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.
Thank you for your response. Could you further explain why progesterone tablets are classified as a Class X medication? From what I've been told, it was completey safe to take because the body naturally produces progesterone when pregnant. (These tablets are a natural form of progesterone, not a chemically derived medication.)
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.
What I know of Progesterone in pregnancy is that it is essentially unsafe due to the changes it can cause in the lining of the uterus (endometrium) and relaxation of the muscle of the uterus. These changes may increase the risk of miscarriage.
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.
Dear Dr. Tomasello,
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.
I really thought I might have been missing something, but recently met with two of my colleagues (one family physician and one OB/GYN, who both agreed that whether it be "synthetic" or "natural" progesterone, it could in fact increase the risk of miscarriage. Neither of them used it during pregnancy and one doctor was shocked that anyone would consider using it. Whenever I am not absolutely sure, I consult with other doctors. In this situation you have 3 doctors who are all in agreement with my original post/reply to the question.
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.
1. Please let me respectfully correct your misinformation....Natural Progesterone (i.e., Prometrium, vaginal suppositories, progesterone in oil injections) is a Category B drug in Pregnancy, not a category X.
2. Progesterone taken in pregnancy due to hormonal deficiency (luteal phase defect and also IVF)..... A. http://www.fertilethoughts.net/faq/ivfphoenix/pregloss.htm
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.
I (we) stand corrected.
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 was taken.
I have looked into the links you mention. I really appreciate your posts here and thank you very much for your input.
Dean M. Tomasello, M.D.
I was put on a course of progesterone during each of my two pregnancies (1987 & 1989) for the 1st trimester until the doctor could hear the embryo's heartbeat each time, to prevent a miscarriage (since with my endometriosis I was at risk of miscarrying). Both pregnancies were totally normal & I gave birth to two very healthy full-term children. My OB/GYN normally has his high risk of miscarrying patients take progesterone in the 1st trimester until he can hear the embryo's heartbeat. (He also only allows us to fly--on airplanes--during the middle trimester of pregnancy to minimize risk of miscarrying.)
Hope this is helpful & reassuring (though its only annecdotal).
Starion--thriving in HI
I am not on here to agree or to disagree with anyone but I made the mistake of listening to one of my doctors and did take progesterone during pregnancy and I miscarried 4 times before they realized what was causing it. I'm sure there are alot of people out there that have and still do take that medication with no problems and I'm greatful that they have successfully carried their babies to term with no complications but in refrence to your input to the young lady who was spotting I do think it is important to let people know that it is very true that the FDA does not approve of this drug and I am the very proof as to why they dont. It is not safe. I have 4 dead fetu's becuase of the unsafeness of this drug during pregnacy and the very fact that patients and doctor's either aren't aware or just don't care of the harm that it is capable of is very sad. I think that more information should begiven to doctor's and patient's when a medication is prescribed. Just because a doctor hands you a presciption and says here take this does not mean you have too. You as a patient have a right and a responsibility to yourself and your unborn child to research what it is that you are putting in your body before you ingest it to make sure that it is safe for all concerned. You can't always trust what your doctor say. No offense Doctor, but they either aren't always truthful, or they simply aren't always fully informed about what it is they are giving you and the risks that it poses to you and your baby. Thats all I am saying. With all do respect to everyone who has posted a comment and the doctors too, I value all your opinoins very much and think all of you make very valid points, but I just think that we all need to take more responsibility to know what it is we are putting in our bodies. I have taken this drug and payed dearly for it. It is not safe for pregnat women. It is not safe for unborn children. I have for children lost not here with me today because of it. No one can tell me otherwise. That's all Im saying. Thanks. Godd Luck to the girl who was spotting. I hope your pregnacy goes well and you have a healthy happy baby. May God Bless you all.
Thank you for your feedback.
This post has troubled me a bit. And without a doubt it is controversial. Personally, I would never prescribe this medication to a pregnant woman, and as I mentioned above, my two colleagues (one a FP who delivers about 100 babies/year and another who is an Ob/Gyn who delivers 300 babies/year) agree that this is not what one would consider to be "safe" to take during pregnancy. That is my opinion. I would not prescribe it.
