Progesterone and preventing postpartum depression

by Jessica
(Wisconsin)

I struggled with severe postpartum depression 4 months after my son was born. Severer insomnia and anxiety plagued me until I went on prescription anxiety and sleep meds. I was on them and they worked fine but after my son turned one year I started having menstrual cycle related insomnia and anxiety ( before ovulation and during the second half of my cycle so pretty sure I am either estrogen dominant or progesterone deficient but never had bloodwork to confirm bc I got pregnant.

I now am pregnant again and due in June. With this pregnancy I have been on 200-600mg of oral progesterone ( prometrium). I was on it throughout my first trimester to prevent miscarriage and also to help with insomnia. I have taken 200-400 mg on occasion during my second trimester to help again with insomnia and anxiety and it works wonders. My aunt is an ob who said that going on micronor (synthetic progesterone for birth control) may help with my postpartum. She said it might be a better option than natural progesterone ( prometrium) because I am nursing.

What I want to know is is it ok to nurse on prometrium and with my history of severe postpartum how much would you recommend to help prevent a reoccurrence and how early postpartum should I start it?

Comments for Progesterone and preventing postpartum depression

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Feb 26, 2013
Progesterone and preventing postpartum depression
by: Carol K

Hi there

I have read your post and with respect to your aunt I do not see how synthetic progesterone can be better than natural bio identical progesterone cream such as Natpro. I am sure Wray will tell you that oral progesterone is not as well absorbed than cream through the skin. I think the fact that you have not taken your aunt's advice shows that instinctively you know that there is another answer out there :). Wray will help you.
Good luck
Carol.

Mar 02, 2013
Progesterone and preventing postpartum depression
by: Wray

Hi Jessica I have answered your other page, the link is here. Take care Wray

Mar 03, 2013
Progesterone and preventing postpartum depression
by: Wray

Hi Carol Thanks for your support! Take care Wray

Mar 03, 2013
Natural Progesterone & Breastfeeding
by: Jessica

Thanks Wray. I'm sorry I posted on the site twice, still trying to figure out exactly where everything is located :)

I posted a follow up question on the other link.

http://www.progesteronetherapy.com/would-love-some-guidance-on-dosing-with-progesterone-cream-severe-symptoms.html#comments

Thanks in advance for your help! I feel like you and this site are a godsend!

Mar 05, 2013
Natural Progesterone & Breastfeeding
by: Wray

Hi Jessica If you're getting those odd emails saying somethings' posted and it's not, it's no wonder you're confused! The emails should give you the link to the page in question too. Bless you for the kind words! Take care Wray

Mar 08, 2013
Progesterone and preventing postpartum depression
by: Jessica

Hi Wray,

I thought I should stop writing on the other page because I felt bad that I had accidentally "hi-jacked Amy's page.

Thank you for your clarification on the progesterone and contraceptives. I do not understand either why most birth control manufacturers make women take progestins days 1-21 and then placebo pills days 22-28, but if I decide to go that route I think I will opt for taking the progesterone all cycle long to counterbalance the oestrogen. Do you have a recommendation on a dosage?

Also thank you so much for your recommended reading of Depression after Childbirth by Dalton. I literally read the book in one night. A few follow up questions I had were that on pages 29 & 32 in her book she specifically calls out that progesterone needs to be administered vaginally, rectally or by intramuscular injections and that it doesn't pass easily through the skin so it's not suitable in cream or patch form. What are your thoughts on this?

I know you recommended on the other page that I take the oral Prometrium and break it open and combine it with skin cream and rub that into my skin at a dose of 800mg/day to prevent the Postpartum Depression. Would inserting oral Prometrium capsules vaginally or rectally also work (to act more of a suppository like Dr. Dalton recommends in the book)?

