Category Archives: Women’s Health

Progesterone is a female sex hormone that is primarily produced in the corpus luteum in normally menstruating women. The main role of progesterone is to prepare the body for pregnancy (1).

For more information about progesterone, see our previous article “What is progesterone?“

What are normal progesterone levels?
Progesterone levels fluctuate during each menstrual cycle. They are low (<0.5 ng/mL) during the follicular phase, with a rapid rise following the luteinizing hormone (LH) surge at ovulation to 10-25 ng/mL. If no conception occurs, progesterone levels decline, and menstruation beings. If an egg is fertilized, the corpus luteum maintains progesterone levels until around week six. The placenta produces progesterone for the remainder of the pregnancy, with levels increasing up to 45 ng/mL in the first trimester, and 230 ng/mL in the third trimester (2).

Estrogen-progesterone balance
Estrogen is the other main female hormone, and the balance of progesterone and estrogen is very important for female health. Although an excess of estrogen (known as estrogen dominance) is more common, some women are instead affected by excess progesterone.

What can cause high progesterone?
An excess of progesterone (in relation to estrogen) can be caused by various factors, including:

• Menstrual cycle changes, such as an extended luteal phase when progesterone levels are higher
• Reduced estrogen
• Excess supplementation with progesterone or progesterone precursors
• Pregnancy
• Adrenal-related problems
• Stress

What are the signs of high progesterone?
There is a wide range of symptoms associated with high progesterone, including:

• Weight changes, usually weight gain
• Low mood
• Drowsiness
• Dizziness or spinning sensation
• Bloating and water retention
• Reduced sex drive
• Anxiety

How can I measure my progesterone levels?
Measuring the levels of progesterone in your blood is very simple and only requires a tiny blood sample from a self-collected finger-prick. See our Progesterone test for more information.

Since the balance between progesterone and estrogen is very important, it is generally recommended that you also measure your estrogen levels at the same time. We offer a test for Estradiol, which is the predominant form of estrogen.

Alternatively, you may wish to select our Women’s Health Hormone Panel, which measures your levels of progesterone and estradiol alongside 10 other important biomarkers.

Are there treatment options for high progesterone?
The treatment options for high progesterone are targeted at the underlying cause, so it is important to determine what could be causing high progesterone.

If high progesterone is associated with taking a progesterone supplement (such as to treat estrogen dominance or other issues around menopause), the dosage of the supplement may need to be reduced.

Birth control pills (which contain a synthetic form of progesterone) can also trick the body into thinking it has too much progesterone and causes some of the common high progesterone symptoms. Hence, it may be necessary to come off birth control pills or switch to a different option.

Adrenal fatigue can cause increased progesterone (3), often accompanied by high cortisol (another hormone analyzed in our Women’s Health Hormone Panel). High cortisol is a sign of stress, so taking measures to reduce stress can be beneficial.

Sometimes thyroid abnormalities can also affect the production of other hormones, so it may be necessary to check your thyroid function and treat any abnormalities. We also offer several thyroid health tests, including our Thyroid Health, Complete Panel.

References:
1. Weigel NL, & Rowan BG. (2001). Estrogen and progesterone action. In L. J. DeGroot, & J. L. Jameson, Endocrinology (Vol. 3, 2053-2060). Philadelphia: WB Saunders Co.
2. Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic & Laboratory Test Reference. 14th ed. St. Louis, Mo: Elsevier; 2019.
3. Herrera AY, Nielsen SE, Mather M. (2016) Stress-induced increases in progesterone and cortisol in naturally cycling women. Neurobiol Stress. 3:96-104.

Estrogen is one of the two primary female sex hormones, with the other being progesterone. Estrogen is absolutely essential for female reproductive health and pregnancy, and also plays a number of other roles in the body too.

The roles of estrogen in females include:

• Maturing and maintaining the reproductive system (mammary gland, uterus, vagina) (1)
• Helping prepare the uterus for pregnancy (1)
• Influencing sexual desire (linked to when a woman is most fertile) (2)
• Development of secondary sexual characteristics (3)
• Helping maintain bone health by controlling rate of bone resorption (4)
• Increasing collagen production and maintaining moisture for skin health (5)
• Improving blood flow (6) and regulating blood clotting (7)
• Regulating cholesterol levels (8)

As you can see estrogen has an extensive range of roles! So, an imbalance in this important hormone is going to cause a few health issues.

What are the signs of high estrogen in females?

