How to Increase Progesterone Before Turning to HRT - Dr. Michael Ruscio, DC

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How to Increase Progesterone Before Turning to HRT

Natural Options For Balancing Your Progesterone Levels

Key Takeaways:

  • When learning how to increase progesterone levels, start with natural therapies like diet, lifestyle, probiotics, and herbal preparations to correct the underlying cause(s) of low progesterone levels.
  • Low progesterone levels may be a result of aging, gut dysbiosis, stress, and insulin resistance.
  • Low progesterone symptoms rather than lab values should guide treatment, as there is no universally “ideal” level.
  • It’s important to restore the balance between estrogen and progesterone for the best results, rather than targeting just one hormone.
  • Progesterone hormone replacement (HRT) can be a good option for women with severe progesterone deficiency and/or symptoms, or who have exhausted other options.
  • HRT may not be the best first step for many women, as it can mask the underlying cause of low progesterone and neglect other hormone imbalances. 

Female hormones are complex and estrogen tends to get most of the air-play. But progesterone, a regulator of estrogen, is equally important and deserves the same amount of attention. 

If you’re wondering how to increase progesterone, it’s important to consider the root cause(s) of your low levels. Gut dysbiosis, stress, and insulin resistance are common culprits that can be corrected with diet, lifestyle, probiotics, and other natural therapies.

Addressing these underlying causes can often reestablish hormone balance without having to resort to hormone replacement therapy (HRT). HRT is certainly an attractive option to raise your progesterone levels, but this approach can miss the underlying cause of your symptoms and a coexisting estrogen imbalance. 

Symptoms like breast tenderness around your periods, mood swings, premenstrual headaches, acne, difficulty sleeping, and short menstrual cycles may be blamed on low progesterone levels or “estrogen dominance,” but are probably more an indicator of an imbalance between estrogen and progesterone.

In this article, I’ll discuss both progesterone and estrogen and how lifestyle can affect their levels. I’ll also share six natural therapies you can use to increase your progesterone levels to restore hormone harmony.

How To Increase Progesterone Naturally

Rather than starting with hormone replacement for low progesterone symptoms right off the bat, you should know there are several natural ways to balance your hormones. A comprehensive approach using diet, lifestyle, probiotics, and other natural therapies that target the root cause(s) of low progesterone levels can help to create hormone balance. 

Before getting into the specifics, I want to give you a snapshot of how to increase progesterone and balance your hormones naturally. This chart lays out 6 areas to address and how to incorporate them:

Diet [1, 2]
  • Whole-foods, anti-inflammatory meal plan 
  • Healthy dietary fat at each meal 
Sleep Hygiene [3, 4, 5]
  • Acupuncture
  • Yoga
  • Regular exercise
  • Healthy sleep routine
Stress Management [6, 7
  • Cognitive behavioral therapy (CBT)
  • Coping skills training
  • Spending time in nature
  • Meditation
  • Yoga
  • Deep breathing
Exercise [8, 9]
  • Walking (especially in nature)
  • Strength training
Probiotics [10, 11
  • Lactobacillus/Bifidobacterium blend
  • Saccharomyces boulardii
  • Soil-based
Herbal supplements [12, 13, 14, 15, 16, 17, 18, 19]

Addressing one or two of these may provide some benefit, but you’ll probably get the best results by making adjustments in each category. Let’s start with diet and work our way through the list.  

How To Increase Progesterone: Diet

A whole-foods, anti-inflammatory diet is a great place to start when you’re trying to increase progesterone levels and balance your hormones. This foundation promotes healthy hormone production by:

  • Optimizing your digestive health
  • Maintaining your blood sugar levels
  • Ensuring you consume adequate levels of vitamins and minerals

Several studies have shown a whole-foods diet with adequate B vitamins to be helpful for improving PMS symptoms (which are often the result of low progesterone levels). One study found that women who have a higher intake of vitamins B1 (found in meat, fish, and whole grains) and B2 (beef liver, dairy, and spinach) had a 35% lower risk of developing PMS [20, 21]. In addition, women who replaced refined grains with whole grains had a significant drop in PMS symptoms [2]. 