Thank you again - and I'll try going forward to ask all my questions on this page, so poor Amy doesn't have to read through all of my madness :)

Mar 11, 2013
Progesterone and preventing postpartum depression
by: Wray

Hi Jessica Don't worry about making comments on another page, it does help that person too. So delighted you read that book of Dalton's, I only wish I'd known about it when I had my PND. The irony was the book was published in 1980, and I had my daughter in 1981, so it was a known therapy. But I got no help from doctors who wanted to give me antidepressants which I refused. I remember talking to her about the cream versus injections/suppositories. My first appointment with her was in Oct 1997, I still have the appointment card out of sentiment! She never charged me for her time, as she knew I was doing it to learn more to help others. When she wrote the book back in 1980 the creams weren't in use at all. But the book was revised in 2001, and they had been in use for about 5 years at that stage, but the studies coming out weren't very conclusive. But one done in 1998 did show positive results, see here. They checked serum levels, and it's now known that saliva is better for topical administration, see here. Another study in 1999 also showed positive results, see here. Quite possibly she didn't get to see these studies before the revision of her book. This 2002 study here came out too late. But it does conclude with "These results demonstrate that topically applied progesterone is rapidly absorbed transdermally and that its patterns of distribution and metabolism are comparable to those previously reported for intravascularly administered progesterone." It's interesting to note that they used 150mg of progesterone, whereas the other studies used amounts far too low to my mind. Using the caps either vaginally or rectally is a good option, the cap will dissolve. I would suggest only using the vagina route at night, as it tends to leak out or drop out if used in the morning. Rectally would be good for that. My preference for using the cream, is having used suppositories before, the cream is pleasanter! Plus having the added benefit of helping the skin, see here. Take care Wray

Mar 12, 2013
progesterone and taking with oral contraceptives
by: Jessica

Thanks again wray. I will try the opening the capsules into the cream route if u feel that will be equally effective in preventing PND. told my husband the other day that you are a godsend.

Just quick question that I posted above...if I take progesterone in conjunction with an oral birth control ( think I probably would take the progesterone all cycle long to start with) do you have a dosing recommendation?

Thanks!

Mar 14, 2013
Progesterone and preventing postpartum depression
by: Jessica

Thanks so much Wray. I think I will most likely go the cream route too. I feel so hopeful being armed with all this information going into the birth of my son. I really feel confident that with your help I'll be able to ward of any PND. :)

If I decide to go on oral contraceptives and take progesterone to supplement, do you have a dosage recommendation?


Mar 16, 2013
progesterone and taking with oral contraceptives
by: Wray

Hi Jessica Sorry I didn't get round to answering your first query, I'm so behind now, too many queries coming in. Anyway I feel you will be better off with a cream, the caps route is messy and you are bound to loose some. I've never had any experience in helping someone with progesterone and the pill, so can't really advise on how much would be protective. But I would recommend the route you've opted for i.e. daily application. When you continue with the progesterone after birth, keep to a good amount, and don't suddenly reduce it. This could cause your period to start earlier than it would otherwise have done. I don't know if you're breast feeding, but this usually prevents the period until ready to wean. One thing I've learnt from women who have written in to this site, is weaning can be just as bad as PND. I had not heard this before and it certainly surprised me! Although I had PND I never had the weaning problem, that would have probably done me in! The PND lasted four years, and I weaned my daughter at 3 years. As I'm writing this to you, I've suddenly had a thought, could I possibly have had the weaning depression too, but it was just rolled into the PND?! And that was why it took so long.....pity I will never know. But having experienced PND it's not something I'd wish on anyone. Very remiss of me, but I see I've forgotten to tell you about excess copper, it can cause severe PND. Plus affecting us during our monthly cycle in the form of PMS, and make Peri-menopause worse. This is an excellent site to look through, Alternative Mental Health. This particular link will take you to an index giving PND, copper, zinc and more. Take care Wray

Mar 17, 2013
Progesterone and preventing postpartum depression
by: Jessica

Thank you Wray. Again, I'm sorry to have posted twice. My original note didn't show up for 4 days, so I thought it never went through...

I went back to the contraceptives page again and re-read things more closely. It looks like at the bottom of the page, that a dosage of 100-200mg of natuaral progesterone daily is recommended when combining it with oral contraceptives...so I will use that amount if I decide to go that route.

