Progesterone questions...advice needed please???

[xtara2003x]

Cross posted...

Hi mamas....

DH will be 27 in June, and I just turned 25 this month. We have one DD who will be 3 April 5th. My pregnancy with her was fine. No complications. Nothing. Delivered her sans medication and vaginally with CNM's at the hospital.

We have been TTC since June 2009. We found out we were pregnant Feb. 13th 2010. I had spotting around 5 weeks, then at 6 weeks (March 3), went in for a blood test and my HCG was 5126, my progesterone was 5.5. I went on prometrium (2-100mg pills once in the am and once in the pm) immediately. The next day had a U/S and the baby had a HB of 114bpm. The next day had my second blood test done and HCG was only 5613 (hardly went up) and progesterone went up to 18.3. I decided to just wait and see...and just kept thinking positive thoughts cuz we saw the HB. Two weeks later...I started spotting again...got a US the next day and the baby didn't have a hb anymore. The day after I started to miscarry. ( I think it took an extra two weeks because of the progesterone).

During all this spotting, I also had a raging a-symptomatic bladder infection (which is what happened with DD's pregnancy too...at 13 weeks with her I was in the ER because I couldn't keep a single thing down..and as soon as they gave me abx for the bladder infection I felt immensely better). I ended up going on abx again with this pregnancy and started them shortly before the first U/S.

Now....a homebirth midwife I was talking to told me she thinks I should go ahead and start TTC right away and 3 dpo start using the prometrium again. She says it can't really hurt..only help...and she thinks that the baby may have made it if I had started progesterone a day earlier. The OB we saw says we should wait to TTC one cycle at least...and then we can try.

DH and I are not so sure about using a medication w/o really truly knowing if it is necessary. It was my first loss. I had a healthy pregnancy and delivery last time. I don't know why my progesterone levels were so so low this time. Could it be simply because something was wrong with "this" baby and my body knew it and didn't produce the right hormones?? Could it just be a one time fluke?

Thyroid issues run in my family. I just went today and had my thyroid tested again. I had it tested 2 years ago and my TSH (I believe) was a 1 which they told me was a great great great number. Hopefully tomorrow I'll get the thyroid test back and see what it is and see if it's drastically different then 2 years ago or not.

Part of me wonders if something is wrong with my thyroid that is causing low progesterone? I temp, and noticed that my temps seem a lot lower before O than most women's do. Here is my chart so you can take a look at both times I've conceived: http://www.fertilityfriend.com/home/128814

I have some "thyroid" symptoms..but they're also symptoms of being a mom IMO...tiredness, cold, dry skin (I live in WI and it's winter!).

Any BTDT's? Anyone else struggle with deciding whether or not to use progesterone every month of TTC?

Part of me feels like if my body needs an extra hormone to sustain a pregnancy (progesterone)..then doesn't that mean I should listen and try to figure out what it is that my body is trying to tell me and try to fix the whole reason for the low progesterone in the first place?

Any suggestions or thoughts would really greatly be appreciated. If anyone has been on progesterone..or decided against it...or feels like they must be on it while TTC would really really help.

TTC is almost all I can think about after the devastation of losing our second baby...and maybe for some people it seems too soon to talk about it...but trying to figure this all out right now feels almost like all I have at the moment to hang on to.

Thanks mamas...

[MaerynPearl]

Your temps do NOT look low at all to me if you are temping orally. Mine were similar, as soon as I started temping vaginally they went into a more normal looking range. Oral temping, especially in colder climates, will tend to give lower numbers.

And yes 1 is a great number, optimally you want it to be between 1 and 2, its still a good number between 2 and 3 and between 3 and 5 is borderline but when TTC worth medicating... anything above 5 is bad bad bad (mine was QUITE high each time I was hypo)

Taking the prometrium each cycle really cannot hurt (outside of convincing you 100% you are pregnant even if you aren't...), having had a previous loss. After all, your body already makes progesterone during that half of your cycle (none in the first half, just in the second.) So if you want to go with what your midwife suggests, you wont be harming your body any. As long as you are 100% sure you don't start it until after you O because if you start it pre-O you can actually cause O not to even happen. but since you chart you don't have as high of risk of that as some women do.

