Progesterone abnormalities refer to irregularities in the levels of the hormone progesterone, a crucial player in the female reproductive system. These imbalances can disrupt the menstrual cycle, leading to issues such as irregular periods, heavy bleeding, or amenorrhea. Inadequate progesterone levels may impact fertility, causing difficulty in conceiving or maintaining a pregnancy. Conversely, excess progesterone can result in symptoms like fatigue, mood swings, and breast tenderness. Progesterone abnormalities is essential for maintaining reproductive health and hormonal balance in both men and women. In men, imbalances in progesterone levels may impact libido, mood, and energy levels. Treatment for progesterone abnormalities typically involves hormone replacement therapy (HRT) to restore balance. In cases of low progesterone, supplemental progesterone medications, such as oral capsules or creams, may be prescribed. Lifestyle modifications, such as stress management and a healthy diet, can also positively impact progesterone levels.

1. University of Chakwal, Pakistan

2. Department of Zoology
Session: 2020-2024
Course: Endocrinology
Presented By: Aqsa Eman
Reg. No: 20M-UOC/ZOL-13
Presented To: Dr. Syeda Nadia Ahmed
Topic: Progesterone Abnormalities

3. Progesterone Abnormalities
Introduction
Significance
Normal ranges
Causes
Symptoms
Tests
Treatments
Progesterone in men
Feminizing Hormonal
Therapy

4. Introduction
 Progesterone is an endogenous steroid
hormone.
 Primary called the “pregnancy
hormone”.
 Mainly released by
Ovarian corpus luteum during the
first ten weeks of pregnancy.
Placenta in the later phase of
pregnancy.
Adrenal cortex.
Testes (Cable & Grider, 2020).
Figure 01: Progesterone Structure
C21H30O2.
https://www.genemedics.com/wp-
content/uploads/2022/07/progesterone.jpg

5. Significance of Progesterone
Progesterone plays an important role in:
Regulating the menstrual cycle.
Supporting pregnancy.
Supporting lactation.
Sexual behaviour of male and female.
Prepare the body for implantation of a
fertilized egg.
Reduce symptoms of menopause or
used as birth control (Cassata, 2022). Figure 02: Hypothalamic pituitary gonadal
axis. https://teachmephysiology.com/wp-
content/uploads/2021/01/hpg-axis.png.webp.

6. Normal Progesterone Ranges
 Progesterone levels are measured through a blood test.
 Progesterone levels fluctuate throughout the menstrual cycle,
depending on your age and whether or not you are pregnant.
 Progesterone is measured in Nano grams per millilitre (ng/mL).
 It is found in much lower in men. Normal levels are less than 0.20
ng/mL (Ray, 2019).

7. Figure 03: Normal Progesterone Ranges.
https://images.app.goo.gl/MAYK5XFHujKExHio8

8. Figure
04:
Menstrual
Cycle.
https://images.app.goo.gl/faNp48un4Hx1UaU87

9. Causes of Progesterone Abnormalities
1. Anovulation
 An egg, or ovum, is not released from ovary during menstrual cycle,
it is known as anovulation.
 The cause of approximately 25% of infertility cases.
 Women who ovulate regularly often see signs like increased amount
of cervical mucus, a drop and subsequent rise in body temperature in
the middle of the menstrual cycle.
 When hypothalamus releases gonadotropin releasing hormone
(GnRH). GnRH causes pituitary gland to secrete follicle stimulating
hormone (FSH) and luteinizing hormone (LH).

10.  FSH triggers the maturation of follicles in one ovary between days 6
and 14 of the menstrual cycle.
 The ovary releases its egg when LH is released, on day 14 of the
menstrual cycle.
 If the egg is fertilized by a sperm, it develops into an embryo and
menstruation happens when an egg that's released from your ovary
isn’t fertilized.
 After ovulation, the ovary produces both estrogen and progesterone,
which prepare the uterus for possible embryo implantation and
pregnancy.
 A high level of androgens and prolactin, low level of thyroid and
GnRH are causes of anovulation. Certain medications can still stop
ovulation (Berry,2023).