I honestly hope this is the last question I have for you for a while. If I decide to use natural progesterone as my means of contraception, Dalton recommends a daily dose of 100mg starting on day 8 of my cycle. Dalton doesn't call out that this dose needs to be split up into two different daily applications, so I'm wondering if I should do 50mg/ twice daily or is 100mg/daily ok? I know in a few places on this site you say that the progesterone typically should be applied twice daily, but I didn't know if this always was the case.

Thanks so much!

Mar 18, 2013
Progesterone and preventing postpartum depression
by: Wray

Hi Jessica Well I've managed to clear the back log of queries, but desperate to get down to updating the web site and write more pages for it. So there might be another hiatus! It is always best to use progesterone a minimum of twice a day as levels begin dropping after about 13hrs. It's difficult when taking info from a book, it could be she did tell her patients to split the amount, even for contraceptive purposes. I know in severe cases she would always split it. For instance she would give 6 x 400mg suppositories to her patients with post natal psychosis. Please be aware that if you should experience any Stress while using it as a contraceptive, levels will drop and it won't be as effective. I would always increase the amount in this case, or use some other temporary form of protection. Using it from day 8 is fine if you have a 28 day cycle, but not if it's less. For instance a woman with a 21 day cycle, would have ovulated the day before, i.e. day 7, so it would be useless! Take care Wray

Mar 22, 2013
Progesterone and preventing postpartum depression
by: Jessica

Hi Wray,

I have a question on Vitamin D. I had levels drawn in January and they were 42.1, just had them drawn yesterday after upping my dose from 4,000-5,000/day to 6,500/day and my levels have actually gone down to 40...which I was very surprised about. I've recently switched Vitamin D brands, going from a liquid gel cap to a tablet, and I'm wondering if the new tablet could be less easily absorbed? That's the only reason I could think that my levels would go down after upping my daily dose. Any thoughts you have on this would be greatly appreciated.

Jessica

Mar 23, 2013
Progesterone and preventing postpartum depression
by: Wray

Hi Jessica It's definitely the brand. Vitamin D is fat soluble, so the liquid gel would contain an oil into which it is dissolved. The tablet would be pressed with some of the many excipients used, which are not really conducive to absorption. They take far longer to dissolve too. One of the best brands is one Dr Cannell put together, see here. Take care Wray

Mar 25, 2013
Progesterone and preventing postpartum Depression
by: Jessica

Hi Wray,

I'm now a regular on your site, scouring it daily for information and sharing it with friends and family. One question I had is that you highly recommend the copper IUD over other forms of birth control (especially synthetic-hormone based contraceptives). But in one of your notes to me, you talked about the issue with copper toxicity in relation to zinc. Could you first explain the copper toxicity further, and give me an idea of how I can avoid this or test for it, and also can you clarify if the Copper IUD increases copper toxicity?

Thanks!

Mar 26, 2013
Progesterone and preventing postpartum Depression
by: Wray

Hi Jessica I'm delighted you're finding the site helpful, and bless you for sharing it too. I am in favour of the copper T IUD, I had one and my daughter and her friends do too. It releases a very small amount of copper, which is easy enough to address by taking zinc. Copper toxicity comes from old copper water pipes still in many older homes, supplements, if labels are not read, copper cooking utensils, swimming pools are a main concern too. Many crops are sprayed with copper fungicides, we'll never know if the crop was sprayed before picking too early. I do know this is the case with many foods. The hair analysis labs believe this is the best way to test, as minerals get sequestered in the hair, see Trace Elements and Analytical Research Labs. But one authority believes serum levels should be checked too. There is one rare inherited disorder where copper is sequestered in various organs, causing them to become toxic, but blood levels are normal, known as Wilson's disease. Neither blood or hair analysis would show this, see here. Take care Wray

Apr 16, 2013
Progesterone and preventing postpartum depression
by: Jessica

Hi Wray,

I've been continuing to do research on preventing postpartum depression (although I'm pretty confident I'll be following your and Dr. Dalton's advice to a tee), and I'm curious as to your thoughts. A lot of the sites I've come across recently regarding hormone replacement therapy and preventing PPD recommend estrogen therapy, not progesterone? They say that declining levels of estrogen after birth could be the cause....