A whole-foods diet can also improve insulin sensitivity, which is often disrupted in polycystic ovary syndrome. When the body’s sensitivity to insulin goes down, more estrogen is made, and circulating levels of estrogen increase [22]. This can cause relatively low progesterone levels and symptoms of a deficiency, making blood sugar control essential in balancing hormones. 

As you can see, estrogen and progesterone have a close relationship, and, like other natural methods to raise progesterone, diet can help balance both.

Your diet should be personalized, but I often recommend the Paleo diet. It’s pretty easy to implement, focuses on whole foods, and cuts out foods that may cause inflammation like dairy products, grains, beans, legumes, unhealthy fats (like corn, soybean, and peanut oils), and artificial sweeteners.

How to Increase Progesterone Before Turning to HRT - Paleo%20Diet%20Landscape L

On the Paleo diet, you’ll be focusing on:

  • Fresh vegetables and fruits
  • Fresh meats, fish, and eggs
  • Healthy fats and oils (avocado, coconut, olive)
  • Nuts
  • Seeds

Healthy fat intake is quite important for hormone production, so let’s spend a little more time on dietary fat and some good sources to include in your meal plan.

Dietary Fat Intake

Since hormones are made from fat, a diet that’s too low in fat will make it difficult for your body to produce enough progesterone (and other steroid hormones) [23, 24]. A good rule of thumb is to include a small portion of healthy fat with every meal.  

Here are some great options:

  • Extra-virgin olive oil
  • Avocado or avocado oil
  • Flaxseed or flaxseed oil
  • Fatty fish
  • Nuts
  • Chia seeds
  • Coconut oil
  • Eggs

While an anti-inflammatory diet adequate in healthy fat will provide the foundation for progesterone production, lifestyle factors like sleep, stress, and exercise are of equal importance. Let’s take a look at how lifestyle can impact your hormone levels.

How To Increase Progesterone: Lifestyle

Along with an anti-inflammatory diet, lifestyle changes that support healthy sleep, stress, and exercise can help to ensure healthy hormone production. Obtaining restorative sleep will be key, so let’s review how to create healthy sleep habits.

Sleep Hygiene

Sleep is one of the factors that significantly affects your internal environment. The quality and quantity of your sleep can actually alter the bacteria living in your body and we know alterations and dysbiosis in the gut can affect sex hormone production. 

But getting quality sleep can be a challenge if your hormones are out of whack. Acupuncture has been shown to reduce sleep disturbances in perimenopausal and menopausal women [4] and yoga improves sleep for women with PMS symptoms [5]. 

Here are some additional tips for sleep optimization:

  • Reduce blue light exposure at night
  • Sleep in a dark, cold, quiet environment
  • Avoid stressful activities before bed
  • Try to get in bed before 10 pm and aim for 7–8 hours of sleep
  • Avoid eating large meals within three hours of bedtime
  • Practice morning meditation
  • Exercise regularly
  • Avoid alcohol (disrupts sleep and may worsen PMS) [25

In addition to restful sleep, balancing stress is a key strategy for improving hormonal balance. Let’s review how stress can impact hormone levels and what you can do about it.

Stress Management

Chronic stress can derail sex hormone levels by disrupting the function of the hypothalamus and pituitary gland in the brain, which regulate hormone production. Stress also alters your digestive system, affecting sex hormone metabolism and elimination [26]. 

In addition, sex hormones like progesterone are partly made by the adrenal glands, which serve to help us manage stress. When stress (whether physical or emotional) is high, the raw materials used for the production of progesterone (and other sex hormones) go into producing stress hormones like cortisol instead [24, 27, 28].

Formal programs like cognitive-behavioral therapy (CBT) [29] and coping-skills training [30] to manage stress have been shown to improve the symptoms of hormonal imbalance. Here are some simple, free ideas for managing your stress:

  • Spending time in nature
  • Meditation
  • Yoga
  • Spending time with loved ones
  • Deep breathing techniques

Of course, not all stress is bad. Exercise is a source of healthy stress that can benefit hormone production. But too much exercise can negatively impact progesterone levels. Here are some tips for adding healthy exercise to your routine.


Exercise improves your internal environment, allowing healthy gut bacteria to flourish, which will promote healthy hormone metabolism. In addition, daily exercise helps to improve your hormones, balances your blood sugar levels (insulin resistance can lead to excess estrogen) [31], improves fatigue [32], and helps you sleep better [33].

