Oral progesterone tapering off after BFP (also tapering off Vitex?)

[Wtbam]

Hi all,

Can't believe I'm actually posting in the 1st Tri forum!

I would just like some opinions.

I came off BC in December, and had a super long and odd cycle (I have PCOS). I ovulated on the 27th March, but thought it was a 'false' ovulation. I was so disheartened after seeing 3 days on no temp rise that I went to the doctor and asked for a 10 day course of progesterone to try to induce AF and end this cycle.

She prescribed me Norethisterone, 5mg 3 times per day.

Fast forward 8 days, I started getting some symptoms. I thought I would check just in case before stopping the progesterone, and low and behold, on the last day of the tablets, at 13DPO I got a BFP on a clear blue digital!

I went to the doctors today and explained the situation. I said I was scared to stop taking the progesterone in case the drop affected the pregnancy. He said it should be a problem, he checked with an on call gynaecologist consultant who also said it shouldn't be a problem, but if I was worried, I could taper the tablets off by taking 2 per day for a week, then one a day for a week.

Does this sound like good advice? I have been reading about progesterone suppositories. What if I have a progesterone deficiency? Will I have time to realise that I need to supplement before I miscarry? Should I insist on having some anyway? Is this a common problem? Am I worrying over nothing?

He said it would be pointless to check my levels because I was taking the tablets so they would be skewed.

Also, I have been taking Vitex 1000mg per day. I know you should not use them during pregnancy but I am concerned about going cold turkey. I have done a lot of reading and the general consensus also seems to be to taper these off, until they are completely gone by about 8 weeks. Does anyone have any experience with this?

Lastly, I am also taking Metformin. The doctor said they are pointless in pregnancy, but do no harm, so I have decided (after much research) to keep taking them until the end of the first trimester, then taper them off. If anyone out there is taking Metformin in the first trimester, what dosage are you on?

Thanks in advance. I am so scared about losing this pregnancy but trying to keep calm and enjoy it!

 

[reeshy]

Hi all,

Can't believe I'm actually posting in the 1st Tri forum!

I would just like some opinions.

I came off BC in December, and had a super long and odd cycle (I have PCOS). I ovulated on the 27th March, but thought it was a 'false' ovulation. I was so disheartened after seeing 3 days on no temp rise that I went to the doctor and asked for a 10 day course of progesterone to try to induce AF and end this cycle.

She prescribed me Norethisterone, 5mg 3 times per day.

Fast forward 8 days, I started getting some symptoms. I thought I would check just in case before stopping the progesterone, and low and behold, on the last day of the tablets, at 13DPO I got a BFP on a clear blue digital!

I went to the doctors today and explained the situation. I said I was scared to stop taking the progesterone in case the drop affected the pregnancy. He said it should be a problem, he checked with an on call gynaecologist consultant who also said it shouldn't be a problem, but if I was worried, I could taper the tablets off by taking 2 per day for a week, then one a day for a week.

Does this sound like good advice? I have been reading about progesterone suppositories. What if I have a progesterone deficiency? Will I have time to realise that I need to supplement before I miscarry? Should I insist on having some anyway? Is this a common problem? Am I worrying over nothing?

He said it would be pointless to check my levels because I was taking the tablets so they would be skewed.

Also, I have been taking Vitex 1000mg per day. I know you should not use them during pregnancy but I am concerned about going cold turkey. I have done a lot of reading and the general consensus also seems to be to taper these off, until they are completely gone by about 8 weeks. Does anyone have any experience with this?

Lastly, I am also taking Metformin. The doctor said they are pointless in pregnancy, but do no harm, so I have decided (after much research) to keep taking them until the end of the first trimester, then taper them off. If anyone out there is taking Metformin in the first trimester, what dosage are you on?

Thanks in advance. I am so scared about losing this pregnancy but trying to keep calm and enjoy it!

I am surprised that you went onto Progesterone to induce AF because in my case, I thought it was prescribed to delay or prevent AF. This is my sixth time being on Progesterone (suppositories) and AF does not come for until I stop taking them (even if I have a BFN).

Did your doctor ever test your progesterone levels before prescribing it? That just seems like such a big jump to me to prescribe it without checking first. If he did, then you would know if you have a progesterone deficiency.

I do think that he is right that it doesn't make sense to test now because your levels really will be distorted.

I think it is reasonable to slowly wean you off. Weaning is typical and good so you don't have a big drop off. I am weaning off too (over a course of four weeks after taking it for three months).

One thing I know about progesterone is that if your body needs to miscarry for typical reasons (chromosomal abnormalities, etc), even progesterone can't stop it. It can only delay it. BUT, if you have a progesterone deficiency, the suppositories can save the pregnancy. So then the big question is, does your doctor have a reason to believe you have a progesterone deficiency?

 

[Wtbam]

Hi Reeshy,

Thanks for the reply!

I had a course of 10 days, which is then stopped, and apparently AF should arrive shortly afterwards due to the drop in hormones?

I understand what you are saying about the miscarriages. Thank you, it does but my mind at ease a little.

