Lacking progesterone in Pregnancy

[LB Mama]

Hello,
I have just learned I am pregnant and my progesterone level is half what it should be at this point, according to the doc. He has prescribed 200 mg of Prometrium 2 times a day.
My problem: I had a miscarriage two years ago, under the same circumstances. I took Prometrium from my 6th week of pregnancy and the fetus died at 8 1/2 weeks. I am soooooooooooooo worried about this one. I don't know what to do. I have a very healthy 3 year old boy, and the pregnancy was trouble-free (no hormone testing even happened). I am wondering if it is just my body that wants a lower progesterone level for the fetus, and maybe I messed with it last time (by taking the prometrium). Then again, I don't want to loose this baby for lack of trusting the doctor.
Does anyone have any experience with any of this? Also, I am breastfeeding my 3 yr old, and I have heard that may affect my progesterone levels? Is it detrimental to the health of the unborn baby?? Please HELP!!!

Thanks!

[selazenby]

I don't know if this is really helpful but here's my experiece.

With my first, we had a hard time getting pregnant. Finally (after a year) we tried using progesterone supplements (vaginal suppositories twice a day). We got pregnant almost right away. We continued using them through the 12 week mark and all was well. I'm now pregnant with #2 - and this time too we tried for a while to get pregnant (not near a year this time - just a couple months) with no luck. Then we started using the progesterone again (this time we used an external cream twice a day rubbed into my inner thigh) - and again got pregnant right away. We again used it through 12 weeks then stopped. By the way, I was nursing ds when I got pregnant for #2 and through that 12 weeks that we were using the progesterone. So for me, I'm convinced that it was helpful. I have a very high level of trust in my midwife - and she too felt that it was it was a fine thing to do.

Incidentally, I really didn't like taking the progesterone either time. It made me feel tired and moody and generally blah. But it was of course worth it and I'd do it again if I needed to.

I hope everything works out great for you! Good luck!

[bri276]

I would ask your doctor to show you one study where progesterone levels dropped BEFORE hcg levels. As far as I am aware, there is not one.
So it's totally up to you and what you feel comfortable with, but if I were you, I'd continue with betas every other day for a couple days and if they're going up fine I don't see any reason for supplements and I can't imagine what reason your doctor could give either. There is always a range of what is normal, and I also don't understand why you had this testing if you've had no prior miscarriages and no bleeding.

[shannon0218]

Actually Lily, if you do any research into recurrent miscarriage, progesterone levels OFTEN start to drop before HCG levels. It's happened to me. To the OP, there are MANY studies to say that starting progesterone after the 4th week of pregnancy is not helpful--so if they tested your progesterone at week 6 and started you on it then, it was probably too late. With Molly (my one and only successful pregnancy) my progesterone was tested every 3 days until week 8. My level never did get truley high which stands to reason it was a big cause of my 3 losses. In spite of supplementation at one test around 5 weeks my progesterone count lowered a bit, at that same blood test my beta level didn't come close to doubling. My progesterone was upped, injections were added to the suppositories and 2 days later my hcg had once again started to double and my progesterone was back to "normal for me" levels.

I researched progesterone use for months before I used it (if you do a search here you find TONS of valuable information) but I can honestly say I've never heard of anyone blame it for their miscarriage--I've seen people say that they don't want the progesterone to prolong a pregnancy that isn't going to stick (and by all research it doesn't seem to other than perhaps by a couple days)

If I had to take a guess (which is all we can really do with these things because no pregnant mama wants to be the test bunnie who knows her progesterone is low and doesn't take the supplement) I'd guess that for your last pregnancy when your levels were tested at 6 weeks, your progesterone had already started to drop--once the progesterone drops, the fetus can no longer be appropriately nurished and then Hcg levels drop. I can't my put my finger on these studies now as it's been well over a year since I was reading them--but there are actually many studies describing that. My RE wrote 2 of them. Like I said though, there is a huge concencus that starting prog as late as 6 weeks will not be effective--many doctors and midwifes do it anyway because the progesterone is basically harmless and there is still that tiny chance it could help.

[shannon0218]

Oh, and Lily, by the time a beta pattern establishes itself as abnormal, it's too late for measures where supplementation will change the outcome. Monitoring the progesterone levels at least gives a heads up that the beta levels can start to fail soon.

[annettemarie]

I worry and wonder about this also. We lost our first baby, and had Michael less than a year later. With Katie Grace they did very early blood tests and my progesterone level was way, way down (8, I think, and I was pregnant) and I took progesterone suppositories. With Nicholas, I made them test me as soon as I knew I was pregnant, and it was also very low, and I took some sort of pill- I forget which.

