The role of progesterone in a woman’s body, concentration in the blood in different phases of the menstrual cycle

Progesterone: phases of the menstrual cycle

Estrogen and progesterone: phases of the menstrual cycle

With the onset of menstruation, during the follicular phase, this hormone is produced in small quantities.

Around the 14th–15th day of menstruation, during the ovulatory phase, hormone levels begin to rise. When the follicle on the ovary bursts and an egg is released, the luteal phase begins. The burst follicle turns into a corpus luteum and begins to produce the “pregnancy hormone”.

During this period progesterone in the blood increases, which is normal for a healthy female body. A high level of this hormone is a signal to the body that it needs to prepare for pregnancy.

Further developments are possible according to one of the scenarios:

If the expectant mother’s body is healthy and produces the “pregnancy hormone” in sufficient quantities, its concentration increases hundreds of times. From the 16th week, sometimes earlier, the placenta begins to produce this hormone. Before this, it is produced by the corpus luteum. The effect of progesterone on the uterus is very important in the second half of the menstrual cycle: the hormone reduces the number of its contractions, and, accordingly, the likelihood of miscarriage decreases.

When does the hormone level decrease?

• Threat of miscarriage
• Galactorrhea-amenorrhea (absence of menstruation)
• Insufficiency of phase 2 of the cycle
• Menopause

Threat of miscarriage

Trouble in the development of the fetus immediately affects the woman’s hormonal background. When there is a threat of miscarriage, the placenta begins to work worse, releasing less progesterone and other hormones. Frozen pregnancy and the onset of premature labor can also be accompanied by changes in hormonal levels. But there are no clear criteria by which to distinguish between normal and pathological. Therefore, measuring progesterone levels during pregnancy, when there is a suspicion of a threat of miscarriage, is inappropriate. There are more accurate and reliable methods (ultrasound, hCG level, CTG).

Galactorrhea-amenorrhea

The combination of two main symptoms - cessation of menstruation and release of milk from the breast - usually indicates a state of hyperprolactinemia. This condition develops with tumors and injuries of the pituitary gland, which leads to an increase in prolactin and a decrease in ovarian sex hormones. Data from tests and MRI of the brain can confirm the diagnosis and prescribe treatment (bromocriptine).

Insufficiency of the luteal (second) phase

Despite the different lengths of the cycle in women, its second phase normally lasts 14 days. This is exactly how long the corpus luteum lives after ovulation. It is formed at the site of a ruptured follicle and actively synthesizes progesterone until its disappearance or transition to the corpus luteum of pregnancy. Sometimes the luteal phase lasts less than 14 days, which leads to a shortening of the cycle and, possibly, problems with bearing a child.

Most often, the cause of such dysfunction is metabolic disorders. Therefore, in addition to infertility, an enlarged thyroid gland (with hypothyroidism) or milk secretion from the breast (with hyperprolactinemia) is diagnosed. These syndromes cause hormonal imbalance, reducing the level of progesterone in the blood.

The main problem with NLF is the rapid onset of menstruation. That is, even if the egg is fertilized, the fertilized egg does not have time to attach to the uterus, as it is rejected along with the endometrium. Until now, scientists have not come to a final conclusion to what extent an inadequate second phase reduces the percentage of successful conception. But if NLF is suspected, progesterone levels are also checked along with other hormones.

The diagnosis can be rejected if the interval from ovulation to menstruation lasts more than 11-14 days. If NLF is suspected, in addition to treatment of the underlying disease (thyroid gland, pituitary gland), the administration of medicinal progesterone may be prescribed for the purpose of achieving and carrying a pregnancy.

Menopause

At the age of 45-55, colossal changes occur in a woman’s body. The ovaries decrease in size and lose sensitivity to hormones. As a result, the level of estrogen and progesterone decreases. This leads to mood changes, hot flashes, decreased libido, a tendency to fractures and the development of atherosclerosis. The main symptom of menopause is the cessation of menstruation. This age-related phenomenon is normal, but if it begins too early or is accompanied by a serious deterioration in health, then, in the absence of risks of cancer, the doctor may prescribe estrogen hormone replacement therapy.

When should I get tested?

Any test must be taken at the “correct” time. This also applies to this hormone. Since its concentration increases in the second half of the menstrual cycle, the appropriate time for analysis is the period after ovulation.

If you want to find out what concentration of progesterone is in your blood and when to take it, an ovulation test will tell you. Usually the test is taken on the 22nd–23rd day after the start of menstruation - with a 28-day cycle. If the cycle is longer (for example, 35 days), then it is taken on the 28th–29th day.

In any case, consult your doctor: he will prescribe a progesterone test and tell you on which day of the cycle it is best to take it.

