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Wednesday, July 26, 2006

Progesterone Supplements (Oral and Vaginal)

Progesterone Supplements (Oral and Vaginal)
by Kris

* Please note that while I reference intramuscular progesterone injections, I don't go into detail as I have no experience with them.

Why would you be taking progesterone supplements?

There are a few reasons you might be taking progesterone supplements, which can be delivered orally, through vaginal suppositories, or via intramuscular injection (commonly referred to as PIO). Some examples: (1) You have low progesterone levels. This is usually diagnosed by having a blood test done 7 days post-ovulation. (2) You have a short luteal phase regardless of the results of the 7 dpo progesterone results. I believe that any luteal phase less than 12 days is considered short. (3) Even if your progesterone level and luteal phase are fine, if you are doing IVF (and depending on the RE, IUI) you will probably be prescribed progesterone supplements. Taking the supplement just covers your bases.

Why would you take them orally or vaginally?

The oral supplement is definitely the least invasive way to do the job if it works for you. However, when you take progesterone (or apparently any hormone) orally, it must be metabolized by the liver, which makes the delivery system inefficient and less effective. As for vaginal supplements versus injections, all I can offer is what I’ve been told. For most women, there seems to be no difference in the results. My clinic uses the suppositories because they feel after all the pre-procedure injections they just don’t want to prescribe more injections. My RE also informed me that when they switched to suppositories their pregnancy rates increased. However, there does seem to be evidence that some women have a better response with the injections. I know there are women out in bloglandia who agree with this.

What to expect

You can expect to take the supplements until you take your beta. If it is negative, you will stop and your period will arrive. If it is positive, you will continue taking the supplements for at least a few more weeks and possibly through the entire first trimester. If you are having blood tests done after insemination or transfer and are using vaginal supplements, your blood tests may not reflect high progesterone levels. Do not freak out if your level seems low compared to your friend doing injections. The vaginal suppositories are not systemic- all the progesterone stays right around your uterus and does not show up in blood tests. That doesn’t mean it isn’t there. The common oral supplement is prometrium. If you are taking this, expect to feel tired… fast. Twenty minutes after taking this I was dead to the world. But I slept great.

There are two vaginal forms: suppository (yellow pill--see picture) and suspended in gel (white bullet-like pill--see picture). The suppositories can be either prometrium (yes, the exact same pill you can take orally) or they can be pharmacy compounded. Not all pharmacies have the capabilities to compound these suppositories- at least not all American pharmacies. I have been told by my RE it doesn’t matter if you use prometrium or pharmacy compounded, but his preference is to use the pharmacy compounded. Whether you use prometrium or the compound suppositories, your dose will typically be 2 to 3 times per day. Expect to feel like you have constantly wet your pants. The prometrium is like a vitamin E--a softish gel capsule. In my experience, prometrium is much less oozy--one or two pantyliners a day should cover you just fine. You may notice some of the yellowish coating on your pantyliner. Gross, but normal. Prometrium can be kept at room temperature. The pharmacy compounded suppositories are very oozy. I frequently change panty liners when using these suppositories. These need to be kept cold or they will melt. When you take it out of the wrapper, it feels kind of waxy. But if you let it rest in your hand, the surface feels slick and oily. This is only the outer coating--if you look at the non-pointy end, you can see there is white goo inside the waxy shell. You may notice some of the disintegrated shell on your panty liner amongst the ooze. Also gross, but also normal.

The suspended in gel supplement (Crinone and similar products) comes in a pre-filled applicator (the pharmacy also gave me an applicator for taking the prometrium vaginally but I've never used it. I use my finger because it’s easier to wash.).

It’s been awhile, but as I recall, these applicators do not need to be kept cold. I don’t really remember any oozing, either. But I definitely remember this…when I read the insert, it said that I might see some of the suspension gel ooze out. I imagined that would be some sort of liquefied substance and I never saw any. Then one day I went to the bathroom and saw on my panties this disgusting glob of grainy cottage-cheesiness and I was horrified. That was a few days of the suspension gel--which doesn’t liquefy like I thought--finally succumbing to gravity. It was very gross and completely not what I expected, but also…normal. With all of these supplements, you may feel some bloating. They also cause me to have to pee a lot--especially in the middle of the night.

Problems you may encounter

Other than feeling like you are going to develop some sort of mold on your constantly moist naughty bits, there really aren’t too many problems. I have noticed that some time into the second week of the vaginal suppositories, my vagina feels irritated. If you’ve ever removed a tampon that was too dry, that’s what it feels like. Oh, and this (which I'm sorry, is painfully graphic)… I wiped front to back and when I first used the compounded suppositories and I noticed some irritation around my anus from the progesterone ooze that would linger behind when I was done. Now I just make sure I wipe the excess away from there--usually with damp tissue--and all sees to be well.

Personal Tips

As if the tush-wiping wasn’t personal. I try to make sure I space my dosages as evenly throughout the day as I can. And I try to lay down for as much of that as possible to allow the progesterone to absorb before oozing out. No one told me to do that…that’s just my neurosis. I have a three-a-day dose. I do one at 8 p.m. and then crawl into bed and read. I set my alarm for 4 a.m.- I usually have to pee around then anyway- and put in the next dose. At night, I fill a small glass with ice and just set the wrapped compounded suppository on top. This way I can keep the glass on my nightstand and avoid fumbling around my kitchen at 4 a.m. Then I go back to sleep for a few more hours. I take the third dose at noon and just deal with the instant ooze, since I’m at work. But if it’s a weekend, I think an afternoon nap is in order.


