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Miscarried for the 3rd time. When to start progesterone therapy?

by Caterina
(Hawaii)

Hello Wray,

On Sunday at 4 in the morning I started to miscarry. This is my third miscarriage at 12 weeks and 6 days, or 13 weeks. I have been on Bio-Identical progesterone cream for the last year because labs showed a level of 1.2 after ovulation. So this pregnancy according to my labs, HCG, and progesterone levels looked great. My pelvic exam showed a closed shut uterus. So this has come as a shock. I recently read about blood clotting disorders as being a possible cause for recurrent miscarriages. I'm being referred to a specialist and I'm looking into having them test me for this as we would like to conceive again soon. I heard my chances of having a healthy pregnancy are higher, but not sure if that applies to someone that tests positive for these blood clotting disorders. I know I need to be on progesterone even without being pregnant, so I know I need it during pregnancy as well. I'm glad I discovered that. I was on 50mg 2x's a day of suppositories and my levels were fantastic.

I wanted to know if you have any advise for me at this time. When do I start charting my cycles again? When do I start my progesterone cream again? If I do test positive on any of those tests, is there supplements or herbs you would recommend me taking as we try to conceive again?

Thanks for your time,
Caterina

Comments for Miscarried for the 3rd time. When to start progesterone therapy?

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May 30, 2012
 Hello Wray
by: Wray

Hi Caterina I'm sorry you had a third miscarriage, unfortunately they are far more common than we realise, or are told. So many things cause them, not just clotting disorders. There's more info about them on our Pregnancy page. Low progesterone is one, but something which doesn't seem to be taken into account is a drop in progesterone. Although your levels were good, did you have any stress a day or two before this last miscarriage, even an hour or so before. It doesn't have to be very great to drop the level. One of my miscarriages occurred two hours after getting home from a lunch party we'd been too. There were a lot of people, and I'm not good with crowds. Not what most people would cause stressful! Another miscarriage occurred after separating a dog fight. The dogs on the farm were often scrapping, I thought nothing of stopping them. But an hour later I miscarried. Most women are given 200-600mg/day progesterone for recurrent miscarriages, this does allow for a drop without causing problems. Something I think you should consider when you fall pregnant again. I know you want to conceive again soon, but please give your body a chance to recover, for your sake and the child's. There are a number of nutrients which make for a successful pregnancy, two of the most important are vitamin D and taurine. A lack of vitamin D causes miscarriages, high oestradiol and testosterone too, these are never checked. Please have a vitamin D test done. I know you live in what is normally regarded as a sunny climate, but even in Hawaii levels are too low, see here. You can start the progesterone as soon as you like. The pregnancy page gives info on this. And the charting as soon as you feel ready, but please wait a month or two before attempting to fall pregnant. Take care Wray
May 31, 2012
 Progesterone Therapy?
by: Anonymous

Hello Wray,

Thanks for your comment. The vitamin D was low last year so I know about taking that. The Taurine I was not taking so I'll look into that. My level of progesterone was great at 29.67. I was absolutely not stressed at all at this time. So it was a real shock. I'm confused about when to take the progesterone. I was told I should get my period within 4-6 weeks. If I take the progesterone now, won't that affect my body from having a period or cause any bleeding? If I wait until I get my period then I may dip too low with my progesterone to estrogen levels and the last time that happened, I went into a depression. Also, I was taking 50 mg. after ovulation, so how much would I start to use if I started it anytime soon?

I saw my OB today and she said to start charting after my first period. What do you thing? My temp is 99.9 today, how would that affect charting?
Jun 02, 2012
 Progesterone Therapy?
by: Wray

