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Can't get pregnant
Missed period
I have trouble with my period
Have irregular vaginal bleeding
Difficulty conceiving
Spotting
Menstrual delay
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A condition caused by low levels of progesterone, the female hormone that controls menstruation. An imbalance in the level of progesterone affects normal egg release (ovulation) and can cause irregular periods. This is also seen as a possible risk factor in early miscarriage and difficulty getting pregnant. Known causes include anorexia, excessive exercise, obesity, diabetes or other hormonal problems (e.g. thyroid disorders).
Your doctor may ask these questions to check for this disease:
Treatment may not be necessary unless planning for pregnancy. Treatment depends on the cause, such as gaining weight in anorexia or losing weight in obesity, correcting other hormonal imbalances etc. Progesterone supplementation may be required in some cases to reduce risk of miscarriage and help with fertility. A specialist consultation is advised.
Reviewed By:
Ravi P. Chokshi, MD (Obstetrics and Gynecology (OBGYN), Critical Care)
Current Maternal Fetal Medicine Fellow with Dual board certification in Obstetrics & Gynecology and Critical Care Medicine. | 5+ years experience managing a general Ob/Gyn practice and working in the Intensive Care Unit. | Previously Physician Lead of a large single specialty practice with 8 Physicians and 10+ Advanced practitioners. | Member of the Society of Maternal Fetal Medicine Patient education committee. | Frequent Medscape Consult contributor.
Seiji Kanazawa, MD, PHD (Obstetrics and Gynecology (OBGYN))
Dr. Kanazawa graduated from the Niigata University Faculty of Medicine and received his Ph.D. from the Tohoku University Graduate School of Medicine. He is working on the front line of the General Perinatal Center, including the Tokyo Tama General Medical Center and the National Center for Research in Fertility Medicine, where he provides maternal and fetal care and undertakes clinical research. At Ubie, Dr. Kanazawa has been designing the Ubie AI Symptom Checker and has taken on the role of general obstetrics and gynecology consultation at FMC Tokyo Clinic by providing fetal ultrasound and prenatal consultation.
Content updated on Dec 13, 2024
Following the Medical Content Editorial Policy
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Q.
Can CoQ10 Improve Egg Quality? What the Science Says & Next Steps
A.
CoQ10 can support egg quality by boosting mitochondrial energy and reducing oxidative stress, with the strongest evidence in women over 35 or with diminished ovarian reserve; it may improve IVF response but does not create new eggs or guarantee pregnancy. Typical use is 200 to 600 mg daily, often ubiquinol, started 2 to 3 months before trying to conceive, but dosing and medication interactions should be reviewed with your clinician. There are several factors to consider, so see below for who benefits most, safety notes, timelines, and other fertility steps that could change your next move.
References:
* Xu Y, et al. Coenzyme Q10 for the treatment of infertility: a systematic review and meta-analysis of randomized controlled trials. J Assist Reprod Genet. 2018 Jan;35(1):141-149. doi: 10.1007/s10815-017-1040-x. Epub 2017 Oct 13. PMID: 29030888; PMCID: PMC5759755.
* Ben-Meir A, et al. Coenzyme Q10 in Women's Health: Focus on Infertility and Recurrent Pregnancy Loss. Int J Mol Sci. 2022 Sep 10;23(18):10471. doi: 10.3390/ijms231810471. PMID: 36142385; PMCID: PMC9502096.
* Florou P, et al. Coenzyme Q10 Supplementation and Assisted Reproductive Technology Outcomes: A Systematic Review and Meta-Analysis. J Clin Med. 2020 Jul 15;9(7):2222. doi: 10.3390/jcm9072222. PMID: 32679815; PMCID: PMC7408990.
* Bentov Y, et al. Coenzyme Q10 and mitochondrial function in oocytes and follicles: a clinical perspective. Fertil Steril. 2014 Mar;101(3):638-43. doi: 10.1016/j.fertnstert.2013.12.028. Epub 2014 Jan 20. PMID: 24360341.
* Liu M, et al. The effect of CoQ10 on improving oocyte quality and fertility preservation strategies in patients with diminished ovarian reserve. Reprod Biol Endocrinol. 2020 Jan 27;18(1):7. doi: 10.1186/s12958-020-0557-y. PMID: 31980068; PMCID: PMC6983058.
