Help with Progesterone-Estrogen Ratio

by Lynne
(West Virginia)

Hi Wray-

What do you make of this: I was severely Estrogen Dominant back in November with an Estradiol Serem of over 1,000 pg/mL. I started using 200 mg per day of Nat Pro and at the beginning of the year (Day 16 of my cycle), Estradiol was 314.7 pg/mL and Progesterone was less than .8 ng/mL. I think this is a ratio of 2:1 if my math is correct. Terrible ratio but I did feel better than I did when it was 1000!

Doctor wanted to see what my Progesterone was during the peak luteal phase and it was 1.52... I didn't have the Estradiol checked that day. Yes, this is low, especially since it should have been peaking.

That was last month. Since Day 12 of this cycle, I have been using 400 mg of Nat Pro per day (1/2 in morning, 1/2 in evening after bath) and I had my levels re-checked on Day 20-
Progesterone was 3.38 and Estradiol was 40.23. My doctor said that for my age (47), my estradiol should be about 100, but of course its going to change and cycle through the month.

So, I believe my new ratio is 84:1... I can't believe I went from off the charts HIGH Estrodiol to what would be considered low- is this okay? And is it the progesterone therapy that is doing it? Again, I feel much better than I did in months past, but I am definitely no where near how I used to feel say two years ago.

I've been using the Energy Formula and trying to battle my insulin resistence via that and a version of the Ketone Diet (combined with Paleo). I really felt I was making some ground and then the day before my dr's appt I swear its like I gained 5 lbs of water- My Vitamin D was 28 ng/dL in March and after four weeks of supplementing with about 11,000 mg per day (including the 5K in the Energy Formula), it is now 43 ng/dL. You had suggested rechecking it in three months but hey, since I was at the lab and they were drawing blood, why not get it checked just to see? Is that a good improvement for one month? My mom wanted me to ask you if you think there is something driving my Vitamin D down. The lab puts me in normal range now but I know it should be much higher... like 70 ng/dL at least.

I know once I get the hormones balanced, it will only be a matter of time before the weight starts to fall off- I won't have to guess as to whether I've lost weight or not.

One last thing- since I was at the lab, I had my cortisol checked- it was 9.15 UG/dL but no range or values have been established for cortisol at this lab. Does that number mean anything to you?

My doctor 'kind of/sort of' seems to know what he is doing but at the same time, it doesn't seem like he 'GETS IT'... I keep saying I'm going to find a female physician... just need to do it!

take care Wray!! Lynne

Comments for Help with Progesterone-Estrogen Ratio

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Apr 08, 2013
Help with Progesterone-Estrogen Ratio
by: Wray

Hi Lynne Your oestradiol was extraordinarily high, you must have felt awful! But I'm pleased the progesterone has brought it down. Your ratio is 2.5:1, still far too low. If you had the test on day 16 you must have a 23 day cycle? It should be done ±7 days after ovulation or before bleeding. Pointless at any other time. And yet you say you had it done at peak levels and it was 1.52, I'm slightly confused! It seems he doesn't understand about ratios, it's essential to have oestradiol checked too. The ratio is critical, not the amount of hormone. So to say you should have a level of 100 is meaningless, what is your progesterone compared to this. If too low you will feel awful. Your ratio is now 84:1, slightly better, but I'm not surprised you still don't feel right. I don't know if you've seen our Saliva Tests? You'll notice the ratios are all 600:1 and over. Women in pre-menopause can have oestradiol ranging from 30 - 400 pg/ml, and post menopause 0 - 30 pg/ml. We do have a page on Hormone Testing you could look through, it gives cortisol too, yours is in range. You are in Peri-menopause now with erratic cycles and erratic hormones! But progesterone is almost always low, oestrogen normal to high. Testosterone is usually rising too, and this is rarely checked, it does having a huge bearing on mood, too high causing severe PMS. I'm pleased you're trying the Energy formula, I take it every day, as I have Insulin Resistance too. Your vitamin D has gone up nicely, I don't think you have anything suppressing it. Yes the lab would put you in normal range. But I prefer to follow what the less cautious specialists are saying, and get it between 70-100ng/ml. For more info on vitamin D levels, test kits etc see the Vitamin D Council, GrassrootsHealth and Birmingham Hospital. Blood levels should be 70-100ng/ml (175-250nmol/L) and not the 30ng/ml (75nmol/L) most labs and doctors regard as adequate. The minimum daily dose should be 5000iu's per day, although recent research indicates it should be 10,000iu's per day, see here. Continued below

