February 21


The Unique Link Between Fatigue And Low Progesterone

Low progesterone is a common cause of fatigue. But progesterone levels isn't the first thing women tend to think of. Keep reading to learn how stress can create low progesterone and contribute to long-lasting fatigue.

By Amy Vespa, MS - Integrative Clinical Nutritionist

February 21, 2022

minutes read time


Fatigue is one of those very common, frustrating symptoms. It can have so many potential causes that it is hard to know where to begin! Today I want to talk about a potentially overlooked reason for fatigue – low progesterone. 

Progesterone is well known as the pregnancy hormone because of its welcome increase during pregnancy. It helps maintain the pregnancy and also has a calming effect (this is why some women love to be pregnant). But progesterone is more than that! It has an important role in the entire female reproductive system. When it is out of balance you can feel it in a variety of ways, including fatigue. 

In this article I will discuss the role of progesterone, how to find out if this is an issue for you, and ways to reduce progesterone fatigue.

Progesterone deficiency symptoms

Before I go into what it is, let’s look at the symptoms of imbalance. These symptoms overlap with estrogen dominance (which I explain below). Common symptoms:

  • menstrual irregularities 
  • PMS symptoms, sometimes for up to 2 weeks before your period
  • moodiness, anxiety
  • headaches
  • low libido
  • brain fog
  • weight gain
  • acne
  • hair loss
  • infertility 
  • trouble sleeping

Do you experience any of these? If yes, then you’ll want to learn more about the effects of progesterone!

What is progesterone

Progesterone is one of the two main female reproductive hormones along with estrogen. It is mainly produced in the ovaries and adrenal glands. This “pregnancy hormone” prepares the uterus for pregnancy and plays a major role in maintaining pregnancy.

There is a delicate balance between progesterone and estrogen during the monthly menstrual cycle. Both hormones rise and lower during different parts of the cycle. Estrogen peaks during days 7-16 of the cycle with  lower progesterone, and progesterone peaks during days 17-26 while estrogen lowers (this is the luteal phase).

When one of these is not at optimal levels, it throws the other off as well. Two big reasons for low progesterone are excess estrogen and stress.

Excess estrogen means low progesterone 

By default, low progesterone means there is too much estrogen. However, this can happen when there is too much estrogen being made OR when there is too low progesterone (which means there is too much estrogen left over). It is the same outcome but with different causes. 

Let’s look at estrogen for a moment. It is produced in adrenal glands, fat cells, and ovaries and is used to prepare the uterus for pregnancy, plays a major role in bone and hearth health, and promotes serotonin production. After it is used it is excreted through the digestive tract. 

When  there is too much estrogen it can cause:

  • moodiness 
  • weight gain
  • inability to lose weight 
  • acne

Excess estrogen (sometimes called estrogen dominance) can be caused by high stress, PCOS, or high sugar consumption. Also, constipation can lead to estrogen being reabsorbed, leading to too much in circulation.

Progesterone is made to oppose estrogen and keep it from getting too high. One natural reason for low progesterone is perimenopause and menopause. Another major reason is chronic stress, so let’s look at that now.

Stress and low progesterone

Progesterone is decreased during chronic stress because of cortisol. During times of stress, the adrenals release cortisol as a way to respond to the stressor, which is a very important response for life! The problem occurs when the demand for cortisol gets too large, such as during ongoing stress.

The adrenal glands produce a hormone called pregnenolone. Pregnenolone is used to make progesterone and then cortisol. Progesterone is not necessary for life but cortisol is, so when more and more cortisol is needed, the body will divert resources to creating more cortisol. 

The increase in cortisol means there is going to be less progesterone being created. This is how low progesterone and adrenal fatigue are connected. 

Do you experience progesterone fatigue?

Now that you have an understanding of progesterone and adrenal fatigue, how can you know if this applies to you? 

  • Have you experienced high and/or ongoing stress (remember ‘stress’ means – busy-ness, poor sleep, constantly going each day, emotional difficulties, poor food quality, annoying boss, when your kids are going through a tough time, finances, etc…)
  • Do you have digestive issues, especially constipation?
  • Is your cycle irregular?
  • Are you constantly fatigued and can’t figure out why?

Any of these can give you a clue about needing to increase progesterone.

One way to know for sure is to get tested – get progesterone tested during your luteal phase, around days 14-28 of your cycle. This is when progesterone should be the highest.

Even without testing there is a lot you can do to support optimal progesterone levels (and your hormones in general):

  • focusing on managing stress
  • supporting your adrenals
  • eating whole, colorful foods
  • focusing on stress (it needed to be mentioned again!)

Increasing progesterone to reduce fatigue

Increasing progesterone by reducing stress and supporting your adrenals is a big task! But there are specific nutrients and lifestyle habits that can help support you during the process. 

B-complex: B vitamins in general are important for energy. Stress and digestion difficulties can decrease these vitamins quickly. Specifically, Vitamin B6 helps increase progesterone while also reducing excess estrogen. Vitamin B5, found in high levels in adrenals glands, helps balance cortisol production. B12 is important for energy, mood, and nerve function.

Magnesium glycinate: Magnesium is important for over 300 body processes and is quickly depleted during stress. It seems contradictory, but this nutrient can increase energy, calm you down, decrease anxiety, and improve low mood (as well as much more). 

Adaptogenic herbs: Ashwagandha, tulsi, and reishi mushrooms (among many others) help your body balance the HPA axis (your stress response), promote sleep, and reduce the effects of stress. They are most helpful when used daily as a tea, capsule, or tincture. (Check out my article on stress and teas for options.

Chasteberry (vitex): Chasteberry has a long history of use for regulating female reproductive hormones by encouraging the body to make more progesterone. 

Fiber: Fiber and hydration will help keep the bowels moving so estrogen cannot be absorbed back into circulation. Vegetables and whole grains are great sources of fiber. Or, add 1-2 tablespoons of ground flaxseed to oatmeal, cereal, or a glass of water for a large dose of fiber. 

Diaphragm breathing: Also called belly breathing, this technique is deeply calming and rejuvenating at the same time. We are accustomed to shallow breathing (only moving the chest), which is linked to higher stress levels and anxiety. Diaphragm breathing slows our breath and calms our nerves by focusing on deep, rhythmic breaths. Here is a good tutorial.)

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