Prometrium Questions UPDATE Post #15 with chart ?

[Sihaya]

I've had two miscarriages over the past six months and this is our first cycle TTC after the 2nd m/c. After speaking to a few midwives and doctors, I think I have a luteal phase issue and will be taking Prometrium during the TWW (and throughout the first trimester once we get pg). I am also taking 100mg B6 daily and started taking Synthroid again due to borderline hypothyroidism (I was being medicated for it when I got pg with DS, but not when I had the 2 m/cs).

I've been getting conflicting information from different sources about when to start taking the Prometrium and how much to take. My family doc's PA prescribed me 200mg pills and told me to take them vaginally, one in the morning and one in the evening. That sounded like a lot to me and we couldn't afford that much at once so after a little research (thread here), I decided to take one pill every evening. (This was right after the last m/c when I thought I had ovulated, but actually hadn't.) From my research, I decided to start taking them at (what I thought was) 3dpo. The PA had no idea/input about when to start.

A couple weeks ago I got in with a natural-minded OB/GYN who is cool with me switching to my home birth midwife at 20 weeks. She suggested that I cut the pills I still have in half and only take one/day in the morning (so 100mg/day). This doesn't sound like enough to me, but it makes it a lot more cost-effective. She also advised that I wait until 6dpo to start taking them. This sounds late to me, but when I asked she said the progesterone is more likely to interfere with implantation at 3dpo.

I believe I am 1dpo today (chart here) and would really like to do everything I possibly can to make this a successful pg. I don't want to take too low a dose or start it too late and suffer a third m/c. At the same time, I trust the OB/GYN's knowledge of dosing a lot more than the PA, I just don't like that the OB's advice conflicts with everything I've read here. Your input is greatly appreciated!

[karmab]

first, i know people here are likely to tell you you need an actual diagnosis after testing to decide if it will really benefit you. im not saying that. im thinking youve done your homework and your healthcare providers agree it could be a problem, so that's enough to try it.

re: 100 mg vs 200 mg vs 400 mg/day, you can only know by trying it, and seeing if your symptoms (what were they?) go away. 200 mg/day is enough for me. i take b6 too, in addition to my prenatal which has b complex. af comes for me anytime between 14dpo (the morning after my prometrium) and about 4 days after ive stopped it.

re: when to start taking it- i have done a heck of a lot of research on this subject and haven't seen anyone say that taking it early could interfere with implantation, but i have seen it written that taking it too late can negate any benefit. my own doc told me to start it on 1 dpo- and that the sooner post-o you take it, the better it will work. i wait until the morning of 3 dpo so i can confirm o, although i have never had an irregular cycle or o'd more than 24 hours +/- my usual o day on cd 14. im just cautious like that. then i take it every night. i do believe the average day of implantation is 8 dpo, and can be anytime between 4 and 12 dpo in some cases though, so im not sure the 3 dpo thing would make a difference even if that's the reasoning.

another thing ive been looking at lately is baby aspirin. since you have had 2 m/c's you might want to ask your doc for thoughts on that. you can google "baby aspirin (or low dose aspirin) and fertility" for some background on that if you are interested.

good luck!

[nintendork]

Originally Posted by karmab

first, i know people here are likely to tell you you need an actual diagnosis after testing to decide if it will really benefit you. im not saying that. im thinking youve done your homework and your healthcare providers agree it could be a problem, so that's enough to try it.

re: 100 mg vs 200 mg vs 400 mg/day, you can only know by trying it, and seeing if your symptoms (what were they?) go away. 200 mg/day is enough for me. i take b6 too, in addition to my prenatal which has b complex. af comes for me anytime between 14dpo (the morning after my prometrium) and about 4 days after ive stopped it.

re: when to start taking it- i have done a heck of a lot of research on this subject and haven't seen anyone say that taking it early could interfere with implantation, but i have seen it written that taking it too late can negate any benefit. my own doc told me to start it on 1 dpo- and that the sooner post-o you take it, the better it will work. i wait until the morning of 3 dpo so i can confirm o, although i have never had an irregular cycle or o'd more than 24 hours +/- my usual o day on cd 14. im just cautious like that. then i take it every night. i do believe the average day of implantation is 8 dpo, and can be anytime between 4 and 12 dpo in some cases though, so im not sure the 3 dpo thing would make a difference even if that's the reasoning.

another thing ive been looking at lately is baby aspirin. since you have had 2 m/c's you might want to ask your doc for thoughts on that. you can google "baby aspirin (or low dose aspirin) and fertility" for some background on that if you are interested.

good luck!

