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Sunday, May 27, 2007

Little Thoughts


When my new OB handed me my new prescription for Prometrium, he mentioned that he prefers patients to take it orally.

"Oh...," I said, trying to decipher his handwriting on the script. I was wracking my brain to remember what Kris wrote about the different progesterones. "So they make an oral progesterone now?"

"It's the same one," he told me. "You can either use it as a suppository or ingest it. I prefer patients to ingest it. I think it works better that way."

No offense, but there are things that belong in your hoohaa and there are things that belong in your mouth. And with a single exception, there is nothing that belongs in both places. You don't put milk-soaked cheerios in your vagina so why should you slip progesterone down your throat?

Am I the only person in the world completely nauseated of the idea of putting something I once thought of as a suppository in my mouth?

Side Effects

I know this is silly because it's only 81 mg, but I thought that one of the side effects of taking a daily baby aspirin would be that I would never get headaches. It would be a preventative painkiller. It would blot out the pre-cramps that signal an upcoming period.

It doesn't really work like that.

At all.

Bell Ringing

This is the worst part about knowledge: you don't know until you have it that you really didn't want it. And at that point, it's too late to unring the bell. After many weeks of thinking about temping and forgetting to temp, my new OB's request to run a new day-21 progesterone test was the perfect reason to pop the thermometer back in my mouth. That number dictated my whole mood for the day.

And this is what I learned after all of those months of having 30-day cycles and thinking that things had somehow normalized with my cycles: I didn't ovulate when I had the right cervical mucous. I ovulated many days later on day-21. My temperatures hovered right above the coverline. My LP ended after 9 days. So much for a perfect 30-day cycle.

I want my new OB to run day-3 blood work for me.

Do I really want to know the results knowing that I can't unring the bell once I see my FSH level?

What does the hope buy me if I end up learning down the line that it was paste instead of diamonds?


Sunny said...

I hate that you are back in the yuck again. Testing and worrying is never fun. I hope you have amazing results that will make you laugh at thinking they would be bad.

Yes the progesterone can be put up or swollowed. :) It doesn't make sense but it works! HA!

bleu said...

I take issue with your RE saying that. When swallowed it had to be processed through your liver, which lessens it's effectiveness quite a bit. Your stomach acids will also denature some of it before absorption. Taken vaginally it is literally right at the site where it is needed.

(mama bear coming out to protect friend)

ms. c said...

Hmm... just had the same conversation about prometrium with my nurse. i heard it was less effective orally as well. She gave me the choice to use it orally or hoohaa-ily, mentioning that it had almost the same effectiveness, though vaginally has less side effects.
I have only ever taken prometrium (orally) to bring on a period, not as support after insemination. I would personally prefer to keep it orally... I guess I feel the opposite that you feel- once it has been in my mouth, do I want to use the same thing "up there"??!!
As for the cycle stuff: sorry darling. Cycling is a mixed blessing...

niobe said...

I don't mean to stretch your metaphor too far, but it made me think that learning they were diamonds instead of paste sometimes brings its own kind of sorrow.

Michell said...

I'm with you on the progesterone. I've heard to much that it's more effective as a suppository and why would you want to swallow it? Yuck. As far as the aspirin preventing headaches, I doubt it would work for me. And the unringing the bell. I have a tendency to believe sometimes that ignorance is bliss but it doesn't get you very far unfortunately. Good luck.

My Reality said...

I can't help but laugh at the single exception!

Happy swallowing. ;)

Isabel said...

How is it possible: injest/insert having the same effect? I don't get it. This goes on my list of things my husband has to research and explain to me in a series of question I store up for him. The only one I remember just now is: do kangaroo pouches have a hole in the bottom for the joey's excrement to exit from? Drat, I'll be pissed if I've forgotten my other burning questions...

They're all biology questions because although I am one smart, smart cookie I am somehow incapable of understanding biology on the first try. Understanding how the placenta works was near impossible. Understanding how vitamin D and sunshine work, also pretty tough. DH had a hard time explaining those but I think I finally got it.

Erin said...

I am so with you on the prometrium. I fear the day my RE ever tells me to start taking them orally because effectiveness aside...EW!

M said...

I had to LOL at this. I wrote about it here, in January 2006

NCD said...

abso-positively gross. Not a chance I would eat those. I hate them up the hoohaa but I would never put one in my mouth.

Celeste said...

oh Mel. there are a few choice curse words running through my head about the latest round of crap for you to deal with. it seems to me that our spokesperson should get to pass go and collect her baby without all this fuss. :stomping my feet:

aside from the indignation, your post made me laugh. love ya, sweets.

Heather said...

I have always taken it orally - today was my first IUI and I have to do it vaginally starting tomorrow...I am also disgusted. I think it should be one or the other.

Karen said...

are you taking the prometrium to bring on a period or to support your progesterone production after ovulation? If the former, it probably doesn't matter which way you take it. If the latter, it's more effective vaginally. (Orally will cause a systemic effect, vaginally will cause a local effect) My problem with taking prometrium orally is that they are huge and truly disgusting capsules. Blech.

I can say from experience that aspirin doesn't eliminate headaches completely. I took a baby aspirin for years after a migraine turned into a TIA. I can't say it did really anything to relieve my headaches/migraines, but I do think it slightly lowered the severity of them.