My question to you is this, we know both Progesterone & Estrogen are high in pregnancy, especially towards the end. How do we know it's the progesterone that needs to be supplemented and not the estrogen in order to prevent PPD?

Mayo Clinic Postpartum depression

Clinical Trial of Estrogen for Postpartum Depression

Thanks for your thoughts!

Apr 17, 2013
Progesterone and preventing postpartum depression
by: Wray

Hi Jessica Oestrogen does rise during pregnancy, all three actually, but the pregnancy oestrogen is oestriol. They never suggest to take that! This is the oestrogen which will drop the furthest, not the other two. We also still continue to make oestrone in our fat cells, in fact to the day we die. Take a look at this info on Oestriol in pregnancy. The article says "In the urine of nonpregnant women the ratio of E3 to E1 (estron) plus E2 (estradiol) is approximately 1:1, whereas in the urine of pregnant women the ratio is 10:1 or more. In pregnant women at or near term there is a daily production of about 300 µmol (80 mg) of E3 and 1 mmol (300 mg) of PRG" PRG stands for progesterone. I've read progesterone rises to over 400mg in other papers. Whereas we normally make during the luteal phase between 5-20mg, some say up to 40mg. So you're looking at a massive drop in progesterone after birth. All secreted by the placenta which of course we shed too. It takes many months before ovulation begins again and we start producing progesterone. Well we won't know the outcome of that clinical trial until 2015. I for one wouldn't touch it myself! Oestrogen is an excitatory, mitogenic, inflammatory, catabolic hormone. It increases glutamate, our most excitatory neurotransmitter, vital but an excess is most certainly not, see here. It increases free radicals, see here, which destroy beta-endorphin neurons in the brain, these produce endorphins which promote a feeling of well being and relaxation. Beta-endorphins also appear to boost the immune system, protecting against cancer, see here. Whereas progesterone protects against glutamate toxicity, it also increases BDNF (brain-derived neuroptrophic factor) in itself protective, see here and here. Excess glutamate increases levels of calcium, an excitatory mineral. Progesterone also protects against calcium induced excitotoxicity, see here. Hope that helps! Take care Wray

Apr 29, 2013
Progesterone and preventing postpartum depression
by: Jessica

Hi Wray,

I'm wondering if you could show many any clinical studies of the safety of taking natural progesterone while breastfeeding? I met with my aunt last week (she's an OB/GYN who specializes in bioidentical hormones). She said she was unaware of any clinical studies that showed natural progesterone's safety during breastfeeding. I referenced your site in great lengths during our visit, but only saw a brief reference to Dr. Dalton saying it was safe (but no medical studies). I also brought up to my aunt that it had to be safe b/c babies are basked in it for 9 months, and if Drs. are willing to give women synthetic progestins while breastfeeding, how can natural progesterone not be safe. Her comment was that the progestins are metabolized differently. Because she didn't have any concrete research to confirm the safety of the natural progesterone while breastfeeding, she wants to monitor me on the natural progesterone for the first 4 weeks after the baby comes to make sure my progesterone levels do not exceed what they normally would in a menstrual cycle (which I think is like 12 to 20 something ng/ml right?). Just wondering if you had any additional information I could pass along to her, as she's very open to using this approach to help me and other patients.

Thanks so much!

