Latest / You Call This Normal? The Root Cause Fertility Podcast / Episode 13: Low Progesterone? It's Pointing at Something That Happened Months Ago.

Transcript

Episode 13: Low Progesterone? It's Pointing at Something That Happened Months Ago. · You Call This Normal? The Root Cause Fertility Podcast

• 0:00
  SPEAKER_00: Before we start, I want to tell you about the first move because if you've got a lab result sitting in your portal that nobody's explained, nobody's asked questions around, this is what it's for.
• 0:11
  SPEAKER_00: It is 60 minutes, one-on-one with me.
• 0:14
  SPEAKER_00: You don't have to prep anything.
• 0:16
  SPEAKER_00: You bring what you've got and I give you my read on it and tell you what to do next.
• 0:20
  SPEAKER_00: I record the call so you're not, you know, having to scribble down notes the whole time.
• 0:24
  SPEAKER_00: And you get a summary email afterwards.
• 0:27
  SPEAKER_00: It's$250.
• 0:28
  SPEAKER_00: And if you decide to work with me in Ascend within seven days, that$250 goes towards it.
• 0:34
  SPEAKER_00: So DM me the word move on Instagram at Neuroshista, or I'll put the link in the show notes.
• 0:39
  SPEAKER_00: Okay, progesterone.
• 0:42
  SPEAKER_00: Low progesterone gets treated like it is the diagnosis, like it is the thing.
• 0:48
  SPEAKER_00: It's a symptom.
• 0:50
  SPEAKER_00: And I want to drop that framing first because I think it's the reason that so many of us are getting stuck with this number.
• 0:57
  SPEAKER_00: Here's how it goes.
• 0:58
  SPEAKER_00: You get your labs back.
• 1:00
  SPEAKER_00: Somewhere in there is progesterone, and it's low.
• 1:03
  SPEAKER_00: And the explanation is some version of here, progesterone's low, here's a prescription.
• 1:09
  SPEAKER_00: Or some cycles are just like that.
• 1:11
  SPEAKER_00: Or and this is the one that bugs me the most.
• 1:14
  SPEAKER_00: Nothing.
• 1:14
  SPEAKER_00: Nobody says anything.
• 1:16
  SPEAKER_00: A number in the portal with a little flag next to it and not a word about what it means.
• 1:21
  SPEAKER_00: I'm not saying the prescription is wrong, and I am not that's not what I'm saying at all.
• 1:26
  SPEAKER_00: Progesterone support has a real place.
• 1:29
  SPEAKER_00: And if your doctor put you on it, there's usually a good reason.
• 1:32
  SPEAKER_00: What I'm saying is that nobody told you what the number is pointing at.
• 1:37
  SPEAKER_00: And once you know that, it stops being a mystery your body's keeping from you, and it starts being information that you can actually do something with.
• 1:44
  SPEAKER_00: So let me start where I always start when someone brings me a low progesterone result.
• 1:49
  SPEAKER_00: Progesterone isn't a hormone your body just decides to make or not to make on its own.
• 1:55
  SPEAKER_00: It's the result of something that's already happened.
• 1:58
  SPEAKER_00: It's the result of ovulation, and more specifically, it's the result of how good that ovulation was.
• 2:06
  SPEAKER_00: When you ovulate, the follicle that released your egg doesn't disappear.
• 2:12
  SPEAKER_00: It turns into a structure or an organ or whatever you want to call it called the corpus luteum.
• 2:17
  SPEAKER_00: The corpus luteum is what makes your progesterone in the second half of your cycle.
• 2:23
  SPEAKER_00: So how strong that corpus luteum is determines how much progesterone you make and how strong it is comes straight from how well that follicle developed before you ovulated.
• 2:37
  SPEAKER_00: So when someone says your progesterone is low, what that's saying underneath is the ovulation that came before this probably wasn't as strong as it could have been.
• 2:47
  SPEAKER_00: And this next part, it's going to reframe everything for me.
• 2:51
  SPEAKER_00: We're not talking about the day that you ovulated.
