Progesterone Levels in Early Pregnancy

In the event that the serum progesterone level is 5-25 ng/mL, further testing using US, additional hormonal assays, or serial examinations is warranted to establish the viability of the pregnancy.
from: Pregnancy Diagnosis

Among women who present with a history of infertility, approximately 3-5% of those with infertility have a true luteal phase defect, with repeated cycles lacking adequate luteal support. The incidence of luteinizing hormone deficiency is higher (10-15%) in subsets of patients who are infertile and have had [repeated miscarriages].
From: Luteinizing Hormone Deficiency

...a quantitative serum progesterone level of more than 25 ng per mL (80 nmol per L) proved 99 percent accurate in predicting a living intrauterine pregnancy. Sixty percent of the patients with progesterone values below 25 ng per mL had abnormal pregnancies.
from: Advances in the diagnosis of first-trimester pregnancy problems

Fourteen infertile women and two women with recurrent abortions were suspected of having luteal phase defect (LPD) by BBT charts. In these patients, the midluteal phase serum progesterone (P) levels were determined together with histological examination by the late luteal endometrial biopsies during the same cycle. The diagnostic criteria for LPD was BBT of luteal phase < or = eleven days, mean P level of 3 blood samples taken on three days during midluteal phase was less than 48 nmol/L (15 ng/ml) and the histological dating of endometrium was two or more days behind. The results showed that histological abnormality and low P level were 6.3% and 31.3%, respectively. When histological abnormality combined with lowered P level at the same cycle, the diagnosis of LPD increased to 87.5%. The author suggests that both midluteal phase P level and late luteal endometrial histological examination should be assessed at the same cycle in the diagnosis of LPD. BBT should also be assessed.
from: Diagnosis of basal body temperature, serum progesterone and endometrial biopsy for luteal phase defect

More about Progesterone Testing and the Value of Pooled Progesterone Testing for Luteal Phase Defect

"Single or multiple pooled serum progesterone values have been used between 21-24 days into the menstrual cycle. A progesterone level greater than 10 ng/mL may represent adequate progesterone support from the corpus luteum. Most authors now agree that a single mid luteal phase progesterone level is not sufficient to evaluate the adequacy of the luteal phase."
From: Lutenizing Hormone Deficiency

"Among women who present with a history of infertility, approximately 3-5% of those with infertility have a true luteal phase defect, with repeated cycles lacking adequate luteal support. The incidence of luteinizing hormone deficiency is higher (10-15%) in subsets of patients who are infertile and have had [repeated miscarriages]."
From: Lutenizing Hormone Deficiency

"As with many hormones, progesterone levels fluctuate hour to hour and day to day, so that a single level is not always an accurate reflection of ovarian function. Also, it is important that progesterone levels are sufficiently elevated for an adequate number of days after ovulation. For these reasons, it is ideal to check more than one blood progesterone level during the time in your cycle when progesterone levels are the highest, approximately 5 to 9 days after the LH surge. In the pooled progesterone test, blood is drawn on three days between the 5th and 9th days of the luteal phase. Blood samples will be "pooled" together, and a single progesterone level will be determined, representing an average of your progesterone levels."
From Pooled Progesterone Test (PDF)

"The results suggest that the most sensitive and specific prediction of low integrated progesterone (and therefore of LPD) was a value of <30 ng/mL for the sum of three (midluteal) serum progesterone measurements (100% sensitivity, 80% specificity).

Even a single (midluteal) progesterone result of <10 ng/mL was highly predictive of LPD (84% sensitivity, 82% specificity). However, a diagnosis based on a single progesterone determination continues to be controversial. Progesterone is secreted in a pulsatile manner, and serial samples obtained over a 24-hour period can range from 2.3 to 40 ng/mL.3 Such fluctuations raise questions about the reliability of a single progesterone determination for the differential diagnosis of LPD. The pulsatile secretion of progesterone argues for either assaying multiple specimens separately or pooling multiple specimens for processing in a single assay."
From: Progesterone: Physiology and Clinical Utility (PDF)

With a pooled progesterone test you should do it fasting, on any three days during your mid-luteal phase -- 5-9 dpo.

