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Family Medicine (Expert Forum)
Spotting During Pregnancy while using Progesterone
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Spotting During Pregnancy while using Progesterone
by Julz, Jan 06, 2002 12:00AM
I started using progesterone cream in Oct. 2001 for controlling PMS. It was not very effective and was switched to 200mg progesteron tabs, twice daily, to begin in Dec. However, because my husband and I were also trying to conceive, was told to wait to begin the progesterone after ovulation to avoid problems with the egg releasing. Last period was 11-21-01.
About 1 week after ovulation, approximately 12-14-01, and before starting the progesterone tabs, I had streaky,pinkish spotting. My doctor said it could either be due to egg implantaion or due to not using the progesterone yet which had been used in the cream form the 2 previous months.
After starting the progest. tabs twice a day as directed, the spotting tapered to nothing within 5 days. Then over Christmas, twice, I forgot to take a tablet in the evening then resumed the regular dosage. During this time, I also took a home pregnancy test and it was positive!
Two days later, 1-1-02, I had pink spotting again. It has continued for 6 days, turning brown when my doctor suggested taking one tab, then turning pink again when doctor suggested taking two again. I also had sharp shooting pains in my lower abdomen but have diminished to almost none now, 1-6-02.
I was on bed rest for 3 days then doctor said it was okay to get up and get back to normal routine. The spotting seems to remain pretty consistent whether I'm on bed rest or up moving around.
The doctor did find a urinary tract infection and has put me on 500 mg of amoxicillin and thought the infection could be causing irritation to my uterus.
A sonongram was done 1-2-02, but it was too earlier to see anything but it did not appear there were any cysts or fibroids. On 1-03-02, a blood test confirmed a pregnancy.
In conclusion, I'm taking 2, 200mg of progesterone while pregnant and having spotting. Can see small pieces of pinkish tissue in toilet after using bathroom.
I've have one normal pregancy, 4 years ago, with no miscarriages to my knowledge. Is the spotting due to the fluctuation in the progesterone, and am I possibly getting too much progesterone? Or, am I working on a miscarriage? The doctor did blood work on 1-4-02, but I have not heard the results as of yet.
I wished I would not have started taking this progesterone with all the problems I've had. Your input would be greatly appreciated. Also, should I be seeing a doctor specializing in high risk preganancy?
About 1 week after ovulation, approximately 12-14-01, and before starting the progesterone tabs, I had streaky,pinkish spotting. My doctor said it could either be due to egg implantaion or due to not using the progesterone yet which had been used in the cream form the 2 previous months.
After starting the progest. tabs twice a day as directed, the spotting tapered to nothing within 5 days. Then over Christmas, twice, I forgot to take a tablet in the evening then resumed the regular dosage. During this time, I also took a home pregnancy test and it was positive!
Two days later, 1-1-02, I had pink spotting again. It has continued for 6 days, turning brown when my doctor suggested taking one tab, then turning pink again when doctor suggested taking two again. I also had sharp shooting pains in my lower abdomen but have diminished to almost none now, 1-6-02.
I was on bed rest for 3 days then doctor said it was okay to get up and get back to normal routine. The spotting seems to remain pretty consistent whether I'm on bed rest or up moving around.
The doctor did find a urinary tract infection and has put me on 500 mg of amoxicillin and thought the infection could be causing irritation to my uterus.
A sonongram was done 1-2-02, but it was too earlier to see anything but it did not appear there were any cysts or fibroids. On 1-03-02, a blood test confirmed a pregnancy.
In conclusion, I'm taking 2, 200mg of progesterone while pregnant and having spotting. Can see small pieces of pinkish tissue in toilet after using bathroom.
I've have one normal pregancy, 4 years ago, with no miscarriages to my knowledge. Is the spotting due to the fluctuation in the progesterone, and am I possibly getting too much progesterone? Or, am I working on a miscarriage? The doctor did blood work on 1-4-02, but I have not heard the results as of yet.
I wished I would not have started taking this progesterone with all the problems I've had. Your input would be greatly appreciated. Also, should I be seeing a doctor specializing in high risk preganancy?
Doctor's Answer
by Forum-M.D.-DT, Jan 07, 2002 12:00AM
Thank you for visiting the family practice forum.
What you describe to me is of GREAT concern. Let me explain why.
Firstly, I am uncertain why your doctor would allow you to take progesterone tablets while pregnant. Progesterone is classified as "Category X" which is defined as "Medication is HIGHLY UNSAFE to take during pregnancy, risk of use outweighs any possible benefit." (This "risk" here is essentially an increased chance of miscarriage).
It is my opinion that taking progesterone while pregnant will increase the risk of miscarriage. If you have a urinary tract infection, this may explain seeing some "redness" in the toilet after urination, however, if there is actual tissue present this may be coming from the vaginal area.