Lollipop Goldstein said...

My OB did the day-21 test and discovered that I had low progesterone. He prescribed Prometrium and gave me a referral to the RE. I started using the Prometrium without instructions...bad idea. He never told me to go off of it. He told me that I would just get my period and then I should stop it. Well...I didn't get my period. My cycle kept going and going and going until I went to the hospital with "abnormal uterine bleeding." Aaaah, thank you, Dr. OB.

So stop them either when you take a beta. Or, in the event that you're not being monitored, do a HPT when your period is one day late and if it isn't positive, stop the Prometrium.

Also, I had terrible mood swings the day after I stopped taking it. Terrible terrible mood swings. So just be forewarned since I know other people talk about the infamous progesterone rages :-)

Anonymous said...

Does anyone know if it's okay to have intercourse while taking the suppositories? I've always assumed it wasn't but recently a friend said it was....any input would be much appreciated!!


Anonymous said...

i am a 31yr old female,have one ovary,recently had a Dr. put me on prometrium because my progesterone level was 3 (low).Anyone in this situation who finally got pregnant.

Anonymous said...

I'm 6 wks, 5 days pregnant. I'm worried b/c my doctor prescribed me 200mg of progesterone orally because i told her i get occassional cramping in my middle lower real pain just a lot of discomfort more like it. I don't hvae a history of miscarriage, and my menstual cycles were normal and regular. This is my first pregnancy. I wasn't tested for progesterone level. Don't even know how it is tested. I'm worried I'm taking it and it is not necessary. Pls help. Thanks.

Mrs. Higrens said...

On 3x vaginal insertion per OB/GYN (still waiting for our May RE appt. which was scheduled back in January! grrr) after low day 21 progesterone. Same instructions - start cycle day 16 and use until your period starts. So I will certainly be keeping an eye on the cycle days so I don't end up at the hospital.

Reaction: immediate (same-day) abdominal bloating, gas, etc. Now on day 4, the bloat seems to have dissipated some.

A small complaint (and perhaps TMI): there's liquid in the pill which does not absorb with the progesterone, so that comes out the only way it can. Pantyliners are a must with the vaginal insertion method.

Anonymous said...

I just want to say thank you for posting this - I thought my pharmacy made a mistake with the pills, but now I see from your post that the same pills are used orally and vaginally. You've put my mind at ease. Thank you.

Anonymous said...

I'm on a progesterone suppository that has got me all confused! My RE made a huge mistake last month and told me to start immediately after Aunt FLow left town...huge mistake. Had to wait 3 dpo, instead. So I did (although reading an OPK was not easy and I am not sure I did it correctly) here I am, 3 days after my expected period, and a negative HPT, but my basal body temps are still high. Soo...what now? Advice out there?

Lollipop Goldstein said...

Anon--I don't know if you'll come back to check, but email me if you have other questions.

I would call your doctor and ask that they draw a beta hCG test to check for a pregnancy. If you are pregnant, you'll keep taking the suppositories. If not, you'll stop them and your period will come after a few days. The suppositories can keep your period from coming.

Unknown said...

That was a quick reply! :) I stopped taking them last night, convinced I was not pg. I had all sorts of symptoms last week, then nothing. Can my bbt reflect 'leftover' traces of progesterone though?

Anonymous said...

Could Prometrium mask any m/s symptoms? I have a history of early m/c(s). I am currently 6 weeks pregnant and have had fairly consistent cramping for the last 4 days, but have not spotted. I wasn't sure if anyone knew if Prometrium would prevent spotting.

Anonymous said...

We are on our 3rd round of clomid with the trigger shot of HcG and IUI. Today was the IUI and I am to start the prometrium vaginally once at night and once in the morning until I take the test on the 26th to see if the IUI worked.

So my question is - was the REI OB right to perscribe this to me?? From what I read on web md it is a med that helps get your period or control it. How does this help with me getting pregnant?? I know the REI OB said something about lessening the chances of a miscarriage (I miscarried Oct 07 at 20 weeks) And it says not to take this med when pregnant?

I'm confused.

The Steadfast Warrior said...

I used prometrium vaginally (200mg before bed) for the first time this last cycle and just a warning that some women can actually get their period despite being on the progesterone. Let me tell you that it's unexpected when you were anticipating having to do hpts to figure out when to stop the pills.

Anonymous said...

I'm taking prometrium (orally) 2x/day because my mid-luteal phase progesterone was borderline (9.6). The night pill is fine, since I just go to bed, but the morning pill makes me so dizzy that I can't get any work done. I'm hesitant to switch to insertion, because I don't want to deal with the mess and hell it's hard enough to feel sexy during IF even w/out this. Any suggestions?

Anonymous said...

I've been taking it vaginally for about 11 days now. My breasts have been extremely tender, ever since right before ovulation (I'm 12 dpo). Is this a result of the prometrium? Or something else? (Hoping for BFP in 3 days!)

Austin said...

I stopped taking it, and now haven't gotten a period. Anyone know how long its supposed to take to get a period? When should I worry?

Unknown said...

I was put on Endometrium suppositories after my IVF cycle. After a week and a half, my husband and I tried to have sex and I felt a horrible burning sensation. We had a chemical pregnancy, and afterwards we stopped the suppositories. Now it has been several weeks after I stopped the progesterone and yet when we tried to have sex again I still felt some burning. Has anyone else experienced this? Any ideas what to do?