I've also read that luteal phase dysfunction is best tested in tandem with an endometrial biopsy and basal charting.

Progesterone and Miscarriage

I've found a few links that I've bookmarked about progesterone and I'll add to this post as I'm able to comb through more. I think that progesterone is part of my problem.

"I myself give progesterone. I'd rather take a chance on delaying a miscarriage than writing off a baby that just might make it..."

"Note: The normal level of progesterone is usually "15-20." If the progesterone level is ~13 or so, this is seen as salvageable. If the progesterone is <5, I've not really seen progesterone do any good."
From: Exercise in Early Pregnancy: Risk, Low Progesterone, and Miscarriage

Hormonal causes for recurrent pregnancy loss

Progesterone Therapy (PDF)

Luteal Phase Progesterone Level(s)

Also estrogen dominance can lead to prolactin excess and low progesterone production. Here's an article about elevated prolactin and miscarriage
High Prolactin Linked To Recurrent Miscarriage

Progesterone Therapy in Pregnancy

Possible Ways to Prevent Miscarriage

"The researchers found stress hormones such as cortisol are raised in the bloodstream, suppressing the production of progesterone - a hormone which is crucial to the maintenance of a healthy pregnancy."
From: Stress 'linked to miscarriages'

"Increased levels of cortisol are associated with pregnancy. Physical and emotional stress can also elevate cortisol levels."
from: Cortisol tests

I'm 16 dpo today and I just got back the results of my second beta. Monday=94 (14dpo) Wed=266 (16dpo). My progesterone was 13.2 but they aren't worrying about it and I'm already supplementing with progesterone cream.

I don't want to say anything until after my 6 week scan, since that was such a rough thing for us last year. After we see a baby then we will let everyone know.

Progesterone cream and pregnancy/miscarriage

I was on 50mg suppositories twice daily at the start of my pg last year and I stopped all at once when I found out it was a blighted ovum and I didn't even spot -- nothing changed, and my pregnancy sure as heck didn't end. Obviously that is a different situation but it did change my impression of how difficult it was to end a pregnancy.

I looked up a lot to see if there was anyway I could get my body to miscarry and other than practically poisoning myself or giving myself a life-threatening uterine infection there really wasn't much I could do. Really, think about it this way, with all the women wanting to terminate their pregnancies when they don't want them, surely if using and stopping progesterone was an easy way out then lots of people would be doing it and it would likely become a controlled substance. No?

The difference between medroxyprogesterone and progesterone

Medroxyprogesterone is a synthetic form of progesterone, it mimic the affects of progesterone on the body. It can cause side effects though that are similar though some of the s/e of progesterone, though it seems to affect more parts of the endocrine system than simple progesterone will cause (yellow eyes indicates liver problems, facial hair growth and loss of head hair indicate adrenal and thyroid involvement):

Medroxyprogesterone

Progesterone

Either way, large doses of hormones are tough on your system so make sure you eat a lot of fiber and drink water and include things like onions, garlic, leafy greens, artichokes and lemon in your diet to help support liver function.

Progesterone Affects During Luteal Phase and Into Pregnancy

I've been researching the affects of progesterone in our bodies, particularly focusing on the affects during the luteal phase. Here is a compilation of the things I've read it does (note that some of the pages I’ve linked to are long, to find the references on the individual pages use your browser’s search function (CONTROL+F in Windows/IE), to locate key words. I suggest starting first with “progesterone” and then going for specifics such as “endometrium”)

Affects of Progesterone During Luteal Phase

• Maintains endometrial lining during luteal phase, and into pregnancy in the presence of a fertilized egg (blocks collagenase from breaking down endometrium(PDF))


• Changes endometrial lining surface to be more receptive of the fertilized egg; causes the surface to have a more mucus like coating; causes glycogen bubbles to occur in endometrium which provide energy for the fertilized egg


• Promotes the endometrial glands to become enlarged, undergo maximum secretory activity and its blood vessels become coiled and enlarged.


