Progesterone Dosage Question

[Sihaya]

I've had 2 miscarriages in the last 6 months after a perfectly normal and healthy pg and birth with my son in 2007. I got the Physician's Assitant at my family doctor's office to prescribe me Prometrium to start using at 3dpo the next cycle we might be pg. I have not had my levels tested post-ovulation during a non-pg cycle, so I don't know for sure that they are low, and if they are, I have no idea how low. I feel like after two losses in a row, with my charts indicating a possible LP issue, it can't hurt and may help to supplement progesterone.

The prescription she wrote was for 200mg Prometrium oral caps to be taken vaginally. She said to take two pills daily (for a total of 400mg a day), one in the AM and one in the PM. In researching progesterone supplementation to prevent miscarriage, this seems to be double what most people are prescribed. When she wrote me the prescription, she told me she hadn't written a prescription for Prometrium since her ob/gyn rotation and didn't remember exactly how much to prescribe, so she didn't necessarily have a specific reason for prescribing the amount she did. She was admittedly guessing at it and trying to err on the side of caution.

Usually this wouldn't bother me and I'd be happy to take the higher dose, but our insurance recently switched to a high-deductible plan ($1250/person), and the cost of this much Prometrium is substantial (~$600 to last through the first trimester IF we get pg immediately and ~$50 more for every TWW that we don't conceive). If I can get away with taking half as much to cut our OOP costs in half, that would be a huge help to our budget.

My concern is that many people taking 200mg/day take two 100mg pills, AM and PM. I am wondering if taking a single 200mg pill at bedtime would be sufficient to keep my levels where they need to be for a full 24 hours. BTDT input would be greatly appreciated, TIA!

[goldfinches]

That's the dose I was on with this pregnancy. It's the only time I've taken prometrium instead of PIO.

I only took it until 11 weeks, and although that was shorter than my other pregnancies, it's still longer than many people have to take it. Your placenta should take over by 9 weeks. So, don't buy enough for the whole trimester at once.

[karmab]

they do tend to say stay on it till 12 wks, but i can vouch for placenta taking over at 9, at least it was sufficient for me with #3 when the corpus luteum cyst burst at 9 weeks. i was not on progesterone, didnt start it, and it was fine.

in any case, that price seems high. i take progesterone suppositories, which are compounded by my pharmacist, using 1 200 mg prometrium per suppository. basically, he just grinds it up and mixes it with something like cocoa butter sort of feeling suppository base, and puts it in a mold. my insurance did end up covering it, but we werent sure at first, and the pharmacist told me it was like $70 for 3 months without insurance, in case i had to pay, he asked if i still wanted it. unless he meant $70/month for 3 months, but even so. ah...YES i want it!

as far as the dosage, it does seem like the majority of the ladies here are on 200 mg, either divided in 2 doses or at once. the suppositories are better once a day at night, so they dont drip out. the have worked perfectly for me, made my 7 day luteal phase go 15 or 16 (i took them till 13 dpo, and tested till 15 days and was negative this time.) there are some ladies here i know have said they take or have taken 400mg, but i dont think they were prescribed that off the bat, i may be wrong, but i think those were gals that took 200 and still had a lot of spotting or af came early anyway.

good luck!

[goldfinches]

Originally Posted by karmab

.) there are some ladies here i know have said they take or have taken 400mg, but i dont think they were prescribed that off the bat, i may be wrong, but i think those were gals that took 200 and still had a lot of spotting or af came early anyway.

Yes, that's my does, 200 mg AM and 200 mg PM. But, I did AF, a frozen embryo transfer, so my body wasn't making any of its own for the whole beginning of my pregnancy. (I tested having low progesterone anyway during infertility testing.)

To answer another of your questions, the only time I took progesterone only once a day was with my first pregnancy. Both other ones, (two different doctors), had me on it twice a day. Progesterone builds up in your body, and I think the twice a day dosage helps it level out instead of peaking once a day.

[KingsDaughter76]

I have taken 200 mg 2 times per day with 2 of my pregnancies...now they are upping mine to 200 mg 3 times per day since my last m/c... I think 200 mg twice per day is pretty standard dose.

