” or a synthetic hormone. This is done so the drug is patent protected. Natural progesterone can not be patented as they are natural. Since the structure of the progesterone has been altered in prescribed progesterone, it will not act the same in the body as natural progesterone and may cause dangerous side effects.

Q: Can I use wild yam cream instead of progesterone cream?
Wild yam cream is not the same as progesterone cream. There is a substance called diosgenin in soybeans and wild yams that is extracted and then modified in a the laboratory to create the progesterone found in progesterone creams. Your body is not able to turn diosgenin directly (from wild yam cream) into hormones itself.

Q: What is the difference between Fertilica Progesterone and Emerita Progesterone?
We sell two different kinds of Progesterone Cream, the Fertilica (our brand) contains other herbs which we find important for hormonal balance and Emerita which is just plain progesterone cream.

The progesterone in both products are formulated from a substance found in Mexican wild yams. United States Pharmacopoeia (USP) denotes a recognized standard of purity and strength. It is sometimes referred to as “human-identical” or “bio-identical” progesterone, which differentiates it from synthetic progestins. USP classifies the progesterone as the highest quality available. Both progesterone creams contain USP grade natural progesterone.

Fertilica Natural Progesterone cream contains 20mg of USP Progesterone per full pump. The bottle contains approximately 70 pumps. It also includes additional hormone balancing herbs.

Emerita Pro-Gest cream contains 450 milligrams (mg) of USP Progesterone per ounce (900 mg per two-ounce tube). Each 1/4 tsp contains approximately 20 mg of USP Progesterone.

Q: Which is the best to take if I have low progesterone… progesterone cream, maca or vitex?
It depends on what is happening in your body. Here are some general guidelines to how each works:

Progesterone cream is a direct way to increase progesterone levels. This is helpful in the case of luteal phase defect, preventing recurrent miscarriages and reversing conditions such as endometriosis and ovarian cysts.

Maca is a nourishing food for the endocrine system, aiding both the pituitary, adrenal, and thyroid glands (all involved in hormonal balance.) Maca has the ability to affect key hormones in both women and men without containing hormones itself. In women maca has been shown in studies to help regulate estrogen and increase progesterone (if that is what the body needs). In men It has been shown to regulate estrogen and increase libido and sperm health.

Vitex has been found to help normalize ovulation, improve a short luteal phase and reduce Polycystic Ovary Syndrome (PCOS), all known fertility inhibitors. In one study, vitex helped normalize progesterone levels and increased the luteal phase from 5.4 days to 11.4 days. In addition, two double-blind studies show vitex extract increases a woman’s fertility and chances of successful conception.

Q: Can you use both progesterone cream and vitex or maca?
Yes, progesterone starts to have an effect the cycle that you start taking it. Vitex and maca both take time to have there effect. The previous question explains in detail the difference of the three. It is also not necessary to take all three. Every situation is unique and different.

Q: If I am using Maca to boost my progesterone should I stop taking it once I become pregnant?
Here is what Dr. Wong has to say on Maca and pregnancy.

Dr Wong “Currently Maca is being used throughout South America to prevent miscarriage and help women carry to term. It also has shown itself to provide a further benefit of increasing the birth weight of children. The average weight of babies born in Denver is lower than of babies born at sea level and Denver is only 5000 feet high. What happens at triple that in the Andes? Nothing, because the Maca increases progesterone production and this adds valuable mass to the child. The higher the birth weight the greater the chance of survival!”

Q: I am using Vitex to increase my progesterone levels should I stop taking it once I become pregnant? Is it safe to take during pregnancy?
Aviva Romm states in her wonderful book Botanical Medicine for Women’s Health…

In placebo controlled studies for teratogenicity and mutagenicity were conducted in rats, and even with the animals ere administered 74 times the dosage typically consumed by humans, no toxicity nor aberrations in fetal development were seen. While Vitex can be used to help a miscarriage that is acute, it is best to use at least 3 months prior to conception and continued into the first trimester to maintain stable progesterone levels. The Botanical Safety Handbook provided no contraindications to use during pregnancy.

Q: I have been taking progesterone and am now pregnant. How much progesterone should I use for pregnancy and how long should I use it for?
While pregnant it is best to work with your health care provider to help monitor and guide your progesterone usage. When you do become pregnant and you have been using progesterone you want to make sure you do not stop taking it. A drop in progesterone levels can cause a spontaneous abortion (miscarriage) to occur.

In the first trimester of pregnancy progesterone production is the sole responsibility of the ovaries, often fail to produce sufficient levels to maintain the pregnancy. By the second trimester, the placenta itself is responsible for producing progesterone, and it hikes the level of this hormone to 486% higher than the non-pregnant norm.

Synthetic progesterone drugs, not being natural progesterone, have side effects that if used to maintain the pregnancy may do damage to the baby.

If you are taking progesterone and get pregnant, you must continue taking progesterone until at least the 16th week. I personally would not stop if I had seriously low levels to begin with. But it is best to work with your health care practitioner if this is the case. They will continuously monitor your levels to make sure they are healthy for pregnancy.

