One of the most commonly used metrics to assess female hormone imbalances is to look at the Progesterone to Estrogen Ratio (aka estradiol ratio), often called the Pg/E2 ratio. When this ratio is less than 200 to 1 symptoms of hormonal imbalance can quickly arise. E2 refers to an estrogen known as estradiol, but there is way more to the story than just high estrogen and low progesterone. In fact, while I find the information very valuable, what you do with the information and how to improve your estrogen and progesterone ratios is more complex than just having numbers.
If you want to learn how to fix your progesterone to estrogen ratio, balance your hormones, and reverse your symptoms with expensive drugs and frequent doctor visits, keep on reading!
Progesterone To Estrogen Ratio – Understanding The Numbers
If you are unfamiliar with what the Pg/E2 (progesterone to estrogen) ratio is, it is something many physicians use when a woman suffers from hormonal symptoms, yet their lab results appear to be within the “normal” range.
I won’t go into the exact calculations as of now, but essentially in both saliva and blood tests, you are aiming for a progesterone to estrogen ratio of 100-500. (To calculate your progesterone to estrogen ratio, take your progesterone and divide it by your estrogen which then provides your progesterone to estrogen ratio. Providers vary but I have observed many practitioners aiming at a progesterone to estrogen ratio greater than 200.)
When progesterone is low in relation to estrogen, then your ratio goes lower. This is what is termed estrogen dominance and is most common especially in women over the age of 40. This also suggests relative progesterone deficiency. (For more on estrogen dominance, read my article here.)
When progesterone is high in relation to estrogen then it is described as progesterone dominance. This also suggests a deficiency of estrogen relative to progesterone.
11 Symptoms of Progesterone to Estrogen Ratio Deficiency (aka Estrogen Dominance)
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- Mood changes
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- Anxiety
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- Nervousness
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- Irritability.
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- Depression
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- Migraines
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- Hot flashes
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- Low libido
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- Menstrual problems (short, long, heavy, irregular)
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- PMS
- Menopause symptoms
Standard Natural Treatment For Optimal Progesterone to Estrogen Ratios
This is where I am going to part ways with many natural doctors or better stated semi-natural doctors. In 2018 the standard “go-to” treatment for estrogen dominance is hormone replacement therapy (HRT) using progesterone to increase progesterone while leaving estrogen the same and thus improving the Pg/E2 ratio. While not everyone is doing this, the vast majority are.
The standard treatment for Progesterone dominance is to use HRT to provide additional estrogen and thus fixing the ideal ratio (100-500).
(I also note that this is an oversimplified example but illustrates the point.)
The PROBLEM!
I personally have a problem with hormone replacement therapy and I think you should too. The problem is that nobody seems to be asking the deeper question of why these ratios are off in the first place! Why in 2018 do so many women need HRT when in even as recent as the year 2000 you were hard pressed to find a women on HRT?
I thought natural practitioners were supposed to be looking for the root cause?
What happened to the days when the physician would dig deep into their wisdom and knowledge base for answers rather than simply prescribing “natural” hormone replacement therapy? If you are missing your ovaries and or uterus, or have other extenuating circumstances then there may be a valid reason for hormone replacement, but otherwise the most natural way to balance your hormones permanently is to avoid adding hormones altogether.
In a subsequent article I will address all the negative side effects of HRT, but for now, know that the biggest problem in my opinion isn’t cancer risk, but rather that it forgets to dig into the WHY and look for a root cause, thus it makes it much like other prescription drugs that only address symptoms. (Yes, I realize that this is a highly controversial statement.)
How to Correct Your Ratio 95% of the time
I get the opportunity to work with a lot women in my practice. Most women don’t come in complaining of hormonal imbalance, yet most have an imbalance that appears during the course of treatment and what I find 95% of the time is that what shows up in the treatment process is high estrogen. The other 4% is low progesterone usually due to excessive stress and there is always the remaining 1% which can be much more complex.
So… if I was a female at home reading this article and guessing which was causing my symptoms regarding libido, hair growth, cramping, tenderness, mood swings, etc. I would guess it was high estrogen.
In fact I would go so far as to say that, even if you are a female that has blood or saliva labs from your doctor that suggest your estrogen is low or even “undetectable” I would still suggest that you are much more likely to have estrogen excess and/or estrogen dysregulation than a true progesterone deficiency.
This does not mean that you shouldn’t treat your progesterone to estrogen ratio, it just means that in my opinion, the best way to balance your Pg/E2 ratio is to lower estrogen almost every time.
Click Here For Dr. A’s Top 3 Favorite Supplements For Female Hormones
Part 2 will cover the detoxification of estrogen so that you don’t fight a never-ending battle of hormone balancing and returning symptoms. I will also cover how to significantly increase your progesterone without HRT.