May 01, 2013
Progesterone and preventing postpartum depression
by: Wray

Hi Jessica A study on progesterone and breastfeeding would be rarer than chickens teeth! Who would benefit, certainly not the drug companies. It would only occur if a government thought it was worth it to spend the money. I can't see that ever happening. There is a study going on now on MS patients. It's about MS relapsing after giving birth, which it does, severely in some cases. The paper says "...reported a significant decline by two-third in the rate of relapses during the third trimester of pregnancy and a significant increase by two-third during the first three months post-partum by comparison to the relapse rate observed during the year prior to the pregnancy........These dramatic changes in the relapse rate occur at a time when impregnation of many substances, among which sexual steroids, is at its highest, before a dramatic decline to the pre-pregnancy levels, immediately following delivery....sexual steroids could exert beneficial effects through a modulation of the immune state with a lowering of the pro-inflammatory lymphocyte responses of the Th1 type and an enhancement of anti-inflammatory responses of the Th2 type....They may also play a direct role in remyelination of central nervous system lesions, as they do in the peripheral nervous system, where progesterone increases the extent of myelin sheath formation after a cryolesion of the male mouse sciatic nerve." See here. Unfortunately they are going to give high dose progestins to the women. Obviously they have no concerns about the 'high dose' and breastfeeding. Although sadly they seem to have no knowledge about progestins. They increase PND. I believe because, as your aunt says, they are metabolised via a different route. The critical difference being progesterone is metabolised to allopregnanolone, a potent anxiolytic and analgesic, see here, here, here, here and here. In fact it's probably the production of this which is of greater importance than progesterone itself. But without progesterone it can't be produced. 20mg/day is no match for any severe problem, far, far more is needed to correct it. I wish you luck! Take care Wray

May 01, 2013
progesterone and preventing postpartum depression
by: Jessica

Thanks Wray as always for you quick and thorough response!

I'm a little confused about the study you posted above (a little too medically for my small brain). Are you merely referencing the fact that they're giving women with MS progestins, and if they're doing that, then natural progesterone must be safe? I don't understand the reference to progesterone in the study? Are they saying that progesterone helps correct some of the demylenation seen after childbirth?

Also, I know Dalton talks about progesterone being safe numerous times in her book (which you reference on this site), but she didn't have any research that we know of to back it up? I've also tried looking on the site to see if there were any breastfeeding success stories with natural progesterone, but was only able to find one where someone was nursing a newborn while taking progesterone....do you happen to know of anymore?
http://www.progesteronetherapy.com/progesterone-and-breast-feeding.html#axzz2Qg0AUMBH

Also, just to clarify my Aunt wants me to take 600mg/day of the natural progesterone to combat the postpartum, but is going to monitor my blood serum levels to make sure they aren't skyrocketing to a level higher than that seen in a normal menstrual cycle (which I believe after ovulation is somewhere between 12-25, right?).

Fingers crossed that with your help I can fight the madness :) Baby is coming in 6 weeks!

Thank you for being such a resource for me and for so many! :)

Jessica

May 01, 2013
progesterone and preventing postpartum depression§
by: Wray

Hi Jessica It was a bit obtuse giving you that paper. But yes you are right. De-myelination doesn't occur after childbirth, in case you think it's going to happen to you. But diseases like MS, motor neuron etc are caused by de-myelination. Progesterone reverses this, I have so many papers but to give them to you is rather off the point. So they were suggesting the relapse in MS could be caused by the precipitous drop in progesterone after giving birth. So in their logic giving a progestin will prevent it! It'll send all the women into PND instead. I do agree with you, they are always couched in such terms that only a person versed in their strange language can fully understand the paper. Some are so badly written the English doesn't make sense, they all need editors! Apart from the page you gave above with the two women using it for breastfeeding, I don't know have another page to give you. I have had email correspondence with some, and I know a distributor of ours who has helped 13 women fall pregnant with progesterone and vitamin D, and she asks them to stay on the progesterone after birth. For some reason I misunderstood you about how much progesterone your aunt wanted to give you. I thought it was going to be 20mg/day! I'm so delighted it's 600mg/day, couldn't be better! If she sticks to serum levels, then it won't sky rocket. If she uses saliva it will. Saliva tests throw doctors into a tail spin. The best guide is symptoms, I don't put any faith in tests. They can't tell how a person is feeling. We run Saliva Tests on our cream, well a naturopath who prescribes our cream does them for us on her new patients, look through them and you'll see progesterone has risen to ±3000pg/ml. A serum test would show a very different result. I think doctors should stick to serum tests. Thanks for the kind words! Take care Wray

Jun 06, 2013
How long to use cream?
by: Liz

Hello,
Ive been using progesterone cream morning and night for the past 10 weeks. How long should I continue? My baby is 13 weeks now, and I started progesterone when my PPD symptoms started (anxiety and panic attacks). I've been feeling mostly well, although I started with symptoms again just yesterday, and that happened to be 29 days after my last anxiety attacks...so these symptoms are definitely tied to my cycle. I actually havent had a real peroid yet, just spotting here and there. I am exclusively breastfeeding.
Thank you!

