Spotting Before Your Period: Is It Low Progesterone?

Spotting before a period is often treated as "proof" for having low progesterone.

Progesterone is usually involved, but spotting is a bleeding pattern, not a hormone test.

To understand why spotting happens, we need to look at the entire sequence: estrogen builds the lining, progesterone organizes and maintains it, and the withdrawal of progesterone helps trigger the period.

Estrogen builds the lining first

During the follicular phase estrogen stimulates the uterine lining to grow. It also prepares the tissue to respond to progesterone after ovulation.^[1,2]

Progesterone doesn't take over estrogen's job. During the luteal phase it transforms the estrogen-built lining to get even thicker, but not by growing through cell division. Instead it accumulates fluid and swells and becomes more "spongy". Most importantly, it stabilizes and maintains the lining, which is crucial for a potential pregnancy.

When estrogen hasn't built and primed enough endometrial tissue, progesterone can't perform its normal job. A strong progesterone or progestogen effect against a thin, poorly estrogenized lining can make it thinner and more fragile, causing breakthrough spotting.^[2,3]

This is why more progesterone isn't automatically the answer. But when it is, it can be used in a different way than you've been told.

The answer lies within your cycle and how the bleeding pattern usually shows up. It also depends on your "hormonal age" and whether you're in perimenopause or not. It's very common with irregular bleeding in perimenopause as the consequence of irregular and/or dysfunctional ovulation.

Not enough estrogen?

The main process that produces estrogen in your body is ovulation. Ovulation is usually presented as the requirement for progesterone production, and while that's true and correct, it's also the requirement for estrogen production.

If you have:

• regular but short cycles
• a period that begins with light spotting a week before the period really begins
• light bleeding

Then you're not producing that much estrogen. The underlying cause for that can be several things, for example that you have a smaller follicle pool due to genetics or aging (ie perimenopause), PMOS (formerly PCOS), or that you have an energy deficit perhaps from under eating or over training.

In this case, you might be ovulating regularly, but the uterine lining doesn't get thick enough so when the progesterone peak comes naturally, the lining breaks down prematurely and you get spotting.

More progesterone will not help in this situation. What you can do however, is a little contra-intuitive, but can work like a charm (according to us at MoodMama that is).

Use a small amount of progesterone cream for a few days leading up to ovulation, in the late follicular phase. This can give estrogen production a little boost so that the lining reaches enough thickness to get stabilized during the luteal phase. The cream recommended for this would be Matriarch 20.

Not enough progesterone?

There are other explanations for spotting that can happen whether you are in perimenopause or not.

After ovulation, the corpus luteum produces progesterone to maintain the lining.

If progesterone begins declining sooner than expected, parts of the endometrium may start breaking down before the actual period begins.^[1,4]

That can produce several days of premenstrual spotting. It can also explain why the bleeding suddenly stops and then starts again.

Does progesterone testing help to explain spotting?

Not really. It just tells you whether you're in the "normal" range a week after ovulation, and basically confirms whether you ovulated or not provided you took the test on the correct cycle day. It's not helpful when you have spotting because you don't need a test to tell you that. You already know.

You also know how your cycle usually behaves, and that's much more useful and actionable information to solve the problem. Tracking your cycle is your best tool.

Too much estrogen?

In perimenopause it's common to produce a bit more estrogen than usual due to ovulation that's becoming more and more erratic.

This can lead to cycles with heavy bleeding because with more estrogen the uterine lining grows thicker than normal. For some, this can show up like spotting before the period starts because the lining simply cannot withhold its structure and starts breaking down sooner than expected.

In this case it can help to add more progesterone as a way to oppose estrogen's effect on the lining. That can both prevent the spotting and make the bleeding less heavy.

Here the lining was adequately built by estrogen, albeit excessively, and you're just topping up your own progesterone to prevent it from getting all too thick. Use Matriarch 100 for this.

Spotting isn't always hormonal

Polyps, fibroids that affect the uterine cavity, adenomyosis, and changes in the cervix can also cause spotting or bleeding between periods.^[5,6]

That matters when spotting is new, happens after sex, appears unpredictably, or continues despite treatment. Those situations require getting a pelvic exam by your doctor.

But when spotting reliably leads into your period, the relationship between estrogen → ovulation → progesterone, and the lining should be the place to look first.