With a regular cycle, the level of this hormone is analyzed seven days before the start of menstruation. When the cycle is irregular, measurements are taken several times. If a woman keeps a basal temperature chart, then blood is donated on the 6th or 7th day after its increase.

Blood for progesterone , as well as for other hormones, must be donated no earlier than 6–8 hours after the last meal. It is best to do this in the morning on an empty stomach.

Progesterone: normal in women

The units in which laboratories measure hormone levels are ng/ml or nmol/l. Their full name is nanograms per milliliter or nanomoles per liter. To convert ng/ml to nmol/l, you need to multiply the value in ng/ml by 3.18.

If the body of childbearing age produces this hormone in sufficient quantities, the norm in women ranges from:

• follicular phase - 0.32–2.23 nmol/l;
• ovulatory phase - 0.48–9.41 nmol/l;
• luteal phase - 6.99–56.63 nmol/l.

After menopause, the hormone level does not rise above 0.64 nmol/l. This hormone is produced in much larger quantities when carrying a child, its norm is:

• I trimester - 8.9–468.4 nmol/l;
• II trimester - 71.5–303.1 nmol/l;
• III trimester - 88.7–771.5 nmol/l.

If you take any medications while carrying a child and are tested for progesterone, be sure to inform the laboratory assistant about this. He will make the necessary notes to correctly decipher the indicators.

is produced at different rates during the weeks Accordingly, the concentration of the hormone in the blood fluctuates. In addition, in various medical sources, hormone norms by week of pregnancy differ significantly. If your blood test results are different from those shown, don't worry.

Normal for men

In men, the level of this hormone is normally low, it ranges from 0.32–0.64 nmol/l.

Amount in the blood of a pregnant woman

Multiple unsuccessful attempts to conceive a child and frequent miscarriages are an obvious indication of the need to track the amount of hubbub. The fact is that fertilization of an egg with a sperm is not a 100% guarantee of success. If progesterone is below normal, the uterus will not be able to accept the egg. The hormone must “prepare the ground” and then block uterine contractions. Otherwise, the embryo will be perceived by the female body as a foreign body and rejected as a result of active uterine spasms.

The normal amount of progesterone in women in the first trimester of pregnancy, that is, from weeks 1 to 13, is 14.9-107.9 nmol/l. Then the hormone level increases rapidly every day and already in the second trimester (14-27 weeks) reaches 61.7-159 nmol/l. This trend continues almost until the very end of the third trimester. Having taken the test at about 38 weeks, you can see a result of 500-509 nmol/l.

The situation changes dramatically just before childbirth. To push the fetus out, the uterus needs to contract, and the high level of progesterone in the blood simply will not allow contractions to begin. That is why, when the baby is ready to be born, the level of progesterone begins its sharp peak.

When it drops to 2.3 nmol/L, it means there are two days left before delivery. The hormone will no longer fall below this mark - the female body still needs it, because now the substance should stimulate lactation.

Progesterone is reduced

If conception has occurred, and there is a lack of this hormone in the body, the body of the expectant mother does not “know” that she needs to prepare for pregnancy. A new monthly cycle begins, and the body rejects the fertilized egg in the uterus. Thus, a lack of progesterone can cause miscarriage in the first trimester.

A lack of the hormone can also be observed during a short luteal phase, when less than 10 days pass from ovulation to the start of the next menstruation. The duration of the luteal phase can be calculated using a basal temperature chart.

If after ovulation the hormone level is reduced, this indicates a hormonal imbalance. Its reasons may be:

• insufficient function of the corpus luteum and placenta;
• uterine bleeding not associated with menstruation;
• miscarriage;
• post-term pregnancy;
• chronic inflammation of the reproductive system;
• intrauterine growth retardation;
• taking certain medications.

In such cases, among other things, treatment with progesterone in dosage form is prescribed.

Progesterone is increased

In women, the level of this hormone in the blood begins to rise in the middle of the menstrual cycle. During this period, the body prepares for a possible pregnancy. When the level is elevated, body temperature rises, including basal temperature.

An increased level may occur with:

• pregnancy;
• renal failure;
• uterine bleeding (not menstruation);
• deviations in the development of the placenta;
• corpus luteum cyst;
• absence of menstruation for more than 6 months;
• production of insufficient or excessive amounts of hormones in the adrenal glands;
• taking certain medications.

When the blood concentration of this hormone is low, medications are prescribed. Taking progesterone can cause side effects: high blood pressure, nausea, swelling.

Drugs are not prescribed if a woman has:

• vaginal bleeding;
• liver function is impaired;
• breast tumor.