Jun 06, 2013
How long to use cream?
by: Wray

Hi Liz It's best to continue until all signs of adverse symptoms have gone. How lucky you knew about progesterone and started using it. I wish I'd known after my daughter, but sadly not and no doctor thought to tell me, so I had PND for 4 years. I suggest shortly before your next 29 days is up, that you increase the progesterone over those few days. This should stop them recurring. We do have a page on Pregnancy and another here. They have info on using progesterone after birth too. Plus we have a general page on How to use progesterone cream. Take care Wray

Jun 06, 2013
progesterone cream
by: Liz

Thanks for your reply Wray!
I'm so sorry that you had to suffer for four years, how horrible!

Another question for you--I have been using the cream every day with no break. do you think I should take a break and not use for 1 week out of the month like many recommend?

thanks again.

Jun 07, 2013
progesterone cream
by: Wray

Hi Liz Yes it was awful, but I now know what it's like so can sympathise with those who get it! And know what to do about it now. Please continue using the progesterone daily, you don't have a cycle, you shouldn't have one while breastfeeding. Once you use the progesterone with a break you will get your period back again. There's evolutionary evidence women should not be having the 400 odd periods in a lifetime that we now have. In the past, and in rural communities now, it was and is only about 100 periods. Due to a large extent to having more children than we have now. But also because they breastfed for much longer, up to three years. So with 9 months of progesterone inhibiting oestrogen, followed by oxytocin production for 3 years which also inhibits it, we were exposed to much lower levels of oestrogen than we are now, see here. These are two others worth reading, see here and here. Let me know how you get on, and if the progesterone is not helping enough, have a look at our Anxiety page, it gives a list of nutrients which also help. Take care Wray

Jun 13, 2013
preventing pnd
by: Jessica

Hi Liz

Just had my baby yesterday and I was wondering if u could tell me how much progesterone u r taking daily? Also I know it says above that you are breastfeeding. Are you taking natural progesterone under the supervision of an obgyn and are they OK with it? Also did you start the progesterone right after birth or did uou wait a few weeks? Just curious about the potential side effects to milk production. Thanks for any advice you have on nursing while taking progesterone

Jun 14, 2013
for Jessica
by: Anonymous

hi,
i'm using a dime sized amount of this twice a day (morning and before bed): see here.

i told my OB i was using it and he basically said if it helps then keep using it. he was neither for or against it. It does not effect breast milk supply.

Congrats on your new baby!

Jun 14, 2013
for liz
by: Jessica

Thanks liz. Do you have any idea how many mg you are getting daily? Just curious on the mg dosage. Did you start it right away or a few weeks after baby?

Jun 15, 2013
Progesterone and preventing postpartum depression
by: Wray

Hi Jessica Wonderful news, it'a all gone so quickly! A 'dime' sized amount would give roughly 1-2ml of cream, depending on how high Liz heaps it. This would give from 32 to 64mg progesterone if used twice a day as she is. Far less than the 600mg/day your aunt suggested you use, which I also agree with. Maybe this is why Liz has some signs of PND. Let us know how you get on. Take care Wray

Jun 16, 2013
pospartum issues
by: Jessica

Hi wray

4 days postpartum and I am having terrible hot flashes and some heart palpitations... was feeling great until today. I have been taking oral prometrium bw 200 and 600 nightly since baby was born...but thinking its not enough. Today I split my 200 mg oral prometrium open and applied the contents directly to my skin and also inserted another 200 mg rectally I'm hoping I will get better absorption. I remember having night sweats with my first son but not daytime hot flashes or heart palps and certainly not this early. Could the prometrium be causing this (like how when u first start prometrium and get estrogen dominance) or is this most likely just a cause of dropping and changing hormones? Thoughts appreciated. And wondering if I can apply prometrium contents directly to skin (it was creamy in nature) or if I have to mix with a lotion for better absorption.

