Dude, where's my progesterone? (lots of prog ?s)

[babygrey]

Ok, this is a part rant, part a million questions. Sorry for the novel in advance.

I've had excessive midcycle spotting for a couple of months. I'm nursing a 13 month old.

chart: http://www.fertilityfriend.com/home/2c383d

I also have endo and chronic pelvic pain from adhesions. To complicate matters, I see an endo specialist GYN, a CNM, a MW and a WHP all for various types of my care. and, of course, they never agree.

I've been told for the spotting to do the following: wait it out (b/c it was likely d/t nursing), take Estrogen, take Provera.
I chose to wait it out. I hate starting to mess around with hormones. I was hoping my body could figure out how to fix itself (I mean, I haven't talked to anyone else who spotted like this for so long, even when nursing. My HCPs said it is abnormal at this point... I mean, I've been spotting almost daily for MONTHS)

Waiting it out didn't make it stop, in fact, it got worse. No one is quite sure why I'm spotting like this, but everyone's opinion is that it probably isn't from nursing.

I had an episode of major pain this week, my CNM saw me. She drew a progesterone level on what I thought might be 3dpo.

My progesterone level was 0.05 FWICT, that's even way too low for a pre-O level, let alone a post-O level. (CNM thinks it is possible the temp spike 3 days ago was O, but I just don't have enough progest to keep even a few days sustained rise)

I just lost a major amount of hope. I know a single-point progest level isn't necessarily diagnostic of anything, but that's really, really low. Plus, I have to do something now, bc there are other problems with my endo that are probably being made worse from a super-low progesterone level and my bleeding (I probably have internal implants bleeding as well as the external spotting)

My healthcare team has been really on-board with TTC until this and now everyone is telling me perhaps I ought to take a break and figure out what the heck is going on with my hormones. (bc, even with nursing, this isn't a "normal" pattern of return of fertility). or wean my baby. I feel like a dummy for putting so much energy into TTC for the last 6 months, when, OBVIOUSLY it couldn't end well.

I have questions for you all. Any advice or BTDT would be fantastic.

My endo GYN wants me to go on BCPs for a few months. He doesn't believe in progesterone supplements.

CNM does believe in progesterone supplements- she wants me to supplement all the time- not just after O. Her theory is that my crappy level is probably keeping me from O'ing- OR it is a side effect of an immature egg being released and I need better levels to mature the egg.

Can someone explain to me in simple terms how progesterone helps release/mature the egg? This is something I didn't know.

I haven't heard of progesterone supplements BEFORE O to make you O... has anyone done this?

I'm scared it will make me NOT O, but she assured me that wouldn't happen. That doesn't make sense to me- does it to you?

Also, she gave me the choice of vaginal suppositories or oral Prometrium. She said vaginal might give me a better level, but will be a pain in the butt since I'm supposedly doing this for months, and maybe I just want to do Prometrium so I can just take a pill at night.

Experiences- vaginal vs. oral? Side effects of either? If you have had experience with both- which would you choose and why?

Has anyone been in a similar situation and successfully conceived?

sigh. thanks for listening.

ETA: I'm taking Vitex. Seems like I should stop that, right? I forgot to ask...

Also, for those who followed my 9dpo pink line last month, CNM thinks I was pg, but, for obvious reasons, that didn't work out

ETAA: Provera vs. Prometrium... prometrium is way less progesterone, yes?

[HulaJenn]

I am sorry, i don't have any experience wiuth progesterone, but wanted to offer hugs and to say, that having 2 kids already should offer up some sort of hope?
I feel your frustration having so many "cooks in the kitchen" re: your health care team.
do you have 1 that you trust more than the others? I am all about second opinions, but having so many options and all not agreeing can be overwhelming. Finding a starting path is always the hardest part. And if 1 thing doesn't work, then you move on to the next option. .. I hope it doesn't take long to find something that works for you.

[MaerynPearl]

Originally Posted by babygrey

CNM does believe in progesterone supplements- she wants me to supplement all the time- not just after O. Her theory is that my crappy level is probably keeping me from O'ing- OR it is a side effect of an immature egg being released and I need better levels to mature the egg.

Can someone explain to me in simple terms how progesterone helps release/mature the egg? This is something I didn't know.

I haven't heard of progesterone supplements BEFORE O to make you O... has anyone done this?

I'm scared it will make me NOT O, but she assured me that wouldn't happen. That doesn't make sense to me- does it to you?

I hate to disagree with your CNM but I am going to have to STRONGLY disagree.