But exercise is a stressor on the body and you can definitely have too much of a good thing. In general, the more stress you have in your life, the less exercise you can tolerate. It’s important to ensure that you’re exercising enough but not too much. I recommend walking as much and as often as you can (preferably in nature), but it’s also vital to focus on strength training and flexibility exercises as well. 

If you’re new to exercise, start out slowly and increase based on your tolerance. Ideally, you’ll be moving your body in a meaningful way each day.

Once you make some changes to your diet and lifestyle, your symptoms of low progesterone may significantly improve. If you’re still not feeling your best, probiotics are a great next option. 

How To Increase Progesterone: Probiotics

Imbalances in the gut microbiome have been shown to disrupt estrogen levels [34, 35], and may lead to progesterone deficiency symptoms. In addition, gut imbalances, such as dysbiosis or inflammation from processed foods, are experienced by your body as stress. As we know, high stress can be harmful to our progesterone levels. 

Probiotics are a great tool for increasing progesterone naturally as they reduce gut inflammation and improve gut microbiome balance allowing for healthy hormone production [10, 11, 35]. They also improve insulin sensitivity, which has the downstream effect of better hormone balance [36, 37].

I advocate for a triple therapy probiotic approach, which simply means using all three categories of probiotics in combination. 

Here’s a chart of the probiotics I recommend:

CategoryType of Probiotic
OneLacto-Bifido Blend (most well-studied)
TwoSaccharomyces boulardii (probiotic yeast)
ThreeSoil-Based (spore-forming)

My Triple Therapy Probiotic Powder Sticks are a convenient option that has all three probiotic categories in one packet. If you’d rather try them separately, start with the Lacto-Bifido Probiotic Blend for a few weeks and then add the other categories based on your tolerance. 

In addition to probiotics, herbal supplements can be helpful for improving your hormone levels too. Let’s discuss some herbal options.

How To Increase Progesterone: Herbal Supplements

As I discuss in Healthy Gut, Healthy You, there are some herbal supplements that can help to balance female hormones, whether your levels are high or low. Some examples are black cohosh and dong quai, which work to balance estrogen, and chaste tree, which works to balance progesterone. 

Estro-Harmony is a blend of gamma oryzanol, black cohosh, dong quai, licorice root, and trans-resveratrol, which have been shown to promote healthy levels of estrogen and improve:

  • Hot flashes [38]
  • Sleep [16]
  • Overall well-being [14]

Progest-Harmony is a blend of white peony root, licorice root, and chaste tree that supports balanced progesterone-to-estrogen hormone levels. This combination has been shown to alleviate PMS-related symptoms [17], hot flashes [38], and symptoms of menopause [39]. 

If you’re cycling, you can try both Estro-Harmony and Progest-Harmony. If you’re not cycling, (menopausal or postmenopausal), you can try Estro-Harmony by itself. 

Progesterone Hormone Replacement Therapy

Progesterone HRT can come in two different forms: bioidentical and synthetic. Progesterone replacement therapy primarily utilizes bioidentical formulas that match your body’s endogenous progesterone. 

Women naturally produce high levels of progesterone during pregnancy, making bioidentical progesterone overdose and adverse events uncommon. Though it’s not completely free of side effects, they are typically less severe than progestins, and primarily consist of fatigue, breast pain, and bloating. 

Bioidentical progesterone most often is used topically, as creams, or orally, as micronized progesterone (Prometrium). However, even vaginal formulas are available, though typically reserved for fertility and pregnancy.

Starting out: If you’ve exhausted all other options or have a severe progesterone deficiency, supplemental oral micronized natural progesterone can be a great option for faster relief while you continue to address the underlying cause(s). Though progesterone creams are available over the counter, it’s strongly recommended to work with a practitioner when using HRT, as it has the potential for toxicity at very high levels.

How to Stop: If you’re already on HRT to boost progesterone levels and you feel great, there’s no need to immediately stop. You can implement the above recommendations while working with your healthcare provider to wean off.