Q: Is progesterone cream safe to take while on the Fertility Cleanse?
If you have been taking progesterone cream before starting the Fertility Cleanse, than continue to use the cream as you have been.

If you are starting the Fertility Cleanse and progesterone cream at the same time I would suggest that you wait and begin the cream after your cleanse. The reason for this is that the Fertility Cleanse has a lot of different herbs that are going to be working on the endocrine system. It will be hard to monitor yourself and see how the progesterone is affecting you. Starting the progesterone cream the cycle after you have completed the Fertility Cleanse makes it easier to see how you are doing with the progesterone.

Q: Does it matter whether natural progesterone cream is made out of soy or wild yam?
No. There is a substance called diosgenin in soybeans and wild yams that is extracted and then modified in a the laboratory to create the progesterone found in progesterone creams. Your body is not able to turn diosgenin directly into hormones itself. So taking just a soy supplement or using wild yam cream will not have the effects that progesterone cream does. It can be confusing because of soy’s phytoestrogen ability to have estrogen-like effects. But those come from a different part of the plant which is accepted by your body.

Q: What is the difference between progesterone and progestins?
Progestins are a synthetic form of progesterone. While progesterone found in progesterone creams is natural and identical to the progesterone in your body. Natural progesterone is much safer to use than progestins which can have serious side effects. During the third trimester of the pregnancy the placenta naturally produces 300-400mg of progesterone daily. If progestins were given to the mother in that same dosage, serious birth defects could occur.

Q: Are there any side effects from using progesterone cream?
It is rare but, yes, there can be. Large doses (100mg) of progesterone can cause side effects, sleepiness, loss of libido, mild depression, exacerbated symptoms of estrogen deficiency, and serious hormonal imbalances.

If you take progesterone out of phase then it may cause the timing of your period to change or spotting to occur.

The best way to avoid these side effects is to make sure to use the progesterone cream as directed, at the correct time of your cycle and not to exceed the recommend amount (10-30mg per application) or to work with a health care practitioner so your progesterone levels can be monitored.

Q: Can too much progesterone cause a light period?
It is hard to say, as there are many factors that can affect your cycle. The timing of when you use progesterone is very important. Taking it the wrong time can cause the cycle to be different. The best way to make sure you are using the cream at the right time is to calculate your progesterone start date by counting two weeks backwards from when your period is due.

Q: I have been using progesterone and am now spotting between periods. This never happened before? What is happening? Is it the progesterone?
A: Spotting could be from a variety of reasons… The most common is a too high dose of progesterone.

The second common is that your timing may be off. If your cycle has been 24 days for years and changes to a 28 day cycle after you’ve began using progesterone cream this could be a sign of changes happening or a confused body. The best way to make sure you are using the cream at the right time is to calculate your progesterone start date by counting two weeks backwards from when your period is due.

The third common reason for spotting is that when the body is making hormonal shifts it sometimes gets out of wack for a cycle or two as it is shifting to its new cycle.

Q: Can I use progesterone cream if I am on birth control pills?

A: We do not know for sure, but it would be best to not mix hormones or use herbal products that can have an impact on your hormones while on birth control. An educated guess is that the birth control would block the progesterone from the receptor sites, but we do not know.

Q: I am preparing for an IVF and will be taking medications. Can I use progesterone cream?
We would not recommend it. When you are preparing for IVF you will be prescribed a very specific hormonal protocol. It would be very dangerous to use anything with hormonal effects during that time. Speak with your doctor if you feel you have low progesterone levels.

Q: I am breastfeeding, can I use progesterone cream? What is the recommended usage?
A: Progesterone cream is not generally recommended postpartum or while breastfeeding. It has been shown to be helpful for the baby blues/postpartum depression though. Talk to your doctor about this, especially if you are breastfeeding as some evidence shows that progesterone can effect lactation from occurring.

Q: Can using progesterone cream prevent menopause from happening?

To learn more about using progesterone for fertility visit the Fertility Progesterone Guide .

Have a question? Ask it below or in our Natural Fertility Community forums . In the forums you will get responses from both herbalists and women sharing their first hand experience.

References 1. Lee, John, M.D. Hormone Balance Made Simple. 2006
2. Lee, John, M.D. What Your Doctor May Not Tell You About Premenopause. 1999
3. Hobbs, Christopher, L.Ac. Vitex The Women’s Herb. 2003
4. Trickey, Ruth. Women, Hormones, and the Menstrual Cycle. 2003
5. Weed, Susun. Herbal for the Childbearing Year. 1986
6. California PSR and CALPIRG. “Generations at Risk” Chemicals and Reproductive Health.PDF
7. Romm, Aviva. Botanical Medicine for Women’s Health. 2009

Comments (1)
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I am almost 80 years of age and have a lapsed uterus.  I have opted to use a pessary instead of surgery.  Doctors have recommended vaginal creams premarin and another gel.  I have refused to use both as the former has too many side effects and the other has peraban.  I have found Emerita and am requesting your recommendation on its use.  Please send your reply to

Thank you.

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