Question

I am a 22 year old female. I got pregnant when I was 17 and gave birth at 18 and always had normal periods until my son turned 6 months old. Then I started bleeding between periods. Every single month I would bleed 3 weeks and one week I would not bleed. The doctor never did anything but asked if I wanted birth control. I said "No." When I was 20 I got pregnant and miscarried at 8 weeks. The baby had a heart beat but grew really slow. Then when I was 21 I had horrible insomnia. I could go 3 weeks without sleep. The doctor gave me an ultrasound and saw that I had cysts all over my ovaries that were 1 to 2 inches and the lining of my uterus was 17 mm thick. The doctor just wanted to put me on birth control. I said "No." I went to a different doctor for my insomnia he said my progesterone was low and testosterone was a little high so he gave me 75 gm of progesterone a day. He said I should be talking 100 mg a day but said he didn't want to give me that much because he didn't want my body to get dependent on it. When I started the 75 mg a day my periods were finally normal after 4 years of non-stop bleeding, and the lining of my uterus was normal and the cysts were gone but did leave craters on my ovaries. I could finally sleep!

Now at almost 23 years old I am 4 weeks pregnant and I am so afraid of miscarrying again. I am seeing a different doctor and she is giving me 25 mg suppositories and told me to stop my hormone. I've been on the 25 mg for 4 days now and all my pregnancy symptoms have disappeared. Since I stopped my 75 mg progesterone I've only had one blood test to see the hcg level which was 60 and I was 4 weeks. I really feel like I'm going to lose the baby because the doctor will not give me stronger progesterone.

Any suggestions???????

Thanks

Answer

For the short term, I would recommend that you get two HCG levels about two days apart as well as a single progesterone level. While you wait for the labs, see if your doctor will give you a shot of progesterone in oil 200 mg. The second choice would be progesterone suppositories, 300 mg at bedtime. If that is not possible then Prometrium 200mg twice a day would be the choice.

A healthy progesterone level would be 25 or greater. 20-25 would be borderline. If it appears that you have miscarried based on the two HCG levels then the progesterone should be stopped.

Your history is certainly quite suggestive of low progesterone levels. Additionally, the irregular menstrual periods and cystic ovaries suggest polycystic ovarian syndrome.

Regardless what happens with this pregnancy, in the future you would be well-served if you started charting your menstrual cycle with the Creighton Model of Fertility Care and had a NaProTechnology evaluation. See www.naprotechnology.com and www.fertilitycarecenter.org and CANFP for more information.

George Delgado, M.D., F.A.A.F.P.
Culture of Life Family Health Care
Voluntary Associate Clinical Professor
Department of Family and Preventive Medicine
School of Medicine, University of California, San Diego

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