Concerned about progesterone levels - spotting 3 days before AF with low temps

[lisaf]

Hi all, I just found this forum and am hoping some of you experts out there can help me. Trying to give you all the information you may need without making this too long!

I had Mirena for 5 years, removed in Sept 09. Fertility was supposed to resume immediately. 48 days later I started my period (spotted for 5-6 days prior, had a blood HCG test done on day 47 and it was negative). Have a very wacky period then, heavier than I'd ever had and wouldn't stop. Doc gave me provera to stop it, then I started the provera bleed which was identical but did end eventually (this lasted a month in total, heavy bleeding all but 4 days). My iron levels were checked afterwards and they were fine.

I was charting my BBT at that point and when no ovulation or period came after 55 days, I went to the doc who gave me provera again and prescribed Clomid.
That cycle was almost text-book, low temps, nice visible rise, etc and AF came on day 14 after ovulation.

However, my temp fell down to my coverline on 11dpo and then dropped below it on 12. I started spotting on 11dpo and kept spotting until AF came.
On my second cycle of Clomid, things were a little different overall, ovulated later etc. At 9dpo my temp dropped to my coverline and hovered there, dropping .02F each day until 13 (today) when it finally fell below. I started spotting on 11dpo again. Its clearly not implantation spotting and my 12dpo test was negative, didn't bother testing this morning.

I am now concerned that I have low progesterone levels. Before Mirena I had fairly regular periods (30-33 days) and never spotted for more than half a day before it came in fully. With my temp dropping and spotting happening, it seems like my lining is starting to deteriorate before a pregnancy can be detected or fully take hold. I haven't had my progesterone tested during a cycle because my doctor felt I was good enough with my BBT charting (and OPKs) that we could confirm ovulation without a test. Which we did just fine.

Even if its not preventing me from implanting, if I finally start to implant next time, could this lead to an early miscarriage/chemical pregnancy?

Is there any reason NOT to give me progesterone suppositories (or cream)? My regular doctor is on vacation for the next several weeks and the doctor covering for him is the one I left because he wanted me to wait a few 'cycles' before worrying about ovulation. I wasn't having any cycles and he still said I should wait. I don't think he'll want to prescribe anything.

I will take vitamin B6 this time which I've heard can help, but will it really help enough? I'm taking women's daily vitamins with 400 of folic acid (the prenatals are more expensive and made me nauseous and the pharmacist said the dailys with folic have the right level for TTC)

I don't want to waste a Clomid cycle on testing only to get my suspicion confirmed. I don't want to get a CD21 test when I ovulated on CD18 this last time. Even if they let me go for a 7dpo test, what if my levels are fine then, but fall off right after? I do get a drop in my chart around 6-7dpo that looks like implantation dip (obviously not though).
Clomid is supposed to lengthen your LP and the one cycle I started on my own had 5-6 days of spotting. The provera-induced cycle right before Clomid did not do this.

Any personal stories about spotting and progesterone issues? Am I worrying too much here? I really really want this next cycle to work because I can't take the devastation when it doesnt.

 

[SquirrelGirl]

Hi, lisaf! Welcome to BnB. I get spotting prior to AF myself and worry about low progesterone. I have been taking B100 Complex, and my spotting seems better, but still not great. Great post, and I can't wait to read some responses.

 

[lisaf]

The doctor who is covering for mine just had the nurse call. He WONT give me the suppositories. Big surprise. This guy won't do anything for fertility. He makes you wait a year then refers you to a specialist. Too bad my own doctor won't be back until late next cycle.

I plan on trying the vitamin B this cycle, but also want testing on 7dpo and then on 9dpo or 10. I don't want just a 7dpo test. If I was spotting for 7 days before my period, sure that might detect it. But I'm not spotting until 11dpo or so. I know that doesn't rule out pregnancy since I can implant earlier, but it narrows that window and while taking Clomid on a limited number of tries, I want that window WIDE open darn it!

