AF inducing progesterone vs LP support progesterone?

[~Adorkable~]

what can folks tell me about the difference between these two:

1. the progesterone that doctors prescribe to induce AF via the withdrawal after it is stopped.

and

2. the progesterone that doctors prescribe post o for those with low progesterone to support their LP


what i am wondering is if there a difference? with the type or amount?

[Tear78]

hmm, good question! I always assumed it was used the same, but now you mention it I'm not sure. Thought I'd post and get the ball rolling though.

[karmab]

wrote you nice answer to this, best i could, and laptop battery died right before i hit submit. hate when that happens. got to get ready for church, but...

the progesterone to kickstart af is usually provera. i believe they give it most often as like 5 pills. i think some use a shot, instead. if everything else is normal, when you stop the provera, you get the withdrawal bleeding, like you said. if you dont bleed, they have to look for another answer, like maybe you need an estrogen/provera regime, and they need to figure out what's the cause. if you just had a fluke anovulatory cycle for no good reason, taking provera and starting your af should help end that long cycle, and then hopefully everything will go back to normal (if there isnt something else funky going on to cause the problem.)

there are tons of different progesterones out there. pretty much all the bc pills have different ones, so if you've ever taken one bcp and it doesnt agree with you, like you gain wt, break out, whatever, you can switch to find one you like.

the one we take for luteal phase problems i think is pretty much straight up naturalish female progesterone. the brand name is prometrium (or is it prometria, i forget.) it takes over for the corpus luteum, so that if the c.l. concks out, our bodies dont catch on, and we dont get the signal too early that 'there wasnt a pregnancy this month, so bring on af' until we know for sure that there really wasnt a preg, and then we stop it, and af comes in a few days as prog is cleared out. i think this is the one they use for pregnancy because it is considered safest in pregnancy, most natural, but i think some docs use this same one to bring on af too.

if we get pg, we keep taking it till placenta takes over for c.l., like 12 wks, although, when i was pg with ds #3, i wasnt on prog, and my corpus luteum cyst burst at 9 weeks. i sat up in bed one morning and had this sudden excrutiating pain, saw stars, and about 30 mins later started bleeding in the shower with a walnut sized clot plopping out. i was hysterical. my ex-dh, who is an obstetrician, took me to his partner- he went into dad mode, not dr mode, cuz he freaked a little too, and anyway, i got an ultrasound and i had blood in my abdomen and a broken cyst. they did not put me on progesterone at that time though, talked about it, but decided placenta was ok to take over, and it did, and i had no further problem.

[~Adorkable~]

But this brings up the point that prometrium is also given similarry to provera to end cycles. Is the only diference that it is suddenly stopped in that case rather than tapered off way later when the placenta takes over?

I see provera have a warning not to take if preggo. And some of the same warnings for prometrium but way less of them.
Im goig to go back and find a link I was reading last night that seemed to show prometrium being used for both, I really want to understand this.

[karmab]

yes, some use prometrium, more i think use provera, but both work the same. i think that is actually prometriums primary use, secondary amenorrhea and some perimenopausal issues. my doc told me the vaginal or oral use of prometrium for LPD is off-label- that's not an FDA approved indication, not that there is anything wrong with that, we use lots and lots of drugs off-label all the time. drug companies dont care much for the liability of their drugs used in pregnancy, so they dont always go that route with marketing. whether they use one or the other to bring on an af is probably preference, like some docs always prescribe a certain bcp, or even a certain antibiotic for an infection, because that's the one they like to use (or maybe it comes from the drug rep they prefer, or they get free samples from the rep, etc.) my ex-dh is an ob, i know uses provera for this, but i dont think that was for any good reason, other than that's how he was trained.

[soso-lynn]

Essentially, the prometrium given to trigger bleeding is the same as the one given during the LP/first trimester. The dosage may be the same, although it is generally given orally instead of vaginally. The dosage for LP will depend greatly on the reason why it is given so it's hard to compare.

When prometrium is prescribed to trigger a period, it is usually taken for 10 days and the withdrawal will normally cause bleeding within a few days. It is the exact same concept as the fact that women on prometrium during their luteal phase will need to stop it to get their period. If a woman is pregnant (except if it was IVF), stopping prometrium will not cause bleeding as the corpus luteum should still be producing a decent amount of progesterone (although there might be some spotting because of the sudden change in PG levels).

Now, provera is a different substance entirely, it is medroxyprogesterone, a different hormone than the LP progesterone. It is a synthetic progestogen that is linked with birth defects and should never be taken during pregnancy. It is used in hormonal therapy for menopausal women or women who have had gynecological cancers because it prevents the lining of the uterus to thicken. It also can induced withdrawal bleeding. Provera is normally given for 5 days.

The choice of which one to use depends a lot on the reason why the woman has no period. If it is simply a matter of a fluke anovulatory cycle, prometrium usually does the trick. In the case of more complex situations where women have diagnosed fertility problems (PCOS, low ovarian reserve, peri-menopausal women, etc), provera might be a better choice as those women do not always respond to prometrium.

The other option to trigger a period is contracpetive pills. Some women do not respond to progesterone or medroxyprogesterone but do respond to the combined effect of estrogen and progesterone.

Hope that helps.

[~Adorkable~]

this does, help.
the reason i am asking this is that i am currently having a random anovulatory cycle, dont usually have them ,but have a few times in the past few years. last one 2 years ago

im now CD23 and anovulatory. i know i am because i chart and my charts are very clear. plus i got a u/s at CD14 and there was nothing at all forming. Now i know that i could o reaaaally late, but that's not great either.

so my RE and i are going to medicate (we have before, but this cycle) next cycle and do iui again, but i need to start af first of course.

since he does not trust my charting, (so anoying) he wants to wait till CD35 and a negative bhcg before giving me provera, since of course accidentally giving during early preggo is so bad.

i'm feeling rushed cause my DH could leave at any time on a army mission and not come back for 6 months or more.

so i was thinking of asking him to give me a progesterone like prometrium that was ok during preggo instead and then after the 10 days or whatever give me a BHCG before then going off it to get af. doing this now may save me almost 2 weeks. sure would be great.

what do you think?

[karmab]

i dont know but did you tell the re there is a chance your dh is going to be shipped out?

[~Adorkable~]

yes and i'm in a military hospital as well, so he certainly knows what i'm dealing with.

[soso-lynn]

Doing prometrium does make sense if your cycle is anovulatory and you are restricted with time. Perhaps getting your progesterone levels checked might convince him or maybe an ultrasound to see what your follicles look like and rule out cysts might be useful as well.

It is technically better to wait it out since most anovulatory cycles do end up with a spontaneous period and taking prometrium might mess with your body. Perhaps you could suggest taking estrogen (estrace pills or estrogen patches) while on the prometrium to synchronize your follicles for next cycle. You would need to take it while on the prometrium and then continue it until you start your stimulation meds after you get your period. We do that in certain IVF protocols before stimulating.

It can be very difficult soemtimes to get doctors to take the time and deviate form standard protocols, especially in fertility where, trust me, patients can get quite lunatic sometimes and make demands that just make no sense. For example, we once had a patient who had a hysterectomy refuse to understand that we could not do a uterus transplant so she could get pregnant. So, try to be persistent to get through that thick lining of skepticism that surrounds your doctor.