Progesterone for recurrent miscarriage
(Los Angeles, California)
Hi Wray - You were kind enough to provide answers to me in another thread, and now that I have more details, I wanted to ask a few more questions. I miscarried a few days ago just shy of 7 weeks. This is my third miscarriage - the first two were extremely early, at just over 4 weeks. The difference this time is that I spent months correcting my low progesterone with vitex and acupuncture. My level came up enough that my doctor initially prescribed 100mg progesterone suppository at night as a "precaution". My 21-day level was nice and high, but by day 25 I was experiencing period-like cramps and felt I would miscarry if nothing was done. My doctor retested, and my progesterone level had dropped, so she put me on 200mg twice a day starting on day 28. The cramping stopped right away and my initial symptoms of estrogen dominance resolved within two days. But then at 6 weeks 2 days, my normal white discharge turned brownish-pink. I thought it was irritation from a yeast infection, but increased the progesterone to 200mg three times a day just to counter the anxiety I was feeling. Then at 6 weeks 4 days, I noticed a tiny amount of red spotting in the morning. This increased throughout the day, period-like cramps started again in the afternoon, and although I remained on the higher dose and rested all day, I miscarried that night.
So, now I'm wondering, 1) Was the 200mg/2xday dose possibly started too late, so that it delayed miscarriage but didn't prevent it? Could implantation have been adversely affected by that 6 day window during which my progesterone levels were dropping?
2) I still experienced moderate morning nausea and fatigue even on 200mg/2x day, though less so than on the lower dose. Should my dose have been higher until the nausea and fatigue were completely gone?
I told my doctor about your forum and Dr. Dalton's work - she is very supportive and will prescribe as much progesterone as I want to take. She was thinking I may need 3x day from the start just to keep my levels constant. Regardless of dose, next time I will start as close to ovulation as possible. Prior to IUI, I am monitored closely via ultrasound, so I know when I am about 12-24 hours from ovulation.
I also checked my vitamin d lab work at your recommendation, and my level was 46 ng/ml, so I am going to increase my supplementation and have that rechecked until it is up to at least 70.
So, lastly, I have two more questions: 3) Some of my options for progesterone are 200mg/3x day, 400mg/2x day, or 400mg/3x day. Do you know of any benefit to dosing 3x day versus 2x? Is there a particular dose you would recommend given my history?
4) Since I have to wait two cycles before trying again, would it be beneficial to take progesterone from ovulation to menstruation in order to further clear my estrogen dominance prior to our next try?
Thanks so much in advance - I felt so lost on this topic until I found your forum. And now that I'm more informed, my doctor is right on the same page with me. I just cannot thank you enough for getting this crucial information out there!