• 2:54
  SPEAKER_00: Follicles develop over roughly 90 days before they release.
• 2:58
  SPEAKER_00: The egg you ovulated this month started its development about three months ago, which means your nutrition, your stress, your thyroid, your blood sugar, your sleep from three months ago helped shape that specific follicle.
• 3:15
  SPEAKER_00: And that follicle shaped your corpus luteum.
• 3:18
  SPEAKER_00: And your corpus luteum set your progesterone.
• 3:21
  SPEAKER_00: So when we look at the number at the end, we're reading that number alone.
• 3:26
  SPEAKER_00: We're reading it without we're reading it like it's the last chapter of the book and it's the only part of the book we read.
• 3:33
  SPEAKER_00: And if we only ever treat it as the last chapter, we're gonna keep getting the same endings.
• 3:39
  SPEAKER_00: The other thing nobody tells you about ovulation is that it isn't a light switch.
• 3:45
  SPEAKER_00: It gets talked about like it is one.
• 3:47
  SPEAKER_00: Did you ovulate?
• 3:48
  SPEAKER_00: Yes or no?
• 3:48
  SPEAKER_00: But ovulation quality is really a spectrum.
• 3:52
  SPEAKER_00: You can ovulate and still make a progesterone level that isn't enough to hold a healthy luteal phase.
• 3:57
  SPEAKER_00: You can get a positive ovulation test every single month and still have follicles that aren't developing as fully as they could before they release the egg.
• 4:06
  SPEAKER_00: A positive ovulation test tells you your body sent the signal to ovulate.
• 4:12
  SPEAKER_00: It doesn't tell you how good the ovulation was, or it doesn't confirm that it actually happened.
• 4:18
  SPEAKER_00: And that difference does not show up on a standard workup.
• 4:22
  SPEAKER_00: It shows up later.
• 4:24
  SPEAKER_00: It shows up as low progesterone, or a luteal phase that's shorter than we would like it to be, or spotting a few days before your period starts.
• 4:32
  SPEAKER_00: If you're tracking with temperatures, it can show up as a temperature rise that's really slow to climb or kind of like wobbly instead of a clear shift.
• 4:43
  SPEAKER_00: It just kind of goes up and down like a seesaw.
• 4:45
  SPEAKER_00: I start paying attention when someone's luteal phase is consistently under 10 days.
• 4:49
  SPEAKER_00: That's a big red flag.
• 4:50
  SPEAKER_00: Can I say one practical thing about the test itself?
• 4:53
  SPEAKER_00: Because I don't want anybody to get tripped up on this.
• 4:55
  SPEAKER_00: Progesterone is usually tested around day 21 of your cycle, and day 21 works if you ovulate on day 14.
• 5:04
  SPEAKER_00: But let's be honest, most women don't ovulate on day 14.
• 5:07
  SPEAKER_00: If you ovulate on day 18 and you get tested on day 21, you're only three days past ovulation, so your progesterone hasn't even peaked yet.
• 5:14
  SPEAKER_00: So yes, it's going to be a low number.
• 5:16
  SPEAKER_00: It might just be early or it might just be late.
• 5:20
  SPEAKER_00: So what you want is a draw that is seven days post-ovulation, whatever cycle day that lands on for you.
• 5:28
  SPEAKER_00: So if you know roughly when you ovulate from tests or temperatures or both, that's worth bringing up with whoever is ordering your labs.
• 5:36
  SPEAKER_00: It's a small thing, it sounds like I know, but it can make such a big difference and it can change what the number actually means completely.
• 5:43
  SPEAKER_00: Okay, so if progesterone is downstream of the follicle, then what decides whether a follicle develops well or not?
• 5:52
  SPEAKER_00: There's a lot of pieces here, but there are three things that I'm looking at first, pretty much every time.
• 5:58
  SPEAKER_00: The first one is blood sugar.
• 6:00
  SPEAKER_00: I bring this up in almost every hormone conversation, and I'm not pushing an angle.
• 6:04
  SPEAKER_00: It's because the connection is real and almost nobody has had it explained to them.