Apr 08, 2013
Help with Progesterone-Estrogen Ratio Part 2
by: Wray

I'm delighted you're doing the Ketogenic diet, and Paleo. These are a few sites which might help you, see here, here and here. I've been putting so many on the keto diet, that I thought I would try it again myself. I did many years ago, making sure the ketostix were in the purple range. Back then I wasn't using the MCT oil. I have been using it for many years for cooking, on salads and veggies, smoothies etc. But now I've ramped it up to about 100-120ml/day and feeling very sorry for myself! It's a potent anti-bacterial and anti-fungal and evidently the bugs in my stomach and blood are not liking it. Having thought I was clear of any of those, it's come as quite a shock! One woman wrote it she had a dreadful Herx reaction and has had to pull back on it, see here. Getting progesterone dominant will stop oestrogen causing any water retention and weight gain, but please don't expect miracles in weight loss. The keto diet will help there. And don't be too hasty in finding a female doctor, they can be worse! Take care Wray

Apr 12, 2013
help with progesterone-estrogen ratio
by: Lynne

Hi Wray- my doctor (this is why I say he kind of gets it but not really) never told me when to get my progesterone and estradiol checked. The first day of my cycle that month was Feb 14th and dr. appt. was March 1st (Day 16). He gave me the order for blood work so I went down the hall and did it while I was in the building. I realize that being in Ovaulation phase makes that reading meaningless. BUT after reading your forums, I realized when it needed to be checked and went on Day 20 the next cycle- that's when I had a ratio of 84:1. Still way too low but moving in the right direction.

I was on birth control pills for 7 years- from 39 to 46. My cycles were always 28 days before the pill and stayed that way on the pill until the last six months when I didn't get a period AT ALL... I was only off the pill for about five weeks and my body went back to 28 day cycles. So my hormones may be erratic, but my cycles are still normal (although I did bleed during the first couple of weeks I used the progesterone)

You asked about my testerone levels- my total testosterone was 9 ng/dL in March and the lab gives a range of 8-60 (this is blood, not saliva). The dr meant to order the FREE Testosterone test so I did that again at the beginning of April and it was 1.2 pg/mL with a reference range of .01-6.4 and the free was 12 on a scale of 2-45. I am low and I think I could benefit from increasing it WITHOUT taking testosterone. Any suggestions?

All of my tests have been blood, but I am very interested in saliva testing- I'll check out your link. Thank you, Wray! (sorry about your tummy!!)

Apr 15, 2013
help with progesterone-estrogen ratio
by: Wray

Hi Lynne Yes I've found all too often they give no thought to when a test should be done. Yes it is moving in the right direction, and will continue to do so. I wish labs all used the same reference ranges, it gets far too confusing. I take mine from Medline, but often I'm given results which make no sense to me. For instance Medline's total testosterone for women is 30 - 95 ng/dL. They don't give free testosterone, but Keratin.com give for a 41 to 60 yr woman 0.4 - 2.5 pg/ml. Also saying that free testosterone ranges from 1 to 4% of total. So your lab must have used different references ranges. If you have a Saliva Test done, your doctor will probably freak! Levels can show very high using topical progesterone, and he'll probably make you come off it or reduce. Please be aware of this. Ah yes my tummy, thanks for asking! All's well now, but I love experimenting. And having suggested to many women they go on the keto diet I thought I should. I last did one 40 years ago! One thing about the MCT oil, it kills cravings and hunger, understandably as it's replacing the glucose with ketones. I rarely feel hungry and if I do I take 2tsp and it goes, so I'm not eating much. Hope I don't turn into a shrivelled prune! Take care Wray

