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Is it normal for progesterone levels to drop in early pregnancy?
Yes, there may be a small temporary drop from weeks 7 – 9 of pregnancy. But if progesterone levels remain low or continue to drop more, that could be a cause for concern. This sometimes indicates an ectopic pregnancy or miscarriage.
Follow along though to learn more about why progesterone levels decrease in early pregnancy. And of course, we’ll also discuss what you should do about it.
The importance of progesterone levels during pregnancy
If you’ve been TTC for some time, you’ve probably heard a thing or two about progesterone. It’s the hormone that rises right after ovulation.
Progesterone also has a big hand in regulating your menstrual cycle and conceiving. But even when you become pregnant, its work isn’t done quite yet!
Here’s a look at the many hats this hormone wears in a normal pregnancy:
- Keeps you from getting pregnant again (by preventing ovulation)
- Bulks up your uterine lining so the embryo can successfully implant
- Keeps your uterus from contracting
- Promotes maternal immune tolerance so the fetus isn’t rejected
- Triggers breast tissue to prepare for milk production
As you can see, progesterone has some pretty hefty functions to carry out before your baby arrives. So it’s only natural to wonder: What should my progesterone levels be during pregnancy?
Keep reading. Next, we’ll uncover the typical trend of progesterone production in pregnancy.
Normal progesterone levels in pregnancy
Progesterone levels first begin rising once you ovulate. During this time, the corpus luteum is responsible for producing this hormone. By stimulating progesterone production, it helps your body prepare for implantation.
Once pregnant though, the placenta eventually jumps in to help out by secreting human chorionic gonadotropin (hCG). hCG assists the corpus luteum in producing progesterone.
By 10-12 weeks, the placenta will fully assume the responsibility of progesterone production. At this point, the corpus luteum fully collapses and is no longer involved in hormone production. (More on this luteal-placental shift in the next section).
Now, let’s see some numbers. Below, you’ll see the typical trend of progesterone production in early pregnancy.
Read more: Progesterone Levels By Week: What’s Normal During Pregnancy
Keep in mind that this table depicts average progesterone ranges. You can have a healthy pregnancy with levels above or below these ranges. But let’s explore what happens when progesterone levels change in early pregnancy.
Is it normal for progesterone to fluctuate in early pregnancy?
A temporary fluctuation in progesterone is normal and not a cause for concern. The luteal-placental shift can cause a brief dip in progesterone around weeks 6 – 8. This is when the responsibility of progesterone production is gradually shifting from the corpus luteum to the placenta.
Usually, this decrease doesn’t last more than a week and levels pick back up again shortly after. (Assuming the pregnancy is healthy).
But other instances of dropping progesterone can be problematic. We’ll look more closely at these scenarios in the next section.
Why is my progesterone dropping in early pregnancy?
By itself, lower-than-average or decreasing progesterone is not a concern. What’s concerning is the underlying cause of the drop in progesterone production. And in early pregnancy, there are a few reasons you could see a decrease in progesterone levels.
Reason for drop | When to be concerned |
Luteal-placental shift | You may notice a slight drop in progesterone between weeks 6 and 8 of your pregnancy. Here’s a look at mean serum progesterone levels by gestational week:
|
Ectopic pregnancy | Mean progesterone levels below 6.4 ng/mL could be a sign of ectopic pregnancy. |
Miscarriage | Progesterone levels above 25 ng/mL were seen in most normal pregnancies. Progesterone values below 5 ng/mL signaled a non-viable pregnancy. |
Let’s further understand why progesterone drops in each of these cases.
- Ectopic pregnancy
This is a type of pregnancy loss caused by the embryo implanting outside of the uterus.
Some research shows that blood progesterone levels less than 5 ng/mL are associated with ectopic pregnancy (ET). (As well as nonviable intrauterine pregnancies – these are unhealthy pregnancies that will end in miscarriage.)
This is helpful to know because ultrasounds on their own in the 4-6 week window aren’t totally reliable for diagnosing ET. Often, it can be challenging to pick up a fetal heartbeat via ultrasound before Week 7 of pregnancy.
Another study examined the mean progesterone level across 280 pregnancies. 140 of them were normal pregnancies compared to 140 ectopic
For the ectopic pregnancies, average progesterone levels were 6.4 ng/mL. But for the 140 normal pregnancies examined, progesterone levels were 24.6 ng/mL on average. This goes to show that progesterone levels can be a helpful marker for pregnancy complications.