Dear Dr. Tomasello,
Granted, I had a very high Risk Pregnancy History including pre-eclampsi, Eclampsi, HELLP Syndrome, Concealed Placental Abrubtion resulting in Neonatal Death of my infant Daughter and Gestational Diabetes, Pre-term Labor in addition my 4 year old son was a twin and I lost his twin at 7 weeks of gestation and the sac did not expell itself which then I had to worry about that but for 100% fact those other 4 miscarriages where proven without a boubt to be caused from this medication. I had to be seen for my other pregnancies by a perinatologist in Lexington KY out of UK Hospital by the name Of John O'Brien. You may of heard of him. He was in the news paer a few years ago for developing a way to allow a fetus to be carried longer after the membranes rupture early on in gestation. Anyway the doctor who gave me this medication was in FLA when I lived there and it was a real mess so I just wanted to tell you that I supported you and your opinion and feel that you are correct in your comment. Thanks for your input and please continue with this website because I really feel that it gives me and so many other people a chance to hear anothers side of things. Thanks so much for your expertese and Good Luck.
Dear Dr. Tomasello,
I still agree with you on the safety factor of this medication, but for your records and the records of your colleagues, I thought this website might be of intrest to you if you have not seen it before. Go to http://www.perinatology.com/exposures/druglist.htm then when it comes up there will be a small window in the center with a list of medications in it. Just scroll down it until you see Progesterone. When you do just click on it and go from there. I hope that helps you out some. Again, I still agree with you but I was shocked when I read this and I think you may be as well. Let me know if we all stand corrected. Thanks Once again for you time and Input.
I just had IVF done, and I was injecting 1cc Progesterone in oil intramuscularly every night for over two weeks. I had apparently a chemical pregnancy-ie had noticable hcg levels on Day 11 after implantation then they lowered on Day 15. At that time doctor said to go off of progesterone and I will start my period. When should I start my period?
I am by all means not a medical specialist. But I've had my share of problems during pregnancy. I always suffer from Hyperemisis and usually end up hospitalized. Fortunately my first pregnancy turned out okay and I had a health baby. I had Hyperemisis with my second pregnancy and it ended up in a miscarriage. I just found out that I am pregnant about 4 days ago. My Dr confirmed my pregnancy with a blood test. And she also checked my progestrone level. It was a little low and she put me on a progestrone suppository.
It is my understanding that it's very normal to check progestrone level during pregnancy and regulate it if it's low. Several of my friends have had to use it as well. I know the big factor with me is that the Dr is concerned about another miscarriage. So if anything....progestrone would help prevent it....not cause it.
Perhaps (like the post above said) there is a confunsion between natural and synthetic progestrone.
I was reading about progesterone usage during pregnancy and would like to comment...starting in 1974 I began getting pregnant and miscarrying within the first 3 months. Finally in 1982 I was diagnosed (after biopsy and other testing) to have inadequate corpus luteum, or, lack of progesterone. Under the guidance of my doctor, and infertility and problem pregnancy specialist, I monitored my ovulation, became pregnant and immediately (within 2 weeks) was able to report this to the doctor. I was given progesterone injections every other day until a pharmacist was able, with the help of Shands in Gainesville, Fl, to create progesterone suppositories for me. I used the suppositories until the 4th month of my prenancy and carried, with no complications, to term. I had a very healthy boy in 1983 and then following the same proceedures, had a second very healthy boy in 1985. My boys are now 19 and 16 and perfectly normal and healthy. In my case, progesterone was not the cause of miscarriage. The lack of progesterone was the culprit and taking progesterone enabled me to carry my babies to term. I had a total of 5 miscarriages until I was finally correctly diagnosed and helped.
I am so shocked and worried after I read your comments. I am 14 weeks pregnant and have been taking progesterone (Prometrium)100 mg. The reason my doctor gave me this is because my temeprature dropped sharply (0.4 F) about a month into my pregnancy. Since I had one miscarriage a year ago, that send me into panic and I called the doctor and got the prescription.
I am going to stop the pill right now but I am really worried if I had hurt the baby in any way. You mentioned that it could cause miscarriage, but so far I am doing very well. I just had ultrasound a few days ago and everything looked good. But do you think there's any other risk associated with the pill besides causing miscarriage?
The only slight risk of progesterone during pregnancy is a rare side effect of cleft palate - says so on every prescription I have ever had. And I've had to have progesterone supplementation for every successful pregnancy I've had (3). It does not increase the chances of miscarriage. If you are going to miscarry, it can keep you from expelling the tissue naturally, or prolonging the process, but it will NOT cause you to miscarry. You must have enough progesterone to carry a baby successfully. My body does not create enough during pregnancy, so I have to supplement with Prometrium. I would not go to a doctor that would not prescribe this medication, because I would then be childless.