Hi there By starting any time, I meant following your cycle. Progesterone is normally used from ovulation, so you should start it when you next ovulate. I'm not sure when this will occur, the mini microscope is the best for this. There is a link on the pregnancy page. Temperature is not very reliable as it varies so much, in some women not at all. Levels of 400mg/day or more progesterone will stop bleeding, but anything under this doesn't. I agree waiting to your next period and then another few weeks until you next ovulate will make the gap too large. So it's best to start the progesterone when you ovulate again. This might not occur so soon after a miscarriage, in which case if you know your cycle length, deduct 14 days from when you should bleed and start the progesterone then. Normal oral body temperature in adult men and women ranges between 33.2–38.2 °C (92–101 °F). Typical average temperatures are 37.0 °C (98.6 °F). In women it varies between the follicular and the luteal phase. During the follicular phase, i.e. from the first day of menstruation to ovulation, it ranges from 36.45 to 36.7 °C (97.6 to 98.1 °F). During the 12-14 day luteal phase, i.e. after ovulation to menstruation, temperature increases by 0.15 - 0.45 °C (0.2 - 0.9 °F) due to the increased metabolic rate caused by rapidly rising levels of progesterone. Temperature ranges between 36.7 - 37.3°C (98.1 - 99.2°F) during the luteal phase, but drops down to follicular levels within a few days of bleeding. It appears you must have ovulated if your temp is that high, unless you normally run a higher temp. I don't believe 50mg/day is enough, I recommend 100-200mg/day, but it is up to the individual. Take care Wray
Jun 08, 2012
 Dizziness and Progesterone
by: Caterina

Hi Wray,
As of today's date(6/8/12), I'm on CD 13 according to the date of miscarriage 5/27/12. I'm feeling exactly how I felt before becoming pregnant with the dizziness and tiredness that I can't shake around ovulation. I started to chart a few days ago and the readings were 97.3 each day, then today 97.9. So I think I'm ovulating already. My cycles were 26 days. I'm desperately wanting to start the progesterone cream at 50mg. twice daily instead of the 25mg twice daily I was on before conceiving, putting me at 100mg daily to start. I'm afraid to mess with my cycle because I'm seeing a Perinatalogist on July 12th for genetic testing, but before that the OB has me doing labs on the third day of my 1st cycle. I was wondering if the progesterone would cause my cycle to be off or counterfeit affecting the lab tests to be performed on the 3rd day of my 1st cycle? The OB is testing: Estradiol, FSH, TSH, Reflex T4, Antiphospholipid Panal, Misc. test to perform Parental Viral Karyotypes in notes. You mentioned in the previous post that I could start prog. around the time I would ovulate instead of waiting 6 wks, which will cause a severe drop for me.

I also wanted to know why I get dizzy and tired around ovulation. I just read the blog on dizziness being associated to the premenstruum, which makes sense why I felt dizzy a few days before bleeding. Maybe because I was not on enough prog. in the past. But what can I do to not feel that way mid cycle since I have to ovulate before I can start the prog. regimen every month? I'm confused because the prog. helps your body to not retain water that causes the dizziness but, you can't take it until you ovulate? Am I doomed to feeling dizzy for 2-3 days mid cycle?

Thanks for your advice, Caterina
Jun 10, 2012
 Dizziness and Progesterone
by: Wray

Hi Caterina If you do start the progesterone it will show a false reading, ie it will obviously not be any your ovaries produced. It's a difficult decision, as you don't feel well not using it, but it will give the doctors a false impression of your own levels. Except I see he's not doing progesterone, so it won't affect the tests. But why are they not testing this? I don't understand why you are having tests done on the 3rd day either. Both progesterone and oestrogen drop to their lowest level during bleeding. Oestrogen begins rising again round about days 4 or 5, peaking just before ovulation. So testing it on day 3 will show it at it's lowest level, what will that achieve? It seems evident that you are not getting the pre-ovulatory rise in progesterone, hence the same symptoms you get then as you do during the premenstruum. In other words oestrogen is dominant, as there is no progesterone to counter it. No one takes cognisance of this, least of all doctors. That pre-ovulatory rise in progesterone is essential to initiate the LH rise, and thence to ovulation. It's also essential to ensure there's an early luteal rise, as this is another essential for successful implantation. There's info about the pre-ovulatory rise on the pregnancy page I gave you. I suggest that women wanting to fall pregnant start the progesterone during that rise. Many women get the same symptoms at ovulation as they do during the premenstruum. I advise them to use the progesterone prior to ovulation. Take care Wray

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