Aug 22, 2013
So sick of being sick and tired!
by: beth

it seems to me that dr and after doctor could easily determine what my hormone issues are, but lab after lab, without insurance at a high cost to me...no one can tell me why i am going through the worst time in my life. i am 35, i am experiencing relentless fatigue, NO libido, brain fog, floaty headed feeling, and migraines for the first time in my life. i am not gaining weight and feel all kinds of different things happening to me, like increased food allergies and stomach problems. i am taking bio-progesterone (20mg from day 1 til 10 cycle then 40mg til i start my period. 1mg testosterone and an adernal rebuilder which i know makes me feel better because i stopped taking it for a while and i could def tell the diff. I still feel terrible despite taking all of this. the vertigo started about 2 months after i tried to stop taking the prog. my last bloodwork showed estrogen at 403, progesterone at 12.8 and testosterone at 54. I am at the end of my rope and sick of hearing these doctors tell me all my labs are normal when i feel ANYTHING but! I really don't know what to do..am i estrogen dominant and i low in progesterone and i high in progesterone, i don't KNOW. My medicine cabinet looks like i am 75 and I'm so over it. So is my husband. PLEASE HELP ME UNDERSTAND MY LABS..I need help, I can't keep going like this. These labs where taken during my luteal phase.

Aug 23, 2013
So sick of being sick and tired!
by: Wray

Hi there I see your doctors, and the labs they've used, haven't looked at the ratios of the hormones. The only labs which do are ZRT Labs and Genova Diagnostics. The ratio is all important not the levels. Your oestrogen is right at the high end of 'normal', in fact slightly above, and your progesterone is about half way 'normal'. But this leaves you with a ratio of 32:1 which is very low. We run Saliva Tests on our cream and in all cases the ratios are 600:1 and over. So you are severely oestrogen dominant, progesterone should always be the dominant hormone. It doesn't surprise me you feel awful. We do have a Hormone Testing page you could look through. You say you are 'taking' progesterone, but it seems you're using a cream, am I correct? Because if it is oral progesterone, it's the least effective Delivery system, "The liver and gut region removed a mean of 96 per cent of the progesterone entering these tissues", see here. Assuming it is a cream, 20-40mg/day could make symptoms worse. And adding testosterone even more so. Although your testosterone is within the 'normal' range, it's pointless giving you the total testosterone, it's the active which is needed. High testosterone in a woman causes severe PMS symptoms. But if bound to SHBG (sex hormone binding globulin) testosterone becomes inactive. Luckily progesterone raises levels of SHBG, see here, so preventing the rise of free testosterone and severe PMS. I suggest continuing with the adrenal re-builder as you say it's effective, but stop the testosterone. We do have a page on Libido you could look through. You'll see that testosterone plays a very small role in raising libido, in men too. We also have a page on Migraines, progesterone certainly helps, so too does vitamin D. Please have a test done. Continued below

Aug 23, 2013
So sick of being sick and tired! part 2
by: Wray

Hi there With all those symptoms, and the low ratio, I feel you'll need about 400mg/day progesterone. But please look at our Oestrogen Dominance page before you start it. The increased allergies, brain fog and fatigue are oestrogen related. Once you get your level down, and progesterone high, these should lift, but it's not a quick fix. Oestrogen and testosterone cause Insulin Resistance, which can cause severe fatigue, this could be another reason you're tired. Take care Wray

Aug 28, 2013
Le bon ratio pour être bien ?
by: Marie

Bonjour,
voici mes résultats 133 pmol/L 17b-estradiol et 11,5 nmol/L progestérone. Pouvez-vous me dire à quoi devrait être le ratio idéal lorsque c'est un test sanguin. Merci Beaucoup

Aug 29, 2013
Progesterone to Estrogen ration
by: Veronique

Bonjour Marie
Je suis une amie de Wray qui m’a demandée de vous répondre en français. D’après vos résultats votre ratio P :E2 progestérone a estrogène est de 86 :1
Ce qui est assez bas !!. Pour se sentir bien c’est aux alentours de 600 :1. Je vous invite à jeter un coup d’œil sur un article sur mon site a ce sujet - here.
Et je vous invite a m’envoyer vos questions en français. Bien cordialement , Véronique