If you came to my office with the history you just described, I would tell you that it sounds like you are pregnant and MAY be having a miscarriage. I would recommend stopping the Progesterone as it is classified as "Category X" and should not be taken during pregnancy. Unfortunately, there is little you can do to prevent miscarriage at this stage (first trimester). If you doctor has told you that you have a urinary tract infection, I would continue the use of the antibiotic presribed (provided you are not allergic to it of course).
I really hope things go well with your pregnancy. At this point I wouldn't necessarily consider you to be a "high-risk" patient. You should have another ultrasound in about 6 weeks to see how things are progressing. If there are problems identified with the pregnancy, you may consider seeing a OB/Gyn specializing in high-risk pregnancy.
I wish you well.
Dean M. Tomasello, M.D.
What you describe to me is of GREAT concern. Let me explain why.
Firstly, I am uncertain why your doctor would allow you to take progesterone tablets while pregnant. Progesterone is classified as "Category X" which is defined as "Medication is HIGHLY UNSAFE to take during pregnancy, risk of use outweighs any possible benefit." (This "risk" here is essentially an increased chance of miscarriage).
It is my opinion that taking progesterone while pregnant will increase the risk of miscarriage. If you have a urinary tract infection, this may explain seeing some "redness" in the toilet after urination, however, if there is actual tissue present this may be coming from the vaginal area.
If you came to my office with the history you just described, I would tell you that it sounds like you are pregnant and MAY be having a miscarriage. I would recommend stopping the Progesterone as it is classified as "Category X" and should not be taken during pregnancy. Unfortunately, there is little you can do to prevent miscarriage at this stage (first trimester). If you doctor has told you that you have a urinary tract infection, I would continue the use of the antibiotic presribed (provided you are not allergic to it of course).
I really hope things go well with your pregnancy. At this point I wouldn't necessarily consider you to be a "high-risk" patient. You should have another ultrasound in about 6 weeks to see how things are progressing. If there are problems identified with the pregnancy, you may consider seeing a OB/Gyn specializing in high-risk pregnancy.
I wish you well.
Dean M. Tomasello, M.D.
The advise I have been given is to not stop taking the progesterone now that I've been using it because it will cause a drop in the progesterone level and increase the chance of a miscarriage.
Right now, I'm pretty confused and concerned. It's hard to get excited about this pregnancy with everything that has been happening. One of my main concerns is that all of this may cause developmental problems with baby and I would always feel guilty for taking the progesterone.
I guess I wasn't to concerned when I started using the progesterone because I had read and was told that many women are actually prescribed progesterone to maintain/keep a pregnancy.
Perhaps I am missing something here. What I do in this forum is share my experience and help to answer questions of visitors to the forum based on my knowledge and experience.
The FDA has never approved the use of progesterone in pregnancy.
The best plan for you is to speak with your doctor about these issues further and see what he/she has to say about the fact that the FDA does not approve the use of progesterone in pregnancy and that Progesterone is considered "Category X" for use in pregnancy.
You are indeed missing something here. Natural progesterone is extremely safe during pregnancy, and ALOT of OB's and RE's prescribe it for thier patients... *especialy* if there is a threat of a miscarriage. To have this women stop taking this natural progesterone she is taking, may actually *cause* her an early pregnancy loss. Synthetic progesterone is NOT safe in pregnancy, perhaps you have gotten the two confused. We are all human, and people tend to forget that about doctors... as they make mistakes too. I do hope this women reads my post or does indeed concur with her own private doctor before she digests your wrong, but well meaning, information that you have provided.
-Rebecca
I appreciate your input. I encourage all visitors to share what their experience/training is. Based on the experience of the individuals and what has been posted, visitors can draw their own conclusions.
I would be interested in hearing your side of this. You have 3 board certified physicians with a combined total of 30 years clinical experience who do not feel it is safe, and may increase the chance of miscarriage.
Thanks again for your input.
Dean M. Tomasello, M.D.
2. Progesterone taken in pregnancy due to hormonal deficiency (luteal phase defect and also IVF)..... A. http://www.fertilethoughts.net/faq/ivfphoenix/pregloss.htm
B. http://www.lvpa.com/articles/lutheal.html
3. Go to www.obgyn.net... type in PROGESTERONE SUPPLEMENTATION and select "all messages that have all keywords" and then... happy reading : )
4. Of course one can also do a simple google.com search, or better yet phone an RE or more ob/gyns. You may be surprised and more informed of the tremendous benefits that progesterone supplementation in pregnancy may provide. After all, a good majority of pregnancies without adequate progesterone will sadly fail.
5. I do hope this has helped, and in no way, shape or form am I providing this information for arguments sake... just enlightenment, and learning is a forever ongoing process. Thank you for asking me for more input, and allowing me to share it.
Sincerely,
Rebecca Frech
In my 10 years of clinical experience I had not heard of this being used in pregnancy and my colleagues had not either.
My priority here, as with treating patients in my practice is to keep with the hippocratic oath of to "first do no harm". I was worried about the potential for problems with using progesterone in pregnancy, particularly since this young lady was "spotting" at the time the medication