Progesterone Supplements: A Pharmacist Explains the Evidence

If you have low progesterone levels, you may consider taking a progesterone supplement to increase them.

Progesterone, a hormone produced naturally in the body, is vital to your reproductive health and maintaining a healthy pregnancy.

It’s important to remember that your progesterone levels are also a part of your broader hormonal picture. In concert with other hormones like estrogen and androgens, progesterone helps regulate sleep, mood, bone health, cognition, mental health, cardiovascular health, and weight.

In females, progesterone helps manage symptoms of endometriosis, as well as perimenopause and menopause, such as hot flashes and mood swings. Attending to these symptoms through effective treatment is vital to improving quality of life and overall health and is critical to a healthy aging strategy.

Though progesterone supplements may support your body, they typically will not contain actual progesterone.

Progesterone Supplements

People have taken progesterone supplements, either alone or in combination with other supplements or prescription medications, to try to increase their progesterone levels. They typically do this because their progesterone levels are low, possibly due to specific conditions or the natural aging process.

As mentioned, though progesterone supplements may support your body’s progesterone production, they do not contain the progesterone hormone. Supplements studied for their potential impact on the body’s production of progesterone include the following:

• • Diindolylmethane (DIM): DIM is derived from indole-3-carbinol (I3C), the bioactive compound found in cruciferous vegetables like broccoli, cauliflower, cabbage, and brussels sprouts. Though how DIM directly affects progesterone is unclear, its influence on estrogen metabolism may help balance progesterone in estrogen dominance.
  • Dehydroepiandrosterone (DHEA): Studies suggest that DHEA increases estrogen and androgens (e.g., testosterone) levels. Increased levels of other hormones may also indirectly increase progesterone levels. However, the exact influence of DHEA on progesterone levels is unclear.
  • Wild yam: Wild yam and other Dioscorea species contain a steroidal compound called diosgenin, a starting material for progesterone production. Diosgenin must be chemically converted into progesterone or other steroid hormones to function as a hormone. This conversion is carried out in a laboratory through a series of chemical reactions. The body cannot do this on its own.
  • Red clover extract: Red clover (Trifolium pratense) is commonly taken to relieve menopausal symptoms. A lab study showed that irilone, a progesterone-like compound found in red clover, improved progesterone signaling, potentially improving conditions such as fibroids and endometriosis.

• Folic acid: Higher intake of dietary synthetic folate was associated with higher progesterone levels. However, further studies are necessary to confirm this.
• Zinc: Zinc deficiency can reduce the production of estrogen and progesterone. Therefore, research has suggested that zinc can benefit people with endometrial conditions.
• Vitamin D: Vitamin D is a steroid hormone, and lab studies have shown it has progesterone-like activity. However, one study suggested that vitamin D ​decreased progesterone in ​adolescents. Further studies are necessary to clarify the effect of vitamin D supplementation on progesterone levels.

What Is Progesterone?

Progesterone is a natural hormone that plays a vital role in your reproductive system and beyond. In males, the testes and adrenal cortex (a part of the adrenal gland) produce testosterone. In females, the corpus luteum (a structure in the ovary), the adrenal cortex, and the placenta (in the case of pregnancy) are the primary producers of progesterone.

Progesterone is critical in regulating menstrual cycles, maintaining a healthy endometrium (uterus lining), and overall hormone balance. It is also essential for maintaining pregnancy. The root word “progesterone” itself essentially means “for pregnancy.” It’s also an essential starting material for other hormones, such as aldosterone, cortisol, estradiol, and testosterone.

Progesterone production tends to decline with the onset of perimenopause, and issues may occur if its levels are too low. Studies suggest that females with optimal progesterone levels may experience better sleep, emotional resilience, and more.

Healthcare providers may prescribe specific medications to increase progesterone levels for conditions that require it.

Is a Progesterone Supplement Safe for Me?

Though hormone-related supplements can offer benefits, taking them with caution is essential.

Critical precautions for specific supplements taken to increase progesterone include the following:

• • Allergies: Avoid wild yam and red clover if you’re allergic to them or their components (parts). Seek immediate medical attention if you have a severe allergic reaction (itching, hives, shortness of breath).
  • Pregnancy and breastfeeding: Not enough safety data exists for wild yam use during pregnancy or breastfeeding. Avoid wild yam if you are pregnant or breastfeeding. Red clover contains isoflavones similar to estrogen, so avoid taking it during pregnancy or breastfeeding. Due to the potential hormonal effects of DIM, check with your healthcare provider before taking it if you are pregnant or breastfeeding. Avoid DHEA if you are pregnant or breastfeeding because it increases the male hormone called androgen.
  • Diabetes: If you have diabetes and are taking DHEA, it may impact your blood sugar levels.
  • High cholesterol or heart disease: DHEA may lower your high-density lipoprotein (HDL, also known as “good” cholesterol). Please speak with your healthcare provider before taking it if you have high cholesterol or heart disease.

