P is for progesterone

After my second miscarriage, I was finally able to start taking the progesterone tablets I had been prescribed.

I found it helpful to wait a couple of months before trying again to regain a bit of equilibrium and then went for it, feeling strangely vindicated by my second miscarriage – I wanted to shout, ‘SEE I WAS RIGHT, THERE IS AN ISSUE – I’M NOT A DELUSIONAL FREAK!’

The tablets I took were called Utrogestan, normally used as part of HRT therapy; consequently the instruction leaflet makes no reference to how to take the tablets in relation to assisting fertility, rendering it useless. You just have to remember the advice you are given on how to take them differently.

To take the tablets at the correct time, I needed to make sure I had ovulated, as you need to start each course just after this and take the tablets right up until you have your next period or, if you become pregnant, through until the end of the first trimester.

As I had already been charting my cycles, I used my basal body temperature readings (which rise after ovulation) combined with ovulation testing kits to ascertain when I had ovulated. You do end up feeling like your life is made up of either shoving a thermometer in your mouth or endlessly weeing on a stick, but you get used to it.

Once I was sure I had ovulated, I began taking the progesterone tablets, one 200mg tablet in the morning and one 200mg tablet in the evening.

After a couple of months, it was clear that the progesterone was significantly lengthening my luteal phase, up from around 8-9 days beforehand to 11-12 days.

The debate about whether progesterone works or not can be very frustrating to women going through problems with miscarriage and infertility. Many doctors do not believe it has any effect and I was very lucky to be able to get someone to take me seriously. It was doubly frustrating to speak to women from my mum’s generation, who back in the 70s received progesterone injections, yet here we were in the 21st century and it seemed we had moved backwards in allowing women access to information and resources to deal with low progesterone.

During IVF treatments, women are routinely given progesterone to support their efforts, which seems to be all back to front to me, treating the symptom rather than the underlying cause.

That is why the PROMISE trial is also disheartening. The five-year trial has shown there is no better outcome for women with unexplained recurrent miscarriage taking progesterone than those who don’t but the key here is that the underlying cause is unexplained. So it’s back to a one size fits all mentality, without pinpointing whether the progesterone is in fact the issue.

I know that progesterone worked to lengthen my luteal phase because I could document that and I was specifically using it for that reason. Once my luteal phase was lengthened, I knew that my pregnancy outcome would be significantly improved because the longer luteal phase and increased progesterone meant the lining of the womb was likely to be much healthier and more able to support a growing embryo. And that had to be a good thing.



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