Prescribe with caution in the following cases:

• diabetes mellitus;
• impaired kidney function;
• epilepsy;
• heart failure;
• migraine attacks;
• depression;
• bronchial asthma;
• breastfeeding;
• ectopic pregnancy.

A specialist can prescribe treatment only after an analysis. The dosage form in which the patient will take the drug - injections or tablets - is chosen by the doctor.

Types of injection solutions: progesterone 2.5%, progesterone 2% and progesterone 1%. In these preparations, the hormone is contained in a solution of olive or almond oil. The shelf life of the drug solution is 5 years from the date of manufacture.

Progesterone 1%, 2% and 2.5%, which is administered intramuscularly or subcutaneously, acts on the body faster and more effectively than tablets.

The form in which progesterone is most often prescribed is injections . The doctor may prescribe a drug if your period is late to correct the hormonal balance. If your hormonal balance is disturbed, then this hormone, when your period is delayed, resumes the normal cycle. If you are pregnant and there is a risk of miscarriage, then it will help preserve the fetus.

When do progesterone levels increase?

In some cases, the amount of the hormone exceeds the norm for a given phase of the menstrual cycle. The reasons for this can be both a variant of the norm and a sign of pathology.

• Pregnancy (normal)
• CCA (congenital adrenal dysfunction)
• Ovarian tumors
• Hydatidiform mole
• Taking progesterone drugs (Utrozhestan, Iprozhin)

The role of the hormone in the onset and maintenance of pregnancy

Pregnancy is considered a “progesterone-dominant” state, that is, the concentration of this hormone in the blood significantly exceeds the level of estrogen, at least until 34-36 weeks.

Progesterone ensures the preparation of the endometrium for the attachment of the fertilized egg, and subsequently reduces the “reactivity” of the uterus, that is, it prevents it from spontaneously contracting under the influence of estrogens. As a result, a securely attached embryo grows and develops until birth. In addition, there is evidence of the immunomodulatory properties of this substance, that is, the hormone indirectly protects the fetus from attack by the maternal immune system.

When a pregnant woman has increased progesterone, symptoms of impaired digestion may appear in the early stages. Constipation occurs most often. This is a normal phenomenon associated with changes in intestinal function under hormonal influence. When your health worsens, microenemas approved for pregnant women or taking Lactulose (Duphalac, etc.) usually help. After the baby is born, digestion returns to normal.

Congenital dysfunction of the adrenal cortex

VDKN or adrenogenital syndrome is a hereditary disease in which the synthesis of sex hormones in the adrenal glands is disrupted. Most cases of the disease are associated with a mutation in the P450c21 gene; this condition is inherited from both parents.

As a result of enzyme malfunction, some adrenal hormones are synthesized insufficiently (cortisol, aldosterone), while others are produced in excess (ACTH and sex hormones).

There are several forms of the disease, varying in severity and age of first symptoms:

• salt-wasting
• simple virile
• non-classical

The first two forms are most often detected immediately after birth. With virile dysfunction, girls have pseudohermaphroditism. This is a change in the shape and size of the clitoris, sometimes even leading to incorrect gender determination in the maternity hospital. Moreover, all internal genital organs (uterus, ovaries) have a normal structure. All patients need treatment, without which primary amenorrhea develops - that is, when puberty is reached, menstruation does not come.

The salt-wasting form of the disease is even more severe. Pseudohermaphroditism is accompanied by an electrolyte imbalance - from the first days of life, vomiting occurs, the body loses salts, and dehydration occurs. Without proper hormonal therapy, the baby can quickly die.

Women with the third type of disease - the non-classical form - usually grow and develop completely normally. They are often brought to see a gynecologist or endocrinologist by skin conditions (acne), increased hair growth, infrequent menstruation and futile attempts to get pregnant.

Diagnosis - the main laboratory sign of the disease, including the non-classical form (nCDCN), is an increase in the level of 17OH-progesterone. The norm for women is no more than 5 nmol/l. If this value exceeds 15 nmol/l on the 3-4th day of the cycle, then the diagnosis can be made with a high degree of probability. At intermediate values, additional tests with synacthen are often required, when after its administration 17OH-progesterone should not exceed 30 nmol/l.

We must not forget that 17OH-progesterone may increase slightly in the second phase of the menstrual cycle (after ovulation) and during pregnancy. Therefore, the definition of this substance in pregnant women does not make any sense.

Treatment of nVDCN is carried out only in cases of pronounced cosmetic defects (severe acne, for example) and in case of infertility. Oral contraceptives and corticosteroids are commonly used. More than half of women with this non-classical form successfully conceive, bear and give birth to children without any therapy.

