My Doctor Will Not Consider Progesterone Support

Dear Ann,

There is good evidence that progesterone therapy prevents preterm birth when given to women in the second trimester. This data has been published in two well respected medical journals: American Journal of Obstetrics and Gynecology and New England Journal of Medicine (Da Fonseca; A Jour Obstet Gynec 188:419-424, 2003; and Meis; N Engl J Med 348:2379-2385, 2003). Based upon this information, and considering that there is NO RISK of progesterone therapy, it is hard to imagine how a doctor could refuse to supplement high risk women starting at least at 12 weeks. These studies did not evaluate whether progesterone given earlier would prevent miscarriage. But it certainly makes intuitive sense from a medical point of view. In addition, many physicians, myself included, who track progesterone levels and supplement with progesterone if necessary (based on measured levels), have found that there are certainly women with a history of multiple miscarriages whose progesterone levels run lower than normal. When supplemented, these women will often keep their pregnancies. This is certainly not proof; but often we make decisions in medicine based upon our understanding of the human body and its function, even before the studies have been done to prove that a certain therapy works. I would challenge you to ask your OB who says that progesterone therapy doesn’t work the following question: “If progesterone therapy does not help prevent miscarriage, why do all the In Vitro Fertilization (IVF) clinics in the US and the world supplement their patients with Progesterone in early pregnancy?” The answer is obvious. These clinics want to do everything possible to prevent miscarriage in their patients. It makes scientific and intuitive sense that progesterone may play a role here, and it carries absolutely no risk–so why not do it?

Just because a woman does not have a luteal phase progesterone deficiency in her normal cycle, does not mean that she can’t miscarry a pregnancy due to low progesterone. Conversely, if a woman does have a luteal phase progesterone deficiency, then her risk of miscarriage may be higher than average. The only way to know if a woman has a luteal phase progesterone deficiency is to measure her luteal phase progesterone levels. If she is deficient, then supplementation, given at the appropriate time, will help normalize these levels. Doing this will help treat abnormal menstrual bleeding, PMS, and may assist with fertility problems. Once you become pregnant, I would recommend measuring your progesterone levels and supplementing with progesterone. Injectable progesterone provides the most reliable blood levels, vaginal capsules are second best, and oral micronized progesterone (e.g. Prometrium) third best. All of these products require a prescription. The topical progesterone cream is unlikely to significantly affect your blood levels; but if given at the right time (after ovulation), it certainly can’t hurt (if it’s your only option).

For progesterone supplementation in pregnancy, I use the progesterone supplementation protocol developed by Dr. Thomas Hilgers, who is an OB/Gyn practicing in Omaha Nebraska. He has a large clinic where he has successfully treated many patients (mine included) with fertility problems which have been considered “hopeless” by other doctors. Dr Hilgers has pioneered a new science called NaPro Technology which is ordered towards diagnosing why a woman has fertility problems, then organizing a treatment plan to correct the underlying defect. He trains other physicians to provide this care. You should visit his web site (www.popepaulvi.com) for a listing of doctors trained in this science. Perhaps there is one close to you who could help.

Best, John Gisla, MD