11. Abnormal Uterine Bleeding
 Experience a “period” without
ovulating. This is known as abnormal
uterine bleeding (AUB), or anovulatory
bleeding.
 Most commonly occurring at menarche
and perimenopause.
 Abnormal uterine bleeding is common
approximately one-third of people who
have a uterus and are of child-bearing
age experience it (Davis & Sparzak,
2019). Figure 05: Causes of AUB
https://images.app.goo.gl/uztnEEruwbHc57339

12. 2) Polycystic Ovary Syndrome (PCOS)
 The name describes the numerous
small cysts (fluid-filled sacs) that
form in the ovaries and contain an
immature eggs.
 A woman doesn’t make enough of
the hormones needed to ovulate.
When ovulation doesn’t happen, the
ovaries can develop many small
cysts. These cysts make hormones
called androgens.
 As a result, the levels of estrogen,
progesterone, LH, and FSH become
imbalanced (outpace8410, 2020) .
Figure 06: Polycystic Ovary
https://images.app.goo.gl/XTdAYvw12ZQm
1GCK7

13.  Exact cause of PCOS is not
clear.
 PCOS may also run in families.
 Many women with PCOS have
insulin resistance.
 Women may be at higher risk
for type 2 diabetes, high blood
pressure, heart problems, and
endometrial cancer.
 Need higher levels of
progesterone.
Figure 07: Symptoms of PCOS.
https://images.app.goo.gl/NsJJQaT47eGtYyJA6

14. 3) High stress
 Pituitary glands control the hormone cortisol, it is produced into the
body in reaction to stress, it is commonly referred to as the "stress
hormone".
 Yet cortisol is not limited to the stress response also plays a vital role in
physiological processes.
 The release of stress hormones, or cortisol, can suppress normal levels
of reproductive hormones LH and FSH, disturb the progesterone level
that potentially leading to abnormal ovulation, anovulation, or
amenorrhea.
 When cortisol level increases in body the progesterone levels decreases.

15. 4) Hypothyroidism
• A condition where the thyroid does not
release enough thyroid hormone into
bloodstream.
• It can alter the secretion of gonadotropin-
releasing hormone (GnRH), the release of
LH and FSH from the pituitary gland.
• When hypothyroidism is present, menstrual
irregularities such as heavy or irregular
periods may occur. These irregularities can
affect the timing and levels of progesterone. Figure 08: Thyroidal Axis.
https://images.app.goo.gl/zR9iR4kARRd
eUsqq5

16. 5) Hyperprolactinemia
• Prolactin is responsible for lactation. After delivery of baby
progesterone levels drop, which increases the number of prolactin
receptors on the mammary alveolar cells.
• Dopamine and estrogen control prolactin production.
• prolactin progesterone can cause certain symptoms, such as
irregular periods, infertility and erectile dysfunction.
• In men, prolactin affects sperm production
• Men: less than 20 ng/mL, Non-pregnant women: less than 25 ng/mL
Pregnant women: 80 to 400 ng/mL are the normal ranges of prolactin.

17. 6) Low Cholesterol
• The body needs cholesterol to make progesterone. So without enough
cholesterol, the body cannot make enough progesterone.
7) Over-exercising or Extreme dieting
• This can increase cortisol levels and put stress on your body. It also
deprives your body of key nutrients needed to sustain healthy hormone
levels (outpace8410, 2020) .

18. 8) Pre-menopause
• Pre-menopause is the transitional period
before menopause.
• During perimenopause, levels of estrogen
and progesterone levels are deficient.
• You may begin having menopause-like
symptoms, such as hot flashes or irregular
periods.
• Pre-menopause can last for years. When
you go a full 12 months without a period,
menopause has begun.
Figure 09: Progesterone and estrogen level
in pre-menopause
https://images.app.goo.gl/nZKkYCWHMVsc
si3b9

19. 9) Obesity & Smoking
• Obese or overweight women can experience suppressed progesterone
production. Obesity along with low progesterone is connected with
endometrial cancer (outpace8410, 2020) .
• Smoking increases adrenal activity. Reported elevated serum
progesterone levels have been measured during the early follicular
phase of the menstrual cycle in premenopausal women who smoke,
which is when most of the progesterone produced originates from the
adrenal glands (Pugle,2022).

20. 10) Congenital Adrenal Hyperplasia
 High levels of progesterone are a consequence of an inherited
condition known as congenital adrenal hyperplasia.
 A fetus affected by this condition will produce excessive male
hormones during development.
 For females, this manifests as excessive hair, called hirsutism due to
excess adrenal androgen and progesterone.

21. 11) Ovarian tumors or caffeine
• Presence of ovarian tumors may provoke consistently high
progesterone levels.
• Studies have shown a trend for high circulating progesterone levels with
the consumption of excessive caffeine.
Figure 10: Types of Ovarian Tumors
https://images.app.goo.gl/y5e8Y75k6YqR6kfu8

22. Headache
Irregular
periods
Symptoms of
Low
Progesterone
in non-
pregnant
Women
Sleeping
difficulty
Bloating or
Weight gain
Hot flashes
Hypothyroidism
anovulation
Mood changes
Difficulty in
conceiving
(Institute, 2022).

