If you've had a m/c you should probably read this stuff

sugarbug · 07-26-2003, 03:46 PM

I met with a perinatologist yesterday to discuss my risks in having another child. She told me I was in the clear as far as blood work, but once I get pregnant I need to continue progesterone throughout my entire pregnancy. She said there have been some new studies on it, and ppl like me with low progesterone PCOS & m/c should stay on the enitre time. So I did some looking this morning, and I shared the info I found with my cycle buddy group, but I thought other women ttc should also become aware since I haven't read anything like this before. HTH

BUG

Here is just an article on progesterone use during pregnancy http://www.msnbc.com/local/khas/M151618.asp Here is a little bleep out of it;
"I get goosebumps right now talking about it," she said.
So what made these pregnancies a success? Lori said in part, Dr. Hilgers and his work at the institute.
Part of that works keeps him out of the office and in front of medical students. On this day, the lesson is on the practice he's known for - using the hormone progesterone into the second and third trimesters.
He explains most doctors only prescribe progesterone for problem pregnancies like Horton's into the first trimester. Hilgers said, though, he has found for many women who miscarry, their progesterone levels are low, so he continues to prescribe the hormone into the second and third trimester. He said it can have dramatic effects.

Another Q & A type question

Dear Dr. Lee:
During the time of the month that I was using the progesterone cream I found out that I was pregnant._ I didn't want to stop taking it, as I know it's important in pregnancy, but I was wondering how much longer I should take it.

Answer:
Most early miscarriages are due to luteal phase failure, a fancy way of saying you're not making enough progesterone._ As you know, progesterone is necessary for the survival and development of a fertilized egg and the survival and development of a baby.

To prevent luteal phase failure and the loss of the pregnancy, my patients used 20mg of progesterone cream twice a day [40mg total per day] for the first month of pregnancy, and then increased it to 20mg three times a day [60mg total per day] in the second month._ After the third month, the placenta starts making more and more progesterone, reaching 300 to 350 mg per day during the third trimester of the pregnancy.

After the third month, my patients continued with progesterone at 20 mg twice a day until a week or so before the baby's due date._ At that time they tapered off the progesterone to allow the baby to choose the time of its own birth date._ The baby does this when his/her adrenal glands become able to make cortisone._ To trigger the birth process, the baby makes a large surge of cortisol._ The cortisol is excreted in the baby's urine into the amniotic fluid._ Half of the cortisol is changed by the placenta into estriol, the hormone that softens the cervix (your physician will call this "ripening"), and the other half occupies progesterone receptors in the wall of the uterus, allowing it to go into contractions that are necessary for pushing the baby through the birth canal.
_There is no harm in continuing progesterone cream in those doses (described above) throughout the pregnancy, and then tapering off the week or 10 days before its due date.
source

Here is why you should take progesterone and what it does during and after pregnancy: click here

Bunnyscott · 08-02-2003, 12:52 PM

Sugarbug -- thanks for the info!!!

I just wanted to add they are also using Progesterone injections to prevent m/c -- starting around 16 weeks and ending at 36 weeks. My MIL told me about a study that was just finished. It was published in the NEJM on June 12, 2003. I printed the article and will take it to my peri for my next pg. It's supposed to help prevent PTL.

I strongly recommend that anyone with a history of recurrent m/c see a peri as soon as possible when they achieve pg. These guys/gals have all the latest info.

sugarbug · 08-03-2003, 07:09 PM

Ohh that sounds like an intresting read- can you copy and paste it here for us?

BUG

Bunnyscott · 08-04-2003, 01:18 AM

Volume 348:2379-2385 June 12, 2003 Number 24

Prevention of Recurrent Preterm Delivery by 17 Alpha-Hydroxyprogesterone Caproate

Background Women who have had a spontaneous preterm delivery are at greatly increased risk for preterm delivery in subsequent pregnancies. The results of several small trials have suggested that 17 alpha-hydroxyprogesterone caproate (17P) may reduce the risk of preterm delivery.

Methods We conducted a double-blind, placebo-controlled trial involving pregnant women with a documented history of spontaneous preterm delivery. Women were enrolled at 19 clinical centers at 16 to 20 weeks of gestation and randomly assigned by a central data center, in a 2:1 ratio, to receive either weekly injections of 250 mg of 17P or weekly injections of an inert oil placebo; injections were continued until delivery or to 36 weeks of gestation. The primary outcome was preterm delivery before 37 weeks of gestation. Analysis was performed according to the intention-to-treat principle.

