How to Fix your Progesterone to Estrogen Ratio for the Last Time

Scottsdale, AZ Hormones Functional Medicine

One of the most commonly used metrics to assess female hormone imbalances is to look at the Progesterone to Estrogen ratio.  While I find the information valuable, how most practitioners treat it is far from holistic and definitely not natural. If you want to learn how to fix your ratio, balance your hormones, reverse your symptoms and live without drugs, keep on reading!

Understanding the Ratio

If you are unfamiliar with what the P/E2 (progesterone to estradiol) 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 ratio of 100-500.  (The basic calculation is progesterone divided by estrogen which then provides this number.  Providers vary but I have observed many practitioners aiming at a ratio >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.

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.

Symptoms of Progesterone Deficiency (aka Estrogen Dominance)

  • Mood changes
  • Anxiety
  • Nervousness
  • Irritability.
  • Depression
  • Migraines
  • Hot flashes
  • Low libido
  • Menstrual problems (short, long, heavy, irregular)
  • PMS
  • Menopause symptoms

Standard Natural Treatment

This is where I am going to part ways with many natural doctors or better stated semi-natural doctors.  In 2017 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 P/E2 ratio.

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.)


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!

I thought natural practitioners were supposed to be looking for the root cause?

What happened to the days when the physician dug 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, then there may be 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.  95% of the time what shows up in the treatment process is high estrogen.  The other 5% is low progesterone.

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, even if I had blood or saliva labs from my natural doctor that said my estrogen was low or even “undetectable” I would still suggest that you are much more likely to have estrogen excess and/or estrogen dysregulation than a progesterone deficiency.

So the best way to balance your P/E2 ratio is to lower estrogen almost every time.

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. 

Click Here For Part 2

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