Polycystic Ovarian Syndrome (PCOS) is a term that describes the underlying hormonal imbalances that cause an array of symptoms like irregular periods, acne, body hair growth, and weight troubles.
While PCOS causes dysfunction of estrogen, progesterone, testosterone, luteinizing hormones, and insulin, one of the hallmarks of PCOS is an ovulation (not releasing an egg from the ovary) and that right there will cause low progesterone.
Progesterone is a common topic our patients want to talk about when they are having fertility struggles. Some experts describe PCOS as a disease of “progesterone deficiency”. Why is progesterone so important anyway? Well, you can’t have a normal pregnancy or even maintain a pregnancy without progesterone. The presence of progesterone is what stops you from getting your period or having a miscarriage.
Progesterone comes from the ovaries. It should be highest in the luteal phase of our cycles, after ovulation, and be lowest during our period. Progesterone’s job is to maintain the uterine lining, creating a soft, fluffy place for an embryo to land. If progesterone is too low, the body won’t be able to make a healthy lining and an embryo has no place to implant. If progesterone drops too quickly or doesn’t stay high enough, this can even trigger an early miscarriage.
Now you may be asking, “why am I having such heavy periods if my progesterone is LOW?” This is because your ovaries are making plenty of estrogen, and growing a thick lining inside your uterus, but the progesterone isn’t there to make it normal and healthy. One way to think about it is that estrogen lays the bricks and progesterone puts in the mortar. Having lots of estrogen means a lot of unstable tissue that is easy to knock down, or in other words, long, heavy and uncomfortable periods.
This is why many conventional doctors put patients on birth control pill when they have PCOS1; if they can override your whacky hormones, they can get you bleeding regularly and less heavily. The problem with this approach: it doesn’t help you get pregnant and it certainly doesn’t fix the underlying cause of PCOS.
For our PCOS patients, we have a very different approach based truly on the underlying cause of why their progesterone levels are out of balance. We need to help their bodies get the message to ovulate and release healthy amounts of progesterone every single month. And while progesterone is certainly a part of that equation, we also have to look at bringing balance to ALL the hormones. This means lowering androgens (like testosterone and DHEA), balancing estrogen and progesterone and helping make the lining inside the uterus respond better to the hormones in the bloodstream.
Ultimately, our job is to help our patients live healthier lives and grow the families they have always dreamed about. Helping women clear up their skin, have predictable and uneventful periods, and experience a healthy, happy pregnancy is what we do every day. We will definitely order labs and review results with a fine-toothed comb (and have a great time doing that because we are total nerds about this stuff!); but we are always thinking about the woman sitting in our office and how her life will be different after we help her figure all this out.
If you are looking for a doctor who works with you and helps you understand how to be in control of your PCOS, schedule a FREE consult call with one of us! We’d love to chat about where you are at in your fertility journey and how we can help smooth the way.
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Lua ACY, How CH, King TFJ. Managing polycystic ovary syndrome in primary care. Singapore Med J. 2018;59(11):567-571. doi:10.11622/smedj.2018135
Endometrial progesterone resistance and PCOS | Journal of Biomedical Science | Full Text. https://jbiomedsci.biomedcentral.com/articles/10.1186/1423-0127-21-2. Accessed April 16, 2019.