When the nurse calls back again I'll ask about testing on one or both of those days. Here's hoping she doesn't insist that it has to be CD21. Thats only true if you ovulated on CD14.

Thanks Squirrelgirl for the info on how well the B vitamin worked for you. Maybe it will be enough to make a difference for me this time!

 

[coleybaby]

Hi Lisaf
I know you wrote this post a while ago but just wondering how you have got on. Your story sounds very similar to mine. I have been spotting 3-4 days before AF for about the last 7 years and no one can seem to tell me why! I only have a 26 day cycle and I ovulate day 12. I have pinky spotting from about day 22 or 23 which gradually turns dark brown, then my period comes. My doc took bloods on cd21 and my progesterone levels were fine, but I am worried they can suddenly dip! Me and DH have been trying for a baby for 14 months and nothing. Every month I get so depressed. I also has an erosion on my cervix which they told me could cause some spotting before my period as your cervix changes. Docs wont give me progesterone as they say my levels are fine.
I have scoured the internet for years looking for an answer. Can anyone help?

 

[lisaf]

Hi Lisaf
I know you wrote this post a while ago but just wondering how you have got on. Your story sounds very similar to mine. I have been spotting 3-4 days before AF for about the last 7 years and no one can seem to tell me why! I only have a 26 day cycle and I ovulate day 12. I have pinky spotting from about day 22 or 23 which gradually turns dark brown, then my period comes. My doc took bloods on cd21 and my progesterone levels were fine, but I am worried they can suddenly dip! Me and DH have been trying for a baby for 14 months and nothing. Every month I get so depressed. I also has an erosion on my cervix which they told me could cause some spotting before my period as your cervix changes. Docs wont give me progesterone as they say my levels are fine.
I have scoured the internet for years looking for an answer. Can anyone help?

I know of at least one person whose doctor did bloods at 7dpo then again at 10dpo to see exactly what her levels were doing. I don't recall if she followed up with the results from those tests or not. Do you chart your temps? I feel I could dismiss my spotting as a non-issue if I didn't also have low temps while it was going on... meaning low progesterone etc.
There can be other causes of spotting like fibroids and cysts - have you been screened for those?

I'm taking a B-100 complex this cycle after reading a thread about it helping women with this issue. I'm only 8dpo right now and I don't usually spot until 11dpo so I can't say if it has helped me yet, but I am freaking out about my temp this morning (view my chart in my signature to see what I mean). Overall my temps have been lower than my previous cycles, which I was hoping meant the progesterone was being doled out slower so it could last longer. I always get a dip around 7dpo but then it goes back up, so when it went even further down, I question if my temp was taken right (I fall asleep with the thermometer in my mouth and I think I had my mouth open for an unknown amount of time).

My doc insisted on day 21 bloodwork even though I ovulated day 17! I managed to get them done day 22 instead, but thats still only 5dpo and of course the day I got my highest temp so far this cycle

I'd be interested to hear what happens for you, if they figure it out and I'd be happy to share with you what happens to me.

I've heard that some women just spot like this and still manage to get pregnant just fine (My current theory is that you just have to hope for an early implantation). I'm more panicked about my issues because I'm on Clomid to make me ovulate, this is round 3 and I can only do it so many times so I need the best possible chance, you know? I'd be more patient if I could just try again and again... not happy, but more patient. At 14 months ttc like you though, I'd be out of patience!