REFERENCES :
- Barbieri R.L. (2014) The Endocrinology of the Menstrual Cycle. In: Rosenwaks Z., Wassarman P. (eds) Human Fertility. Methods in Molecular Biology (Methods and Protocols), vol 1154. Humana Press, New York, NY PMID: 24782009
- Grodin, J.M., et al.(1973). Source of estrogen production in postmenopausal women. J. Clin. Endocrinol. Metab. 36(2): 207-14.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138025/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063249/
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Hi. Just had got my estrogen 129 ,progesterone 12 levels checked . What does this mean? Day 21 of cycle. Thanks.
Andrea, you should speak with your local doctor concerning your individual lab results because they only have value in context of your symptoms and history. If you are just looking for your ratio, this would make it 93. Best wishes!
I had Estrogen tested at cycle day 3 (270 pmol/l) and Progesterone at day 21 (51.8 nmol/l). Can i calculate my ratio or they need to be tested on the same day? I have all the symptoms you mentioned, did all the tests under the sun, and all doctors including a functional dr and an endocrinologist say i’m ok, but i’m feeling awful. (i also had 3 miscarriages, and all related tests are normal)
FS, Yes, the hormones need to be tested on the same day. Often times we are focusing on hormones when the problem does not lie in the endocrine system. Even if the symptoms are hormonal, you may need to look at your other body systems.
My acupuncture practitioner told me i have like acidity in my blood and he is treating my digestive system along with my hormones, (also with diet) which is helping with my symptoms, but since i started the treatment, i had my third miscarriage. So i keep thinking something else is wrong. My friend who is a chiropractor told me it seems like i’m in chronic fight or flight mode and my adrenals must be having a hard time so i tested cortisol at 8 am and it was a little bit under the lowest end, again, my functional dr told me i’m fine. (i read about it and i have almost all the symptoms, especially depression, i snap at every little thing, i feel alert and in danger, i cry all the time, i cannot stand myself. (i sleep like a baby, but get up exhausted)
I have very low homocysteine like a lot under the normal range and every dr i saw the past year overlooked it, i asked several of them and they don’t know what it means. I just read low homocysteine can prevent me from detoxifying properly, and recovering from “oxidative stress” which led me to keep reading and i feel it’s all related. I had a very traumatic car accident in 2001 and i feel i never fully recovered from that, and the last two years have been emotionally exhausting, my father passed away alone at his home, i went through the heartache of miscarrying three times, my mom almost passed away when she got an anaphylactic shock when she also was alone (the same night i miscarried my 11 week old baby at home) among other stuff. it was an ordeal. So i guess i must be very stressed up, i just didn’t realized i was so “strong” for so long. I’m sorry for this long rant, i feel so alone in finding answers, i’m trying to learn by myself and test what i can, because i’m terrified of getting pregnant again before i find what’s going on, and i’m almost 40. I have a 3 year old who came into this world easily and without complications but since that pregnancy everything went down hill in my body and i’m trying hard to get back to normal. (cycles are 28-29 days, very regular and always got pregnant easily)
These are some of my symptoms: weight gain (cannot lose it even when i eat healthy and after a whole month of quitting sugar soy and wheat i didn’t lose a single gram); low libido, i mean the lowest you can imagine, and i was never like this. I broke my rib twice last year with a cough (been sick with sinus infections, eye infections, sore throat and flu 11 times in 2017), i have very low vitamin d, anemia (these are improving with acupuncture), my legs hurt when i get on my knees to change my daughter’s pants (and it’s hard to get back up!) i have hot flashes (also improving with treatment) hair loss and thinning, dry hair, eyes and skin, i cry a lot! i’m a very strong and positive person, and suddenly i don’t recognize myself anymore. I was thinking about seeing a psychiatrist for some pills, then i got my period and i’m a happy new person all of a sudden. Please, if you can help me with any leads or articles it would mean the world to me. Thank you so much and again sorry it got so long.
I forgot to mention i had my thyroid tested, FT3 and FT4 were at the 1/4 lower range. TSH is ok, but with my pregnancies it went up, i had 3.88 at week 4. I take Iron supplements, vit c, d, b complex, a prenatal with folate (instead of folic acid), and three months ago i started taking coQ10 ubiquinol. I realized that when i forgot to take my supplements especially the coQ10, i was a lot more exhausted that very same day. I thought it was a coincidence, but it happened 3 times.
Hello, you will need to work with a highly skilled practitioner. You can find some here. https://systemshealthcare.net/find-a-practitioner/
I am 74 and my progesterone was .73 ng and estradiol <5 pg. what is my ratio? Should i take progesterone or estrogen?