• 6:09
  SPEAKER_00: Your ovaries respond to insulin.
• 6:11
  SPEAKER_00: Period.
• 6:12
  SPEAKER_00: Not just in PMOS, in everyone.
• 6:15
  SPEAKER_00: Insulin has a hand in how your follicles mature, and it has a hand in the environment your developing egg is sitting in for months.
• 6:23
  SPEAKER_00: Blood sugar instability in real life doesn't have to look dramatic.
• 6:28
  SPEAKER_00: It can look like coffee before food.
• 6:31
  SPEAKER_00: It looks like lunch maybe being the first real meal you've had that day.
• 6:36
  SPEAKER_00: It looks like two o'clock, three o'clock, four o'clock crash, whatever is closest and fastest, you suddenly want it like five minutes ago.
• 6:43
  SPEAKER_00: It looks like waking up at two in the morning, at three in the morning, and not being able to get back to sleep, which is often your body pulling cortisol to bring your blood sugar back up.
• 6:54
  SPEAKER_00: None of that feels like a fertility problem.
• 6:57
  SPEAKER_00: It feels like being a busy adult, but your body reads it as unstable fuel.
• 7:02
  SPEAKER_00: You have an unstable fuel supply, it's sending red alerts.
• 7:06
  SPEAKER_00: And nobody that thinks fuel is unstable is gonna go all in on something as expensive as growing a high-quality follicle or another human.
• 7:15
  SPEAKER_00: The second one is your thyroid, and this is where I see a huge gap in how a workup gets done.
• 7:20
  SPEAKER_00: If you've been told your thyroid's normal, my first question is what did they test?
• 7:24
  SPEAKER_00: Because if it was only TSH, that's an incomplete picture for fertility.
• 7:28
  SPEAKER_00: TSH, she's a messenger.
• 7:31
  SPEAKER_00: It's your brain telling your thyroid how hard to work.
• 7:33
  SPEAKER_00: It does not tell you or me what your thyroid is producing or how well your body is turning that into the form that it can use.
• 7:41
  SPEAKER_00: Your thyroid makes mostly T4, which is pretty inactive.
• 7:46
  SPEAKER_00: That has to be converted, converted, converted into T3, which is the active form, the one that does the work in your cells.
• 7:54
  SPEAKER_00: And that conversation depends on your stress, your inflammation inflammation levels, and your nutrient status.
• 8:02
  SPEAKER_00: And why does that matter for progesterone?
• 8:04
  SPEAKER_00: Your ovaries have thyroid receptors, and thyroid hormones play a role in how your follicles develop.
• 8:11
  SPEAKER_00: So you can walk around with a perfectly normal TSH thinking your thyroid has been ruled out while you're walking around with your T3 being low and it's quietly holding your follicles back from being their true selves.
• 8:24
  SPEAKER_00: If your workup was TSH only, there's more to look at.
• 8:29
  SPEAKER_00: So get free T3, free T4, reverse T3, and thyroid antibodies checked.
• 8:36
  SPEAKER_00: That's the full picture of the thyroid.
• 8:38
  SPEAKER_00: The third one is stress.
• 8:40
  SPEAKER_00: This is a tricky one.
• 8:41
  SPEAKER_00: I'm not gonna tell you stop stressing out, chill.
• 8:46
  SPEAKER_00: I don't know what else, because that is absolutely useless.
• 8:49
  SPEAKER_00: I want to give you the mechanism.
• 8:52
  SPEAKER_00: Your body makes several hormones from a starting material called pregnanolone.
• 9:00
  SPEAKER_00: Progesterone is one of them.
• 9:02
  SPEAKER_00: Cortisol, your main stress hormone is another one of those.
• 9:06
  SPEAKER_00: Whether your stress signaling is high at the time, your body prioritizes cortisol.
• 9:12
  SPEAKER_00: Because dealing with a threat outranks reproduction.
• 9:16
  SPEAKER_00: Keeping yourself alive is your body's top priority.