Q.
Preparing for Egg Freezing: The Nutrition & Lifestyle Roadmap
A.
There are several factors to consider. Use the next 2 to 3 months to emphasize a Mediterranean-style, whole food approach that keeps blood sugar steady, with adequate protein and healthy fats, plus key nutrients like folate, vitamin D, omega-3s, iron, and choline. Sleep, moderate exercise, limiting alcohol, quitting smoking, reducing toxins, managing stress, and discussing supplements like CoQ10 and any red flags with your doctor also matter; see below for the complete, step-by-step roadmap and nuances that could change your next healthcare steps.
References:
* Khodamoradi, K., et al. "The impact of lifestyle and dietary factors on female fertility." *International Journal of Fertility and Sterility*, 2022, 16(2), 79-88.
* Gaskins, A. J., & Chavarro, J. E. "Diet and fertility: a comprehensive review." *The American Journal of Clinical Nutrition*, 2018, 108(6), 1314S-1329S.
* Rossi, B. V., & Tayem, Y. "The impact of lifestyle factors on reproductive outcomes in women undergoing assisted reproductive technologies: a systematic review." *Journal of Assisted Reproduction and Genetics*, 2017, 34(7), 817-832.
* Cingillioglu, S. A., et al. "Nutritional supplements and their effect on oocyte quality and in vitro fertilization outcomes: A systematic review." *International Journal of Fertility and Sterility*, 2023, 17(1), 1-14.
* Zhang, X., et al. "Environmental and lifestyle factors in female infertility: a comprehensive review." *Reproductive Health*, 2022, 19(1), 227.
Q.
Luteal Phase Symptoms? Why Your Body Is Reacting & Medical Next Steps
A.
Luteal phase symptoms are common in the 1 to 2 weeks after ovulation when progesterone rises then falls, causing PMS-like changes such as bloating, breast tenderness, headaches, fatigue, mood swings, anxiety, and sleep issues. Most are normal, but severe or disruptive symptoms can point to PMDD, luteal insufficiency, thyroid problems, PCOS, or other hormonal conditions. Next steps include tracking cycles and symptoms, asking your clinician about correctly timed hormone and thyroid tests, and considering individualized treatments like CBT or SSRIs for mood, hormonal contraception, or progesterone in select cases, with urgent care for red flag bleeding, severe pain, or suicidal thoughts. There are several factors to consider, and key details that could change your next steps appear below.
References:
* O'Brien PM, et al. Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD): A Narrative Review of Etiology, Diagnosis and Management. *Int J Womens Health*. 2021 Oct 27;13:955-965. doi: 10.2147/IJWH.S339599. PMID: 34720980; PMCID: PMC8559005.
* Li Q, et al. Understanding Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) from a Chinese Perspective: A Review. *Int J Environ Res Public Health*. 2022 Mar 30;19(7):4076. doi: 10.3390/ijerph19074076. PMID: 35409949; PMCID: PMC9000100.
* Payne JL, et al. Premenstrual Dysphoric Disorder: Recognition and Treatment. *Am J Psychiatry*. 2016 Jan 1;173(1):12-21. doi: 10.1176/appi.ajp.2015.15081068. PMID: 26658097.
* Rapkin AJ, Winer SA. Impact of the Luteal Phase on Premenstrual Symptoms: A Comprehensive Review. *Clin Obstet Gynecol*. 2020 Dec;63(4):810-822. doi: 10.1097/GRF.0000000000000578. PMID: 33109923.
* Nevatte T, et al. Pharmacological Treatments for Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Review. *Drugs*. 2022 Aug;82(12):1273-1288. doi: 10.1007/s40265-022-01764-x. PMID: 35925340.
Q.
Embryo Not Implanting? The Medical Reality and Your Proven Next Steps
A.
Implantation often fails because of embryo chromosomal abnormalities, progesterone or timing issues, and uterine lining problems, with immune and metabolic conditions sometimes playing a role; even a normal looking embryo may not implant, and a euploid embryo implants only about 50 to 70 percent of the time. Next steps include reviewing embryo genetics and grading, optimizing progesterone and transfer timing, assessing the uterine cavity and lining, and checking thyroid, glucose, and vitamin D while addressing lifestyle factors; many more important details that can affect your personal plan, including when to add testing and urgent symptoms to watch for, are explained below.