Aug 29, 2013
Progesterone to Estrogen ration
by: Wray

Hi Vero Merci beaucoup! Bisous Wray

Aug 29, 2013
Suite besoin d'aide
by: Anonymous

Bonjour Véronique,
Un grand merci de me répondre je suis tellement contente.
J'avais bien fait le calcul c'est déjà un bon départ. J'avais pas bien compris par exemple pour le 600:1 je suis très loin du compte. Mais j'ai un problème avec la progestérone elle me donne tellement de somnolence en après-midi que je ne suis pas capable de fonctionner. Si j'augmente ma dose je dors littéralement tous les après-midi et je suis léthargique, aucune concentration, je cherche mes mots, j'ai de la misère à parler correctement. J'ai aussi depuis que je prends de la progestérone (avril 2013) pris 15 livres donc 5 en trois semaines. Je suis totalement décourager et je n'arrive pas à balancer. J'utilise actuellement Estrogel une dose de un coup de pompe le soir et Prométrium une capscule le soir. Je suis ménopausée par chirurgie depuis 2001 estérectomie totale. J'ai actuellement 47 ans et depuis mon opération je n'avais que l'estrogène comme thérapie. Pouvez-vous m'aider ?
Merci beaucoup

Aug 29, 2013
RE: So sick of being sick and tired!
by: beth

thank you so much for all of your help, u are a blessing! I will stop the testosterone today. I started supplementing with DIM, it has helped a bit, but obviously not going to fix the problem since my progesterone is so low. what do you think about supplementing with Vitex, and if you approve, how much should i be taking...I have read to little or too much could make or break you. I am so ready to feel normal again. I am not sure if my doctor will prescribe such a high dose of progesterone, they seem to think I don't need it anyways because I am still cycling regularly..it was like pulling teeth to get them to do blood work a second time and prescribe the little bit of cream that they did. I cannot thank you enough for what you are doing on this site, women all over the world are struggling with doctors and their lack of concern for hormonal issues. They don't understand what we are going through, because most of us look rather healthy but are falling apart on the inside, emotionally, physically and psychologically..it breaks us and I personally feel totally defeated and alone..until now. I was at the end of my rope when i sent you that message in desperation, and I believe you are sincere in helping me and the others on this site to get WELL. THANK YOU. If yes to vitex, when during my cycle, how much and how often...if not..then back to cream..again how much, what time during my cycle? I cannot thank you enough!!

Aug 30, 2013
suite ratio progestérone
by: Marie

Bonjour Véronique, je suis désolée j'ai oublié d'écrire mon nom c'est moi Marie.
Un grand merci de me repondre je suis Tellement contente.
J'AVAIS bien fait le calcul C'est déjà Un bon Départ. J'AVAIS Pas bien compris par Exemple Pour Le 600:1 je suis tres loin du Compte. MAIS J'ai un Problème avec la progestérone Elle Me Donne Tellement de somnolence en après-midi Que je ne suis Pas capable de trabalho. Si j'augmente ma dose je dors littéralement Tous les après-midi et je suis léthargique, Aucune concentration, je cherche mes mots, J'ai de la misère à Parler correctement. J'ai also DEPUIS Que je prends de la progestérone (avril 2013) Prix de vente conseillé de 15 livres Fait 5 fr Trois Semaines. Je suis Totalement décourager et je n'arrive Pas un équilibreur. J'utilise ACTUELLEMENT Estrogel Une dose de un coup de pompe le soir et PROMETRIUM juin capscule le soir. Je suis ménopausée par chirurgie DEPUIS 2001 estérectomie Totale. J'ai 47 ans et ACTUELLEMENT DEPUIS mon opération je n'avais Que l'estrogène Comme thérapie. Pouvez-vous m'aider?
Merci beaucoup