I hate taking "extra" meds, and I carried Michael with no extra progesterone and no problems. I never am quite sure what the right thing is to do, and as we begin to think about another baby, I am finding this on my mind again.

[shannon0218]

I forgot something else, for many women, just because you have low progesterone with one pregnancy doesn't mean you will have it with another, same holds true just for low progesterone during your LP, in my testing I had some LP's that had awesome progesterone numbers and others where it was very low.

[AAK]

With my first, my prog. levels were borderline--dr. monitored it but didn't supplement. However, each of my subsequent pregnancies have had miserable prog. count. Each of those times I was nursing a toddler. I have never been told to wean, but have been grateful for the prog. supplements. I did a lot of research before first taking it and although I found arguements about its effectiveness, I never saw anything that even questioned it in terms of causing miscarriage. If a miscarriage is inevitable for other reasons, it will still happen with the supplements. I understand that you need to be on the supplements ASAP and continue until the placenta has been developed which is supposed to be around 10 weeks. My dr. prescribed them for slightly longer than the 10 weeks to account for possible dating errors.

Take them!

Amy

[Heart.Revolution]

I had a couple miscarriages due to having low progesterone. The last pregancy that I miscarried i found out at 6 weeks that my progesterone was 6.2 and i miscarried a few days later after i started taking the vaginal sup.

It took me over a year to get pregnant again and this time I had the progesterone in my fridge and ready to take. I got a positive test and started it right away. As of last week my progest number was up to 28. My HCG levels are all in normal range too and I also had an ultrasound and saw the baby and heard the heartbeat. So far so good...

[gonnabeamom]

I'll add my purely anecdotal experience. It took us a year to get pregnant. During that time I was charting and seemed to fit the profile for Luteal Phase defect. The theory is that women who have a short luteal phase, (the period between ovulation and menstruation) don't build up enough a supply of progesterone, or high enough quality progesterone to signal the existence of a pregnancy. Even if you make past your initial period you continue to run behind on the amount of progesterone needed to sustain a pregnancy. I also had some hormone testing done that was consistent with low progesterone.

So we lost our first intended pregnancy (I had an early m/c when we didn't know I was pregnant) fairly early, Think maybe 8 weeks. Then we managed to get pregnant again reasonably quickly and lost that as well at 11 weeks.

Finally we got a new doctor who was willing to really look into our recurrent m/c problem, and did a bunch of testing on both of us, and he agreed with me that Luteal Phase Defect/low progesterone fit the pattern of losses I'd had. We still didn't get pregnant for a while, and eventually added clomid to the mix (which in addition to treating women who don't ovulate is used as a LPD treatment). Once we got pregnant, my Dr. prescribed progesterone suppositories. Until we reached 12 weeks pregnancy (when the placenta takes over producing the progesterone). I'm 29 weeks pregnant now, and all seems to be going well.

There is a school of thought that says the progesterone suppositories are more effective than the oral prometrium. I had no problems with taking the progesterone, though I was wretchedly nauseaus, but that continued after I stopped taking progesterone.

I'll never be 100% incontrovertible sure or able to prove that supplementing saved this pregnancy, but it is what I believe.

[LB Mama]

Thank you all for your speedy replies. I hadn't added that I did actually have my 1st ultrasound and we confirmed that I am around 7 weeks....which does add to the worry of what some said about taking the progesterone too late. (and, yes, saw a beautiful heartbeat!)
I had started taking one of the two pills immediately, just out of blind faith and fear, I suppose. But, now that I have had some time to research it and hear responses, I started taking them twice a day.
I still FEEL pregnant :) ...but, I literally needed to sleep 3.5 more hours than usual today...Is that normal? I am unbelieveably tired and then some!!
Also, we are unsure of the exact date, and so now I am also worried about stopping the progesterone too early. I understand that you should take it up to 12 weeks. Is it standard that the doc can adjust for this kind of uncertainty?
Are any of you familiar with fetal dopplers? We are considering using one if this pregnancy continues. Could anyone offer suggestions on which ones are good?
Thanks :)

[AAK]

If you already had an ultrasound, I would use that date. Early ultrasounds are rather accurate in dating a pregnancy. Take the progestrone as long as the dr. says too (usually around 12 weeks--the minimum is 10 weeks but you could mess stuff up that way if your dates are off) 12 weeks is a safe route.

Amy

[LB Mama]

Hi Amy,

How about decreasing progsterone...have you ever heard of that? My original bloodwork showed progesterone level of 9. I have been taking prometrium 200 mg 2 times a day for a few days now, and progesterone now shows at 55. The nurse said to decrease by half (1 pill a day)...is that safe? She also mentioned that a level of 90 is dangerous for the fetus...so I am also concerned about staying on the same dosage.

THanks, Dani