References:
* Al-Hussaini TK, Salih ZT. Recurrent Implantation Failure: A Review of Current Concepts and Clinical Management. Cureus. 2021 Feb 17;13(2):e13388. doi: 10.7759/cureus.13388. PMID: 33621404; PMCID: PMC7971358.
* Giannini A, D'Oria O, Saccardi C, Cignini P, D'Ambrosio V, Di Carlo C, De Leo V, Fava C. Treatment Strategies for Recurrent Implantation Failure: A Narrative Review. J Clin Med. 2023 Feb 6;12(4):1259. doi: 10.3390/jcm12041259. PMID: 36768784; PMCID: PMC9959639.
* Tan J, Jin L, Qu R, Zhou T, Fan M, Li S. Recurrent implantation failure: an update and management. Front Biosci (Elite Ed). 2023 Mar 15;15(1):7. doi: 10.31083/j.fbe.2023.01.007. PMID: 36920251.
* Guo M, Yuan H, Ma M, Fu X, Wang B, Pan X. Recurrent implantation failure: an overview of common causes and treatments. Front Med (Lausanne). 2022 Dec 1;9:1062085. doi: 10.3389/fmed.2022.1062085. PMID: 36531388; PMCID: PMC9750796.
* Xu S, Liang X, Zhang X, Tian N, Wu J, Ma H, Sun Y, Chen C. Recurrent implantation failure: A comprehensive review on classification, diagnosis, and treatment. Front Cell Dev Biol. 2022 Nov 22;10:1048498. doi: 10.3389/fcell.2022.1048498. PMID: 36496030; PMCID: PMC9724125.
Q.
Norethindrone Side Effects? Why Your Body Reacts + Medically Approved Next Steps
A.
Norethindrone side effects include irregular bleeding or spotting, headaches or migraines, breast tenderness, mood changes, bloating with small weight shifts, and occasional acne, largely because progesterone-like signals alter the uterine lining, brain chemistry, and fluid balance; most improve within 1 to 3 cycles. Take it exactly as prescribed and track symptoms, but get urgent care for chest pain, shortness of breath, sudden severe headache or vision changes, one-sided weakness, or yellowing skin; there are several factors and medically approved alternatives that can change your next steps, so see the complete guidance below.
References:
* Stanczyk FZ, Hapke A, Stanczyk GP. Progestins used in hormonal contraception: clinical pharmacology and metabolic effects. Contraception. 2021 Jul;104(1):21-29. doi: 10.1016/j.contraception.2021.03.010. Epub 2021 Mar 18. PMID: 33744319.
* Kwiecien M, Ziemons J, Reuter C, Plag J, Strowitzki T. Progestogen-only contraception: past, present, and future. Arch Gynecol Obstet. 2022 Sep;306(3):685-699. doi: 10.1007/s00404-022-06497-6. Epub 2022 Apr 1. PMID: 35361730; PMCID: PMC9393049.
* Mestrovic N, Kaerner S, Leithner K, Oberaigner W, Toth B. Bleeding Patterns and Contraceptive Effectiveness of Hormonal Contraceptives in Women with Endometriosis: A Systematic Review. J Clin Med. 2023 Apr 1;12(7):2630. doi: 10.3390/jcm12072630. PMID: 37048757; PMCID: PMC10094595.
* Faghfoury H, Abedian M, Yousefi A. Effects of Hormonal Contraceptives on Psychological Disorders: A Systematic Review and Meta-Analysis. Int J Womens Health. 2023 Apr 27;15:691-706. doi: 10.2147/IJWH.S407481. PMID: 37131758; PMCID: PMC10151125.
* Sitruk-Ware R, Nath A. Characteristics and metabolic effects of progestins. Best Pract Res Clin Obstet Gynaecol. 2010 Dec;24(6):615-26. doi: 10.1016/j.bpobgyn.2010.04.008. Epub 2010 May 20. PMID: 20494411.
Q.
Low Progesterone? Why Your Hormones Are Crashing & Medically Approved Next Steps
A.