Results Base-line characteristics of the 310 women in the progesterone group and the 153 women in the placebo group were similar. Treatment with 17P significantly reduced the risk of delivery at less than 37 weeks of gestation (incidence, 36.3 percent in the progesterone group vs. 54.9 percent in the placebo group; relative risk, 0.66 [95 percent confidence interval, 0.54 to 0.81]), delivery at less than 35 weeks of gestation (incidence, 20.6 percent vs. 30.7 percent; relative risk, 0.67 [95 percent confidence interval, 0.48 to 0.93]), and delivery at less than 32 weeks of gestation (11.4 percent vs. 19.6 percent; relative risk, 0.58 [95 percent confidence interval, 0.37 to 0.91]). Infants of women treated with 17P had significantly lower rates of necrotizing enterocolitis, intraventricular hemorrhage, and need for supplemental oxygen.

Conclusions Weekly injections of 17P resulted in a substantial reduction in the rate of recurrent preterm delivery among women who were at particularly high risk for preterm delivery and reduced the likelihood of several complications in their infants.

Source Information

From Wake Forest University, Winston-Salem, N.C. (P.J.M.); the National Institute of Child Health and Human Development, Bethesda, Md. (M.K., C.Y.S.); the Biostatistics Center, George Washington University, Rockville, Md. (E.T.); Wayne State University, Detroit (M.P.D.); the University of Tennessee, Memphis (B.S.); the University of Chicago, Chicago (A.H.M.); the University of Alabama, Birmingham (J.C.H.); the University of Cincinnati, Cincinnati, and Columbia University, New York (M.M.); the University of Utah, Salt Lake City (M.W.V.); the University of Texas Southwestern Medical Center, Dallas (K.J.L.); the University of Pittsburgh, Pittsburgh (S.N.C.); Ohio State University, Columbus (J.D.I.); Thomas Jefferson University, Philadelphia (R.J.W.); the University of Texas, San Antonio (D.C.); the University of Miami, Miami (M.J.O.); Brown University, Providence, R.I. (M.C.); Case Western Reserve University, Cleveland (B.M.); the University of Texas, Houston (S.M.R.); the University of North Carolina, Chapel Hill (J.M.T.); and Northwestern University, Chicago (A.M.P.).

Address reprint requests to Dr. Meis at the Department of Obstetrics and Gynecology, Wake Forest University, Medical Center Blvd., Winston-Salem, NC 27157, or at pmeis@wfubmc.edu.

sugarbug · 08-05-2003, 01:37 AM

WOW that was a good study- Thanks for sharing & posting it!

BUG

sugarbug · 08-10-2003, 03:23 AM

kellymay · 08-10-2003, 01:03 PM

About the link to PTL, I totally believe it! My BF's little girl was born at 25wks gestation. She went through a lot, and has mild CP and vision problems, but other than that is doing just fine at almost 5 years old now. She has since had 2 more pregnancies, both which ended in early m/c. After the second one, I strongly encouraged her to go to an RE for recurrent m/c testing. She finally did, and it turns out that she a has an LPD!! After poking around the internet, I found an article that also supports the idea that low progesterone can cause PTL. My BF now has a script for p4 supps for early pregnancy, and is armed with info to bring to her dr. regarding p4 shots for the 2nd-3rd trimesters! Thanks for posting about this subject!!!

heidi 1973 · 09-16-2003, 07:41 PM

BUMP

Hey Mods - can we turn this post into a sticky please!

This post is so important to PCOS cysters!

sugarbug · 01-11-2004, 08:33 PM

CathyWood · 01-12-2004, 12:08 AM

Thanks for sharing...as soon as I can I will take a look at this.

sugarbug · 04-10-2004, 04:33 PM

josie111 · 04-15-2004, 10:39 AM

Hi Sugarbug and all, I am new to the Soul Cyster group:o)
I must say thank you so much for that information it was very interesting.

I have had 5 m/c's in the last year before I was diagnosed with PCOS.

I have been put on Metformin, 50mg's of Clomid and now a new drug called Letrozole none of these have worked.

I don't know if my situation is differnt because with PCOS they say you have irregular periods and that you don't ovulate.

I have had regular periods to date and I must have been ovulating in order to get pregnant do you think in my situation Progesterone would be helpfull?

I would appreciate any info or comments that you or anyone would be able to give me.

Congrat's on your Pregnancy:0)
Have a great day everyone

sugarbug · 04-15-2004, 01:05 PM

There are lots of reasons miscarriages happen- so, it's not easy to say if in your case it would help. It depends on your progesterone level, and your causes for miscarriage.

I had a miscarriage due to low progesterone, my progesterone level was 10 when I got pregnant and I miscarried 2 weeks later (at 6 weeks 3 days) In this pregnancy, I have used progesterone support, and have not miscarried (I'm 20 weeks tomorrow) but when I try and lower my progesterone support I start to have preterm labor problems. So I know, for me, progesterone is needed.

Really the only way you can know is to have progesterone testing done. I'm sorry for your losses, and hoped I answered your question.

Good Luck!
Bug

P.S. If your already pregnant and over 12 weeks there isn't any reason to worry about progesterone levels, because you've passed the most dangerous part. The only concern would be pre-term labor later in pregnancy, but if you don't have a history for that, then your probably okay. (JMO!)