23. Symptoms of Low Progesterone in Pregnant Women
Spotting (light
bleeding)
Low blood sugar
Breast tenderness
Fatigue
Miscarriage
(Institute, 2022).

24. Symptoms of
High Progesterone
Level
Breast swelling
Breast tenderness
Bloating
Anxiety or
agitation
Low libido
Fatigue
Depression Weight gain
(Pugle,2022)

25. Figure 11: Progesterone Test
https://images.app.goo.gl/CX56rcDYKq8MF3md9

26. Treatments for Progesterone Abnormalities
Natural remedies for raising low progesterone levels include:
1. Change your lifestyle.
Increasing your intake of vitamins B and C.
Eating more foods with zinc, like shellfish and getting regular sleep.
2. Maintain a healthy body weight.
Excess weight causes a woman’s body to produce more estrogen.
This creates an imbalance in progesterone.
3. Reduce stress.
Stress triggers the production of stress hormones and can cause the
kidneys to convert hormones like progesterone to cortisol.

27. Figure no. 12: Progesterone medications
https://images.app.goo.gl/5EHmBLAB7y3yxNas9

28. Progesterone in Men
 Most people think progesterone is a hormone that exists only in women.
But both men and women contain estrogen, progesterone and
testosterone.
 Progesterone is essential in defining characteristics of men.
 When men's progesterone levels are out of balance, it can lead to a
condition called "estrogen dominance" which is usually associated
with women but can also affect men and cause anxiety, erectile
dysfunction, exhaustion, prostate enlargement, low libido, increased
abdominal fat, and insulin resistance (Progesterone in Men, 2021) .

29. Progesterone and Menopause
• Periods end during menopause as a result of body producing far less
reproductive hormones. During menopause, estrogen levels fall.
• Menopause symptoms include vaginal dryness, weight gain, hot flashes,
night sweats, and insomnia.
• Many people find ending of their periods to be beneficial, managing the
negative effects can be challenging.
• Hormone replacement therapy is the best treatment for menopausal
symptoms.
• Most popular treatment for those without uterus is estrogen. Estrogen
alone raises the risk of uterine cancer and other major health issues, if
you do have a uterus, a combination of progesterone and estrogen is
frequently advised (Contributors, 2023).

30. Feminizing Hormonal Therapy
 Also called gender-affirming hormone therapy.
 This therapy is an option for transwomen people who were assigned
male at birth (AMAB) but identify as women because of low estrogen.
 Taking estrogen and progesterone helps to develop breasts, softer skin,
rounder hips and more.
 It can be done alone or along with feminizing surgery.
 Changes from anti-androgen therapy include: Decreased muscle mass,
change in sex drive (libido), smaller testicles, thinning facial and body
hair (Mayo Clinic Staff, 2021).

31.  Berry J. (July 11, 2023). Anovulation: All you need to know.
https://www.medicalnewstoday.com/articles/318552#Side-effects-of-
drugs
 Cassata, C. (2022, October 8). What Is Progesterone?
EverydayHealth.com.
https://www.everydayhealth.com/progesterone/guide
 Cable, J. K., & Grider, M. H. (2020). Physiology, Progesterone. PubMed;
StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK558960/
 Contributors, W. E. (2023, October 11). Menopause and Hormone
Replacement Therapy. WebMD.
https://www.webmd.com/menopause/menopause-hormone-therapy
 Davis, E., & Sparzak, P. B. (2019, August 2). Abnormal Uterine Bleeding
(Dysfunctional Uterine Bleeding). Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK532913/
References

32.  Institute, C. (2022, September 6). Low Progesterone Symptoms. Coyle
Institute. https://coyleinstitute.com/low-progesterone-symptoms/
 Mayo Clinic Staff. (2021, March 18). Feminizing Hormone Therapy - Mayo
Clinic. Www.mayoclinic.org. https://www.mayoclinic.org/tests-
procedures/feminizing-hormone-therapy/about/pac-20385096
 outpace8410. (2020, February 7). Causes and Symptoms of Progesterone
Deficiency | OK Pain Doc. Oklahoma Spine & Pain Management.
https://oklahomapaindoc.com/articles/causes-and-symptoms-of-
progesterone-deficiency/
 Progesterone in Men. (2021, June 15). Clinicum St. Georg.
https://www.klinik-st-georg.de/en/progesterone-in-men/
 Pugle, M. (2022, January 28). High Progesterone: Signs, Symptoms, and
Complications. Verywell Health. https://www.verywellhealth.com/high-
progesterone-symptoms-5185751
 Ray, L. (2019, May 27). Progesterone 101. Helloclue.com; Clue.
https://helloclue.com/articles/cycle-a-z/progesterone-101