It’s important to note that progesterone is a drug with a potential for adverse effects, so there are no Food and Drug Administration (FDA) approved over-the-counter (OTC) progesterone products [40]. In addition, quality research on the long-term use of progesterone by itself is lacking [41]. 

With that being said, the biggest risks of bioidentical progesterone as a stand-alone treatment, are that it can mask the underlying cause of symptoms and neglect other hormone imbalances, like estrogen. 

What About Birth Control to Raise Progesterone?

Synthetic progesterone, known as progestin, is the form contained in birth control pills and is more often linked to side effects. For this reason, progestins are rarely used in hormone replacement therapy. 

The chronic use of progestins may lead to the following side effects [27]:

  • Abdominal cramps
  • Back pain
  • Breast tenderness
  • Low blood pressure
  • Dizziness
  • Increased blood clot development (rare)
  • Vaginal bleeding

While their most common use is in pregnancy prevention, they are frequently prescribed in conventional medicine to address hormonal issues like PMS, premenstrual dysphoric disorder (PMDD), and polycystic ovary syndrome (PCOS). 

These conditions will often respond to natural therapies and/or bioidentical progesterone but may require synthetic versions in rare cases. While we don’t recommend progestins for raising progesterone levels, they certainly have their place in gynecological care and contraception.

The bottom line on progesterone HRT is to make sure you discuss all of your options with your HRT-knowledgable provider to see what’s best for you.

What are Normal Progesterone Levels?

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Female steroid hormone tests suffer from a lack of standardized collection methods and reference ranges. This makes them notoriously hard to interpret, which is worsened by the variability of female hormone levels throughout the menstrual cycle and amongst women. To sum it up — there is no “normal” when it comes to female hormone levels, which can make discovering and treating low progesterone tricky.

However, monitoring hormonal fluctuations throughout a full menstrual cycle in cycling women can help identify hormonal imbalances and is among the most important diagnostic tools for determining infertility. 

You can measure female steroid hormones in several ways, but serum testing (blood collected in a test tube) is considered the gold standard. Here’s a chart of normal levels based on menstrual cycle timing and pregnancy:

Cycle StageStandard Progesterone Values
Follicular phase (days 1 to 14)<1 ng/mL
Luteal Phase (days 15 to 28)2.6-21.5 ng/mL (8-18 ng/mL may be optimal)
Postmenopausal<0.5 ng/mL
Pregnancy: First Trimester4.1-34 ng/mL
Pregnancy: Second Trimester24-76 ng/mL
Pregnancy: Third Trimester52-302 ng/mL

It’s important to note that testing ranges vary, so speak with your healthcare provider about your specific levels.

In my experience, levels of progesterone higher than 10 ng/mL in the mid-luteal phase indicate a woman is ovulating. These levels also correspond with the resolution of low progesterone symptoms and restore the estrogen-progesterone relationship. There can still be ovulation at levels as low as 2.5 ng/mL but a range of 8 to 18 ng/mL may suggest you’re more fertile and your uterus will more likely receive a fertilized egg and maintain a pregnancy [42, 43].  

However, many women with mid-luteal progesterone levels below 8 ng/mL will have no symptoms of low progesterone. And women with day 21 levels of 15 ng/mL may still have low progesterone symptoms. This is why, when it comes to hormones, symptoms not lab values should guide your treatment.

Low Progesterone Symptoms

When progesterone is too low, it’s often mistaken as “estrogen dominance”, which refers to an excess of estrogen relative to progesterone. However, when progesterone levels are very low, estrogen levels could also be low (but relatively higher), causing symptoms [27]. This is why it’s important to treat all hormones, not just one. 

Here are some of the symptoms of estrogen dominance and/or low progesterone levels [44] :

  • Cyclic breast tenderness or pain (especially in the second half of the menstrual cycle)
  • Mood swings, irritability, and/or tearfulness with premenstrual syndrome (PMS)
  • Premenstrual headaches or “menstrual migraines”
  • Acne, especially in the first half of the menstrual cycle
  • Irregular or heavy periods
  • Weight gain around the hips and butt
  • Difficulty sleeping
  • Short cycles (21-24 days)
  • Spotting

When progesterone is low, there is the potential that excess estrogen can run wild, which can promote tumor growth (especially in breast cancer). Aside from lowering cancer risk, balancing these two hormones is important for maintaining healthy [41]:

  • Bone density
  • Uterine lining
  • Cervical tissue
  • Breast tissue
  • Heart and blood vessels
  • Brain function
  • Sleep patterns

When you address the root causes of low progesterone levels with natural therapies, hormone balance can often be restored to your whole endocrine system.