Aug 31, 2013
RE: So sick of being sick and tired!
by: Wray

Hi Beth You hit the nail on the head with your "look rather healthy but are falling apart on the inside, emotionally, physically and psychologically." I looked so healthy too, but internally it was turmoil! I likened myself to a hot water bottle, the slightest squeeze and the tears would flow! DIM can help, so too can calcium D-glucarate, the DIM by preventing the conversion of a relatively mild oestrogen to a potent one. The Ca D-glucarate helps with detoxing oestrogen. My views on vitex are ambivalent. It's been used for many problems which women suffer from, PMS, mastalgia, menstrual irregularities, fibrocystic breasts, increasing lactation and more, see here. It can also reduce prolactin levels, prolactin is an inflammatory hormone which can cause tender breasts, see here. It can help with luteal phase dysfunction, with subsequent problems in embryo implantation, see here. But because it has a mild oestrogenic action, levels of 17 beta-oestradiol can increase. One study found mild ovarian hyperstimulation syndrome occurred in the luteal phase, see here. If Prolactin levels are high both progesterone and the amino acid tyrosine are very affective at suppressing it. Agnus castus doesn't contain progesterone as so many seem to think. You might have uphill getting enough progesterone from your doctors. You don't have to get it through them, although of course if medical aid pay it's a bonus. You might like to look at getting a cream either from us or another brand. And these comments from other users of high amounts might encourage you, see here, here, here and here. This comment is very interesting, she's given some excellent articles too, see here. Let me know how you get on. Take care Wray

Sep 01, 2013
thank you Wray!
by: beth

New things going on now...I am still taking the DIM, stopped the testosterone like you said, still taking adrenal rebuilder...and the day after you told me about upping my progesterone, I decided to just double my current cream that night, so i took 80mg instead of the normal 40. My headache has been gone for a week now from taking the DIM, but now for the first time in my life i am having heart palpitations!! And i feel depressed today...I am about 4 days from my period, what in the world could be causing the palpitations, am i bringing my estrogen down TOO LOW now taking the DIM, is it the higher dose of progesterone? I don't want to make myself even worse!! What do you think? keep taking the DIM and keep at the 80mg of progesterone and see what happens or stop? I want to just give up and fall apart, I really can't take much more of this :(

Sep 01, 2013
thank you Wray!
by: Wray

Hi Beth 80mg/day is not enough, I said I thought you needed 400mg/day. Oestrogen causes prolongation of the QT interval, which results in palpitations, arrhythmia, Torsades de Pointes and sudden death. Whereas progesterone shortens the QT interval, see here, here, here, here, here, here, here, here, here and here. These symptoms occur far more frequently in women who naturally have a long QT interval, rather than men who naturally have a short QT interval. So the 80mg/day has merely stimulated the oestrogen which is causing the palps. 4 days from your period is the time when most women feel awful. Both progesterone and oestrogen peak mid-luteal phase which is ±7 days before bleeding. Both begin dropping round about day 4 before bleeding, but it's the withdrawal of progesterone which causes the symptoms. And don't forget you haven't been off the testosterone for long, the progesterone is having an uphill battle correcting all those symptoms you have. Please don't forget the vitamin D, please have a test, please get your level up high. You will find it helps. And please read those comments I gave you from other women. Take care Wray

Sep 02, 2013
Sorry Wray!
by: Anonymous

I should have went through and read your section on Estrogen Dominance a second go around, the heart palpitations were on the list! Thank you for putting me on the right track, you are truly a blessing to me and my family, and you may have saved my beautiful little family, because I couldn't take much more of this. Thank you from the bottom of my heart. i will keep in touch and let you know how things are progressing.

Sep 02, 2013
Sorry Wray!
by: Wray

Hi Beth Bless you for the kind words. I did say I know exactly how you feel too, I don't know how my family put up with me either. Thank god a distant memory now, although I can remember it all too clearly. Please don't forget to use enough progesterone, it really is most important. And don't forget the vitamin D too! Let me know how you get on. Take care Wray

Sep 05, 2013
Dosage Info
by: beth

hey Wray, me again! Getting ready to order Natpro and start the 400mg/day dosage. I am very nervous, but I believe you are doing everything you can to help me and I greatly appreciate that. I see that the tubes have a total of 2000mg or progesterone, correct? So how do i take this 400mg? Daily? After ovulation until period starts again? And how long am I supposed to take this amount for? Will i know if i need to cut back from the 400mg..will there be signs if it is possibly too much for me and if so how much should i cut back to? Thank you so much! I AM HONESTLY NERVOUS, and PRAYING.