:

also I am taking 100 mg every evening right now and it is working for me (i.e. it is keeping my period away).

[sweetest77]

I didn't know you could cut the 200mg capsules in half... If you can do that then I do think it would be a good idea to split the dose if you want to start with only 200mg/day.

As far as how much to take, that really varies by person. I started out on 200mg once a day orally and my LP got longer but I still had LP spotting, just later in my cycle. Once I switched to 200mg twice a day vaginally, my spotting went away completely. So for me, I really think I needed the higher dose (although I do still wonder if the lower dose would have worked vaginally).

Honestly, if I didn't have any way of knowing a lower dose was working (like LP spotting going away) and was taking it to prevent a future miscarriage I would take the higher dosage just to err on the side of caution. Of course that is easy for me to say because I have insurance that covers the cost of my pills, so my cost is the same regardless of dose.

I've never heard that starting later/earlier will affect implantation... I really wouldn't think that would be a problem for you since you already have proven that you can implant... from what I have seen, many women taking prog. to prevent miscarriage don't even start until they get a BFP.

Good luck!

[contactmaya]

I agree with what the pp said, that if you are already getting past 2weeks, then it may not be a progesterone problem. But i am no expert.

I have been taking progesterone , 200mg/day, which i think is way too much, but couldnt reduce the dose, because the pills cannot be divided. I bought Progonel recently, which comes in tiny pills of 8mg. This way you can have greater control over your dose. There are 320 in the pack, and it costs $31. I dont have the link handy, but google the name, and if it doesnt come up, ask me, and i will dig up the link.

Also google Dr Lee and progesterone. (you probably already have)
Maya

[Sihaya]

Thanks so much for your replies! They are so helpful

Originally Posted by karmab

first, i know people here are likely to tell you you need an actual diagnosis after testing to decide if it will really benefit you. im not saying that. im thinking youve done your homework and your healthcare providers agree it could be a problem, so that's enough to try it.

Of the 4 providers I've talked to, not one of them has suggested testing my progesterone (which was tested during my most recent pg and was fine at the beginning and only somewhat low right before the m/c started). All of them agreed that we could start supplementation now "just in case" and then if I go on to have a third m/c, I will have in-depth testing, which will be more likely to be covered by insurance at that time than it would now. Also, testing would mean waiting another full cycle without trying and we're ready to move on and TTC ASAP. We've agreed that if I have a third m/c, we will take a much longer break for testing and treating whatever we find.

Originally Posted by karmab

re: 100 mg vs 200 mg vs 400 mg/day, you can only know by trying it, and seeing if your symptoms (what were they?) go away.

My symptoms are short LP (avg 7-9 days) and spotting during my LP (as long as a week before AF). BUT, I've never had those symptoms during a cycle where I've gotten pg, I get pg every time we DTD during my fertile phase (), and I'm not willing to wait longer to TTC or to pay for progesterone during non-TTC cycles. So there's really no good way to monitor my symptoms to adjust my dosage.

Originally Posted by karmab

re: when to start taking it- i have done a heck of a lot of research on this subject and haven't seen anyone say that taking it early could interfere with implantation, but i have seen it written that taking it too late can negate any benefit.

I'm glad to hear someone else who's never heard of it affecting implantation. I'm really leaning toward starting it at 3dpo. Part of me is scared of what the OB will say when I come in for my 8 week ultrasound and tell her I didn't follow the protocol she suggested. But she is just a doctor. I need to remember that I'm the only one who can make decisions for me and even though she has lots of training and experience, she isn't me and I should do what I'm most comfortable with.

Originally Posted by karmab

another thing ive been looking at lately is baby aspirin. since you have had 2 m/c's you might want to ask your doc for thoughts on that. you can google "baby aspirin (or low dose aspirin) and fertility" for some background on that if you are interested.

I'm definitely keeping it in mind. At this point, though, if I do get pg and carry the baby to term, I'll have to do everything I'm doing now every single time we want to get pg in the future. So, I'm reluctant to try baby aspirin "just in case" until I know that the Synthroid/Prometrium/B6 combo isn't enough, KWIM?

