Hormone Biomarkers: Progesterone in Women

Optimal Takeaways

Progesterone is an important hormone that helps maintain fertility and a healthy pregnancy but also supports cardiovascular, neurological, and bone health. Low levels are associated with infertility, miscarriage, ovarian dysfunction, PCOS, and mood changes. High levels of progesterone are seen following ovulation, with pregnancy, and with ovarian cysts, hyperadrenocorticalism, and adrenocortical hyperplasia.

Standard Ranges (Immunoassay)

• Follicular Phase: <1.0 ng/mL (3.18 nmol/L)
• Luteal Phase: 2.6-21.5 ng/mL (8.27 – 68.37 nmol/L)
• Postmenopausal: <0.5 ng/mL (1.59 nmol/L)

Pregnancy

• First Trimester: 4.1-34.0 ng/mL (13.04 – 108.12 nmol/L)
• Second Trimester: 24.0-76.0 ng/mL (76.32 – 241.68 nmol/L)
• Third Trimester: 52.0-302.0 ng/mL (165.38 – 960.36 nmol/L)

Low progesterone may be associated with menopause, preeclampsia, amenorrhea, and ovarian hypofunction or neoplasm (Pagana 2021). Insufficient progesterone is associated with a luteal-phase deficiency that can cause infertility and miscarriage (Piette 2018), and reduced progesterone can be seen with PCOS (Unfer 2005). Low progesterone may be associated with PCOS (Unfer 2005), as well as aggressive behavior and fatigue during the premenstrual period (Taraborrelli 2015).

High progesterone may be associated with ovulation, pregnancy, luteal ovarian cysts, hyperadrenocorticalism, and adrenocortical hyperplasia (Pagana 2021). Progesterone in general may inhibit sexual desire in women (Taraborrelli 2015). Higher progesterone was associated with prediabetes and type 2 diabetes in men and postmenopausal women (Jiang 2019).

Overview

Progesterone is a steroid hormone produced from cholesterol in the gonads and adrenal glands. It plays an important role in fertility as a facilitator of pregnancy in females and of spermatozoa function in males. Progesterone also has direct effects on the bones and the cardiovascular and nervous systems and is considered neuroprotective. Its use as a therapeutic agent in cerebral edema, Alzheimer’s disease, diabetic neuropathy, and osteoporosis is being explored (Taraborrelli 2015).

Progesterone and its metabolites have anesthetic, analgesic, antidepressant, anxiolytic, and anticonvulsant effects as well, and may regulate sleep and reduce sleep disturbances (Piette 2018). Systemically progesterone increases diuresis, triggers catabolic metabolism, increases basal body temperature, relaxes smooth muscle, and supports visual memory (Regidor 2014).

Progesterone also plays an immunomodulatory role which may affect the increased risk of autoimmune disorders associated with the female gender, though further research is warranted (Hughes 2012).

Progesterone is crucial to the maintenance and preparation of the uterus for pregnancy. While it remains very low in the follicular phase of the menstrual cycle, levels increase following ovulation and peak during the luteal phase. In the event of a pregnancy, progesterone levels rise as the placenta takes over production from the corpus luteum (Pagana 2021). Luteal phase defect may impair the endometrium’s ability to sustain a pregnancy and a luteal phase progesterone of 15 ng/dL (47.7 nmol/L) or below may contribute to the condition. However, a luteal phase level consistently above 15 ng/mL should rule out this disorder (Young 2010).

It is important to remember that serum testing of progesterone is a general “spot check” and more detailed testing should be conducted if dysfunction is suspected.

References

Hughes, Grant C. “Progesterone and autoimmune disease.” Autoimmunity reviews vol. 11,6-7 (2012): A502-14. doi:10.1016/j.autrev.2011.12.003

Jiang, Jingjing et al. “The effect of progesterone and pregnenolone on diabetes status in Chinese rural population: a dose-response analysis from Henan Rural Cohort.” European journal of endocrinology vol. 181,6 (2019): 603-614. doi:10.1530/EJE-19-0352

Pagana, Kathleen Deska, et al. Mosby's Diagnostic and Laboratory Test Reference. 15th ed., Mosby, 2021.

Piette, P. “The history of natural progesterone, the never-ending story.” Climacteric : the journal of the International Menopause Society vol. 21,4 (2018): 308-314. doi:10.1080/13697137.2018.1462792

Quest Progesterone Immunoassay Ranges.

Regidor, P-A. “Progesterone in Peri- and Postmenopause: A Review.” Geburtshilfe und Frauenheilkunde vol. 74,11 (2014): 995-1002. doi:10.1055/s-0034-1383297

Taraborrelli, Stefania. “Physiology, production and action of progesterone.” Acta obstetricia et gynecologica Scandinavica vol. 94 Suppl 161 (2015): 8-16. doi:10.1111/aogs.12771

Unfer, Vittorio et al. “Different routes of progesterone administration and polycystic ovary syndrome: a review of the literature.” Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology vol. 21,2 (2005): 119-27. doi:10.1080/09513590500170049

Young, Steven L, and Bruce A Lessey. “Progesterone function in human endometrium: clinical perspectives.” Seminars in reproductive medicine vol. 28,1 (2010): 5-16. doi:10.1055/s-0029-1242988