• Prevents the woman’s body from rejecting the fertilized egg, stops rejection of fetal (foreign) DNA


• Reduces certain types of prostaglandin production to reduce uterine contractions making the uterus more hospitable to the fertilized egg/embryo (“progesterone block”)


• Affects blood sugar levels


• Affects zinc and copper levels (1),(2)


• Stimulates growth of breast tissue


• Facilitates thyroid function


• Raises body temperature about .5 degrees Centigrade (0.9 degrees F.)


• Causes relaxation of smooth muscle cells throughout the body (1), (2)


• Facilitates egg transport through the fallopian tube

Another list of functions of progesterone

A new article/research that looks into the role of progesterone and
estrogen as influencers of fibroid growth.

Sex steroidal regulation of uterine leiomyoma growth and apoptosis

[The abstract is available to anyone, the full text requires a
subscription or you can pay for 24 hour access.]


UPDATE ON ME
My beta dropped this week from last week from 543 to 289 (thurs to
tues) which is a good sign and the doctor says we can just wait and
do another blood draw on Monday (the other alternatives were a repeat d&c or methotraxate - yuck!).

The rest of my bloodwork came back normal, which is good since I've
been bleeding/spotting for a month.

My basel temperature also dropped for the first time since the
miscarriage (where it dropped just one day) and is the lowest it has
been since I got pregnant. Keep your fingers crossed that all goes
well and that I get my period in the next week.

I got measurement info about my fibroid, here's for the last 4
ultrasounds (approximately) -- in September 2002 it was 6x6 cm:

Feb 2004 - 6 x 6.5 x 9 cm

June 9 2004 -- 6 x 7 cm (day I found out I was 2.5 weeks pregnant,
with weekly acupuncture treatments and chinese herbs starting in
January)

July 8 2004 -- 9 x 9 x 11 cm (after 3 weeks on 100mg supplemental
progesterone and one week prior off to the ultrasound - 6.5 weeks
pregnant)

August 17 -- 9 x 7 cm (with beta still elevated post miscarriage)

I've researched progesterone a lot and I've used both a topical cream and Rx vaginal suppositories. My progesterone level was low when I had my 7dpo test last October, and I have other small symptoms of low progesterone as well. My mother had low progesterone prior to conceiving my brother, after 3 miscarriages -- although she is allergic to iodine and has thyroid trouble.

My P4 at 19 dpo was 18.4 which is low I know. I used NPC (natural progesterone cream) for 4 days (19dpo-22dpo) and then the vag. suppositories (V.S.), 50 mg twice daily starting a week after that (there was a problem with the Rx so hence the delay.

My early pregnancy was full of queasiness (like motion sickness -- I recall it now from physical memory like being on a roller coaster -- which I hate!!!). My breasts were huge and sore, I felt like I was surrounded by cotton -- I couldn't think clearly. And my mood! I was like Attila the Hun there, snapping and losing it at the drop of a hat.

When I found out about my blighted ovum I stopped taking the progesterone and magically I felt 100 times better. I had no idea when I was taking it that it was the progesterone that was jerking me around so much. Now that I've finally kicked the bugger out (d&c yesterday) and I'm preparing myself for my next try (in a few weeks or so) I feel just so confused about the progesterone. It seems like it caused some fibroid growth, made me feel like HELL and hardly functional at all. I'm feeling reluctant to take it, at least in that high dosage the next time.

I didn't have any bloodwork done when I was on the V.S. so I don't know if my body is super killer at processing progesterone or if I'm absolutely horrible at metabolizing it so it just builds up to unbearable degrees. I guess I'll have to talk to my doc.