Provera (aka medroxyprogesterone... or in most cases its known as the progesterone pill) is a birth control pill, if you take it all cycle it will STOP you from ovulating. Hence depo-provera (the shot) doing the same thing. If you only take it post-O it will help keep your progesterone up.

You should have little to no progesterone in your system leading up to O.

Basically... both your OB and your CNM told you to do the same thing. Go on BCP for a few cycles, see if it helps kickstart your system itself. Ive heard of ladies trying this. Cant tell you the results, I dont even know.

Personally I would listen to them to see if it helps. It would be better if you can go into this with your body already doing what it is supposed to rather than having to supplement for what it is doing incorrectly.

[babygrey]

Originally Posted by MaerynPearl

I hate to disagree with your CNM but I am going to have to STRONGLY disagree.

Provera (aka medroxyprogesterone... or in most cases its known as the progesterone pill) is a birth control pill, if you take it all cycle it will STOP you from ovulating. Hence depo-provera (the shot) doing the same thing. If you only take it post-O it will help keep your progesterone up.

You should have little to no progesterone in your system leading up to O.

Basically... both your OB and your CNM told you to do the same thing. Go on BCP for a few cycles, see if it helps kickstart your system itself. Ive heard of ladies trying this. Cant tell you the results, I dont even know.

Personally I would listen to them to see if it helps. It would be better if you can go into this with your body already doing what it is supposed to rather than having to supplement for what it is doing incorrectly.

Thanks, MP. Disagree all you want. That's what I posted for, cuz it didn't make much sense to me. If I've learned one thing from seeing so many different types of providers, it is that clearly there's an art, and clearly HCPs can be very wrong.

But, I think I was unclear- CNM is NOT telling me to do Provera right now (that was someone else last month ),

She wants me to do compounded vaginal progesterone or Prometrium- less progesterone, and bio-identical vs. provera's synthetic high dose withdrawl bleed method. She specifically does not want me to do Provera, or mini-pills bc, as you said, too much progesterone... her thought was that prometrium or the like was little enough bio-avail progesterone that it wouldn't hold off O but it would stop my bleeding.

now, whether that is true or not, IDK... do you think I'm understanding wrong?

[babygrey]

Originally Posted by HulaJenn

I am sorry, i don't have any experience wiuth progesterone, but wanted to offer hugs and to say, that having 2 kids already should offer up some sort of hope?
I feel your frustration having so many "cooks in the kitchen" re: your health care team.
do you have 1 that you trust more than the others? I am all about second opinions, but having so many options and all not agreeing can be overwhelming. Finding a starting path is always the hardest part. And if 1 thing doesn't work, then you move on to the next option. .. I hope it doesn't take long to find something that works for you.

Thank you. I really appreciated this. I'm (obviously) overwhelmed. In general, I trust my CNM the most. But, to add annoyance to everything else, if my MD doesn't agree, he can over-ride her.
Regardless of me venting more, I really appreciated your kind response.

[karmab]

1- when i look at your chart, i dont see any o anywhere, myself. i think its just anovulatory, and if you are nursing a 13 m.o., that's not surprising at all.

2- easiest question to answer- oral vs. vaginal prometrium- ive been taking vag prometrium during lp for 3 mths, it is a pain. im going to likely switch to oral soon cuz it really does cramp your style, no pun intended.

3- provera will stop you from o'ing, absolutely. re: taking progesterone all the time, i have never heard of anyone o'ing while on progesterone. have you heard of dr lee? if you google his name and progesterone, you will find him. he does kick start women's fertility, he mainly is dealing with women approaching menopause that are trying to get pg, but suppressing o's with progesterone for a few months, similar to the idea your doc has of putting you on the pill for a few months. now, the pill will likely affect your milk supply. the mini-pill - progestin only- shouldnt.

babygrey- how old are you? if you are young, here's what i would do- bf my baby, not try to prevent but not even think about ttc, and enjoy my baby. when the bf'ing tapers off, see what happens with your cycles. they might all fall back into place. ttc while nursing a 13 mo is like swimming up stream- i know it is possible, but it really is against mother nature, so it's complicated. if your cycles are wonky, well, that may not mean that anything is WRONG, it may be totally normal for a woman bf'ing a young child. if you are getting up there in age, you could try one of these various progesterone plans, and maybe it will work. or you could try to work toward weaning, and see what happens with your cycles, but if you are older, there is no guarantee that things will end up perfectly normal even if you totally wean, so it's really a sophie's choice.