Originally Posted by sweetest77

I didn't know you could cut the 200mg capsules in half... If you can do that then I do think it would be a good idea to split the dose if you want to start with only 200mg/day.
<snip>
Honestly, if I didn't have any way of knowing a lower dose was working (like LP spotting going away) and was taking it to prevent a future miscarriage I would take the higher dosage just to err on the side of caution.

This is what I'm thinking. I'm not going to take the 400mg dose regardless because that's just way too much based on my specific issues. I'm thinking I'll cut the 200mg pills in half and take 1/2 pill each in the morning and at night. If I'm pg, that will last me past my 8wk u/s, at which point I can ask the OB to prescribe just enough to get me to 11-12 weeks instead of refilling my current prescription, which would cost $$$ and give me way too many extra pills.

Thanks again for the input and please keep it coming!

[Sihaya]

Maya, we cross-posted.

Originally Posted by contactmaya

I agree with what the pp said, that if you are already getting past 2weeks, then it may not be a progesterone problem. But i am no expert.

I am not losing the pgs until 9-10 weeks, but at that point, they only measure ~4-5 weeks (from LMP), so it's still possible that progesterone is a problem and my body is just, for whatever reason, retaining the baby which has already stopped growing.

Originally Posted by contactmaya

I have been taking progesterone , 200mg/day, which i think is way too much, but couldnt reduce the dose, because the pills cannot be divided. I bought Progonel recently, which comes in tiny pills of 8mg. This way you can have greater control over your dose. There are 320 in the pack, and it costs $31. I dont have the link handy, but google the name, and if it doesnt come up, ask me, and i will dig up the link.

Thanks for the recommendation! Is the Progonel oral or vaginal? I wasn't able to find anything when I googled. It just pointed me to Progon-B, which looks to be similar. Either way, both are about the same price as the Prometrium. But I already have 45 pills of Prometrium sitting in my medicine cabinet, so it's not really worth my while to switch at this point. But I will keep it in mind for future cycles/pgs.

Originally Posted by contactmaya

Also google Dr Lee and progesterone. (you probably already have)

I have looked at Dr. Lee's site in the past. I took an OTC progesterone cream with my first m/c. I'm much more comfortable taking something where I know for certain exactly how much progesterone I am getting in each dose.

[contactmaya]

Yes, Progon B is the same thing.
They are oral, but i take them vaginally.

Ill dig up the link...

[sweetest77]

Have you already tried cutting the pills? I really didn't think you could do that...although I do know there is a 100mg dose of prometrium available.

If you don't conceive this cycle, and if your short LP and spotting don't get better on the lower dose, then I would definitely recommend bumping it up. Adding another 200mg made all the difference for me!

I had my progesterone tested when my LP was short and I was spotting and it was in normal range, so I don't really think your prog. number really tells you much. I really think sometimes you need to go by symptoms. I wouldn't worry too much about not getting tested, and consider yourself lucky you have a Dr. that doesn't just go strictly by the #s and insist on testing first

[Sihaya]

I haven't personally tried cutting the pills yet. I heard from other mamas IRL that it can be done and my OB told me to do it. If I can't, I'll just do what I did last time and take one 200mg pill every day. The OB said I should take it in the morning because metabolism is slowed overnight, but everything I've read/heard said to take it at night, so I'll have to make a decision on when to take it if I'm not able to cut them in half.

[karmab]

usually, when there are pills that you are not supposed to cut, it's because they are enteric coated to protect your stomach or because they are supposed to be released farther down the g.i. tract. i dont have much experience with taking pills vaginally, but my guess is, it would be ok. things like suppositories, on the other hand, you probably should not cut, because the way they are mixed with a media (like cocoa butter for example) when you cut it in half, there's no way to know if the media and the med were mixed completely thoroughly so that each half will have equal concentration, or not.

i also dont know about the morning or night for metabolism or absorption of it, but they often say if you are just taking the suppositories once a day, it's recommended at night only because when you are walking around during the day, it will drip out and you will lose some, so you've got a better chance to absorb more over night when it stays in place!

[bella99]

When I was pregnant with my daughter, I took 200mg of Prometrium vaginally every night until 12 weeks. 200mg is not a high dose.

It was the standard protocol at my RE's office, regardless of the cause of your infertility.

Taking them vaginally is supposed to increase the amount that is absorbed, and taking them at night before bed really minimizes the mess.

Treatment with prometrium is often a "won't hurt, might help" kind of thing.