If a mutation is proven, it is necessary to check the partner for a similar disorder. After all, if the gene defect is repeated in both parents, then the child may also inherit a severe form of the disease - salt-wasting disease.

Hydatidiform mole

Unfortunately, the level of the hormone increases not only during normal pregnancy, but also during a serious condition - hydatidiform mole. This occurs when an egg is fertilized by two sperm, or when the original maternal material is defective. In this case, chorion tissue actively “eats” into the uterus, grows, and releases hCG. As a result, all pregnancy hormones increase many times over. This disease is usually easily diagnosed by ultrasound and human chorionic gonadotropin levels. Chemotherapy is successfully used for treatment, since there is a risk of degeneration into a malignant tumor.

Taking progesterone medications

Hormonal support is often prescribed to treat certain conditions or prepare for IVF. This may be the introduction of progesterone or hCG drugs. In both cases, the level of the hormone in the blood plasma increases, so only a doctor can interpret it.

OH-progesterone

OH-progesterone (other names: 17-OH-progesterone, 17-OH, 17-alpha-hydroxyprogesterone, 17-OPG), contrary to popular belief, is not a hormone. It is a product of the metabolism of steroid hormones, which is secreted by the ovaries and the adrenal cortex. This is a kind of “semi-finished product” from which important hormones are formed. OH-progesterone is elevated or decreased during pregnancy A blood test during this period does not provide any useful information to the doctor. It is important what level of progesterone the baby has after birth.

Excess and deficiency

Since the hormone progesterone is responsible for the functioning of the reproductive system, its lack primarily affects its functioning: disruptions in the menstrual cycle appear, the uterus becomes unable to accept a fertilized egg, and a woman cannot become pregnant.

If conception does occur, the risk of miscarriage remains throughout the pregnancy. Low levels negatively affect the functioning of the mammary glands.

With prolonged imbalance, fibrous nodes begin to form in the mammary gland.

A high level of the described hormone in a non-pregnant woman occurs in the presence of malignant neoplasms or corpus luteum cysts in the ovaries; it may indicate renal failure or hyperplasia of the adrenal cortex.

The latter pathology is the cause of obesity and infertility.

The formation of high levels of progesterone in a woman is influenced by long-term use of synthetic hormone analogues, antifungal drugs, hormonal agents (Clomiphene, Mifepristone), antiepileptic drugs such as Depakina, for example.

If during pregnancy the corpus luteum promotes increased production of the hormone progesterone, problems arise with the development of the fetus.

This indicator indicates improper functioning of the placenta, the organ that ensures the natural formation of the embryo. In such a situation, pregnancy loss or premature birth is possible.

High progesterone in a pregnant woman can trigger a phenomenon called “hydatidiform mole.” With it, the fetus stops developing, but all its membranes grow.

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Causes

A lack of this hormone can be caused by:

• Diseases of the genitourinary system.
• Long-term use of medications.
• Chronic stress.
• Past abortions.
• Disorders of the adrenal glands, thyroid gland, pituitary gland.
• Neoplasms in the ovaries.

A high level indirectly indicates the presence of malfunctions in the endocrine system; it can be a consequence of long-term use of contraceptive drugs.

Symptoms

Progesterone affects a woman’s body, preparing it for pregnancy and gestation. There are direct symptoms that can indicate its deficiency.

OH-progesterone: normal

An analysis of the hormone concentration is taken on the 4th–5th day of the cycle. This must be done 8 hours or more after the last meal. If the adrenal glands are healthy and secrete OH-progesterone in sufficient quantities, the norm in women of childbearing age should be within the following range:

• 1.24–8.24 nmol/l - follicular phase;
• 0.91–4.24 nmol/l - ovulatory phase;
• 0.99–11.51 nmol/l - luteal phase.

During menopause, the hormone level decreases to 0.39–1.55 nmol/l. It can be increased in women during pregnancy:

• I trimester - 3.55–17.03 nmol/l;
• II trimester - 3.55–20 nmol/l;
• III trimester - 3.75–33.33 nmol/l.

Increase in OH-progesterone

At elevated levels, the following may develop:

• adrenal tumors;
• ovarian tumors;
• congenital disorders of the adrenal cortex.

Disturbances in the functioning of the adrenal cortex can manifest themselves:

• increased amount of hair in women on the face and chest;
• acne;
• menstrual irregularities;
• polycystic ovary syndrome;
• stillbirth;
• miscarriages;
• early child mortality.

Congenital adrenal cortex dysfunction (CAD) in a woman can also lead to infertility, but sometimes symptoms do not appear and pregnancy occurs without complications. If you have a decrease or increase in hormone levels, consult a specialist. With correct and timely analysis, you will be prescribed treatment that will help avoid the unpleasant consequences of the disease.