However, if you want, many health care professionals also have women start taking it as of their BFP and for any woman without a luteal phase defect, that wont be too late... maybe ask your midwife if she thinks that's an acceptable option?

Though I do agree, there is no way of knowing for sure if the progesterone caused the miscarriage or not... mine was at a 7 early on in this pregnancy... we did NOTHING for it and the next check it was 17 and I'm now 15 weeks along. For some miscarriages, low progesterone is a sign that things aren't progressing, not the cause. For some pregnancies, low progesterone just means that your progesterone was low at that exact moment when your blood was taken (it comes in spurts throughout the day, its not a steady hormone. you could test half an hour apart and have one be 5 and the next be 20 if you test just before and just after a spurt)

So really its up to you... but yes, there IS a chance that the progesterone was the cause of the miscarriage... so if, at the very least, you go with taking the prometrium after the BFP you still have the benefits from it... and for most women that take it that's for like... 12 weeks or so? Then you stop. I have not heard of any woman being made to take it the entire pregnancy that was not self-medicating (which is dangerous! always talk to your doctor/midwife about how/when to take it before you do so!)

As for the waiting one month... having a loss that early it isn't for any physical reason to wait, its more psychological. When I had my miscarriage (at 13 weeks), the doctor told me that if I was upset over it I should wait a few months to cope with the loss... then I can conceive again when I have handled it (I didn't wait until I had coped and ended up with some pretty severe depression through my pregnancy with my son... however if you think you have coped with it pretty well, listen to your midwife)

[MI_Dawn]

Just anecdotal - I DO have thyroid issues, and your pre-O temps look very similar to mine.

Also, even if your numbers look "normal" you can still be hypothyroid.

[xtara2003x]

Thank you ladies so much for your responses.

I had my thyroid tested yesterday. I just called for the results and will continue to call and bug them until they give them to be...so hopefully by the end of the day I will have them. I'm hoping that since I had it checked 2 years ago..i have a baseline..and I can see if my number now is drastically different from 2 years ago.

If I would have progesterone problems....wouldn't my LP be short? My LP is pretty much ALWAYS 13 days....at least as far as I can tell. Because I have a normal LP.....would that make you disregard any progesterone issues?

I never had my progesterone checked with DD1. Never had any spotting with her either...never had any complications at all.

I guess, in the long run, I won't really EVER know why our baby died. And it may have nothing to do with any progesterone....it might have just been that this particular baby was not developing right.

I'm just a littler nervous...I feel like I have this "feeling" that I'm not going to just have one miscarriage..and it scares me.

Also, how would you temp vaginally? How far would you have to put the thermometer in? Not very far I assume? Is Vaginally more accurate? I tend to wake up an hour before the normal 5am waking time (maybe I should move my time to 4...but oftentimes I go to bed late so I wouldn't be sleeping more then 3 hours then). I wonder if I temped vaginally if that would be a lot more accurate for me..

MI Dawn....your chart does look incredibly similar to mine. If my numbers come back "good"....what would I do then? I mean....what further testing would need to be done in order to really "know" that my thyroid is fine? I guess I felt like if my thyroid came back "good"...or very similar to my last test 2 years ago, that would make me feel like maybe this baby just wasn't developing right and my body knew it, so my body didn't produce the progesterone like it should have knowing i was going to miscarry? Am I giving my body too much credit there?

Do any of you know if there any side effects from prometrium? I haven't found much..which makes me think maybe it really truly is "okay". One of my friends mentioned genital abnormalities..but she said she thought that was from the progesterone shots instead of the vaginal suppositories.