• Fluid retention and weight gain, particularly around the abdomen, hips, and thighs
• Acne
• Severe premenstrual syndrome symptoms
• Constipation
• Decreased libido (sex drive)
• Irregular menstrual periods
• Depression
• Mood swings
• Fertility issues
• Noncancerous lumps in the breasts and uterus
• Fatigue
• Headaches
• Sleeping issues

High estrogen can also increase the risk of more serious health complications (9), including:

• Thyroid diseases
• Blood clots
• Heart attack
• Stroke
• Breast and ovarian cancer

What are the possible causes of high estrogen?

• Estrogen replacement therapy (used to treat menopause symptoms)
• Hormonal contraceptives
• Certain antibiotics and herbal remedies
• Obesity (increases the conversion of fat into estrogen)
• Ovarian tumors
• Liver disease (inhibits the normal breakdown of extra estrogen)
• Genetic variation
• Poor nutrition
• Excess alcohol and drug use
• Low progesterone levels (causes a hormone imbalance)

How can I check my estrogen levels?
We offer several different tests to measure your estradiol levels. Estradiol is the strongest of the three estrogen hormones. These tests just require a small blood sample collected from a simple finger prick in the privacy of your own home. Test results are available through our online portal, thereby avoiding the need to make any doctor or lab appointments. Of course, you may also wish to discuss your results with your healthcare professional, and this is highly recommended if you receive any results that fall outside the normal range.

The Estradiol (E2) test measures just your estradiol levels. For females of reproductive age, it is helpful to know what stage of your menstrual cycle your sample was collected at, as normal levels vary throughout each cycle.

There are various combination tests available for females that include estradiol along with other important hormones:

• Women’s Fertility Panel (5 biomarkers)
• Women’s Health Hormone Panel (12 biomarkers)
• Women’s Hormone Panel (E2, FSH, LH, Prolactin)
• Women’s Perimenopause Panel (E2, FSH, LH)
• Women’s Postmenopause Panel (E2, P4)

What are ways to lower high estrogen?

• Lose weight (if overweight)
• Moderate exercise may be beneficial (10)
• Follow a healthy diet, particularly with high fiber (11) and only limited alcohol (12)
• Change medications if they could be the cause of elevated estrogen (discuss any medication changes with your healthcare provider)
• Limit certain animal products, including red and processed meats (13)

References:
1. Oestradiol. You and your Hormones, an education resource from the Society for Endocrinology. Reviewed Mar 2018.
2. University of California – Santa Barbara. “Hormone levels and sexual motivation among young women.” ScienceDaily. 25 April 2013.
3. Estrogen’s Effects on the Female Body. John Hopkins Medicine.
4. Seifert-Klauss V & Prior JC. (2010) Progesterone and Bone: Actions Promoting Bone Health in Women. J Osteoporos. 2010: 845180.
5. Shah MG, Maibach HI. (2001) Estrogen and skin. An overview. Am J Clin Dermatol. 2(3): 143-50.
6. Prior JC. (2011). Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn, 3 (2), 109-120.
7. Mendelsohn ME (2002). Protective effects of estrogen on the cardiovascular system. Am J Cardiol. 89(12, S1): 12-17.
8. What is Estrogen? Hormone Health Network. Updated August 2018.
9. Leonard J (reviewed by Biggers A) (2018) What are the symptoms of high estrogen? Medical News Today.
10. Kossman DA, et al. (2011) Exercise lowers estrogen and progesterone levels in premenopausal women at high risk of breast cancer. J Appl Physiol (1985). 111(6): 1687-93.
11. Cui X, et al. (2010) Dietary fat, fiber, and carbohydrate intake and endogenous hormone levels in premenopausal women. Horm Cancer. 1(5): 265-276.
12. Erol A, et al. (2019) Sex hormones in alcohol consumption: a systematic review of evidence. Addict Biol. 24(2): 157–169.
13. Harmon B, et al. Estrogen levels in serum and urine of vegetarian and omnivore premenopausal women. Public Health Nutr. 17(9): 2087–2093.

In many countries around the world, the age of a mother at the birth of her first child is increasing. And with this increasing maternal age comes an increased risk of fertility issues, as well as an increased risk of chromosomal abnormalities. Yet, paternal age (father’s age) doesn’t have such an effect. Why is this the case? Read on to find out.

Sperm production versus egg production
Males can produce more than 100 million sperm a day, with an average ejaculate containing more than 40 million sperm (1).

In contrast, females have a peak number of oocytes (immature eggs) while they themselves are only 20-week-old fetuses. By birth, the number of viable oocytes has already dropped to 1–2 million, and by puberty, there are usually only 300,000–500,000 viable oocytes remaining. Throughout a women’s reproductive life, she will ovulate 400–500 oocytes and the remainder will be lost to atresia (normal degeneration) (1).