 

[coleybaby]

Hi, thanks for your reply. I have been screened for fibroids etc and all clear. I have charted in the past and my temps stay highish (above coverline but starting to go down) until my actual AF starts which makes me think it isnt progesterone related, but cant think what else it could be! It is driving me mad! As I said, I have an erosion on my cervix which comes and goes but last time I went to the hosp the consultant said it had cleared up.
I have ordered some natural progeserone cream off the internet to start trying this month, just to see if it makes a difference. I would be really grateful if you could keep me posted on how you get on!
Thanks

 

[lisaf]

Hi, thanks for your reply. I have been screened for fibroids etc and all clear. I have charted in the past and my temps stay highish (above coverline but starting to go down) until my actual AF starts which makes me think it isnt progesterone related, but cant think what else it could be! It is driving me mad! As I said, I have an erosion on my cervix which comes and goes but last time I went to the hosp the consultant said it had cleared up.
I have ordered some natural progeserone cream off the internet to start trying this month, just to see if it makes a difference. I would be really grateful if you could keep me posted on how you get on!
Thanks

No problem!
I'm a little scared of the progesterone creams.. from what I hear, the over-the-counter ones aren't strong enough to help and the stronger ones from the doctor cost a lot without insurance and if you forget to take it one day, you can cause a miscarriage. Hoping not to have to go that route, but willing to do whatever it takes at the same time, you know?

 

[redjetta]

Lisaf, I was googling and came across your post. Our situations are very similar. I had Mirena for 2 years and never got AF. I got it taken out in June '09 and conceived on the 3rd cycle trying. When we went for the 8-week ultrasound, we found out it was a blighted ovum, which I think was due to low progesterone. I miscarried naturally.

We have been TTC since then (December '09) with no luck. I have the SAME spotting that you have. I always get my hopes up that it's implantation bleeding but then I never get a BFP.

I just tried 50 mg of Clomid for the first time last month. I am 13 dpo and still BFN. I had the same spotting this cycle and my temps were all over. I also had a lot of pain in my ovaries around ovulation, which scared me a bit.

I have not yet been to a RE. My OB is great but get this, he does not believe in progesterone testing. He thinks it is kind of like hcg testing - there is such a wide range of normal that it does not really tell him much. He really thought that Clomid would help if progesterone is the issue. He has always planned to give me progesterone as soon as I get a BFP, but not before. I have the same concerns as you, though, that maybe I need the progesterone earlier in order to help me get a BFP!

I feel really lost. I wonder if there is something wrong with the lining of my uterus. Or maybe it's just the progesterone. I have no idea. My DH wants to hold off on going to an RE until we have tried 3 months of Clomid. He really likes my OB. So do I, but I worry that we really don't know what the issue is, and are just sort of flailing in the wind, you know????

Anyways, I was really hoping you could tell me what is going on with you. Did you ever figure out the cause of the spotting? How are you doing?

 

[lisaf]

Wow its nice to hear from you.. its nice not to feel so alone in all this.
I got my progesterone tested on my 3rd and 4th Clomid rounds. (I'm in the US so anything above a 5 is considered ovulatory, a minimum of 10 is expected for natural rounds and a minimum of 15 is expected for Clomid rounds... one of my friends TTC naturally got a 15)
3rd round it was 6.5 (test was taken 5dpo because the nurse insisted I had to be tested at CD21 despite ovulating later than CD14 - I knew it needed to be 7dpo but she claimed she checked with the doctor and I didn't want them to ignore my results because I didn't do as instructed)
4th round it was 8.8 (test was taken 8dpo - spoke to doctor and he seemed to think it was obvious I needed to go test at 7dpo, not CD21)
I had to take a break from the clomid after that
Just finished my first non-clomid cycle and my 7dpo progesterone was 6.9. I expected it to be low because my temps were looking a lot like my 3rd round of clomid. I had an ultrasound done 3 days before ovulation and I had one follicle on each ovary... one 15mm and one 17mm (no real abnormalities in my uterus). They need to be 18mm to be released and both of them should have been that size by the time my body triggered for ovualtion. So if I did release 2 eggs, that progesterone is WAY too low.

I started taking a B-100 complex on the 3rd clomid round and am still taking it.
Halfway through the 4th round I started acupuncture because the stress of TTC was really getting to me (I was ready to have a full breakdown, lol).
I did not spot this cycle until the day before AF which I think is great/normal. Last cycle I didn't spot until AF was due.