Because my charts clearly show that I ovulate....even though it did seem like I had a slow rise this last pregnancy....it makes me think that maybe I truly do not have a "progesterone problem" at all and that next time I should be fine?

It's hard for me...because part of me feels like if I need to be on a medication to sustain a pregnancy...(for me personally) then maybe I need to delve deeper into why I'm not producing the correct hormones myself to sustain a pregnancy....kwim? I am not anti medications necessarily, but it is definitely difficult for me when I feel like I "have" to take them (like with the abx this past pregnancy when I had a raging bladder infection that I thought could have caused the spotting). I obviously know now that it was most likely the fact that there were problems with the baby in general. I spotted the first time before I even knew about the bladder infection...and it was about a week before the baby had actually died.

Anyway, thanks so much ladies. I deeply appreciate your responses!!!

[treehugginhippie]

Are you still nursing? Nursing causes progesterone to be lower from what I've read

[xtara2003x]

I am still nursing...1 x per day though (well I was...now that I'm not pregnant anymore I'm letting her nurse a little more). I did notice while pregnant on two occasions that when I nursed DD a lot more then usual the night before, the next day I would spot (that's when I stopped nursing her completely while pregnant). I guess that's definitely a possibility in all of this. I just figured nursing her only 1 x per day...(and I don't have any milk left) would be fine.

[MaerynPearl]

you can have pregnancy related progesterone deficiency and not luteal phase progesterone deficiency. Which is why some women start the progesterone as soon as they get bfp and not 3dpo.

To temp vaginally you just put it in until it is comfortable... theres a distinct area between feeling like its going to fall out and definitely being in way too far... it wont take you long to find that place. Your temps will be higher (possibly by as much as a whole degree or more! mine were 96.3 average pre-O and 97.2 average post-O with oral temping, average 97.6 pre-O and 98.3 post-O with vaginal temping)

Really... you cant be hypo with great numbers (in the 1-2 range) you can be hypo with numbers that some doctors would consider normal (in the 3-5 range) because many doctors have not updated their charts to reflect the best in .3-3 range with 1-2 being optimal and still go with 5 as the high point, which is now known not to be a normal level by any means. If you are still between 1 and 2 I would not worry about it at all. Make sure you do get the actual level and not whether or not its good because good for them could be the 5 max still.

My last number was 1.92 and my doctor will still be checking every time I go in because I do have a history of being hypo (looking back my first number was 19! wowsers...) but the sort I get is the sort that goes away on its own after some time (not a normal thing to happen though)

Side effects of taking progesterone are every single symptom of early pregnancy... tender breasts, nausea, running warm, dizziness, bloody gums, bloody nose, etc. You are not guaranteed to get any of these symptoms but getting them also does not mean you are pregnant for sure. But as I already said, taking it will convince anyone they are pregnant, it really does mimmic a pregnancy.

Some bad things that come with progesterone use are: if you use it before you O, you will hold off O (as I already stated, since you chart you dont run as high of a risk of that happening)
constant use (use pre-O not just post-O) for long periods of time can cause abnormal weight gain (as is a side effect of using it for birth control) but since you will not be using it the whole cycle this also shouldn't be a problem for you.



You know... when it comes down to it... it really could just be that something was wrong with the baby (as was the case with my miscarriage) and that you have nothing at all wrong with you... the use of progesterone is just to prevent you from going through that heartbreak again if that were the cause.

[treehugginhippie]

Originally Posted by xtara2003x

I am still nursing...1 x per day though (well I was...now that I'm not pregnant anymore I'm letting her nurse a little more). I did notice while pregnant on two occasions that when I nursed DD a lot more then usual the night before, the next day I would spot (that's when I stopped nursing her completely while pregnant). I guess that's definitely a possibility in all of this. I just figured nursing her only 1 x per day...(and I don't have any milk left) would be fine.