I haven't posted here so much in a while, I was off of NPC (natural progesterone cream) for a while during my acupuncture treatment for my uterine fibroid. I did have a positive pregnancy though and my RE had me use progesterone suppositories. Last week I found out that we have a blighted ovum so I stopped using the progesterone. I thought I would add my experiences with being on it and off of it in higher doses just to help add to the information pool.

The week I found out I was pg, several days after AF was due I was having a lot of light contractions in my pelvis. My progesterone tested at 18.4 ng/ml at 18dpo (I think it was). I used my Emerita for a few days until the Rx was filled (prescription was lost at first - argh!) and that helped keep the cramps under control.

I started using the suppositories (50mg) as directed, twice a day when going to bed and before I got up in the morning; about 20 mins before I was advised by the nurse and I shouldn't worry about it after that since that was about all my body would absorb so she had heard from the pharmacist. Vaginal progesterone suppositories aren't fun, they melted for hours and added to the discharge so I had to wear a pantyliner at least and they might still leak onto underwear and clothing.

I thought my pg symptoms were really crazy how strong they were -- sore, sore breasts, bloated belly, mood swings, my head felt like it was full of cotton, nausea daily (mostly felt like motion sickness coming on)... Now that I'm off the progesterone I have to say that I feel sooo much better and more like myself. I haven't had any cramping really since I've been off the suppositories, my breasts are still sensitive but not quite so "punchy", and my belly is more normal.

I stopped using the progesterone cold turkey in the hopes that it would help my body realize that the pg wasn't progressing but no such luck. My temps are still up in the AM (around 98.6), no sign of anything vaguely looking like spotting or cramping.

My fibroid feels enlarged but until my uterus isn't swollen by the pg anymore I can't tell really about any growth. I didn't have any constipation problems from being on that much progesterone, actually after I stopped it my digestive system was totally blocked feeling and it's taken every diet trick in the book to get things moving again (sorry if TMI).

So, my experience with higher doses than we use for topical treatment is that progesterone is really strong stuff. (and don't put it anywhere near your breasts as I learned months ago, that will make them blow up like balloons and hurt like the dickens -- although I had the same reaction with the higher dose suppositories).

How are you all today? I've been supplementing my progesterone with natural progesterone cream since the Rx for the suppositories was messed up on Friday. I started the suppositories last night. Today I'm feeling a little tired and achy, my breasts are sore and there are fewer contractions (which could be because of the progesterone).

I woke up before 5am this morning for no reason in particular. My partner stroked my back for a while until I fell asleep again but then I still woke up at 7am -- still early compared to me before last week. It's like the pg hormones have triggered my circadian rhythms to go to a different pattern or something.

I also have to get up in the middle of the night to pee whereas before I was sleeping like a rock all the night through.

I get a little faint queasiness in the morning so I have to eat but that doesn't count as morning sickness in my book.

When can they see the heartbeat do you know? I'm wondering if anything will show up on my 7/1 appointment u/s. [I found this link which describes the various things they are looking for in the ultrasounds of early pregnancy: http://radiology.creighton.edu/ultraofearlypreg.html]

My partner's mother left a message on his phone yesterday saying that she had a dream that he told her I was pregnant; I think she's pretty excited for more grandkids than just my dear nephew.

I'm off to get my next blood sample. The nurses were total flakes yesterday. My doc said on Wed to call on Thursday to find out if I should do supplemental progesterone. I had to call twice and I didn't hear back until 5pm yesterday that I should but by then they couldn't call the order in until today. I've been using my natural progesterone cream in the meantime. My mother had low progesterone when she was pregnant with her first baby so I think it might be a genetic thing that we aren't such great producers of progesterone.

A message to another woman with fibroids

I have low progesterone as well, I haven't had my DHEA tested though.

Low progesterone is linked to several things which can happen in any combination (and I'm sure there are more than I'm listing here):

* poor ovulation -- the follicle doesn't develop as well as it should and the remaining corpus luteum doesn't produce enough progesterone. also, progesterone is produced by the ovary prior to ovulation which helps to mature the follicle granulosa cells and helps set the stage for ovulation to occur. If you are low progesterone I suppose that this process can be somewhat compromised.

