High progesterone: Symptoms and side effects

Progesterone is a vital female sex hormone, the other being estrogen. Progesterone plays an essential role in the female reproductive system, supporting menstruation and maintaining the initial stages of pregnancy. Some of the symptoms of high progesterone include water retention, fatigue, mood changes, and weight fluctuations.

The article describes the causes of high progesterone, both normal and abnormal, the symptoms of high progesterone, and when to consult a healthcare provider.

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What are the Functions of Progesterone?

Progesterone’s primary role is to prepare the uterine lining for the implantation and growth of a fertilized egg. If you do not conceive, the uterine lining is shed during periods. If pregnancy occurs, the levels of progesterone increase to help support and maintain the pregnancy.

Some of the functions of progesterone are:

• Regulating menstrual bleeding
• Thickening the uterine lining for implantation of the fertilized egg
• Supporting and maintaining a pregnancy if conception occurs
• Supporting the functioning of the thyroid gland
• Supporting breastfeeding
• Helping improve mood

Causes of High Progesterone

Normal Changes

Progesterone During Menstruation

Ovulation (the release of an egg by the ovary) usually happens during the middle part of your menstrual cycle. After the release of the egg, the empty follicle forms the corpus luteum (a temporary gland) and starts secreting progesterone, increasing the levels of progesterone.

If pregnancy occurs, the corpus luteum supports the initial stages of pregnancy. The progesterone hormone helps by thickening the uterine lining, preparing it for implantation and growth of the fertilized egg.

If the egg is not fertilized during the menstrual cycle, the corpus luteum disintegrates, and the levels of progesterone drop back to their usual levels. The latter causes the thinning and breaking down of the uterine lining, starting your periods.

Progesterone Levels During Pregnancy

If pregnancy occurs, the corpus luteum remains active and keeps secreting progesterone. The higher levels of progesterone ensure that the uterine lining stays thick and enriched with blood vessels, providing key nutrients to the developing embryo.

After the formation of the placenta, the latter takes over the role of producing progesterone. Thereafter, the levels of progesterone continue to rise, reaching their highest during your third pregnancy trimester.

During pregnancy, the body produces approximately ten times more progesterone than it does during the non-pregnant state.

What are the Symptoms of High Progesterone?

Symptoms of High Progesterone Due to PMS

The natural rise in the levels of progesterone at the time of ovulation during your menstrual cycle (ovulatory phase) results in a group of emotional and physical symptoms referred to as the premenstrual syndrome or PMS.

Some of the high progesterone symptoms of PMS are:

• Breast tenderness and swelling: Increased progesterone may result in breast tenderness and swelling.
• Bloating and water retention: High levels of progesterone may affect your fluid balance, leading to water retention and bloating.
• Weight gain: Weight gain is one of the common symptoms of high progesterone, which occurs due to fluid retention and changes in metabolism.
• Tiredness and Fatigue: Another sign of high progesterone is increased tiredness and fatigue.
• Agitation or anxiety: High progesterone levels may cause mood changes with anxiety and depression.
• Decreased libido or sex drive: Elevated levels of progesterone may cause reduced sex drive in some people.

These signs of high progesterone usually start 4-5 days before the beginning of periods and get better within 3-4 days after the beginning of the period.

Symptoms of High Progesterone During Pregnancy

If you get pregnant and the levels of progesterone continue to rise, you may get high progesterone symptoms, like premenstrual syndrome, such as bloating and breast tenderness. During this phase, you will also observe elevated progesterone symptoms as early symptoms of pregnancy. 

These include:

• Food cravings
• Headaches
• Increased sensitivity of nipples
• Muscle aches

One to two weeks post-implantation, high progesterone levels along with high HCG (human chorionic gonadotropin) levels may also cause more apparent pregnancy symptoms.

Some of the elevated progesterone symptoms during this phase are:

• Fatigue
• Spotting or implantation bleeding
• Pigmentation of the nipples
• Food cravings with increased appetite
• Diarrhea (loose stool)
• Cramping
• Increase urination

Abnormal Causes of High Progesterone

In some cases, levels of progesterone may increase due to some medical problems. Some of these are:

Ovarian Cysts

These are fluid-filled masses present in the ovaries. Some kinds of ovarian cysts may secrete both estrogen and progesterone, thereby increasing the levels of both.

The cysts that increase only progesterone levels are usually corpus luteum cysts. The latter are generally harmless and do not cause any signs of high progesterone. They may disappear without any treatment.

Hormone Replacement Therapy (HRT)

Your physician may recommend hormone replacement therapy (containing both estrogen and progesterone) if you suffer from symptoms and signs of menopause including hot flashes, vaginal dryness, night sweats, mood swings, or discomfort during intercourse.