Increase Progesterone Naturally With Diet, Lifestyle, and Probiotics

Progesterone is a steroid hormone that helps keep estrogen levels in check but it’s also vital for pregnancy and menstruation. When progesterone levels are too low, you can experience everything from menstrual irregularities and PMS symptoms to sleep disturbances and infertility. 

Low progesterone levels may be the result of aging, but can also be caused by chronic stress, gut imbalances, and insulin resistance. While hormone replacement therapy may be recommended, it doesn’t come without risk. Natural therapies like diet, lifestyle changes, probiotics, and herbal supplements can be very helpful for correcting the underlying causes of low progesterone levels to restore hormone balance.

If you’ve tried diet and lifestyle interventions but still struggle with low progesterone symptoms, contact us at the Ruscio Institute for Functional Medicine for a more personalized plan. 

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
  1. Bajalan Z, Alimoradi Z, Moafi F. Nutrition as a potential factor of primary dysmenorrhea: A systematic review of observational studies. Gynecol Obstet Invest. 2019 Jan 10;84(3):209–24. DOI: 10.1159/000495408. PMID: 30630172.
  2. Esmaeilpour M, Ghasemian S, Alizadeh M. Diets enriched with whole grains reduce premenstrual syndrome scores in nurses: an open-label parallel randomised controlled trial. Br J Nutr. 2019 May;121(9):992–1001. DOI: 10.1017/S0007114519000333. PMID: 30761961.
  3. Morssinkhof MWL, van Wylick DW, Priester-Vink S, van der Werf YD, den Heijer M, van den Heuvel OA, et al. Associations between sex hormones, sleep problems and depression: A systematic review. Neurosci Biobehav Rev. 2020 Nov;118:669–80. DOI: 10.1016/j.neubiorev.2020.08.006. PMID: 32882313.
  4. Chiu H-Y, Hsieh Y-J, Tsai P-S. Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016 Mar;127(3):507–15. DOI: 10.1097/AOG.0000000000001268. PMID: 26855097.
  5. Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M, Alibaf L. Effects of yoga on quality of sleep of women with premenstrual syndrome. Altern Ther Health Med. 2019 Sep;25(5):40–7. PMID: 31221931.
  6. Vaghela N, Mishra D, Sheth M, Dani VB. To compare the effects of aerobic exercise and yoga on Premenstrual syndrome. J Educ Health Promot. 2019 Oct 24;8:199. DOI: 10.4103/jehp.jehp_50_19. PMID: 31867375. PMCID: PMC6852652.
  7. Chiaramonte D, Ring M, Locke AB. Integrative Women’s Health. Med Clin North Am. 2017 Sep;101(5):955–75. DOI: 10.1016/j.mcna.2017.04.010. PMID: 28802473.
  8. Ennour-Idrissi K, Maunsell E, Diorio C. Effect of physical activity on sex hormones in women: a systematic review and meta-analysis of randomized controlled trials. Breast Cancer Res. 2015 Nov 5;17(1):139. DOI: 10.1186/s13058-015-0647-3. PMID: 26541144. PMCID: PMC4635995.
  9. de Roon M, May AM, McTiernan A, Scholten RJPM, Peeters PHM, Friedenreich CM, et al. Effect of exercise and/or reduced calorie dietary interventions on breast cancer-related endogenous sex hormones in healthy postmenopausal women. Breast Cancer Res. 2018 Aug 2;20(1):81. DOI: 10.1186/s13058-018-1009-8. PMID: 30071893. PMCID: PMC6090977.
  10. Shamasbi SG, Ghanbari-Homayi S, Mirghafourvand M. The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: a systematic review and meta-analysis. Eur J Nutr. 2020 Mar;59(2):433–50. DOI: 10.1007/s00394-019-02033-1. PMID: 31256251.