* annovulation -- your aren't ovulating and therefore aren't having the corpus luteum available to produce progesterone. The more cycles without ovulating the higher your estrogen to progesterone ratio rises furthering the imbalance. Polycystic ovaries can also cause annovulation I think.

* stress -- when you are under prolonged stress your adrenal glands go from producing adrenaline to producing cortisol. Cortisol is made in the body from progesterone and I've heard mention that this reduces the availabilty of progesterone in the body. Also, cortisol will bind to progesterone receptors in the body so that they aren't able to do their progesterone related actions.

Working too much, not eating regular meals, consuming too many simple carbohydrates and sugars -- basic the equivalent of running your body on empty (and we all know that feeling) -- creates additional stress in your body and stresses the adrenals and further promotes adrenal exhaustion and cortisol production. If you get tired easily then this might be a contributing factor.

This page/site is rather interesting in how it talks about symptoms of low progesterone/estrogen dominance, and other endocrinological imbalances:

http://www.digitalnaturopath.com/cond/C8769.html

Things to do:

* Eat regular meals
* Make sure you are getting enough nutrients from your diet and supplement when needed
* Cut back on caffeine (bad for adrenals) and simple sugars (don't give in to the sweets in the late afternoon -- eat something healthy like nuts if your energy starts to lag)
* get enough rest -- sleep deprivation is stressful on your body
* drink 6 glasses of water a day
* consider consulting with an herbalist, naturopath or chinese medicine practitioner for assistance with a customize herbal regime

Also, I used natural progesterone cream for a few cycles with some good results (even mood, less sore breasts among other things). This may be beneficial although treatment with progesterone has had mixed results in randomized medical trials and might for some women be linked to increased fibroid growth.

This actually goes back to my cake metaphor for hormones (I think I posted a couple months ago about it on the uterinefibroids list), a cake takes all of its ingredients in their proper measure, adding more salt won't make up for too little sugar -- it only makes it worse. Our hormones are a complicated, individual "symphony" (I think that is what Dr John Lee referred to it as). The more stories we hear from the list members and from the studies we read, etc. that while pregnancy can make fibroids grow, that for some other pregnant women they shrink. Fibroids are thought to be a condition of peri-menopausal women and yet we've seen young women of 19 and 20 show up with fibroids in our groups. Obviously there is a lot at play and the more we each learn the more we start to realize that our behavior and lifestyles have contributed to our hormonal imbalances which in turn has helped activate our genes to start developing fibroids.

Uterine Cramps and Pelvic Pain

Fibroids cause pelvic pain, here's what I know about uterine cramps and their physiology from a variety of sources...

From an RE...
Prostaglandins cause uterine contractions. Ibuprofen can be taken regularly to reduce prostaglandin formation but won't help if contractions and pain are present since the prostaglandins are already causing problems. If you are trying to conceive though you shouldn't be taking ibuprofen or other NSAIDs as they can impair ovulation and possibly implantation (there's no winning is there?).

From naturopathy...
Arachidonic acid is involved in the production of prostaglandins and is found in animal products. Reduce animal products consumption such as meat and dairy products, increase essential fatty acid consumption (such as flax seed oil). As ibuprofen interferes with the liver it is not advised.

From acupuncture...
My acupuncturist says that the weird crampy fullness in my belly is related to blood flow not going the right direction. Acupuncture can stimulate blood flow to go in the correct direction.

From my personal experience...
Ibuprofen won't stop cramps from fibroids. Hot water bottles do help with the pain and discomfort. Food and gas passing through your colon that is having to negotiate around the fibroid can also feel like cramps or cause uterine area discomfort -- as can a full bladder. Acupuncture can help with pain. I just had an amazing treatment this morning BTW, and I can't feel my fibroid at all right now and I feel really energized, almost lightheaded and lighthearted. My practitioner said that my blood was swirling around the fibroid and that instead of flowing in the right direction it was coming back around where it wasn't supposed to.

