Tuesday, June 12, 2012

Progesterone Therapy

I had a reader ask me recently about how my doctor is using progesterone to help my cycle and PCOS. I knew it would turn into a combox novel, so I thought I would address it in a post. Since not all my readers use Creighton, or even NFP, or know the ins and outs of PCOS (lucky!) I am going to try to break it down into laymen's terms. And I'm not a doctor or an NFP expert, so feel free to correct me if I get something wrong (here's looking at you, Katie!).

PCOS causes me to have a very long cycle... as in, I've had cycles in the past that were many, many months long (the one I remember most was 7 months long). After I started taking better care of myself, my cycles since I started NFP have been right about 45 days long. The good news was that they are fairly consistent and the bad news is that they are long and my doctor thinks I haven't ovulated most of those cycles. There is one that looks hopeful, but a few that don't. So there were a few goals.... 1) to shorten my cycle to a more normal length, 2) to get me ovulating, and 3) to balance my hormones (which I know are unbalanced because I have signs that appear fertile all month, where most people just have them when they actually are fertile).

He obviously had to do something in line with church teaching, and I am SO THANKFUL for being done with the days when doctors shove me back on the pill, which only masks the issue and does absolutely nothing to help. Anyway, for someone charting, they know then their peak day is, which is the day they ovulate. So he would normally look at my chart, see my peak day, and order blood work on certain days which would tell him if I actually ovulated and what my hormonal balance was those specific days. But it seems that I've been having "ovulatory events" which look like ovulation, but aren't necessarily. It's my body trying her darndest to get an egg out! Because of this, he can't really do any testing or treatment on certain days based on my chart, because we don't really know if/when my peak day is happening. So instead, he opted to treat me with progesterone on day 18, 21, and 24 for a few cycles. This is pre-peak (pre-ovulation/ pre ovulatory event) for me due to my long cycles, but he said that it should lessen the length of my cycles and hopefully get me ovulating by balancing out my hormones (this is the part I'm a bit iffy on and probably grossly paraphrasing).

So cycle one of the treatment I got the injection on day 18, 21, and 24. About 4-5 days later I started a period which I'm guessing was a withdrawal from the progesterone. So then I went back on day 18 of cycle two of the treatment and he said we would do another month, but that he already saw improvement because my cycle was about 32 days instead of my typical 45. Note when I say "about", that doesn't mean I don't know; it means that I'm too lazy to go upstairs and get my chart. So I had my three injections again, but this time something was different. This time, I had an ovulatory event while still on the progesterone, which he said was possible (at first I thought there was no way I would ovulate because normally you don't have progesterone in your body until AFTER you ovulate, so I thought it would suppress any attempt). But he said I could spontaneously ovulate, and that's what I'm hoping happened. PLUS this was a 29 day cycle, which is even better than the last one!

At some point, he will change my injections to be after my peak day instead of doing them pre peak.. once he is comfortable that I am having a peak day and identifying it. I'm hoping this cycle brings me closer to that goal! Then he can do the post peak blood work to find out if I in fact am ovulating and how my hormone levels are. It's funny that no one seems to have heard of treating someone pre-peak with progesterone injections. I will admit that, because of that, I was extremely skeptical. But so far so good! I will keep you updated!

Some helpful info about progesterone:
Bioidentical progesterone is best. It has less side effects and is absorbed better into your body But it's also the most expensive and my doctor has yet to see an insurance cover it. It was a bit of a shock to us, though it's worth it.

It hurts like a mother anywhere but your hip/butt area. Even then, a firm rubbing on the injection spot afterward is helpful to dissipate the oil that is injected and will otherwise form a painful lump. Note: rubbing the injection spot in the parking lot in your car is frowned upon. Ask me how I know.

You've got to have a bit of a flexible schedule because the injections have to be done on certain days. But if I can do it with a job and a dr who is an hour drive away, so can you!


  1. Thanks for all of this detail. Like you, I questioned the progesterone pre-ovulation, but it sounds like your dr. knows what he is doing and is watching you closely.

    Prayers that this all works well for you!

    (I think I've asked you this before, please excuse my forgetful self, but do you also have insulin resistance and/or take metformin?)

  2. Oh, and your wedding dress is awesome!

  3. Oh I love progesterone! I had injections for the first 20 weeks of my pregnancies... ouch. Sounds like you have a really good doctor.