[Sihaya]

Thanks so much for the responses so far! To clarify, my calculation was based on taking 3 months worth of pills (180 pills total) which would get me through to at least 14wks pg. They'll last even longer if I wean off gradually (1/day for a week then 1 every other day for a week) as I've seen suggested to prevent side effects caused by stopping suddenly.

I do know that the placenta takes over progesterone supplementation around 9 weeks. My last 2 pgs ended at 9 and 10 weeks, so I think stopping supplementation around that time could cause unnecessary anxiety. I believe taking them for an extra month would help give me a little extra peace of mind.

Originally Posted by goldfinches

I only took it until 11 weeks, and although that was shorter than my other pregnancies, it's still longer than many people have to take it. Your placenta should take over by 9 weeks. So, don't buy enough for the whole trimester at once.

Thanks! I'll be buying 30 days at a time and plan on having an u/s at 8 weeks and doppler checks for heart tones at 12 and 16 weeks since the Prometrium can mask a missed miscarriage.

[Sihaya]

In doing further research, I'm noticing that people taking the larger doses tend to fall into at least one of the following categories:

• They are using ART and/or taking medication to achieve pregnancy
• They have had 3 or more losses
• They have been tested for and diagnosed with very low progesterone levels
• They are considered "advanced maternal age"

I don't fit in any of those categories right now, so I'm leaning toward taking 1 200mg pill each evening to save money. I think I ovulated yesterday, so if my temp stays up for two more days, it looks like I will have to start taking them Sunday evening.

I would welcome more BTDT stories and advice if anyone has any. Thanks so much!

[lesliesara63]

I am so sorry for your loss. Losing a baby is just heartbreaking.

My progesterone has never tested low. I've been to one RE who only uses Prometrium with IVF cycles so I never used it. The next RE has everyone (regardless of test results) take 600 mg/day whether you are doing clomid, injectibles or IVF. I've heard this is high and I'm not really sure why he does it. In any case I didn't get pregnant and I'm going back to the other RE who doesn't use it. I wish you have happy and healthy pregnancy very, very soon.

[xtara2003x]

Hi Sihaya s

I just had a miscarriage as well....and had some testing done and found that my progesterone was quite low. I had it tested, found out it was a 5, started 200 mg of the pills (100 mg in the morning, 100mg at night) and two days later my progesterone was 18.3. Both the doctor and the homebirth midwife wanted me on the 100mg twice a day....and I also had read that progesterone supplements last 6-8 hours, so taking it twice a day gave you coverage of the hormone much longer than taking a bigger dose once a day would. However, shortly after that second blood draw where the progesterone had gone up so much in two days (the HCG hadn't gone up much at all) the baby had died, but since I was on the progesterone, we didn't know that until 2 weeks later...so I had a missed miscarriage.

I am really struggling with what to do when we TTC again as far as progesterone goes (not sure if we want to go ahead and start immediately or wait one cycle or what). Also not sure if I want to use the progesterone or not..ugh. Such hard decisions!

I'll keep reading everyone's progesterone stories!

[karmab]

not sure about the 6-8 hours- when i stopped taking it at the end of last cycle because i was not pg, it took 3 days for levels to fall enough to get af. i took the suppositories once a day, 200 mg.

[Sihaya]

6-8 hours sounds wrong to me, too. If that were the case, many more people would be taking pils 3x/day. I do remember reading that someone's doctor told them the pills last 12-24 hours and so taking two/day is a better guarantee of full coverage. But, it also seems to me that 200mg might last longer than 100mg. Of course, I have no proof to back that up. Just my thoughts.

[karmab]

http://www.flexyx.com/P/Prometrium.html

http://129.128.185.122/drugbank2/dru...fda_labels/188

i looked up some info, so here are a couple links to drug info on prometrium. it's half-life is 35-55 hours, so that is how long it takes your body to eliminate half of the medication. with medications with long half lives, the dosage in your body continues to build over several days as you take it, but you won't be without it at anytime after the first dose- not even half of it is eliminated for at least 35 hours.

[Sihaya]

karmab, Thank you so much for looking up that info! That's really the root of the question I was asking when I started this thread. Makes me feel much better about only taking it once a day.

[mama2toomany]

with this pregnancy.. I took 200mg vag caps 3 times a day.. so a total of 600mg a day.

If that means anything.. I took it until 12 weeks pregnant.