Is it only about lower egg quantity? Or is egg quality affected too?
During a women’s 20s and early 30s, there is about a 1 in 4 chance of conceiving during any single menstrual cycle (2). However, when a woman reaches 32 years, her fertility begins to decline, with a more rapid decline from the age of 37 (3). By age 40, a woman has only about 3% of her pre-birth egg supply (3), and there is only about a 1 in 10 chance, or less, of conceiving in any single menstrual cycle (2).

But it is not just the number of eggs that matter. The eggs in an older woman have been around since before she was born, so there is a much higher risk of chromosomal abnormalities, such as Down syndrome (3).

Are there things that increase egg loss?
Yes, smoking, as well as certain chemotherapies and radiation can accelerate egg loss in females.

What other factors influence female fertility?
Older women also have a much higher risk of other disorders that can affect the chance of getting pregnant, such as uterine fibroids (growths in the uterus) and endometriosis (a painful disorder where tissue that normally lines the uterus grows outside the uterus) (3).

As women age, they also have an increased risk of complications during pregnancy, including preeclampsia, premature birth, miscarriage, and stillbirth (2).

Do sperm quantity and quality decrease with age too?
Fully understanding the influence of male age on fertility is difficult, as an older male is more likely to be having a child with an older female, so it is difficult to distinguish between the influence of the increasing female age versus the increasing male age. However, it has now been shown that fertility in males actually does also decrease with age, just not to the same extent as in females. Older males may have decreased semen quality and also have increased rates of DNA fragmentation, which can cause fertility issues. In addition, there is a link between male age and the likelihood of birth defects and chromosomal abnormalities (1).

What tests are available to determine my egg count?
A measurement of follicle-stimulating hormone (FSH) levels provides an indirect analysis of egg count or ovarian reserve as it is commonly known. We offer an FSH test, as well as a Fertility Panel that includes five biomarkers to gain a better understanding of your hormone levels and how they could be influencing your likelihood of conceiving.

References:
1. Harris ID et al. (2011) Fertility and the Aging Male. Rev Urol. 13(4): e184-e190.
2. Having a baby after age 35: How aging affects fertility and pregnancy. ACOG. Reviewed October 2020.
3. Lewis R (Reviewed by Kallen A) (2020) How many eggs are women born with? And other questions about egg supply. Healthline.

Polycystic ovary syndrome (PCOS) is a complex condition that affects 6–12% of reproductive-age women in the United States (1). Affected women may have elevated androgen levels (hyperandrogenemia) and/or small cysts on one or both ovaries (polycystic ovaries) (2).

What are the symptoms associated with PCOS?
Androgens are male sex hormones, such as testosterone. Usually, women only have low androgen levels, but elevated androgen levels are a characteristic of PCOS (2). This hyperandrogenemia can cause numerous symptoms, including:

• Problems with the menstrual cycle
• Fertility issues
• Excess body hair (e.g., on the chest, stomach, and back)
• Weight gain, especially in the abdomen
• Acne
• Male-pattern baldness
• Skin tags (excess skin on the neck or armpits)

What causes PCOS?
Both genetic and environmental factors are thought to contribute to PCOS. A family history of PCOS is relatively common, with current literature suggesting an autosomal dominant pattern of inheritance (2).

Being overweight and physically inactive can increase the risk of PCOS, but many women of normal weight have PCOS, and many overweight women don’t have PCOS (1).

Insulin resistance is a big factor linked to PCOS. Insulin-resistant people are able to make insulin but their body doesn’t respond to it very well. Usually, insulin helps to regulate ovarian function, and if there is excess insulin, the ovaries respond by producing more androgens (2). Often lifestyle choices, such as poor diet and lack of exercise, are contributing factors towards insulin resistance (1).

What serious health complications are associated with PCOS?
The insulin resistance that is a contributing risk factor for PCOS significantly increases the risk of developing type 2 diabetes. In fact, more than half of women with PCOS develop type 2 diabetes by 40 years of age, with a higher risk among those who are overweight. Gestational diabetes is another possible complication linked to PCOS, insulin resistance, and being overweight. Gestational diabetes is diabetes during pregnancy and can put the pregnancy and baby at risk, and also increase the likelihood of type 2 diabetes later in life for both the mother and child (1).

The risk of heart problems also increases for women with PCOS, again with a heightened risk for those that are also overweight. Elevated LDL (“bad”) cholesterol and low HDL (“good”) cholesterol can occur and increase the risk of heart disease. There is also an increased risk of blood clots and stroke when the elevated LDL cholesterol can cause plaques to clog the blood vessels (1).