[babygrey]

Originally Posted by karmab

1- when i look at your chart, i dont see any o anywhere, myself. i think its just anovulatory, and if you are nursing a 13 m.o., that's not surprising at all.

2- easiest question to answer- oral vs. vaginal prometrium- ive been taking vag prometrium during lp for 3 mths, it is a pain. im going to likely switch to oral soon cuz it really does cramp your style, no pun intended.

3- provera will stop you from o'ing, absolutely. re: taking progesterone all the time, i have never heard of anyone o'ing while on progesterone. have you heard of dr lee? if you google his name and progesterone, you will find him. he does kick start women's fertility, he mainly is dealing with women approaching menopause that are trying to get pg, but suppressing o's with progesterone for a few months, similar to the idea your doc has of putting you on the pill for a few months. now, the pill will likely affect your milk supply. the mini-pill - progestin only- shouldnt.

babygrey- how old are you? if you are young, here's what i would do- bf my baby, not try to prevent but not even think about ttc, and enjoy my baby. when the bf'ing tapers off, see what happens with your cycles. they might all fall back into place. ttc while nursing a 13 mo is like swimming up stream- i know it is possible, but it really is against mother nature, so it's complicated. if your cycles are wonky, well, that may not mean that anything is WRONG, it may be totally normal for a woman bf'ing a young child. if you are getting up there in age, you could try one of these various progesterone plans, and maybe it will work. or you could try to work toward weaning, and see what happens with your cycles, but if you are older, there is no guarantee that things will end up perfectly normal even if you totally wean, so it's really a sophie's choice.

Thanks much! You ladies are so awesome for advice.

I think I need to edit my OP , no one wants me on Provera right now. CNM wants me on low-dose bio-identical progesterone/prometrium- like she gives to correct LPD or possibly prevent m/c in women with progest issues. In my understanding, that's way less progesterone than Provera, yes?

Thanks for the personal experience re: vaginal progest... wondering if you can tell me- I took oral progest PP for a month to prevent PPD and the side effects were awful; headaches, nausea, dizzy, sleepy. How are the s/e with vaginal?

on your other ? - I'm in my early 30s. Age pretty much on my side. That said, I have major secondary fertility issues that are NOT on my side (endo and one blocked tube), plus serious chronic pain from resulting issues from the endo and scar tissue from the resulting bunch of abdominal surgeries. My right tube was not blocked pre-DD, and now it is, so there's a sense of urgency that, should I chose to wait, I'll wait myself right out of an option.

The rush to TTC is, in part, b/c my endo clinic wants to talk hysterectomy and/or artificial menopause with me and I won't go there b/c we want another child desperately. It was actually my HCPs advice we TTC that gave us the push to dive in while I was still nursing.

I know it is a long shot, tho 'natural pg spacing' of 14ish months was making me a little optimistic as DD gets older. That's why, when given options months ago to deal with this, I chose to wait it out. Buuut.. then come in the secondary issues, and I've been bleeding daily for months. (talk about cramping your style ). The consensus seems to be that there is something else going on with me other than just being a nursing mom.

I haven't seen those progesterone plans, thank you for suggesting. I will look into them, bc I feel like, with all the disagreement btwn my HCT, everyone's just guessing here.

So, I don't know. This is a lot to digest, and, honestly, I need to do something about the bleeding, given that I've probably got internal endo implants bleeding, regardless of my TTC wishes.

Anyway, thank you for your thoughts and kind words. I am sincerely appreciative. It helps to have an outside perspective, and see the forest for a bit.

[karmab]

i really havent had too bad s/e from prometrium. no headache, nausea, dizziness, or sleepiness really. some cramping, some emotional stuff- just like being very sensitive- the kind where i routinely cry at hallmark or on*star commercials. when im on it, i tend to think, oh it's not so bad, then i get off it and say 'oo, i feel better!' but it's just one of those things, not horrible, just a pain, and worth it.

i wish you much much luck, baby grey. the endo stuff and the chronic bleeding is tough.

[treehugginhippie]

Just my observation (in myself)...a very small percentage of women simply cannot conceive/carry to term a baby while nursing. This may be your body's way of telling you that you cannot do both. Hugs...I know how hard it can be to be ready and your body is not cooperating.

[kikaaaso]

Re

I really don't have any advice..I just wanted to come on here and give you a big(((Hugs))). I pray that you are able to find a solution to this spotting, and with that your body will do what it needs to so that you get things normalized. Once that happens, I truly believe you'll get that next blessing. (((hugs)))