Progesterone Supplements (oral & vaginal)

Most of this was taken from an excellent blog that I stumbled across. Many thanks to the Stirrup Queen for compiling this information... as a writer I am flattered by imitation, so in my utmost belief that most of the world thinks exactly as I do (or should, anyhow), I am sure she is happy that I have endured to copy her work.... right?

Why would you be taking progesterone supplements?

There are a few reasons you might be taking progesterone supplements, which can be delivered orally, through vaginal suppositories, or via intramuscular injection (commonly referred to as PIO).

Some examples:

(1) You have low progesterone levels. This is usually diagnosed by having a blood test done 7 days post-ovulation.

(2) You have a short luteal phase regardless of the results of the 7 dpo progesterone results. I believe that any luteal phase less than 12 days is considered short.

(3) Even if your progesterone level and luteal phase are fine, if you are doing IVF (and depending on the RE, IUI) you will probably be prescribed progesterone supplements. Taking the supplement just covers your bases.

Why would you take them orally or vaginally?

The oral supplement is definitely the least invasive way to do the job if it works for you. However, when you take progesterone (or apparently any hormone) orally, it must be metabolized by the liver, which makes the delivery system inefficient and less effective.

As for vaginal supplements versus injections, for most women, there seems to be no difference in the results. Many clinics use the suppositories because they feel after all the pre-procedure injections they just don’t want to prescribe more injections. Some clinics state that when they switched to suppositories their pregnancy rates increased. However, there does seem to be evidence that some women have a better response with the injections.

What to expect:

You can expect to take the supplements until you take your beta. If it is negative, you will stop and your period will arrive. If it is positive, you will continue taking the supplements for at least a few more weeks and possibly through the entire first trimester. If you are having blood tests done after insemination or transfer and are using vaginal supplements, your blood tests may not reflect high progesterone levels. Do not freak out if your level seems low compared to your friend doing injections. The vaginal suppositories are not systemic- all the progesterone stays right around your uterus and does not show up in blood tests. That doesn’t mean it isn’t there.

The common oral supplement is prometrium. If you are taking this, expect to feel tired… fast. Twenty minutes after taking this you may feel dead to the world.

There are two vaginal forms:

suppository (yellow pill--see picture)
suspended in gel (white bullet-like pill--see picture)

The suppositories can be either prometrium (yes, the exact same pill you can take orally) or they can be pharmacy compounded. Not all pharmacies have the capabilities to compound these suppositories. I have read that it doesn’t matter if you use prometrium or pharmacy compounded. Whether you use prometrium or the compound suppositories, your dose will typically be 2 to 3 times per day.

Expect to feel like you have constantly wet your pants. The prometrium is like a vitamin E--a softish gel capsule. Prometrium is much less oozy--one or two pantyliners a day should cover you just fine. You may notice some of the yellowish coating on your pantyliner. Gross, but normal. Prometrium can be kept at room temperature. The pharmacy compounded suppositories are very oozy. These need to be kept cold or they will melt. When you take it out of the wrapper, it feels kind of waxy. But if you let it rest in your hand, the surface feels slick and oily. This is only the outer coating--if you look at the non-pointy end, you can see there is white goo inside the waxy shell. You may notice some of the disintegrated shell on your panty liner amongst the ooze. Also gross, but also normal. The suspended in gel supplement (Crinone and similar products) comes in a pre-filled applicator (the pharmacy will give you an applicator for taking the prometrium vaginally but using your finger may be more comfy and is easier to wash.). You might see some of the suspension gel ooze out.

With all of these supplements, you may feel some bloating. They also cause me to have to pee a lot--especially in the middle of the night.