I had my progesterone levels tested twice (both under 5), but I was having anovulatory cycles at the time. I never managed to get them checked post ovulation, because I caught that first egg which turned into a BFP, and I was already taking the Norethisterone at the time.

Do you think I should push for them to test my levels when I start tapering off? Off the top of your head, do you know what the levels should be?

Is there a point in the pregnancy when the natural progesterone levels taper off and another hormone (HCG perhaps?) takes over - or do they always remain high?

Are there any symptoms of a progesterone deficiency I may be able to cross reference? I have never had any spotting before periods - I know that is one.

I have PCOS- could that cause a deficiency?

 

[reeshy]

I never knew they used Progesterone that way! It makes sense because AF always starts right away for me after I stop.

I think a level 5 all depends on where you were in your cycle when you were being tested. Since you didn’t ovulate in the cycle, it seems like the number should be low (something like 5 doesn’t jump out as crazy to me, but I am no doctor). In fact, it kind of makes sense that your progesterone level during an anovulatory cycle could be 5 or even lower because a normal menstrual bleeding is the result of progesterone withdrawal bleeding. This is definitely a question for your doc to clarify.

It is a tricky place that you are in! Since you are now pregnant, your level should be higher than 20 for your doc to consider it a nice number. But a level of only 5 PRE-PREGNANCY doesn’t mean much because there is so much variability even in a typical menstrual cycle based on where you are, and even more so in an anovulatory cycle.

My doc told me that around week 10 is when the placenta begins to take over and progesterone isn’t as critical. Starting at week 10 is when she had me start to ween off.

For my experience, I actually have never known if I even have a progesterone issue! I have had plenty of reproductive issues though and my doctors are pretty automatic when treating their IVF patients over 35 with progesterone just as an extra precaution. So, it seemed like for me, it was okay to be on it to stay on the safe side. So it might not hurt to ask if you can stay on longer if you explain that you are nervous . As far as I have read, there can be small issues with your baby’s teeth from too much progesterone but no other big issues (anyone know if I am wrong about this?)

Is this an OBGYN, fertility doc, or family doc helping you with this? I ask because I have learned to ABSOLUTELY trust my fertility docs but I now give very little credit to my family doctor after so many experiences where it has become obvious that they do not know nearly enough about fertility issues ☺ If my fertility doc told me that I should start weaning off now, I would follow her advice without question. I would likely trust my OBGYN with her advice but continue to ask plenty of questions and voice my concerns. If you have concerns and your doc doesn’t extend your prescription, is it a possibility for you to meet with a fertility specialist?

 

[dairymomma]

I have a progesterone deficiency during my first trimester and the only sign I've ever had of it is I've tended to miscarry between 7-9 weeks if I'm not supplementing. I take progesterone supplements from bfp to at least 12 weeks as the doctor said the placenta takes over making progesterone by that point (I've heard the placenta takes over progesterone production between 8-12 weeks.). With my son, I stopped the progesterone at 12 weeks. With my daughter I stayed on it until 13 weeks but that's only because I had enough pills left to do so. With my current pregnancy, I'd had bleeding early on so I was more leery of stopping it cold turkey (I was on an increased dose from my previous pregnancies as well) so I started weaning myself off of it at 13 weeks and was totally done at 14 weeks.

 

[Rhapsodi]

I have a luteal phase defect which is low progesterone. (Dr think possible endo not pcos). Anyways I take 200mg progesterone suppositories peak plus 3 through peak plus 12. Then usually 2 days later AF comes. However this last cycle AF never came. So I tested almost a week after I was due and it was positive. I was off progesterone (went back to 200mg/day) almost a week. I was ok. I did have bleeding a few days later when I tested levels (I was off meds for 24hours). I am now up to 800mg a day. Bleeding never was explained but could have been from low progesterone.

There are ways to test but you should be ok to stop. I would see if they would test a few days after you stop. I would see if you have a NaPro dr near you. (They are world wide just google to find a locator). These Drs are highly specialized in hormones.

 

[EarthMama]

There is nothing wrong with continuing vitex through the first trimester. Disclaimers to discontinue are for liability purposes. Vitex has traditionally been used to help prevent miscarriage. I continued with vitex and my baby is perfect at 21 weeks according to my recent anatomy scan! What I did was I just reduced my dosage slowly from the time I got my bfp until about 16 weeks. Hope that helps!

 

[Wtbam]

THank you! Im definately going to reduce the vitex dose slowly.

I am trying not to be concerned about this progesterone issue. I have never been tested or had symptoms of a progesterone deficiency, although I was never looking out for it. The only thing that makes me wonder If I do is that for 3 days after ovulatiom I had no temp rise (it only rose when ii started taking the norethisterone).

The dr advised me to taper it off, sp 2 a day for a week, then 1 a day for week. I know everyone says stop temping when you get your bfp but should I carry on to see if my temp is dropping? If I find I have deficiency, will I have time to correct it while I am tapering off?

 

[nduati]

I would just continue taking it until 14 weeks. it cant hurt the baby. but i would be scared to come off it suddenly and induce a loss.

 

[SmallBear]

I'm really surprised the doc said this has no purpose when you're pregnant. Look it up -- so many good studies showing better outcomes for women with PCOS when we stay on the Metformin.