  11. McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008 May 7;14(17):2650–61. DOI: 10.3748/wjg.14.2650. PMID: 18461650. PMCID: PMC2709042.
  12. Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol. 2007 Feb;23(2):117–22. DOI: 10.1080/09513590701200900. PMID: 17454163.
  13. Jiang K, Jin Y, Huang L, Feng S, Hou X, Du B, et al. Black cohosh improves objective sleep in postmenopausal women with sleep disturbance. Climacteric. 2015 May 22;18(4):559–67. DOI: 10.3109/13697137.2015.1042450. PMID: 26000551.
  14. Wong RHX, Evans HM, Howe PRC. Resveratrol supplementation reduces pain experience by postmenopausal women. Menopause. 2017 Aug;24(8):916–22. DOI: 10.1097/GME.0000000000000861. PMID: 28350759.
  15. Evans HM, Howe PRC, Wong RHX. Effects of Resveratrol on Cognitive Performance, Mood and Cerebrovascular Function in Post-Menopausal Women; A 14-Week Randomised Placebo-Controlled Intervention Trial. Nutrients. 2017 Jan 3;9(1). DOI: 10.3390/nu9010027. PMID: 28054939. PMCID: PMC5295071.
  16. Ishihara M, Ito Y, Nakakita T, Maehama T, Hieda S, Yamamoto K, et al. [Clinical effect of gamma-oryzanol on climacteric disturbance -on serum lipid peroxides (author’s transl)]. Nippon Sanka Fujinka Gakkai Zasshi. 1982 Feb;34(2):243–51. PMID: 7061906.
  17. Maleki-Saghooni N, Karimi FZ, Behboodi Moghadam Z, Mirzaii Najmabadi K. The effectiveness and safety of Iranian herbal medicines for treatment of premenstrual syndrome: A systematic review. Avicenna J Phytomed. 2018 Apr;8(2):96–113. PMID: 29632841. PMCID: PMC5885324.
  18. Verkaik S, Kamperman AM, van Westrhenen R, Schulte PFJ. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017 Aug;217(2):150–66. DOI: 10.1016/j.ajog.2017.02.028. PMID: 28237870.
  19. Moini Jazani A, Hamdi K, Tansaz M, Nazemiyeh H, Sadeghi Bazargani H, Fazljou SMB, et al. Herbal medicine for oligomenorrhea and amenorrhea: A systematic review of ancient and conventional medicine. Biomed Res Int. 2018 Mar 18;2018:3052768. DOI: 10.1155/2018/3052768. PMID: 29744355. PMCID: PMC5878906.
  20. Wyatt KM, Dimmock PW, Jones PW, Shaughn O’Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. 1999 May 22;318(7195):1375–81. DOI: 10.1136/bmj.318.7195.1375. PMID: 10334745. PMCID: PMC27878.
  21. Retallick-Brown H, Blampied N, Rucklidge JJ. A Pilot Randomized Treatment-Controlled Trial Comparing Vitamin B6 with Broad-Spectrum Micronutrients for Premenstrual Syndrome. J Altern Complement Med. 2020 Feb;26(2):88–97. DOI: 10.1089/acm.2019.0305. PMID: 31928364.
  22. Estrogen Dominance – Whole Health Library [Internet]. [cited 2022 Mar 18]. Available from:
  23. Delgado BJ, Lopez-Ojeda W. Estrogen. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 30855848.
  24. Nassar GN, Leslie SW. Physiology, Testosterone. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 30252384.
  25. Fernández MDM, Saulyte J, Inskip HM, Takkouche B. Premenstrual syndrome and alcohol consumption: a systematic review and meta-analysis. BMJ Open. 2018 Apr 16;8(3):e019490. DOI: 10.1136/bmjopen-2017-019490. PMID: 29661913. PMCID: PMC5905748.
  26. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017 Jul 21;16:1057–72. DOI: 10.17179/excli2017-480. PMID: 28900385. PMCID: PMC5579396.
  27. Cable JK, Grider MH. Physiology, Progesterone. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 32644386.
  28. Hariri L, Rehman A. Estradiol. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 31747204.
