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Last Updated:
Jan 3rd, 2010 - 00:09:53
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Question
I am 31 years of age and have been using the Creighton Model for the last 6 years, but have been stumped for the last couple years. My husband and I have two children ages 4 and 3, both of which were healthy, all natural, normal pregnancies. However after the birth of our 3-yr old, my charts were off. Both my NFP instructor and my Creighton model-trained NFP family doctor decided since my post peak phases were short (9-10 days) and my peak-type mucus was abundant, that my progesterone levels must be low. I then started Prometrium (progesterone pill) of 200 mg at peak plus 3. This seemed to help immediately to tame my charts and made them a lot easier to read since I was no longer overwhelmed with 10ck's!
In July 2007 I went off the Prometrium pills to see where my normal progesterone levels were at peak plus 7. Unfortunately the levels came back low (believe an 8) and worst of all, we realized we had accidentally conceived this same month. Knowing how low my levels were, my doctor started Progesterone shots immediately (2 shots twice a week). I continued to get shots up until 15 weeks. At that time my levels seemed to be high enough and studies show that the placenta takes over at that time so we stopped the shots. At my 18 week appointment, no heart beat was discovered. God bless Baby John. I am not sure if we lost our baby due to low progesterone levels because we didn't request any tests to be done.
Now since November 2007, I have struggled immensely with finding the right dosage of progesterone. I have gone from a special oral compound made at Kubat Pharmacy of 200 mg and then eventually down to 100 mg. My charts are good, meaning I have good peak-type mucus, a post peak phase of 12-13 days, and a generally speaking normal chart. However, I am struggling with my own hormonal moodiness. God bless my husband and his path to sainthood! At peak plus 2 I start to get moody and can't wait to take my progesterone the next day. Within 24 hours I feel myself again. Then after 2 days of progesterone (100 mg) I start to get moody again, like it is too much for my body. I then sit on the fence post waiting for my period so I can be normal again.
For about the past 6 months of me choosing when and when not to take my progesterone, I decided to go off the progesterone last month (December 2008) to see what my natural levels were at peak plus 7. Unfortunately my levels were at a 9. From my understanding they should be at 15 during time, so I know I need to do something. My thyroid numbers are good at peak plus 7, but could there be more to this than just progesterone?
If it can only be progesterone, is there another way to introduce progesterone so I do not encounter progesterone moodiness? Should I request to lower my dosage to 50mg? Also, what are your thoughts on the multi-vitamin Optivite? I have read a book on fertility cycles and they suggested this as a solution.
In Christ,
Amanda
Answer
Dear Amanada,
I am sorry about your pregnancy loss. Since your miscarriage was not associated with bleeding or premature labor, it might have been due to some other cause than low progesterone. You should have a further workup such as blood sugar and insulin levels and a thrombophilia profile (to check factors that might cause clots in the placenta) to see if there are treatable causes of midtrimester pregnancy loss.
To improve your luteal phase problem, Optivite is an excellent choice to help raise progesterone. Fish oil 2000 mg. daily will help ovulatory function, as will eliminating sugar and trans-fats and limiting refined carbohydrates. You should have your estradiol levels measured in the luteal phase in addition to progetserone levels. They should be 100-120 pg. If your estradiol is low, you can improve it with low dose estradiol patches (the whole cycle) or use HCG injecions in the luteal phase. HCG injections will raise both progesterone and estrogen.
For optimizing progesterone levels if you are not using injections, you could try another route rather than pills. Oral progesterone gets broken down in the stomach, whereas vaginal capsules or suppositories or skin creams more directly raise progesterone levels and might work better for your symptoms.
If the main problem is mood and optimizing hormones does not bring full relief, you could try improving your serotonin and dopamine levels (neurotransmitters)using amino acid therapy such as tyrosine and 5-hydroxytryptophan. You would take these supplements every day. Neurotransmitter testing and high quality supplements are available at Neuroscience https://www.neurorelief.com/. These supplements are great pre-pregnancy, but should be discontinued when you become pregnant because they contain herbs not tested in pregnancy. In addition, mild to moderate exercise is an excellent therapy for mood if you are not already in the habit.
Good luck!
Mary L. Davenport, M.D.
Dr. Mary Davenport is an obstetrician-gynecologist in private practice in El Sobrante, California.
She graduated from Tufts University School of Medicine and completed her residency at the University of California, San Diego.
Dr. Davenport is also a Fellow of the American College of Obstetrics and Gynecology.
She has an NFP-only medical practice and is a Medical Consultant in Natural Family Planning.
She is a board member for CANFP and the American Association of Pro-Life OBGyn's.
© Copyright 2005 by CANFP
The information on this page and web site is for informational purposes only,
and is not a substitute for medical diagnosis and treatment by a physician.
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