• Mood conditions: DHEA may cause excitability, impulsiveness, and irritability. If you have a mood condition, please speak with your healthcare provider before taking DHEA.
• Hormone-sensitive conditions: Though your body is unable to make steroidal hormones such as estrogen from diosgenin, you may still want to avoid wild yam if you have hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids. Avoid DHEA if you have hormone-sensitive conditions that estrogen worsens, such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids. If you have polycystic ovary syndrome (PCOS), avoid taking DHEA, which can worsen it.
• Liver conditions: Avoid DHEA if you have liver problems, which may worsen them.

Interactions

Keep in mind the following interactions when considering progesterone supplements:

• DIM: DIM may interact with the medication Soltamox (tamoxifen) by decreasing blood levels of endoxifen, the active form of tamoxifen. Please check with your oncologist before starting any supplements if you take any prescription medications that affect hormones.
• Folic acid: Folic acid decreases the effects of Trexall (methotrexate), a medication taken for various conditions, including certain types of cancer, rheumatoid arthritis, and psoriasis.
  
• Zinc: Zinc decreases the absorption of some medications, such as quinolone antibiotics (such as Cipro, also known as ciprofloxacin), tetracycline antibiotics (such as Vibramycin, also known as doxycycline), Keflex (cephalexin), Platinol (cisplatin), and integrase inhibitors (medications for HIV/AIDS).

Dosage

The following includes dosages used in research studies and amounts needed according to dietary guidelines:

• Dehydroepiandrosterone (DHEA): DHEA should not be taken in doses higher than 50 to 100 milligrams (mg) daily or for an extended period due to the potential for an increased risk.
• Vitamin D: Vitamin D supplementation is safe at a dose of 4,000 international units (IU) per day for 24 to 28 weeks during pregnancy.
• Zinc: High doses of zinc may impair copper absorption and cause harm. Do not exceed 40 milligrams (mg) daily.

Consult your healthcare provider to avoid adverse effects or interactions before taking a progesterone supplement.

Alternative Ways to Support Your Progesterone Levels

In addition to supplements, lifestyle and therapeutic approaches may help support healthy progesterone levels.

Some of the following have better evidence to support their effectiveness than others:

• Acupuncture: A review showed that acupuncture had varying effects on progesterone levels. Further studies are necessary to confirm the results.
• Movement: Though daily movement is vital for health, it is essential not to overdo it. One study showed that progesterone levels decreased one hour after exercise in female athletes.
• Mindfulness and stress reduction: Both cortisol and progesterone are steroid hormones derived from the same starting material. When stressed, the body prioritizes the production of cortisol over progesterone. Therefore, progesterone production is low in times of stress. Mindfulness and stress reduction techniques such as yoga have decreased cortisol levels.
• Healthy fats: Because cholesterol is necessary for progesterone production, consuming healthy fats like avocado, nuts, and extra virgin olive oil may support progesterone production.
• Prescription medication: Prescription medication (progestins) intended as progesterone replacement therapy is another evidence-based option for increasing progesterone levels.

Please consult your healthcare provider to determine if any of the above suits you.

Progesterone Replacement Therapy

The following prescription medications are taken to increase progesterone levels:

• Progestin: This synthetic (human-made) form mimics the effects of progesterone. A healthcare provider usually prescribes it. It can be administered via oral capsules, topical gels, vaginal products (suppositories, inserts, capsules), or the Mirena IUD (intrauterine device).
• Bioidentical progesterone: This plant-derived progesterone is identical in structure and action to your body’s natural progesterone. Micronized progesterone is a commonly prescribed bioidentical form similar to the progesterone found in the ovaries.

Healthcare providers typically prescribe synthetic progesterone (known as progestin) to treat or prevent the following:

• • Endometriosis: Endometriosis is a condition in which the tissues lining the uterus grow outside the uterine cavity, causing pain and infertility. Healthcare providers prescribe progestins such as Depo-Provera (medroxyprogesterone acetate) or Mirena (levonorgestrel) to relieve endometriosis-associated pain.
  • Perimenopause: Perimenopause is the period before menopause when hormone levels begin to decrease. Significant symptoms, such as hot flashes, menstrual irregularities, and sleep disturbance characterize it. To manage such symptoms, some healthcare providers may prescribe hormone replacement therapy consisting of estrogen or a combination of estrogen and progesterone.
  • Menopause: Menopause is the absence of menstruation for 12 months without other known causes. Similar to perimenopause, hormone replacement therapy can manage menopausal symptoms such as hot flashes.
  • Premenstrual syndrome: Premenstrual syndrome (PMS) is associated with physical and behavioral symptoms that occur between ovulation and the onset of menstruation. Combined oral contraceptives consisting of ethinyl estradiol (synthetic estrogen) and drospirenone (progestin) have decreased the physical and emotional symptoms of PMS.

• Preterm labor: Preterm birth or labor is defined as delivery before 37 weeks of gestation. The International Federation of Gynecology and Obstetrics (FIGO) proposed the use of progesterone to prevent preterm birth.

Summary

Progesterone is a hormone essential for reproductive function, including the maintenance of pregnancy.

In addition to prescription progesterone medications and certain lifestyle and dietary strategies, supplements that purportedly support progesterone production include DIM, folic acid, red clover extract, zinc, and vitamin D.

It is important to consult with your healthcare provider before starting progesterone supplements because they may interact with certain prescription medications.