[KingsDaughter76]

200 mg is a very small dose....400mg per day is a common dose for most women...and I am now on 600 mg per day once I confirm pregnancy because 400 was not enough this last pregnancy I had and I still lost the baby. I am suppose to take 400 mg from 3 dpo until I get a + on a pregnancy test...then immediatly increase it with one more pill vaginally at night... prometrium has helped me carry 2 pregnancies...and I am hoping the higher dose will help us carry one more successfully.

[lesliesara63]

My former RE had all patients take 600mg/day and started the day before ovulation when we did our trigger shot. I didn't get pregnant any of those months, but it did make my lp about 3-4 days longer.

[Sihaya]

Originally Posted by karmab

usually, when there are pills that you are not supposed to cut, it's because they are enteric coated to protect your stomach or because they are supposed to be released farther down the g.i. tract. i dont have much experience with taking pills vaginally, but my guess is, it would be ok. things like suppositories, on the other hand, you probably should not cut, because the way they are mixed with a media (like cocoa butter for example) when you cut it in half, there's no way to know if the media and the med were mixed completely thoroughly so that each half will have equal concentration, or not.

These are great points. I tried to cut the pill in half and it was a mess! I put it in the fridge to see if it would get more solid (it was 75 degrees in my house), but that didn't help. A google search turned up a link from someone who said they froze the pills before halving them, which I'm not comfortable doing in case it does something to the progesterone to make it less effective. So, 200mg every evening it looks like it will be.

Originally Posted by bella99

It was the standard protocol at my RE's office, regardless of the cause of your infertility.

Originally Posted by lesliesara63

My former RE had all patients take 600mg/day and started the day before ovulation when we did our trigger shot. I didn't get pregnant any of those months, but it did make my lp about 3-4 days longer.

It looks like both of you use an RE. I do not have infertility of any kind, nor age or other risk factors that would get an RE to even be willing to see me until I have a third consecutive loss. So, I'm thinking the higher doses probably aren't necessary in my situation. Though, if I get pg and miscarry on 200mg/day, I will definitely discuss upping my dose with my care providers.

A minor update: I am what I thought was 3 dpo today and got very ambiguous temps this morning. The temp on my chart was taken 30 minutes after the normal time, once I had laid with all my limbs under the blankets for a half hour. The first temp was taken at the normal time, but with my arms out of the blankets, which almost always results in a big dip in my temp. That temp was 96.93, which makes it look like I didn't O at all, but I'm 99% certain that I did and pretty sure I O'd twice, on CD16 and CD18. Not sure if I should start the Prometrium tonight, or if I should wait one more day to be absolutely sure of whether I ovulated or not. I would hate to miss our chance this month because I started the progesterone too early and ended up never ovulating at all. I would welcome your input and what you would do in my situation. Thanks again, everyone!

[karmab]

if it were me, i would wait one more day. i think the first temp is likely the more reliable one, and that's not to say if you go by that, that you didnt o. it could be a fallback rise. but in any case, it should be clear one way or the other by tomorrow. (just aside- everything i have read has said if you o twice, it will be within 24 hours due to the lh surge and the progesterone produced by the first corpus luteum. not saying you couldnt have o'd 48 hours apart, but not sure you can. if you are going by o pain, that can for sure happen before, during, or after o. if you've ever seen pics of ovulation, it's no wonder it hurts!)

[Sihaya]

Thanks, karmab! I think I'll wait for tomorrow's temp and try to DTD some time today/tonight just in case I haven't O'd at all yet.

I don't trust O pain at all, it's more cervical changes that have me suspecting two eggs. I thought I remembered it being possible for double O to be up to 48 hours apart. I'll have to look that up, but if it was CD16 and CD18, it seemed more like 30-36 hours apart, not a full 48.

[karmab]

hmmm. it could be, but i think cervical position and texture is in response to changes in estrogen levels if that's what you mean, and they aren't steady of course around the time you are o'ing or even gearing up to o. im not sure your cervix really has a way to know technically if you are actually o'ing.

[kalamos23]

If you had a fallback thermal shift at 2dpo, that would make it appear like you ovulated twice wrt cervical position/CM.

[bella99]

My point was that even if you were seeing an RE for male factor infertility, they would still put you on the Prometrium, because it was standard protocol. And there's nothing wrong with a regular OB prescribing it if they think it might be related to your losses.

FWIW, I've never had a problem with my progesterone levels.

As for your chart, I had a fall back temp 2dpo with ewcm. Here's my chart if you want to take a look.

http://www.fertilityfriend.com/home/19b8de