My dd1 (3 yrs old at the time) was nursing 1 somtimes 2x's a day when I conceived and m/c but I know I had low prog due to nursing even before I conceived as I had a short LP (even when not nursing too). I had major cramping when the baby was trying to implant (more than normal) so that's how I knew also (looking back) that I had low prog to begin with (my uterine lining was too thin).

You could have your prog (and hcg) tested the day/next day you get your BFP next time (l had mine tested this last time when I got a BFP at 10 DPO). Or you could even have prog tested mid cycle too I believe if you felt your prog might be low instead of just taking "just in case".

Prog might not even be the issue as discussed but wanted to reply anyways

p.s.- kinda off the topic but wanted to say that I've had 3 pregnancies before last dc. All 3 involved cramping and spotting during implantation which I knew was totally normal. I had low prog in 2 out of the 3 pregnancies before (numbers were 11 and 2.9 respectively) and the 1st m/c was a chemical I believe.This last pregnancy (dd2) I had no implantation spotting OR cramping AT ALL! In fact, that is why I didn't believe I was preggo because these things didn't happen. I did supplement w/ prog (sublingual) right after ovulation and when I got my BFP at 10 DPO it was 32. The other thing I did different other than taking prog is that I read and applied all the principals in the book The Infertility Cure.

Not sure if anyone can use this info but wanted to throw my experience out there.

[karmab]

maeryn pearl has hit this all right on the head, so i won't repeat what she said, but i pretty much agree with it all. the only thing i could add would be re: side effects- add to that lots of cramping and some mood swings, or for me, more like a heightened emotional sensitivity. essentially, it's probably fair to say any pms type symptom, or any early early pg type symptom is fair game with progesterone. how it effects you will depend on how your body responds to it, as well as the dosage, and the mode of administration.

as far as genital defects or other danger to the baby, no. prometrium is not the same as the progestins that are in bc pills or hormonal contraception, although any birth defects even with those synthetic progestins are very very rare. strong steroids like danazol can cause genital changes in girl fetuses, but i can't even remember ever hearing of that happening irl after bcps etc. unlike the others, prometrium is bio-identical to your own progesterone, there is no way for your body to tell the difference. the goal with dosing would be to be in a normal (therapeutic) range.

i will say there is a little bit of controversy on how effective it is to start progesterone after your bfp. to me, i see no reason not to, and many docs do prescribe it that way for recurrant m/cs without lpd, but i do know that it is a little controversial as far as whether or not it is really beneficial. personally, i have to think it can't hurt. and yes, they do typically use it until 12 wks, although after 9-ish, you are probably safe.

the only other thing i can think to mention, however this fits into the equation, is that a hcg of 5000 or so at 6 wks is low. the absolute minimum expected value would be 10,000, but it would be expected to be much higher than that, like usually closer to 100,000. that may be an indication that there was indeed something wrong beyond a progesterone issue, or that it may have been part of the cause of the prog problem.

you are asking really good questions, i hope our answers have helped. one other thing i think of reading your post, of course we aren't here to give medical advice, just share our experiences and what we have learned, but given your uti problems in pregnancy, you may want to talk about macrobid suppression, and very frequent urine cultures, maybe starting even as soon as you get pg? you might even want to do clean catch urines at home and at least dip them so you have a better chance of catching it early if you are usually not symptomatic.

[MaerynPearl]

Originally Posted by karmab

one other thing i think of reading your post, of course we aren't here to give medical advice, just share our experiences and what we have learned, but given your uti problems in pregnancy, you may want to talk about macrobid suppression, and very frequent urine cultures, maybe starting even as soon as you get pg? you might even want to do clean catch urines at home and at least dip them so you have a better chance of catching it early if you are usually not symptomatic.

didn't even think of this... every single time I go in I get checked for UTI/bladder infection. I also get a quick pelvic check for yeast/bv because I do have problems with those too without symptoms.

In addition, while pregnant I am told (and would anyway) to drink way more water and avoid too much refined sugar (dehydration and sugars contribute to UTIs)

[treehugginhippie]

You can get at home UTI tests at Wal-Mart (and other places too).