• 9:19
  SPEAKER_00: So more of that starting material, the kindling for that fire, gets pulled towards cortisol, and your progesterone downstream is gonna take a hit.
• 9:29
  SPEAKER_00: It just is.
• 9:30
  SPEAKER_00: Which, when you think about it, is a pretty rational call for your body to make, although frustrating, but it's making the call with the information that it's getting.
• 9:39
  SPEAKER_00: And then there's a second layer to this cake: chronic stress.
• 9:42
  SPEAKER_00: It weakens the signal from your brain that supports the corpus luteum throughout your luteal phase.
• 9:48
  SPEAKER_00: So it makes less progesterone.
• 9:50
  SPEAKER_00: When you understand how all of this is connected, then reduce your stress stops being something you don't take seriously, or something that feels like a guilt trip.
• 10:04
  SPEAKER_00: It becomes a real strategy.
• 10:06
  SPEAKER_00: Sleep, blood sugar, nervous system work.
• 10:08
  SPEAKER_00: What we talked about in the NSDR episode, I'd put those at the top of the list, not at the bottom, as some, I don't know, nice extra to have.
• 10:17
  SPEAKER_00: I would really move up your nervous system practice.
• 10:19
  SPEAKER_00: And I will name inflammation quickly because it sits underneath a lot of this.
• 10:24
  SPEAKER_00: Inflammation changes how your hormones signal and what environment in your uterus and what the environment inside of your uterus looks like.
• 10:33
  SPEAKER_00: And it can come from your gut, your sleep, your blood sugar, things in your environment, things that nobody's ever given a name to.
• 10:40
  SPEAKER_00: When low progesterone is showing up and you are running high with inflammation, I don't think that's a coincidence or a weird synchronicity.
• 10:52
  SPEAKER_00: I think it's kind of part of the terrain.
• 10:54
  SPEAKER_00: So if you walk away with anything from this episode today, it should be low progesterone is a signal.
• 11:02
  SPEAKER_00: It's a symptom, it's a result with a story behind it.
• 11:06
  SPEAKER_00: And the story is about how your follicle developed, how supported your ovulation was, what kind of environment your hormones have been living in for the last 90 to 120 plus days.
• 11:19
  SPEAKER_00: When it gets treated like a diagnosis, a number to match with a supplement and move on, that whole story is getting skipped.
• 11:29
  SPEAKER_00: And it's a really important one.
• 11:31
  SPEAKER_00: The story is where the help is.
• 11:33
  SPEAKER_00: The work I care about is upstream, going back to the follicle, the blood sugar, the thyroid, the stress, and your inflammation levels.
• 11:41
  SPEAKER_00: When those all get supported, progesterone often comes up on its own because when we change the conditions that we're holding it down, and that can also happen alongside whatever your doctor has you on or has you doing.
• 11:54
  SPEAKER_00: It's not an either-or situation.
• 11:56
  SPEAKER_00: If you want a place to start this week, look at your breakfast.
• 12:00
  SPEAKER_00: Is there protein in it?
• 12:02
  SPEAKER_00: Is it before coffee or after?
• 12:04
  SPEAKER_00: Is it within an hour of waking in the morning?
• 12:08
  SPEAKER_00: And look at your thyroid panel.
• 12:10
  SPEAKER_00: Pull up the actual results and see what was tested because I want all of those things that I mentioned earlier to be in there.
• 12:17
  SPEAKER_00: Free T3, free T4, reverse T3, and thyroid antibodies, not just TSH.
• 12:23
  SPEAKER_00: And if you want help with the blood sugar side of this, what to eat in your luteal phase, how to build breakfast, how to eat for the labs you've got, that's what the Neurashista AI does.
• 12:34
  SPEAKER_00: You tell it where you are in your cycle, what your labs show, and it builds your meals around that.
• 12:40
  SPEAKER_00: 67 a month for founding members.
• 12:43
  SPEAKER_00: DM me the word nourish on Instagram at Nourishista, or I'll pop the link in the show notes.
• 12:48
  SPEAKER_00: Okay, I'll see you next week.