Low progesterone can cause shorter or irregular cycles, spotting, heavy bleeding, mood changes, sleep issues, and fertility problems, often linked to inconsistent ovulation, chronic stress, thyroid imbalance, perimenopause, or other conditions. There are several factors to consider; see below to understand likely causes like luteal insufficiency and when symptoms require urgent care. Medically approved next steps include properly timed progesterone blood testing about 7 days after ovulation, assessment of ovulation and thyroid function, treating root causes, considering prescription progesterone under clinician guidance, and targeted lifestyle changes, with detailed checklists and red flags outlined below.
References:
* Zorrilla CP, Cardenas VM, Kallen DE, Speroff MA. Luteal phase defect: etiologies and current treatments. Fertil Steril. 2017 Jan;107(1):12-19. doi: 10.1016/j.fertnstert.2016.11.006. PMID: 27956697.
* Gore S, Balthazart JV, Balthazart LL, Meakin JC, Aronov VI. Endocrine disruptors and female reproductive health. Vitam Horm. 2018;107:119-158. doi: 10.1016/bs.vh.2018.01.007. PMID: 29871583.
* Kalra J, Kalra MJ. The interplay between stress, cortisol, and the female reproductive axis. Best Pract Res Clin Obstet Gynaecol. 2015 Oct;29(7):933-40. doi: 10.1016/j.bpobgyn.2015.05.006. PMID: 25845000.
* Kumar S, Kumar G, Kumar S. Progesterone in reproductive medicine: diagnosis and treatment challenges. Reprod Biomed Online. 2020 Aug;41(2):331-343. doi: 10.1016/j.rbmo.2020.04.004. Epub 2020 Jul 20. PMID: 32668388.
* Stanczyk JG. Progesterone: The Neglected Hormone in Women's Health. Clin Obstet Gynecol. 2019 Dec;62(4):795-802. doi: 10.1097/GRF.0000000000000494. PMID: 31731695.
Q.
Protein for Women 30-45: Solve Symptoms & Your Vital Next Steps
A.
Protein is a key lever for women 30 to 45 to ease fatigue, brain fog, cravings, and mood swings by stabilizing hormones, preserving muscle, and steadying blood sugar, and most do best around 1.2 to 1.6 grams per kilogram per day. There are several factors to consider. See below to understand more. Because these symptoms can also reflect thyroid disease, iron deficiency, or other issues, your vital next steps are to track current intake, center meals on protein and add resistance training, monitor cycle changes and use the luteal insufficiency symptom check if needed, and speak with a clinician for persistent or severe signs, with full guidance and red flags detailed below.
References:
* Oikawa SY, O'Connor LE, Enger MM, et al. Protein intake and functional outcomes in women across the lifespan: A systematic review. J Appl Physiol (1985). 2020 Jul 1;129(1):122-132. doi: 10.1152/japplphysiol.00693.2019. Epub 2020 Apr 16. PMID: 32295055.
* Oikawa SY, McGlory C, Baker SK, Phillips SM. Dietary protein and skeletal muscle health in women across the lifespan. Am J Clin Nutr. 2019 Aug 1;110(2):473-484. doi: 10.1093/ajcn/nqz123. PMID: 31382433.
* Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight management and satiety. Am J Clin Nutr. 2015 May;101(5):1320S-1329S. doi: 10.3945/ajcn.114.084038. PMID: 25926512.
* Shams-White MM, Chung M, Fusaro M, et al. Dietary protein and bone health: a new perspective. Curr Opin Clin Nutr Metab Care. 2019 Nov;22(6):443-449. doi: 10.1097/MCO.0000000000000600. PMID: 31191560.
* O'Connor L, Mente A, O'Connor M, et al. Dietary protein intake and body composition in adult women: a systematic review and meta-analysis. Front Nutr. 2023 Aug 7;10:1229718. doi: 10.3389/fnut.2023.1229718. PMID: 37604313; PMCID: PMC10440333.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Progesterone and the Luteal Phase
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436586/Luteal insufficiency in first trimester
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659905/Luteal Insufficiency
https://www.sciencedirect.com/topics/medicine-and-dentistry/luteal-insufficiency#:~:text=Corpus%20luteum%20insufficiency%20(also%20referred,%E2%80%9312%20ng%2FmL).