Sleep apnea is another possible complication of PCOS. This disorder causes breathing to stop during sleep and is also linked to an increased risk of heart disease and type 2 diabetes. Depression and anxiety are also more common in women with PCOS (1).

How is PCOS diagnosed?
The symptoms of PCOS can vary from person to person, so diagnosis can be difficult and often delayed. Commonly women find out they have PCOS when they have difficulty getting pregnant, but often they have actually had PCOS for many years by this point. Generally, a doctor will check for at least two of these three symptoms for a PCOS diagnosis (1):

• Irregular periods or a lack of periods
• Elevated male hormones (e.g., testosterone) detected through blood tests such as this
• Multiple cysts on the ovaries detected by ultrasound

Blood tests can also be used to detect elevated levels of luteinizing hormone (LH), which is common in PCOS (2). We offer a test here for LH. Commonly other blood tests are also conducted to provide a broad health overview, including measuring glucose and lipid levels.

How is PCOS treated?
The treatment options for PCOS vary depending on what symptoms and other health complications are also present. If type 2 diabetes (or prediabetes) is also diagnosed, losing excess weight and increasing physical activity can help prevent and manage diabetes and delay the onset of other health problems (1). Losing weight also helps to decrease androgen and LH levels (2).

Other medications are also available to help ovulation (and enable pregnancy), reduce acne, and control hair growth (1). For women who are not aiming to get pregnant, oral contraceptives can be effective for regulating menstrual cycles, as well as reducing excess body hair, acne, and androgen levels (2).

References:
1. PCOS (Polycystic Ovary Syndrome) and Diabetes. CDC. March 2020.
2. Ndefo UA et al. (2013) Polycystic Ovary Syndrome. Pharmacy and Therapeutics. 38(6): 348-355.

Estrogen and progesterone are the primary female sex hormones. They are essential for female reproductive health and pregnancy, but they also have a number of other roles in the body too. In this article, we will go over the major roles of these two hormones in females.

Fertility
The primary function of estradiol (the strongest estrogen hormone) in females is to mature and maintain the reproductive system, including the mammary glands, uterus, and vagina. During each menstrual cycle, estradiol levels increase to trigger the maturation and release of the egg. Increasing levels of progesterone are required to cause the thickening of the uterus lining to allow a fertilized egg to implant (if conception occurs) (1).

Pregnancy
In females of reproductive age, estradiol levels rise and fall twice during each menstrual cycle. At the beginning of the follicular phase of the cycle (when menstruation occurs), estradiol levels are low, with levels gradually increasing, until a rapid increase just before ovulation occurs (when an egg is released), followed by a rapid decrease. During the luteal phase, estradiol levels gradually increase again, along with an increase in progesterone to prepare the uterus and to stimulate the secretion of nutrients to provide the perfect environment for the implantation of a fertilized egg. Progesterone also inhibits muscular contractions of the uterus that would prevent a fertilized egg from implanting (2).

During pregnancy, estradiol levels keep increasing, until they reach levels as high as 40,000 pg/mL during the third trimester (3). After a fertilized egg becomes implanted, the placenta forms and takes over the production of progesterone at around 6-12 weeks. The placenta continues to produce progesterone for the remainder of the pregnancy, with progesterone levels steadily rising throughout pregnancy (4).

Throughout the pregnancy, progesterone is important for the development of the fetus, as well as stimulating the growth of maternal breast tissue in preparation for breastfeeding and strengthening the pelvic wall muscles in preparation for labor (4).

Libido
Studies have shown that both estrogen and progesterone levels influence sexual desire. Higher levels of estrogen are linked to increased libido (but with a two-day lag). In contrast, higher levels of progesterone have a negative effect on libido. This influence on sexual desire, particularly for higher estrogen levels, is thought to be linked to the time of the menstrual cycle when a woman is the most fertile (5).

Puberty
Increasing estrogen and progesterone levels in young girls stimulate the development of female secondary sexual characteristics, (such as breasts, female fat distribution, and pubic hair), as well as triggering the menstrual cycles to begin (6). 

Bone health
Estrogen and progesterone work in sync for optimum bone health. Estrogen controls the rate of bone resorption, while progesterone is important for bone formation (7). In healthy bone, resorption (breakdown) and formation are kept in balance. However, if estrogen and progesterone levels are low, bone resorption exceeds bone formation, resulting in a weakening of the bone and an increased likelihood of osteoporosis.