HRT may raise the levels of progesterone, causing elevated progesterone symptoms:

• Breast tenderness or pain
• Lightheadedness or dizziness
• Headache
• Swelling of lower legs and feet (water retention)
• Weight gain
• Spotting or vaginal bleeding

Hormonal Contraceptives

Certain kinds of hormonal contraceptives (birth control methods) may raise your progesterone levels, leading to signs of high progesterone. A synthetic version of the progesterone hormone called progestin is present in these contraceptives.

Congenital Adrenal Hyperplasia (CAH)

Congenital adrenal hyperplasia is a group of genetic disorders affecting the adrenal glands. The latter are a pair of glands about the size of a walnut located above your kidneys. The adrenal glands produce vital hormones, including the stress hormone (cortisol), aldosterone, and testosterone (the male sex hormone).

CAH occurs due to the deficiency of certain enzymes, which the body requires to synthesize these hormones.

The levels of progesterone may become high in CAH (late-onset), due to a decline in cortisol levels. Progesterone acts as a precursor to cortisol, and the enzyme that accelerates this conversion is 17 alpha-hydroxylase. In CAH, the enzyme is deficient, leading to the accumulation of progesterone.

Late-onset CAH affects women more than men, who usually do not have high progesterone symptoms.

Molar Pregnancy

High progesterone levels and progesterone dominance symptoms may be present in another condition known as molar pregnancy.

Molar pregnancy is a condition characterized by the development of a tumor (referred to as a mole) from a fertilized, non-viable egg, instead of a fetus.

Molar pregnancy proceeds as a normal pregnancy, though non-viable. There will be an increased secretion of the progesterone hormone and development of the placenta.

What are the Normal Levels of Progesterone?

Your healthcare provider will conduct a blood test to measure your progesterone levels in ng/mL (nanograms per milliliter). It is essential to keep in mind that the levels change throughout the monthly cycle.

The normal progesterone levels in an adult woman (reference range) during pregnancy and different phases of the menstrual cycle are:

• Follicular stage (initial stage) of the menstrual cycle: less than 0.7 ng/mL
• Luteal stage (post-ovulation stage) of the menstrual cycle: 2-25 ng/mL
• First pregnancy trimester: 10-44 ng/mL
• Second pregnancy trimester: 19.5-82.5 ng/mL
• Third pregnancy trimester: 65-290 ng/mL

If your levels are higher than the reference range during the phase of pregnancy or the menstrual cycle, or you observe any of the symptoms of high progesterone, consult your healthcare provider.

Why are the Levels of Progesterone Checked?

Your healthcare physician may test your levels for progesterone not only when you experience high progesterone symptoms, but also for some other reasons, including:

• To determine whether a person has ovulated
• To determine whether a person has an ectopic pregnancy or a miscarriage
• To find out the various causes of difficulty conceiving (infertility)
• To evaluate the effectiveness of fertility treatments.
• To assess individuals who are consuming progesterone during their pregnancy
• To assess individuals who have a high-risk pregnancy
• To diagnose the disorder of the adrenal gland
• To determine the causes of dysfunctional uterine bleeding (bleeding that occurs apart from your periods)

Low vs High Progesterone Symptoms

Both high and low progesterone levels can produce a variety of signs and symptoms.

Low progesterone may cause heavy or irregular periods, difficulty getting pregnant, trouble sleeping, hot flashes, low sex drive, breast tenderness, headaches, and mood swings.

Some of the symptoms of high progesterone are:

• Digestive problems: Bloating and constipation
• Skin issues: Acne
• Dizziness
• Blurred vision/difficulty in focusing
• Fluctuations in weight (weight gain)
• Fatigue
• Fluid retention that causes bloating
• Low sex drive
• Mood changes, anxiety, and depression

When to Consult A Health Care Physician?

If you develop high progesterone symptoms (premenstrual symptoms) outside the menstrual cycle, you should see your healthcare provider. This is more important if you have persistent symptoms and you are not pregnant.

Your healthcare provider will conduct a blood test to find out the levels of progesterone. If the levels are high, they may recommend other tests to determine the cause.

Conclusion

High progesterone symptoms may normally develop at the time of ovulation during the monthly menstrual cycle or pregnancy. The levels may also become high if you are taking hormonal medicines such as hormonal contraceptives. Elevated progesterone symptoms may also occur in certain medical conditions such as ovarian cysts, molar pregnancy, or congenital adrenal hyperplasia.

If you develop any of the symptoms of high progesterone outside your menstrual cycle or pregnancy, you must consult your healthcare physician.

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