EP.150/ Endo and PMS: Low Moods, Low Progesterone, Low GABA
A few weeks ago, I shared an episode on addressing low moods in your luteal phase (that’s your premenstrual phase, which occurs after ovulation and lasts around two weeks), and I started with low blood sugar.
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In this episode, I want to talk about the other common issue which can cause low moods at this time of your cycle, and that’s low progesterone. I was originally going to also talk about low neurotransmitters as well, but actually just low progesterone alone has so many parts to it (and I didn’t even touch upon them all!) that I think it would be good to separate this theme into three episodes, so one on blood sugar, one on low progesterone and one on low neurotransmitters. That way, you can work on an area and observe the difference, rather than trying to address all the issues at once, when some of them may not even be relevant to you.
If you haven’t listened to my previous episode, then I really strongly suggest you start there and begin balancing your blood sugar first, because you may not even need to address these next steps if your symptoms improve with better blood sugar levels!
And the reason why I am covering this, is because 93% of you said that you suffer with low moods in the week or so before your period, and endometriosis is enough to deal with, let alone with feeling extra teary, anxious, or irritable! I want to make your period and the rest of your cycle as manageable, and even as easy as possible for you, so even though this may not seem directly linked to endo, it will improve your overall experience of your cycle. In fact, addressing these problems will likely help your endo too – and I’ll explain why as we go through the episode.
So, let’s dive into low progesterone. And to understand this, we need to understand how progesterone is produced. The majority of our progesterone comes from a gland called the corpus luteum. This is a temporary gland that is formed once our chosen mature egg is released from its sack-like follicle during ovulation. When this sack no longer holds the egg, it transforms into our corpus luteum, and this gland releases progesterone during the second half of our cycle.
Progesterone is responsible for various reproductive roles, such as further preparing the uterine lining and supporting a healthy pregnancy, which is why it’s so crucial to have good progesterone levels if you’re trying to conceive or struggling with miscarriages. But it is also a mood soother and without enough of it, we can get cranky, irritable, depressed, or anxious…
Progesterone produces a metabolite, which is essentially a by-product that is made as a result of progesterone being used. This metabolite is called allopregnanolone and it usually has a positive impact on nerve signalling and brain function. Allopregnanolone binds to GABA receptors, and GABA is a neurotransmitter which tends to soothe and calm the nervous system. And just to be clear, a neurotransmitter is essentially a chemical messenger which transfers information from one brain neuron to another, they include other neurotransmitters like serotonin and dopamine. So, this binding to the GABA receptor enhances the calming effects of GABA, creating a sedative like response which can improve sleep, calm anxiety, and generally soothe both body and mind.
However, if we’re low in progesterone, we may not have enough allopregnanolone to reap the benefits of GABA, and the reason why we’ll notice this so dramatically in the second half of the cycle, is because in the first half, oestrogen is supporting serotonin production, our happy hormone. So, when oestrogen lowers in the second half of our cycle, if we don’t have enough progesterone, we may feel a real crash in our mood.
On the flip side of this, research is showing that in those with PMDD, regardless of the levels of progesterone, these people have a negative reaction to the binding of allopregnanolone to GABA receptors. They actually have the opposite reaction; they become anxious, the nervous system over responds, etc. So, if you suspect you have PMDD, just have an awareness of this – healthy hormone levels will help, but you may also need some extra support due to this reaction. I’ve put a link into the show notes where you can read up on this a little more and to two podcast episodes where I cover PMDD and how to manage it.
But for those of us without PMDD, lower levels of progesterone can cause insomnia, anxiety, depression, and irritability. And also, if you suspect you have oestrogen dominance and you’re wondering why we don’t just keep reaping the benefits of serotonin if our oestrogen levels are higher than they should be in the luteal phase, well in many cases, it’s not that oestrogen is high, but that progesterone is too low, and this creates an imbalance where oestrogen is too high in relation to progesterone. Or you may genuinely have high levels of oestrogen and too low progesterone, or simply just have high levels of oestrogen and normal levels of progesterone, but regardless, that doesn’t mean the effects will be positive! If your hormones are not doing what they’re supposed to be in the second half of the cycle, you’re going to run into problems and oestrogen dominance or excess oestrogen causes PMS, which of course, causes mood swings. So, the best way to have balanced moods in your luteal phase, is to balance our hormones.
So how do our levels of progesterone get too low in the first place?
So, number one is a lack of ovulation. If we don’t ovulate, we don’t have healthy progesterone levels, because the majority of progesterone will come from the corpus luteum, which is only made once we’ve ovulated.
And many people think if they have a period, they’ve ovulated, but this isn’t the case. You can still have a period without ovulation, it’s just not a true period, it’s sort of like a breakthrough bleed. If you want to know for sure if you’re ovulating, then you need to use the Fertility Awareness Method to track your cycle and this will measure your basal body temperature, cervical fluid and cervix position and will give you the exact date you ovulated on. Understanding the Fertility Awareness Method is really another podcast episode, so I’ve provided a link to where you can learn more about it in the show notes, but I also share how to do it in my course and with my clients, if you want more support on how to do it.
So, what stops up from ovulating? Many things, but the key is usually stress, whether that’s emotional or physical. And that stress can look like work stress, money stress, general life stress, but it can also be physical stressors like chronic inflammation, gut health conditions like SIBO, blood sugar imbalances, too much caffeine (because caffeine turns on the stress response), etc.
