Progesterone and what you should know when TTC



What is progesterone?


During the menstrual cycle, when an egg is released from the ovary at ovulation (approximately day 14), the remnants of the ovarian follicle that enclosed the developing egg form a structure called the corpus luteum. This releases progesterone and, to a lesser extent, oestradiol. The progesterone prepares the body for pregnancy in the event that the released egg is fertilised. If the egg is not fertilised, the corpus luteum breaks down, the production of progesterone falls and a new menstrual cycle begins.

If the egg is fertilised, progesterone stimulates the growth of blood vessels that supply the lining of the womb (endometrium) and stimulates glands in the endometrium to secrete nutrients that nourish the early embryo. Progesterone then prepares the tissue lining of the uterus to allow the fertilised egg to implant and helps to maintain the endometrium throughout pregnancy. During the early stages of pregnancy, progesterone is still produced by the corpus luteum and is essential for supporting the pregnancy and establishing the placenta. Once the placenta is established, it then takes over progesterone production at around week 12 of pregnancy. During pregnancy, progesterone plays an important role in the development of the foetus; stimulates the growth of maternal breast tissue; prevents lactation; and strengthens the pelvic wall muscles in preparation for labour. The level of progesterone in the body steadily rises throughout pregnancy until labour occurs and the baby is born.
Although the corpus luteum in the ovaries is the major site of progesterone production in humans, progesterone is also produced in smaller quantities by the ovaries themselves, the adrenal glands and, during pregnancy, the placenta.



 How is progesterone controlled?

The formation of the corpus luteum (which produces the majority of progesterone) is triggered by a surge in luteinising hormone production by the anterior pituitary gland. This normally occurs at approximately day 14 of the menstrual cycle and it stimulates the release of an egg from the ovary and the formation of the corpus luteum. The corpus luteum then releases progesterone which prepares the body for pregnancy. If the egg is not fertilised and no embryo is conceived, the corpus luteum breaks down and the production of progesterone decreases. As the lining of the womb is no longer maintained by progesterone from the corpus luteum, it breaks away and menstrual bleeding occurs, marking the start of a new menstrual cycle.

However, if the ovulated egg is fertilised and gives rise to an embryo, the cells that surround this early embryo (which are destined to form the placenta) will secrete human chorionic gonadotrophin. This hormone has a very similar chemical structure to luteinising hormone. This means it can bind to and activate the same receptors as luteinising hormone, meaning that the corpus luteum does not break down and instead keeps producing progesterone until the placenta is established.

What happens if I have too much progesterone?


Progesterone, either alone or in combination with oestrogen, is taken by women as an oral contraceptive (‘the pill’). ‘The pill’ works by preventing ovulation, making it nearly 100% effective in preventing pregnancy.
Progesterone is used in hormone replacement therapy to relieve symptoms of the menopause in women. There are many recognised pros and cons to hormone replacement therapy.



 What happens if I have too little progesterone?

If progesterone is absent or levels are too low, irregular and heavy menstrual bleeding can occur. A drop in progesterone during pregnancy can result in a miscarriage and early labour. Mothers at risk of giving birth too soon can be given a synthetic form of progesterone to delay the onset of labour.

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