Sep 07, 2013
Dosage Info
by: Wray

Hi Beth If you feel nervous, please read again those comments from women who used high amounts. It should reassure you. I'm concerned you haven't mentioned having a vitamin D test done. I can't stress how important it is to get your level up high. In fact I feel it's almost pointless using progesterone until it is, it's certainly a waste as it won't be as effective. Please have that test and let me know the results. There are 2000mg progesterone in one tube. The 400mg should be used daily, and split into at least twice a day. Some women split the amount into hourly applications. It is normal to use it from ovulation, but with your symptoms I feel you should use it daily for 2-3 months or until you feel stable. Only then follow your cycle. You will know when you can begin reducing the amount, besides I can help you. But I don't think this will be for many months, unless you get your vitamin D level up too. I could be very wrong and it is high, maybe you already know it? The symptoms to watch for are listed on the Oestrogen Dominance page. If any should occur you have two options, to sit them out or increase the progesterone. But if anything happens you're not sure of, please just contact me again. Take care Wray

Sep 10, 2013
Vitamin D Info Wray
by: Anonymous

Hey Wray! I went and got the test results that I had done back in May of this year..she did do a Vit d test that time..these are what the results say, Vit D, 1,23,(OH)2, TOTAL says 58. Vit D2, 1,25 (OH)2 says <8 and last Vit D3, 1,25 (OH)2 says 58. Please let me know what you think now that we have these results, I am eager get the progesterone started. I have been supplementing with Vit D and magnesium at night before bed for about 2 weeks now...continue this too? Just let me know what to do!! Thank you SOOOOO MUCH!!!

Sep 11, 2013
Vitamin D Info Wray
by: Wray

Hi Beth Well your results have me puzzled because 1,23 (OH)2 doesn't exist. The only vitamin D which should be tested is 25(OH)D. 1,25(OH)2 D is the hormone and is not usually tested. It's from the 25(OH)D that's it's made, which is why the 25(OH)D is so important, and yet you don't mention it. You've given me 1,23(OH)D and 1,25(OH)D and both are 58 which means something is wrong. Please check again. If as I suspect the 58 is for the 25(OH)D, then it's not too bad. Although best if it's between 70-100ng/ml. Very happy you're now supplementing with it though, and the magnesium too. So definitely continue with these two, but get your level checked again in about 3 months. In some women in rises, in some little to no rise occurs. It depends so much on what is happening in the body. Stress, which includes inflammation, causes levels to drop. Please let me know how much vitamin D you're taking. Take care Wray

Oct 29, 2013
Are my E and P levels to be expected?
by: Deb

Can anyone help? I hadan incredibly stressful year in 2011 and then a hysterectomy and removal of 1 ovary. Since this time I have experienced severe anxiety, lessening off now, really bad insomnia, thumping heart, exhaustion, nausea and intermittent headaches. Recent bloods showed my estrogen at less than 44 and my progesterone at .5. What does this mean? Am I estrogen dominant? I have started on a evorel 25 patch and some progesterone cream. My symptoms have eased a little bur the anxiety is all consuming. Am I going about this the right way as I haven't a clue and am not getting much help from my GP. Thank you anyone who replies.

Jun 23, 2014
Sad story...
by: Lara

Dear Wray, please advice. I have a long-term problem. I made a test of saliva. Estradiol 19.2 pg / ml Progesterone 117 pg / ml. Test I did on the 30th day of the cycle. Please advice how to proceed. respectfully

Jul 18, 2014
No relief
by: Sick and tired myself

For several months I've been having issues feeling just awful with my hormones after being on them for approximately five years. My progesterone is 13 my estriol is 13.6 and my total estrogen is 145 where my going wrong please help. I will also mention that these are blood test that are being done. Do you have any suggestions on what I should be doing differently. Thank you so much

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