Contact your doctor ASAP if you think you’re experiencing an ectopic pregnancy. These can cause internal bleeding and even become life-threatening.
- Miscarriage
Many women worry: does decreasing progesterone mean miscarriage? Sadly in some cases, yes, it does indicate a miscarriage.
A miscarriage occurs when an unhealthy pregnancy ends in a loss before 20 weeks gestation. Miscarriages mostly happen due to chromosomal abnormalities. One major sign to look for is abnormal hormone production.
In an unhealthy pregnancy, hCG will not be produced in adequate amounts. And therefore, the corpus luteum won’t have enough support for healthy progesterone levels.
As a result, you’ll notice progesterone levels dropping. And eventually, the pregnancy will end. But the only way to know for sure if you’re having a miscarriage is to contact your doctor for further testing.
My progesterone levels are dropping: what should I do?
In most cases, a drop in progesterone levels means the pregnancy could be at risk. To get to the root of the dropping levels, you’ll likely need further testing done.
So if you have concerns that your progesterone levels are dropping, talk to your doctor right away. They can conduct a blood test or an ultrasound if necessary.
Can supplementation help prevent progesterone from dropping?
For some, progesterone therapy can help the pregnancy. This is usually in the form of intramuscular injections or vaginal progesterone.
In general though, supplementation is not beneficial for all women. This is true for women with normal progesterone levels who just want to see a boost.
But progesterone supplements may help women who:
- Are at risk of miscarriage, including having recurrent miscarriages
- Have an abnormal luteal phase
- Experience a threatened miscarriage
- Are undergoing assisted reproductive treatment or other fertility treatments like ovulation induction
- Have a shortened cervix or history of preterm birth
Read more: Progesterone Supplementation 101: Everything You Need to Know
Still wondering: Can a pregnancy survive low progesterone? There is some hope. Keep reading!
Can my progesterone be low and still be pregnant?
Most successful pregnancies fall within typical ranges for progesterone levels. In the first trimester, this range is 10 – 44 ng/mL. In the second trimester, this range is 19.5 to 82.5 ng/mL.
Even still, there are some cases of women having healthy pregnancies with low progesterone. You can see some real-life examples in the next section!
Cases of successful pregnancy with low progesterone
One example is a 41-year-old woman. She successfully conceived with progesterone levels less than 1 ng/mL. At the time of her reported case, she had already made it well into her third trimester. And this is despite having progesterone levels way below average in early pregnancy.
Other women have reported similar successes with the aid of supplementation:
“I was on progesterone suppositories at the beginning of my pregnancy because my levels were a bit low (about 3-4 weeks along) until about 9 weeks and everything was fine! The suppositories raised my levels within a few days.”
“I was on a progesterone suppository for two weeks in my first trimester after a sudden drop while dealing with a subchorionic hematoma (SCH). After two weeks, my levels peaked, stayed normal and I’ve had no issues since at 37 weeks.”
Takeaways
- Dropping progesterone is often associated with adverse pregnancy outcomes. These include early pregnancy loss due to ectopic pregnancy or miscarriage.
- Progesterone decreases can also happen during the luteal-placental shift. This is a temporary drop that happens in early pregnancy. It is not a cause for concern unless the shift happens too early.
- In a normal pregnancy, progesterone should be around 10 – 44 ng/mL in the first trimester. And by the second trimester, levels should be around 19.5 to 82.5 ng/mL.
- Depending on your situation, a doctor may prescribe you progesterone supplementation. In some cases, this could help with the pregnancy outcome.
- It is possible to have a healthy pregnancy in spite of low progesterone. But contact your HCP to be safe.
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- Progesterone – Health Encyclopedia – University of Rochester Medical Center
- Spontaneous early pregnancy with very low levels of progesterone during controlled ovarian stimulation-A case report – PMC
- CHAPTER 32 – Evaluation of Hormonal Status
- Hormones in pregnancy – PMC
- The timing of placental competence in pregnancy after oocyte donation
- Gestational age-specific normative values and determinants of serum progesterone through the first trimester of pregnancy | Scientific Reports
- The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a meta-analysis.
- Serum Progesterone Measurement in Diagnosis of Ectopic Pregnancy
- Progesterone – Health Encyclopedia – University of Rochester Medical Center
- Updated Clinical Guidance for the Use of Progesterone Supplementation for the Prevention of Recurrent Preterm Birth | ACOG
- Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT
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