Testing Progesterone: Why It’s Important and How to do it Correctly
- Progesterone testing can confirm ovulation and that progesterone levels are sufficient to support implantation of an embryo.
- There are two ways to test progesterone: through serum blood tests or through urine-based PdG (urine metabolite of progesterone) tests. Both have their pros and cons.
- If your progesterone test results come back negative, you may be at risk for low progesterone. You may be able to treat low progesterone with lifestyle changes, supplements, or medications.
If you’re trying to conceive, you may have heard about testing your progesterone. Progesterone levels rise during the second half of your cycle, the luteal phase. After an egg is released, the empty follicle (or corpus luteum) produces progesterone.
Progesterone works to prepare the uterine lining for implantation and creates a healthy uterine environment in which an embryo can thrive, should the egg be fertilized. If conception and implantation do occur, progesterone remains elevated throughout the pregnancy.
Testing your progesterone levels gives you crucial information about your cycle and chances at conceiving. But how do you know if and when you should test progesterone?
Why is progesterone testing important?
First, since progesterone is only produced by an empty follicle, elevated levels confirm ovulation. Testing progesterone approximately seven days after suspected ovulation can tell you if you did in fact ovulate. If an egg is not released, there is no empty follicle and therefore no progesterone production. This is critical information when trying to conceive as without ovulation, conception is not possible.
Additionally, testing progesterone levels can tell you if progesterone is present and how much you have. Insufficient progesterone levels can make it more difficult for an embryo to implant and survive. Ensuring high enough levels of progesterone sustaining a healthy pregnancy.
How can I test progesterone?
There are two common ways to test progesterone levels: through blood and through urine. You should choose the best testing option for you, as both have their pros and cons.
Progesterone blood testing
Progesterone blood testing can be done one of two ways: at a lab with your doctor or at home through a mail away blood testing kit. Progesterone blood tests are typically done on cycle day 21—seven days after suspected ovulation—when progesterone should be elevated if ovulation has occurred.
Results from blood tests are quantitative, or numeric. Progesterone levels of at least 5 ng/mL indicate ovulation. Reproductive endocrinologist, Dr. Aimee Eyvazzadeh, agrees that, “a level of progesterone above 10 ng/ml is ideal to support a healthy pregnancy.”
Progesterone blood tests can be beneficial as they are very accurate and give you an exact level. However, they are one-time tests and only give you a “snapshot” of your progesterone levels.
Studies have shown that progesterone levels can fluctuate hour by hour. This means a progesterone blood test could give you vastly different results if you were to test at 11 am versus 5 pm. Therefore, a single progesterone blood test might not be the best option for you if you are trying to determine average progesterone levels after ovulation.
Progesterone urine testing
Urine-based progesterone tests measure PdG (pregnanediol glucuronide) which is the urine metabolite of progesterone. Studies have shown that PdG levels in first morning urine show an average of progesterone levels in blood from the previous day.
The DUTCH test tracks many hormones in urine, including PdG throughout the cycle for a more complete picture of PdG levels in all phases of your cycle. The DUTCH cycle mapping test involves collecting urine samples at home, sending them to a lab, and waiting 7-10 days for the results.
The Proov PdG test only measures PdG in urine. The Proov protocol suggests testing PdG levels in first morning urine four times on days 7-10 after suspected peak fertility. While a single positive Proov test confirms ovulation, positive results observed each day of the testing window confirm “successful” ovulation. This means PdG levels remained elevated long enough to confirm that ovulation was healthy, which is important for providing the best chance at conception. These tests are done at home and results are readable in 5 minutes.
In rare cases, women can experience what’s called LUFs or Luteinized Unruptured Follicle Syndrome. In the case of LUFs, the follicle fails to rupture and release an egg but still releases progesterone. The only way to confirm ovulation in this case is via ultrasound.
Progesterone urine testing is non-invasive and convenient. Unlike a blood test, you don’t have to be pricked by a needle and testing can be easily done from your home. Additionally, the ability to test PdG levels multiple days in a row gives you a more complete progesterone picture rather than a one-time snapshot. However, because these urine based tests are qualitative rather than quantitative, they will not give you the precise, numeric results you would get from a progesterone blood test.
After I’ve tested, what’s next?
If your progesterone test shows sufficient levels then you’re all good to go! If your tests show insufficient levels, you may be at risk for low progesterone, which can make it difficult to get and stay pregnant. Luckily there are lots of options for increasing progesterone levels.
You can start with diet and lifestyle changes. While foods don’t directly contain progesterone, some foods are associated with higher progesterone levels such as foods rich in omega-3 fatty acids, like seafood. Other foods associated with supporting progesterone include vegetable protein sources, high fat dairy, and plant-based iron sources.
Other options include supplements or medications. Progesterone creams are available over-the-counter, but studies show creams may not be the most effective option. Prescription-level progesterone supplements are another option for increasing progesterone levels that has shown better efficacy in recent studies. Some options for prescription supplements include Prometrium or Crinone. If you’re interested in prescription level supplements, we recommend consulting your doctor.
Testing your progesterone levels can give you critical information about your body that can help you conceive faster.
Chee Wai Ku, John C. Allen Jr., et. al., Serum progesterone distribution in normal pregnancies compared to pregnancies complicated by threatened miscarriage from 5 to 13 weeks gestation: a prospective cohort study, BMC Pregnancy and Childbirth, 5 Sep 2018.
Mark Newman, Suzanne M. Pratt, et. al, Evaluating urinary estrogen and progesterone metabolites using dried filter paper samples and gas chromatography with tandem mass spectrometry, BMC Chemistry, 4 Feb 2019.
María Elena Allende, José Antonio Arraztoa, Towards the Clinical Evaluation of the Luteal Phase in Fertile Women: A Preliminary Study of Normative Urinary Hormone Profiles, Frontiers in Public Healthy, 31 May 2018.
Sunni L. Mumford, Jorge E. Chavarro, et. al., Dietary fat intake and reproductive hormone concentrations and ovulation in regularly menstruating women, American Society for Clinical Nutrition, Mar 2016.
Arri Coomarasamy, M.B., Ch.B., M.D., F.R.C.O.G, Adam J. Devall, B.Med.Sci., Ph.D., et. al., A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy, The New England Journal of Medicine, 9 May 2019.