From the web...

There are links between progesterone and ararchidonic acid but I haven't totally made sense of them yet (I'll continue to research and see if I can make more sense of it for us).

I do know that progesterone stops contractions of smooth muscle (see: http://www.rnceus.com/hormone/progest.html and http://arbl.cvmbs.colostate.edu/hbooks/pathphys/reprod/placenta/endocr
ine.html)

Arachidonic acid is also linked to tumor formation as well (scary but here we all are with our tumors):

The Role of Essential Fatty Acids in Cancer
http://www.positivehealth.com/permit/Articles/Cancer/good6.htm

Skin carcinogenesis, inflammation, arachidonic acid metabolism, cancer prevention
Susan M. Fischer, Ph.D.
http://sciencepark.mdanderson.org/documents/sfischer/fischer.html
(note that they are interested in applying this research on skin tumors to prostate cancer)

This page has links to a bunch of studies that are available through Amazon.com about arachidonic acid:
http://www.health.xq23.com/arthritis/Arachidonic_acid.html

Luteal Phase Dysfunction - Low Progesterone Info

I found this article which talks about low progesterone in the post-ovulatory (luteal phase) and saw that it does mention fibroids in the clinical section.

Luteal Phase Dysfunction

I know that not everyone has the same hormonal cause for their fibroids, and that they don't really know very precisely which they are and in which combination but for some of us progesterone supplementation might be helpful.

Natural Progesterone Info

This site has a lot of information about progesterone but the navigation is a little weird -- you have to use the left navigation bar, roll-over HORMONES, the over SEX HORMONES, then over PROGESTERONE and you can click on the links that show up there. The directions they give are in contradiction with other information I've seen where you should only use it post ovulation (whenever ovulation occurs).

http://thecompounder.com/hormonesprogesteronefaq.html

I have this article bookmarked from this site linked which you might find helpful, it is by Dr John Lee and it talks about why transdermal dosing of progesterone is preferable. Note that it says too much progesterone can "[result] in rather high levels of allopregnanolone and the woman becomes rather anesthetized by it, a state that is sometimes confused with depression" -- so that would be a side effect if too much is taken.

LETTER TO A COMPOUNDING PHARMACIST
Delivery of steroid hormones.

You can learn more about progesterone by reading What Your Doctor May Not Tell You About Pre-Menopause(also by Dr Lee)

Back from RE#2

I've just gotten back from a visit with the RE and guess what my pooled progesterone test showed....I have low progesterone. (I feel like I have a twisted mind because I'm glad they actually found something off in my endocrine system). The doctor said that they would have to supplement me during the second half of my cycle when I was trying to conceive (um, wasn't that what I was already doing?). My progesterone is 9.4 and I found mention of it on a site that said "A level above 15 ng/dl is desirable".

I brought up the desire to have UAE with him and he said he could tell I was extremely knowledgeble on the subject -- thanks of course to the ladies on the NUFF group and on the embo list. He wasn't aware that there was anyone doing the procedure at that medical center (and the RE is the head of the fertility clinic) so my research and consultations with the IR may help other women as well. He did mention that he was understanding my willingness to be a guinea pig (which I am), since there isn't that much information (no randomized studies) on the affects of embolization on fertility.

He told me that I should continue taking iron supplementation ongoing due to my heavier periods. I know this to be true even though my menorrhagia (heavy periods) are nothing compared to the flooding some other women have reported in the NUFF group. FYI my period lasts a full 7 days, it is a little heavier now than when I was younger (I'm now 33) but not dramatically so. I do have some clotting and I do also double up on protection since a bad episode with flooding when I was in high school.

He said that there wasn't a link between hypothyroidism and low progesterone (although Dr Lee mentioned that low progesterone may mimic mild hypothyroidism).

I have a referral/Rx for the MRI now so I can schedule that and get more info.

So, it wasn't that bad and we didn't get into any arguments. He's going to consult with the IR next week.

Stay tuned for more info soon.