Both cycles that I haven't spotted on though I believe I've had chemical pregnancies. Its a little hard to say because most of the tests that came out positive were not totally clear (some dye still left in the background). The day after the first time this happened, I called the doc who said it was positive when i described the test and he put me on the suppositories. It held off my period (with some spotting) and raised my temp back up, but I didn't get another positive pee test and they finally did a blood test 4 days later which was negative.

It really seems that by the time I get a positive test, its too late to save whatever was implanting. It might be because there is something wrong with it.. it might be because my progesterone is already failing or my corpus luteum can't recover enough from shutting down by the time it gets the signal that there is something implanting. It might be that my lining isn't getting adequately prepared to support a pregnancy so it tries to implant but can't get a good hold because the lining isn't right.

I made an appointment with a FS for next week. He agreed that my progesterone doesn't sound right. However I've heard he's conservative about giving the progesterone supplements/suppositories also. I'm hoping that my 2 suspected chemicals tips the scale in my favor. It makes me pretty angry to have 'figured' this out on my own months ago and wasted all this time and emotion on each cycle when things were not working right.

I don't know if my spotting got better because of the B-100 complex, my acupuncture or because I had something implanting.. so far it seems to have gotten better even if my progesterone is still crappy. The cycle with an 8.8 was one of my best looking temp cycles too (you have to ignore the last rise since it was caused by the progesterone suppositories).
I started Vitex and some chinese herbs once I was off the clomid (you can't take much when you are on the clomid).

So thats where I'm at right now.

I strongly suggest you insist on progesterone testing with your clomid cycles. It is considered standard practice.. .both to confirm ovualtion and to detect overstimulation. I regret not doing it on my first 2 rounds of clomid.
I have some progesterone suppositories left over but I'm afraid to take them after ovulation without a doctor's OK... in case there is a very good reason it could screw things up for me.

Sorry for the novel, lol a lot has happened since this post first started!

 

[lisaf]

I should also say that I've found a lot of information out there about progesterone and most of what I read says that the suppositories will not always be enough to save a pregnancy if you wait until you get a positive test. That studies have shown there are most effective if helping progesterone levels if taken within 48 hours of ovulation (if you take it before ovulation it can make you not ovulate).

I did see a chart once of a woman's progesterone levels throughout a day... progesterone is produced in surges.. sometimes it was above normal, sometimes below at different points in the day.
Thats also what my doctor told me.. that the levels vary throughout the day so just because it didn't test about a 10 or 15 doesn't mean I didn't get that high.

My thought is that they developed the standard of what was the normal minimum levels before they knew that... so if its normal to be above a 10, then you should still fall in that normal range no matter what time of the day you're testing (I would say if you had a 9 though its probably close enough).

I do feel like I slightly wasted 4 of my 6 clomid rounds because we didn't test and my doctor didn't want to increase my dose after that first low test (many doctors would have). So... don't make the same mistake I did and waste your rounds by not testing or by keeping with that doctor at a low clomid dose if you get low progesterone levels.

Oh... I should mention that if you have a progesterone deficiency, one of the treatments is clomid since it boosts the size of your follicles and therefore makes your corpus luteum bigger and your progesterone higher (also increase the quantity of eggs so you might have extra progesterone coming from a 2nd corpus luteum).... which is partly why I'm so concerned about my levels being so low on Clomid.

 

[redjetta]

Wow, Lisaf, I cannot thank you enough for sharing all this. I have the same exact concerns about failed implantation that you do. I am really curious to hear what the FS says. Is that the same as a RE?

The similarities in our situations are pretty interesting. I do wonder if Mirena played a role in this. Anyways, I have been doing acupuncture for a couple of months, too. I had a great cycle (temp wise) before I went on Clomid. Clomid made my temps erratic. So I think acupuncture was working, or at least making me feel better. And I did not spot that cycle prior to Clomid. My acupuncturist thinks I have a blood deficiency as well as low progesterone. She has been a godsend - now if only she can get me that BFP!