After menopause, both estrogen and progesterone are at much lower levels than in pre-menopausal women. This contributes to increased bone loss during postmenopause, with an average bone mineral density loss of 1–2% each year after menopause (8), while some women can lose up to 20% of their bone density in just the 5–7 years following menopause (9).

Skin and hair health
Estrogen plays a prominent role in overall skin health. It is associated with increased collagen production, so is beneficial for maintaining skin thickness, as well as reducing the appearance of wrinkles. Estrogen also helps maintain skin moisture and topical estrogen has even been found to improve wound healing (10). Progesterone is also important for skin health, with evidence showing how topical progesterone can increase skin elasticity and decrease wrinkling (11).

Estrogen and progesterone are also required for optimum hair growth and health, which is evident with slower hair growth and thinner hair in postmenopausal women with lower levels of these two important hormones. The sharp decline in estrogen and progesterone that occurs at menopause is also linked to increased or imbalanced androgen levels (e.g., testosterone). Androgens tend to shrink hair follicles on the head, resulting in hair loss and thinner hair, but can also cause more hair to grow on the face. This is why some women at perimenopause and postmenopause have increased hair on the chin and upper lip (12).

Cardiovascular system
Estrogen has many protective effects on the cardiovascular system, including increasing nitric oxide activity (in coordination with progesterone) to improve blood flow (13) and lower blood pressure (14), soaking up free radicals that can damage arteries and other tissues, and helping regulate blood clotting (15). Estrogen is also important to keep cholesterol levels under control (16), which helps explain why females generally have lower cholesterol levels than males until postmenopause when estrogen levels are very low in females.

How can I measure my estrogen and progesterone levels?
Estradiol is the strongest of the three estrogen hormones and we offer several different tests to measure your estradiol levels. We also have tests available to measure your progesterone levels. These tests just require a small blood sample collected from a simple finger-prick in the privacy of your own home. Test results are available through our online portal, thereby avoiding the need to make any doctor or lab appointments. Of course, you may also wish to discuss your results with your healthcare professional, and this is highly recommended if you receive any results that fall outside the normal range.

The Estradiol (E2) and Progesterone (P4) tests measure just your estradiol levels and progesterone levels, respectively. For females of reproductive age, it is helpful to know what stage of your menstrual cycle your sample was collected at, as normal levels vary throughout each cycle.

There are various combination tests available for females that include estradiol and/or progesterone along with other important hormones:

• Women’s Fertility Panel (5 biomarkers)
• Women’s Health Hormone Panel (12 biomarkers)
• Women’s Hormone Panel (E2, FSH, LH, Prolactin)
• Women’s Perimenopause Panel (E2, FSH, LH)
• Women’s Postmenopause Panel (E2, P4)

References:
1. Oestradiol. You and your Hormones, an education resource from the Society for Endocrinology. Reviewed Mar 2018.
2. Progesterone. Encyclopedia Britannica. (Edited August 2020)
3. Speroff L, Glass RH, and Kase NG. (1994). The Endocrinology of Pregnancy. In: Mitchell C, editor. Clinical Gynecologic Endocrinology and Infertility, 5th ed. Baltimore: Williams and Wilkins. 251-289.
4. You and Your Hormones. An education resource from the Society of Endocrinology. (Reviewed July 2021)
5. University of California – Santa Barbara. “Hormone levels and sexual motivation among young women.” ScienceDaily. 25 April 2013.
6. Estrogen’s Effects on the Female Body. John Hopkins Medicine.
7. Seifert-Klauss V & Prior JC. (2010) Progesterone and Bone: Actions Promoting Bone Health in Women. J Osteoporos. 2010: 845180.
8. Ahlborg HG, et al. (2003) Bone Loss and Bone Size after Menopause. N Engl J Med. 349: 327-334.
9. What Women Need to Know. Bone Health & Osteoporosis Foundation.
10. Shah MG, Maibach HI. (2001) Estrogen and skin. An overview. Am J Clin Dermatol. 2(3): 143-50.
11. Holzer G, et al. (2005) Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study. Br J Dermatol. 153: 626–34.
12. Cappelloni L (reviewed by Sullivan D). (2019) Menopause Hair Loss Prevention. Healthline.
13. Prior JC. (2011). Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn, 3 (2), 109-120.
14. Thomas P & Pang Y. (2013). Protective actions of progesterone in the cardiovascular system: potential role of membrane progesterone receptors (mPRs) in mediating rapid effects. Steroids. 78(6): 583-588.
15. Mendelsohn ME (2002). Protective effects of estrogen on the cardiovascular system. Am J Cardiol. 89(12, S1): 12-17.
16. What is Estrogen? Hormone Health Network. Updated August 2018.