I do hope things work out well with the new OB. I, too, am sorry you're back in the yuck (though happy if it helps you to achieve your dreams and goals).

Aurelia said...

Nevermind the disgust issue, DO NOT swallow it unless you are trying to achieve the effect of sleep medication, and do not care about getting pregnant.

Menopausal women use it orally to enhance sleep, because low estrogen causes sleep issues. Sleep Doctors prescribe it for women who can't take other kinds of sleeping pills.

According to my RE, and he's researched this drug for years, it's only good for fertility treatment vaginally. I use it that way because after giving birth to a few full term babies, things are slightly ahem prolapsed, and prometrium stays up there and absorbs better than suppositories.

As for the high FSH, the only reason to measure it, is to deny you treatment. High FSH is irrelevant, as that study I emailed you proves, but Docs use it to eliminate any patient who might lower their success rate. But if you do monitored cycles and know for sure when you ovulate, you can take prometrium and extend your LP just fine.

Take it for what it is, just another number, and make sure you ask your RE about that estrogen injection treatment protocol I sent you.

Bea said...

Yes... it is kind of a gross thought. Hope the headaches/cramps aren't too bad.

As for the info - always a tough one. Info is good if it will change what you do, but otherwise, it can be a double-edged sword. My ability to obsess and worry over results which might, or might not, be bad exceeds my ability to obsess over results which actually *are* bad, so I tend to end up deciding to test/temp/gather that info. That tendency may be changing over time, though, as I feel less inclined to worry about things in advance and more inclined to take them as they come. The assvice here is go with whatever option makes your mind quieter.


Natalie said...

Wow, I don't think I could handle taking that orally either. I'm with you... one or the other!! Plus I've always heard that it's far more effective vaginally.

Sorry about the rest of it. :( Sucks.

Changing Expectations said...

I agree with Bleu, my RE also mentioned that the suppository version is much more effective. I also thought that the aspirin would help the headaches, but not so much.

Hang in there with the testing. Thinking about you.

Thalia said...

I agree with others, the evidence actually says that the injections or the suppositories are orders of magnitude more effective, they have to give you a lot more orally to get to the same levels.

Also, it isn't (or shouldn't be) the same thing orally as in a suppository. The active ingredient is similar (although not precisely the same due to the way it's metabolised differently) but the packaging is vegetable oil (suppository) or capsule (orally) - you simply couldn't swallow the suppository orally plus the drug would disintegrate before it was absorbed.

I don't think your doctor was being terribly helpful...

TeamWinks said...

It just doesn't feel right that it can go either way. Icky. Sorry about the cycle as well. Also icky.

I guess this really is a case of ignorance is truly bliss!

Barely Sane said...

Can you unring the bell? Nope. I have a feeling that will be the one thing that keeps me putting off any attempts at providing Sweet Pea with a sibling. I've barely got that ringing in my ears to stop!

I would think the LDA isn't enought to stop a headache. My RE told me it's actually completely diff than the regular dose ASA. Hmmm, who knew??

I've saved the best for last - prog supps. Or as I prefer to refer to them: cooter shooters!! I was told they simply absorb into the system faster as a supp and that they have no s/e (if you call leaking white crap from your vajayjay all day no s/e). When I had to take them orally (before a tsfr), I got really dizzy about an hour afterwards.

I know this post is getting long, but funny story. For my first FET, my lining wasn't getting thick so they had me take my BLUE estrace pills, the ones I'd been taking orally, and start using them as a supp. So for 2 weeks, I felt like freakin Smurf*ette as I was leaking blue! Worst part of it all? The darn cycle was cancelled due to a poor lining. Uggg!

Sorry you have to go thru this all again.

SPJ said...

Hooray for the single exception!

Samantha said...

I dunno what to say about the progesterone. I've always done it vaginally for reasons others have listed. But frankly, I wouldn't mind being able to take it orally.

Good luck with everything!

Melissa said...

If I'm taking the prometrium to trigger a period, my doctor has me take it by mouth. If I'm taking it for progesterone supplementation during a treatment cycle, my doctor prescribes it as a suppository. Crazy, huh?

Wen782 said...

Ya know what? I hate not knowing. Knowing sucks, but not knowing means not being able to develop a plan of attack. I say GO FOR IT on the FSH testing. A bellringer can also bring about great things, ya know. What if it's not FSH hell, but rather a simple thing like a prolactin problem or some such that will be an easily fixable thing? (Wasn't for me, but hey, someone's gotta get lucky, might as well be you! :) )

Good luck, miss!!

PCOSMama said...

Yuck, I think I'd puke it right back up! Just for the record, when I used the Prometrium my RE also told me to take it v@gin@lly because it is most effective that way. Maybe the rules have changed? said...

Another pill with dual use is vi.agra.... men take it orally for, well, its *intended* purpose, and yet some REs prescribe it va.ginally for women to help with lining issues, particularly with FETS.

I too have taken progesterone orally to bring on a period, and va.ginally for support. I've also taken va.ginal progesterone suppositories, but these are compounded at the pharmacy, and a lot more messy than the prometrium pills, which I assume is what you are talking about. (No way would even the sickets RE prescribe anyone to take the compounded suppository orally--bleah!).