  29. Kancheva Landolt N, Ivanov K. Short report: cognitive behavioral therapy – a primary mode for premenstrual syndrome management: systematic literature review. Psychol Health Med. 2021 Dec;26(10):1282–93. DOI: 10.1080/13548506.2020.1810718. PMID: 32845159.
  30. Han J, Cha Y, Kim S. Effect of psychosocial interventions on the severity of premenstrual syndrome: a meta-analysis. J Psychosom Obstet Gynaecol. 2019 Sep;40(3):176–84. DOI: 10.1080/0167482X.2018.1480606. PMID: 29962276.
  31. Kirwan JP, Sacks J, Nieuwoudt S. The essential role of exercise in the management of type 2 diabetes. Cleve Clin J Med. 2017 Jul;84(7 Suppl 1):S15–21. DOI: 10.3949/ccjm.84.s1.03. PMID: 28708479. PMCID: PMC5846677.
  32. Ruegsegger GN, Booth FW. Health benefits of exercise. Cold Spring Harb Perspect Med. 2018 Jul 2;8(7). DOI: 10.1101/cshperspect.a029694. PMID: 28507196. PMCID: PMC6027933.
  33. Kelley GA, Kelley KS. Exercise and sleep: a systematic review of previous meta-analyses. J Evid Based Med. 2017 Feb;10(1):26–36. DOI: 10.1111/jebm.12236. PMID: 28276627. PMCID: PMC5527334.
  34. Fuhrman BJ, Feigelson HS, Flores R, Gail MH, Xu X, Ravel J, et al. Associations of the fecal microbiome with urinary estrogens and estrogen metabolites in postmenopausal women. J Clin Endocrinol Metab. 2014 Dec;99(12):4632–40. DOI: 10.1210/jc.2014-2222. PMID: 25211668. PMCID: PMC4255131.
  35. Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103:45–53. DOI: 10.1016/j.maturitas.2017.06.025. PMID: 28778332.
  36. Heshmati J, Farsi F, Yosaee S, Razavi M, Rezaeinejad M, Karimie E, et al. The Effects of Probiotics or Synbiotics Supplementation in Women with Polycystic Ovarian Syndrome: a Systematic Review and Meta-Analysis of Randomized Clinical Trials. Probiotics Antimicrob Proteins. 2019 Dec;11(4):1236–47. DOI: 10.1007/s12602-018-9493-9. PMID: 30547393.
  37. Liao D, Zhong C, Li C, Mo L, Liu Y. Meta-analysis of the effects of probiotic supplementation on glycemia, lipidic profiles, weight loss and C-reactive protein in women with polycystic ovarian syndrome. Minerva Med. 2018 Dec;109(6):479–87. DOI: 10.23736/S0026-4806.18.05728-2. PMID: 30256077.
  38. Johnson A, Roberts L, Elkins G. Complementary and alternative medicine for menopause. J Evid Based Integr Med. 2019;24:2515690X19829380. DOI: 10.1177/2515690X19829380. PMID: 30868921. PMCID: PMC6419242.
  39. Dietz BM, Hajirahimkhan A, Dunlap TL, Bolton JL. Botanicals and their bioactive phytochemicals for women’s health. Pharmacol Rev. 2016 Oct;68(4):1026–73. DOI: 10.1124/pr.115.010843. PMID: 27677719. PMCID: PMC5050441.
  40. CFR – Code of Federal Regulations Title 21 [Internet]. [cited 2022 Oct 4]. Available from:
  41. Prior JC. Women’s reproductive system as balanced estradiol and progesterone actions—A revolutionary, paradigm-shifting concept in women’s health. Drug Discovery Today: Disease Models. 2020;32:31–40. DOI: 10.1016/j.ddmod.2020.11.005.
  42. Carmina E, Stanczyk FZ, Lobo RA. Laboratory Assessment. In: Yen & jaffe’s reproductive endocrinology. Elsevier; 2014. p. 822-850.e3. DOI: 10.1016/B978-1-4557-2758-2.00034-2.
  43. Carmina E, Lobo RA. Evaluation of hormonal status. In: Yen & jaffe’s reproductive endocrinology. Elsevier; 2009. p. 801–23. DOI: 10.1016/B978-1-4160-4907-4.00032-2.
  44. Mahannah DrK. 10 Signs You May Have Estrogen Dominance [Internet]. 2020 [cited 2022 Dec 12]. Available from:

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