Despite the improvements from acupuncture, I got anxious when I did not get pregnant last cycle and decided to go for the Clomid, which made the spotting worse. I am 34 with an almost 3 year-old daughter, and I have really started to feel added guilt and stress to get going on completing our family. I am also worried about twins like you - I really just want 1 more health baby!

My OB has decided to do an utrasound on Monday to make sure that I don't have anything anatomical that is causing the bleeding every month. Then I am going to have a progesterone test at CD 22. I guess I am going to take clomid again, starting today at CD 3. He said that if we are still stumped in another month or 2 and I am not pregnant, he thinks I should see a RE. Of course, I looked it up and my insurance does not cover anything for infertility. So that is going to be a huge problem for us. But we will still do it regardless. I thought we had really good insurance so I am pretty perturbed!

I think having the ultrasound will make me feel better and even though I'll be on clomid, the progesterone test should hopefully be helpful. My only concern is that CD 22 is before it seems to drop (usually around 9-10 dpo when I start bleeding), so it might not really tell us much info, like you said.

Thanks so much for your advice about the testing and for sharing everything. I really hope we can share more of what we learn as well as some very happy news soon! Andie

 

[lisaf]

Hey Andie -
I do wonder about the Mirena... I just heard from another former-Mirena user who is having spotting issues (though her progesterone levels are fine). I know that some women get the spotting after they've had a child though so that might be what causes it for some women.

I read that this one doctor feels they should do a test at 5dpo, 7dpo and 9dpo to help diagnose a progesterone deficiency/LPD since it may rise to a good peak, but fall too fast. Maybe see if your doctor will do that?
I was ready to ask for that, but my levels clearly aren't peaking high enough as it is so there is clearly already a problem.

The FS I am going to see is an RE... its usually the same thing I think though I suppose not all FSs are REs. My appointment is for the first week in July though... I lost my appointment (thought I had to reschedule then found out I didn't have to but my appt was given away). So I'm pretty bummed about that.

My insurance will only cover items that are for irregular periods, not infertility. So far the u/s and the bloodwork has mostly been covered under that reason. I just got the bill for my CD3 lab work and Glucose Tolerance Test... originally over $600... insurance paid $100... I only have to pay $11... the rest was reduced due to insurance-negotiated prices. My doctor put the reason for the bloodwork down as period-related so they covered it. They covered most of my ultrasound too because of that.
Apparently there is no way an HSG would be covered though because its not used for anything but fertility testing (though the lab said the $1K price would only be $400 if I paid at the time of service). So the costs don't HAVE to get crazy-high right away.

I'm really hoping I won't have to have much more testing before being given the progesterone supplement.... I don't know if there is a good reason to test more first or if there is good reason to just give it a shot. It'd be a lot cheaper to just give it a shot, lol.

 

[Laughkay]

Hi Lisaf,

I have PCOS and sadly miscarried last November. I was convinced it was because I had low levels of progesterone (even though I wasn't tested for it).

When I fell pregnant I was over the moon and everything seemed fine. Then the bleeding started. It was only when I wiped, a small pinkish stain, and that's when I found this site as I needed reassurance.
I had my Hcg tested and tested and I kept asking them to check my progesterone. After brushing my question away for the third time I got a bit forceful and asked again. The nurse very bluntly said that they wouldn't give me anything for it even if it was low as it would only prolong an unsuccessful pregnancy.
Cue the tears!

Hope this sheds some light on the situation? It seems like if the pregnancy is viable it will generate the progesterone it needs.
Good luck Lisa!

 

[lisaf]

Laughkay -
I have read that some doctors have that opinion you encountered. The fear is that the progesterone is falling because the pregnancy is already failing. Any attempt to raise progesterone will merely keep the lining from shedding, not stop a failing pregnancy.
This is true to some extent..... meaning IF the pregnancy is already failing for other reasons, then progesterone will not 'save' it.