Jun 16, 2013
pospartum issues
by: Wray

Hi Jessica For some reason I thought the progesterone you were going to use was a cream, not oral. It's not surprising you've getting those symptoms, it's the least effective Delivery system, "The liver and gut region removed a mean of 96 per cent of the progesterone entering these tissues", see here. So the 800mg you're taking is only giving you about 80mg, if that. If you take the 4% effectiveness from the paper above you're getting 32mg. Perfect for stimulating oestrogen. Do you have the URL for the study relating to oestrogen crashing 3 days after birth? I've not heard of this. According to evidence I found, Hot Flushes are not caused by low oestrogen, but a number of factors. Please read through the link I've given you. You've done exactly what I suggest others do if given oral progesterone, and that's open the capsule. I do suggest adding the contents to a small amount of skin cream, more for ease of use, it spreads further. So it's up to you. Let me know if using it topically helps, it should. Take care Wray

Jun 16, 2013
pnd
by: Jessica

I guess according to an article online 3 days after birth is when estrogen levels crash. Is it still an advisable time to up my progesterone levels or is this going to make my crashing estrogen levels and hot flashes worse? Crazy this article recommends supplementing estrogen


Jun 16, 2013
PND
by: Jessica

Thanks Wray. I've heard from numerous sources that estrogen drops significantly after childbirth, just like the progesterone, so I'm wondering if what I'm feeling right now with the hot flashes is just that...estrogen and progesterone levels dropping signifcantly. As far as the oral vs. cream, I was going to use the cream, but I have a lot of oral capsules left from my first trimester, and they were very expensive, so I thought I'd use those up first. I'm hoping if I break them open and apply them topically (you'd recommend that over inserting them rectally?) that this will help.

Here is the link I was referring to.
http://www.divinecaroline.com/life-etc/hormones-surge-and-crash-after-birth-one-mom-sweats-it-out

Please let me know your additional thoughts...I find it very interesting that you think I'd be stimulating too much estrogen at this point and that could be causing it...vs. the big drop in estrogen.

Thanks for being such a great reference. I'm hoping that with both yours and my aunt's guidance I can avoid the throws of postpartum.


Jun 17, 2013
PND
by: Wray

Hi Jessica Definitely use up the capsules, it's a pity to waste them. Either as you suggested neat, or mixed with some skin cream. The capsule does dissolve if used rectally, so another option. It will if used in the vagina too, but best at night as during the day it could fall out. I did say I hadn't heard of oestrogen crashing 3 days post partum. I should have made myself a bit clearer. The placenta is the main source of the three oestrogens and progesterone during pregnancy, so when that comes away levels of all hormones will fall. So levels will fall shortly after giving birth, whether the affect of this is apparent immediately or not depends on a great number of factors. So it could be three days after or more. There are three oestrogens, all three rise during pregnancy, but oestriol by the greatest extent. Progesterone rises of course. These are the figures ...."The overall percentage increases in the median concentrations of E3, E2, E1 and progesterone were 718, 370, 80 and 214%, respectively, in the last 20 weeks and 149, 82, 24 and 41%, respectively, in the last 6 weeks of pregnancy." See here and here. Progesterone levels begin dropping shortly before birth, many believe this is one cause of labour starting, "Central to the onset of parturition will be a mechanism for progesterone withdrawal and estrogen activation in human", see here and here. Interestingly the actual birth process including labour is an inflammatory process, see here and here. Oxytocin plays a role too. So where does that leave us? With progesterone levels dropping prior to birth, oestriol rising, the rise of inflammatory cytokines, chemokines and more to initiate labour, the once pregnant woman is left without progesterone and a body full of inflammatory substances! So what causes depression, well one paper suggests it's these inflammatory substances, see here. Others of course swear by falling oestrogen levels and that replacing this is the answer. Continued below