[xtara2003x]

Originally Posted by karmab

you are asking really good questions, i hope our answers have helped. one other thing i think of reading your post, of course we aren't here to give medical advice, just share our experiences and what we have learned, but given your uti problems in pregnancy, you may want to talk about macrobid suppression, and very frequent urine cultures, maybe starting even as soon as you get pg? you might even want to do clean catch urines at home and at least dip them so you have a better chance of catching it early if you are usually not symptomatic.

Thank you so much for your reply!! You ladies are really really helping.

What exactly is macrobid suppression? That is the antibiotic that I was on while pregnant this time. Since getting pregnant in February...I had decided that while TTC...I was going to take higher doses of D Mannose (cranberry pills) which help with UTI's as well as drown myself with a lot of extra water, and drink pure cranberry juice (the non sugar kind). My friend has the pee sticks, and that is how I found out I had a bad infection. I ended up going in and getting it tested and sure enough it was pretty bad.

Also, the HB midwife said she thinks the better idea is to take the prometrium starting around 3 DPO. I had asked her if she thought it would be an option of starting the prometrium once I would get a BFP...but she didn't really think that would be a good idea. She would rather I start it 3DPO.

As far as side effects go, I didn't really notice anything this last time I was on it. I was on prometrium for about 2 weeks...however, around the time I had started, the baby had already died so I'm thinking that could be why I never had any symptoms at all. (I had no pregnancy symptoms even before I started progesterone).

There are no side effects to using prometrium for the baby though? It seems like any side effects that would occur would just be heightened pregnancy symptoms for me.

Can I ask where you learned that 5000 HCG is a low number for 6 weeks pregnant? That is exactly what I thought too when they had read the me results. I was shocked because I expected them to at least be around 20-30,000. When they said 5,000....I could hardly believe it. When I asked though, they said they weren't concerned and that it was definitely still in the "normal" range.

So M&P... if I were to have pregnancy related progesterone deficiency..my LP would be normal..and the progesterone would only appear out of whack while pregnant I take it?

Also...as far as the thyroid goes..I just got my test results back.

My TSH was 0.98 (2 years ago it was .90). My Free T4 was 1.24 (and 2 years ago it was 1.27). So in your opinions....would you really feel comfortable saying that my thyroid is really not out of whack and more than likely had nothing to do with the miscarriage??

Thanks again ladies..you are helping so so much!!!!

[MaerynPearl]

Yes, your thyroid sounds pretty nearly perfect and closer to being hyper than hypo (not hyper, mind you, still nearly perfect, below .3 would point to hyper and 1 is a perfect so really pretty close to perfect)

During pregnancy, natural progesterone levels should skyrocket. Since prometrium is just progesterone (and not a horribly high amount of it) its not adding anything to your body that your body is not already making, just ensuring that your level stays high enough not to cause a problem.

To give you an idea... at 7dpo they want to see your level above 10 (anything above 5 means you did ovulate) or above 15 if you are medicated, by 4 weeks the average level is 20... by 14 weeks, average is 40. Second trimester ends with an average around 90 and third trimester ends around 170...

so the amounts the prometrium would put into you (from what Ive seen its effects up your number by about 10) are FAR less than what pregnancy does to you on its own...

The reason women with early pregnancy progesterone problems take it until 12 weeks is because somewhere around 9 weeks the placenta kicks in and signals your body to make more progesterone, before then it is your luteal cyst signaling the production... low early pregnancy progesterone levels are believed to be caused by your luteal cyst not sending the signal strong enough or what-not.

By 12 weeks you should know for sure that your dates are not off and you are without a doubt past 9 weeks and not risking anything by stopping it early. (Some women have their dates off, for example DFs cousin who thought she was due 2 weeks after me found out at what she thought was 12 weeks that she is actually due the same day I am!)