But NOBODY knows why it may be failing. There are THOUSANDS of women who lose every pregnancy, test with low progesterone, then use suppositories and carry successfully to term.
Progesterone keeps the lining from shedding... if your corpus luteum is not making enough progesterone to keep the lining intact, you WILL miscarry (again, its not the only cause of miscarriage.. just one possibility). The only 'harm' in using the progesterone suppositories is that you may carry an unviable pregnancy a little longer... to me thats not enough of a risk to make it not worth trying in case its something else.
I have a very good friend who had repeated chemical pregnancys, had an endometrial biopsy and tons of bloodwork... found she had progesterone deficiency/luteal phase defect... did one round of clomid and progesterone suppositories and has a healthy son now.

I appreciate your input and experience.. however, I really think that your doctors should at least be testing your progesterone. There is NO reason not to test it!! The spotting is not always progesterone-related though and is common in early pregnancy. I still think they should test the level just for your peace of mind.
I have heard of some women carrying their pregnancy just fine with levels of 8 (when a 10 is minimum they like to see). So a little on the low side is not a for-sure problem....

Anyway, thanks for the input, I personally think the doctors who won't try or even test for progesterone are making some big assumptions as to why the pregnancy is failing.

 

[Corsa]

i've been spootibg for before period for months now i think i've got low progesterone but consultant won't give me anything he is useless! Any advice

 

[lisaf]

i've been spootibg for before period for months now i think i've got low progesterone but consultant won't give me anything he is useless! Any advice

The most my doctor would do is agree to give me progesterone suppositories IF I got a positive test. This was only after 2 blood tests confirmed my progesterone was lower than ideal.
I had a 3rd blood test that showed that I'm still low (the first 2 were on Clomid and were below the norm for a natural cycle... the 3rd was a natural cycle and was about the same as the clomid ones).
I am going to a specialist at this point.

My GYN told me that he's not very good at detecting a luteal phase defect or a progesterone deficiency. He had said he would refer me onward if my tests continued to be low. I went and found my own specialist without waiting for a referral from him.

My best advice is to insist on the blood testing. It is not going to hurt anything and it may ease your mind if your levels are great on their own. If your first 7dpo blood test is normal and you still spot, you should ask for a blood test at 5dpo, 7dpo and 9dpo on the same cycle.
Another method is to have a scoop of your lining taken but that is a little invasive and not always worth the risk if you can detect it other ways.

 

[lisaf]

I thought I'd add an update here.
I saw my specialist. He agrees that progesterone is my problem. He wants me to try clomid again at 100mg will full monitoring. If my follicles are good size but progesterone still isn't getting higher then he will want me to move to injectibles. He'll let me use the progesterone suppositories before a BFP but not until after I get a blood test to see what my levels are and to make sure I need it.

I ovulated on my own this (2nd natural) cycle, just very late. He had me come in for blood work a little before 7dpo and of course my number was pathetic... a new low for me, lol. But he put me on the suppositories right away. My temps have improved and I'm really hoping this is all I need to get my BFP because its going to start to get pretty expensive from here on out.

 

[nevertogether]

lisa - just curious. all your cycles that i looked at in charting you had low bbt temps before ovulation like i am having now and did last cycle. however, your they were higher before ovulation. what caused this? just curious, as i've been concerned about my low pre ovulation temps.

 

[lisaf]

The pre-O temps aren't as important. Estrogen lowers your temp and you produce estrogen when preparing a follicle. I actually think my higher temps before ovulation were a bad sign... I was on 100mg of clomid which is what really helped me, lol.
My acupuncturist didn't like my pre-O temps lately either... all that spiking up and down said to her that I was stressed.

 

[nevertogether]

i guess i'm just over analyzing! i haven't got to temp much this cycle because of sleep and i'm on a 24 hour shift right now so of course temping isn't possible. but what i have seen it has gone up and down a lot. i usually have stable temps, but i guess my impending visit to see DH is stressing me out even though i don't feel like it is. very anxious as to what is causing me to not get pregnant.