Jun 17, 2013
PND Part 2
by: Wray

Hi Jessica I still stick with the view that it's progesterone withdrawal prior to birth, and an even sharper drop after that is the prime cause. It's always the ratio of the hormones which should be looked at, and not the levels. So in your case, using such a small amount of progesterone would be enough to stimulate what oestrogen you have. You only have to look at PMS and the fact it's caused by progesterone withdrawal prior to bleeding to realise it's the same principle at work. I did look at the link you gave, but as with all those promoting oestrogen's role, he makes no mention of progesterone at all, why? It's the main reason we carry a child to term, without it we suffer miscarriages and pre-term births. It's the one hormone that prevents the mother's body rejecting the baby, in fact implantation is another inflammatory process. His “biologically plausible explanation” for hot flushes after birth is to keep the baby warm, is not plausible to me. If anything it would be progesterone as that raises temps. Thank heavens I never had those! And hives are often a result of high oestrogen levels. Let me know if the higher amount of progesterone helps you. Take care Wray

Jun 18, 2013
PND
by: Jessica

Hi Wray,

So I started to empty the contents of the oral prometrium into my skin starting on Sunday and it seems to be helping a bit with the daytime hot flashes. Yesterday I did 200mg into my skin in the morning and 200mg into my skin at night, but then I also took an additional 400 mg orally to try to help with sleep (since my aunt believes that oral progesterone helps more with trying to sleep and bad insomnia was what threw me into PND last time). I didn't have a good night at all. For some reason I was extremely dizzy and almost felt drugged and was once again having severe hot flashes...something I've never had before with taking the oral prometrium...which I did on and off throughout my entire pregnancy. Wondering your thoughts? Would you discontinue the oral completely? I'm just worried that the cream alone won't be enough to help get me to sleep, or do you think it will? Do you think I should be upping my dose? And if so what would you recommend for dosage and at what times to maximize sleep. I took 400mg this morning via skin application in hopes that it will help. I just am worried that I'm going to spiral out of control again with complete lack of sleep. My baby is sleeping great...just not this mama. Thanks in advance!

Jun 18, 2013
one more thing
by: Jessica

A nurse today told me to be very careful about where I apply the progesterone cream since we don't want it to come into contact with baby...she said it can cause hyperprogesterone symptoms which are enlarged breasts and weight gain. Wondering your thoughts on this? I said are you sure progesterone causes this and not the stimulation of estrogen..she said no. Definitely wanted me to avoid all cream contact with baby.

Jun 19, 2013
pnd
by: Jessica

Hi wray

Still trying to get my progesterone up as to not stimulate estrogen but to make progesterone dominant.I have sent two other notes that I still don't see posted so I imagine there is a backlog and you are busy :) one other question I have for you is that after starting to apply prometrium topically I started having severe acid reflux...something I didn't have at all previously even when pregnant. Wondering if you had thoughts on this? I am thinking its hormones and specifically the progesterone... as I know in pregnancy progesterone is responsible for loosening the flap in the esophagus..but would be weird that I have it now when those levels would never be what they were while pregnant. Anyone else have this issue while on progesterone after pregnancy?

Sep 15, 2013
prog contact with baby
by: Kaylana

Hi Jessica,
Just curious if Wray answered your question about the baby coming in contact with the cream. I was looking for her advice regarding breastfeeding too.

I recently had a wonderful delivery and plan to share it on a different page soon.

Incidentally my newborn baby girl had enlarged breasts, but I'm sure it was all normal especially since I wasn't using any progesterone prior to delivery and two weeks afterwards.
Thanks!

Sep 18, 2013
prog contact with baby
by: Wray

Hi Kaylana Wonderful news! It's gone so quickly, would love to hear how you fared. I don't know why I missed these queries, but have now seen yours, odd! Jessica started a new page here. For some reason she couldn't add to this one. She stopped the progesterone and is now on antidepressants. I'm always amazed by the ignorance surrounding progesterone. If we make over 400mg/day while pregnant, and it really had that affect on breasts, why then are children not born with ones that are fully formed! Although this page on Man Boobs is about men, there is info about enlarged breasts, including Witch's milk, in infants. Oestrogen causes breast enlargement, see here. I have advised many women over the years to use progesterone on a fractious baby, it calms them down, they sleep better, and it prevents outbursts of anger when a bit older. As you've had a baby girl, please read our page on Menstruation. Vitamin D is so essential to stop early puberty. Take care Wray

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