[karmab]

you know what, let me double check that beta quant range again. i am formerly a high risk ob nurse (RNC-HROB) but i work in another area now (after i divorced my ob/gyn louse of an ex-husband, i couldnt go back to ob and have to look at his puss all the time) so although i loooove what i do now, ob is my first love. these numbers arent on the top of my head though, i just looked back at my references. virtually everything in ob is by lmp, since conception (and o) is (except for ladies like us!) considered an unknown. on this chart i've got here at home, the only thing i can think of if they told you it was in the normal range is maybe it's by conception date, which would be odd, but it's been a while since i've looked at it and i cant remember. so i will check it out and see if that could be.

[xtara2003x]

karmab~Thanks so much for checking that for me! Like I said I just "knew" it was low and something was wrong but they insisted I was in the "normal range".

MaerynPearl~A few people with hashimotos have stated that I could have normal TSH and T4 levels but my antibodies could be crazy out of whack. I've never heard my family say anything about hashimotos so I'm thinking that they most likely don't have it (or I would have heard about it - but I will ask them to be sure).

Thanks so much for all the progesterone answers.

When I had my progesterone tested on March 3...my number was a 5.5. That night I took one 100mg pill orally and one 100mg pill vaginally. The next day I took one in the morning vaginally, one at night vaginally, and the next morning I took one vaginally. Then I got my second blood draw and they told me that my progesterone number went up to 18.3...which would definitely be pretty close to raising my number by 10...slightly more.

I think my biggest fear is that the medication could possibly harm the baby....but no research has really supported that fear it seems. Secondly, it scared me that I would have to take a medication to try to get pregnant because everything went so well with my daughter and I was just wondering what the cause of things not working properly now would be.

Someone had mentioned after taking a look at my chart that it seems like my LP was a lot longer when I got pregnant with my daughter...which I think is true. I had around 35 day cycles when I got pregnant with my daughter. I had come off the pill around January 2006...and then in July is when we got pregnant. My cycles were consistently 34-36 days long. I also never get early BFP's. I got a BFP at 15DPO with DD, and this last pregnancy at 14DPO (and I tested early both times and there were no lines).

I got my cycle back when DD was 15 months old. My first cycle was like 37 days long, then it went down to around 29-31 days pretty consistently.

I almost wonder if my body really does need a longer LP but that it's not getting from my cycles being shorter now. I mean obviously while I was on the pill (which I would never in a million years ever go on ever ever again) my cycle was 28 days long. Hmm..not sure I guess?

treehugginhippie~ I definitely will be getting those pee strips and testing my own pee to see what is going on. I'm also going to start taking higher doses of pro biotics and see if that helps along with the D mannose for UTI's.

As far as implantation and everything, I had no cramps or anything with this pregnancy until I started to miscarry 2 weeks after the baby had already died. Mine was a missed miscarriage because of the progesterone I believe. I think the pg kept my lining stronger and maybe even continued to grow my lining and chorionic villi (as when I miscarried I definitely saw the chorionic villi and it was a normal size for being around 8.5-9 weeks along according to my mw. The baby however appeared to be closer to around 5 weeks...it was almost as if he stopped growing even though his heart was beating long after he stopped growing...kwim?

I only spotted one time around 5 weeks, and it was just the size of two quarters together and it was light brown. Then I was fine for a week. Then I had more brown spotting with a tiny tinge of pinkish but hardly any, but I was already freaking out so I got the blood test done, then the US the next day where there was a HB (114pbm at around 6.5 weeks...is that a "good" hb? or should it have already been much much higher?)

Anyway...thanks again so much ladies. You are all really helping!!!!! s

[MaerynPearl]

at 6.5 weeks theres really no such thing as a good heartbeat rate as it could have just recently started beating and could be quite low still... any heartbeat is a good heartbeat... but of course, your risk for miscarriage does not drop when you see the heartbeat, but when you hear it with a doppler, because by then it is loud and strong and you are far enough along that almost all of the miscarriage risk has gone away as it is (from 25-30% to 1-5%)