When our body is stressed, it kicks into survival mode and energy is taken away from non-essential functions and directed to essential functions that will help us to survive ovulation is not one of those, so that is put on the backburner. Additionally, having a baby when we’re under threat, from a biological standpoint, is not the best time to bring offspring into the world, so there are several ways the body responds to stop us from conceiving, and most of these result in a lack of ovulation.
Additionally, when we’re stressed, the body will always prioritise cortisol, our stress hormone. Cortisol and progesterone actually fit into the same cell receptors, so when we have higher levels of cortisol, progesterone is blocked from cells, preventing it from getting to work. So even if we have healthy levels of progesterone, if we’re stressed, we may not be reaping the same benefits.
Another possible cause of low progesterone is hypothyroidism, which is when the thyroid is producing too little thyroid hormones. Autoimmune hypothyroidism, known as hashimoto's thyroiditis, has actually been linked to endometriosis in several studies, indicating that there could be a greater risk of developing the autoimmune condition in those of us with endo.
Some signs of an underactive thyroid are:
· Chronic fatigue
· Low libido
· Painful joints
· Cognitive impairment such as brain fog and forgetfulness
· Feeling cold all the time or particularly sensitive to cold
· Constipation
· Dry skin and hair
· Hair loss or thinning (including eyebrows)
· Weight gain
· Low moods or depression
· Period problems such as heavy, long, or painful periods
· Infertility or miscarriage
I’ve written an article about the subject, though it is fairly old, and I’d love to update it, but it does have some good guidance on how to check for signs of hypothyroidism and how to correctly test your thyroid too!
However, the bottom line is, if you’re not producing enough thyroid hormones, you won’t be making enough progesterone because a lack of thyroid hormones can stop or delay ovulation and additionally directly affect our ability to make enough progesterone.
Another cause of low progesterone would be nutrient deficiencies. Nutrient deficiencies are a stressor on the body regardless, and so that could interrupt ovulation, but if we don’t have adequate nutrients, we may struggle to develop healthy follicles, meaning that even if an egg does make it to ovulation, the corpus luteum might be too poor quality to produce sufficient levels of progesterone.
So, what can we do about low moods caused by low progesterone? Well, clearly, there could be a number of causes, so I’m not going to give you a huge to-do list because that’ll be overwhelming. Instead, I’m going o give you some baby steps to try and if they don’t help over the next few cycles, you can turn to the deeper investigations.
My first suggestion is to manage stress and raise GABA levels with one action. Any stress reduction exercises can help to lower stress and raise GABA levels according to Trudy Scott, in her book, The Anti-Anxiety Food Solution, but particularly, yoga has been shown to be a shining star here. Additionally, you could try deep breathing exercises or slow movement like tai chi or forest bathing (a fancy term for walking in nature)! The more you do of these in your luteal cycle, the better you’ll likely feel and the more you do of them all month long, the less likely you’ll be to feel low in your luteal phase, because hopefully, the stress reduction has supported a healthy ovulation!
My second suggestion is to eat more fat. Yep, I really said that. And when I say fats, I mean healthy fats, like olive oil, avocados, and nut butter. Our hormones are made of fat and protein, specifically cholesterol and a protein called STAR protein. If we’re not consuming adequate fat, we won’t be developing healthy follicles leading to low levels of progesterone or a lack of ovulation entirely. Additionally, eating enough fat keeps blood sugar levels stable, and we know that imbalanced blood sugar is a major stressor to the body, which of course can lead to delayed or missing ovulation and resulting PMS. When we’re thinking about serving sizes of healthy fats, we want to be eating around two golf ball sized servings of fat with every single meal. So that might look like two tablespoons of nut butter, or maybe a third of a large avocado for example.
So that’s it. Those are two fairly easy and pleasant actions to get started with – try eating more fat and try out some gentle exercises like yoga, breathing or slow movement, ideally at least one of these once a day if possible.
Now of course, if you have hypothyroidism or you suspect you do, then these exercises aren’t going to be enough to recover your progesterone levels and you’ll need to get that addressed.
And additionally, if you have gut health issues like SIBO, gut dysbiosis, candida, etc. these are going to be a significant source of inflammation in the body and will be a chronic stressor, which could be having a real effect on your hormones. In fact, gut health issues are a leading cause of hormonal imbalances; the healthier your gut, the better your hormones will be – and the better your endo symptoms will be! Gut health problems will also very much be behind nutrient deficiencies as well, if you have them that is, as they’ll often affect nutrient absorption. And the toxin known as LPS, which comes from gram-negative bacteria and escape through a leaky gut wall, have also been shown to contribute to the development of autoimmune hypothyroidism. LPS levels are very high in SIBO, so healing that will help to prevent the development of hypothyroidism or will improve your symptoms if you already have it.
Now of course, gut healing is a whole other topic and can often take some time to work on, so I’m not going to dive into that here. What I will say is I have plenty of episodes on leaky gut, SIBO and gut healing in general, and I’m also running a free gut healing challenge at the moment, called the Endo Belly Challenge, so you can sign up to that if you’d like to begin working on this area of healing.
And finally, the standard protocols I always go on about such as eating a nutrient dense anti-inflammatory diet and balancing your blood sugar will have a significantly positive impact on ovulation and progesterone production, so generally trying to keep those in mind is going to help here too.
In the future, I’ll do another spotlight episode on progesterone and how to boost that but start here and see how you do for a few cycles and then if you’re not experiencing much of a response, begin to investigate some of the other issues I raised today like PMDD, hypothyroidism and SIBO. Additionally, listen out for the final episode in this series to see if that could help you too!
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