Wow I must say reading the different opinions on progesterone are quite scary. I am 39 and I started to notice a brown discharge at the time my period was due. It turned out I am pregnant. June 7 was my last period. At 6 weeks into my pregnancy I sat up in bed and felt a gush of liquid. Immediately I went to the bathroom and was bleeding bright red. I called my OBGYN and he immediately calmed me down and told me to get in bed and make sure I was not soaking a pad every hour. I wasn't soaking a pad at all after the initial gush the bleeding subsided. I then passed a large clot which I assumed was the miscarriage happening. I had no pain though. I continued to rest and stay off my feet. This was Saturday. Sunday my Dr. called to check on me and said he will see me Monday. He felt sure I had a miscarriage also. Well to my surprise on Monday during the sonogram there was the heartbeat of my baby. I could not believe it. It was like a miracle because I was sure I had a miscarriage. That day he prescribed progesterone suppositories 2x a day. He also noticed some blood still in my uterus very close to the baby. On Thursday that same week I went back for another sonogram. The blood moved away from the sac and the baby grew a whole lot bigger than Monday it was so amazing to see this.Only 4 days went by and wow how big. He said continue the suppositories and I will see you in 1 week. I was also told COMPLETE BEDREST only get up to go to the bathroom from the day the suppositories were prescribed. I am interested in any others who have had these symptoms and what happened. I feel like celebrating the pregnancy but I just can't seem to be happy because of everything happening. Maybe Thursday my Dr will tell me it is ok to get out of bed then I will maybe feel more normal being pregnant this time. Any comments are very appreciated. Good luck to all
Sincerely Christina mom of a 4 year old and 1 on the way : )
I am experiencing the exact same symptoms. I have a 10 yr old daughter born healthy when i was 17. I am now 27 and have had 6 early pregnancy losses. I have been working closly with a specialist and recently found out we are pregnant. He put me on Progestrim a natural tablet form of Progesterone. A few days after taking it I started noticing brown spotting and called my doctor right away, he assured me eveything was fine. The bleeding stopped, but a day or two later i woke up to bright red blood. It continued for a few minutes and I passed some tissue or a clot, I was sure I was loosing the baby. The bleeding stopped. I took myself to the hospital and was told by ultasound everything was fine. However my cervix is filled with brown blood that isnt really going anywhere or very slowly at that. I have no heartbeat to go by, I wish I was ferther along so I had that security, However being only three weeks along Im uncertain. Reading everything I have about this stuff and noticing all these thing after taking it i wonder. I am praying for a healthy baby. My daughter wants a sibling so bad, and my husband and I are ready for a new addition. This pregnancy came two weeks before our booked IVF appointment. Really cant handle anymore to my body mind or soul. Its frustrating wanting something so bad, and just being able to wait.
Sincerely Hopefully Waiting
Just wanted to correct my spelling so no one gets confused. The doc put me on Prometrium.
If anyone else has had a good experience with this drug please give me hope.
I am sorry for all you are going through. I know it is hard. First of all it is excellent you are seeing a specialist. You will be watched very carefully so that is a good thing. I must say my gyno is excellent and he is watching me very closely also. I hope you will soon see the heartbeat and feel alittle better because the stress alone is awful. We must relax and pray for everything to go well. I know the brown is old blood which I still have also and I am wondering why too. They don;t tell us much I guess to keep us calm but then we go to sites and get more nervous. Anyhow, Just try to relax and stay in bed as much as you can. Keep me updated. When is your next appt for a sonogram? I go tomorrow I hope that your daughter helps you my son is 4 and is so wonderful I must say I am lucky but I do send him to grandmas for a few days every week since all this just for some real relaxation and really staying in my bed because I must say that staying in bed is the best thing. My Dr. saw a huge difference just in 4 days. So far I am lucky but I still am prepared for the worst. Good luck to you I hope everything works out. You are young just stay healthy and all will work out for you. Sincerely, Christina
Thanks for responding so quickly. I have an appointment today, and I hope everything will be fine. After having quite a few early pregnancy losses in the oast has me prepared for the worst. What I dont understand is that I took a home pregnancy test on the 16th of July and it came back positive however all of the doctors urin test even now are comming back negative. Blood work and ultrasounds have proven I am pregnant. I thought I was at least three to four weeks, but over the past three weeks , and three ultrasounds later there hasnt been much embryotic growth. I am worried about that. The doctor sais I may only be a few weeks along, but still it does not make sence. The other thing I worry about is that when I went to the hospital, they said I was full of old blood but dont understand why its not comming out or very slowly at that. I hope all the blood is not harming the embryo. I hope and pray but am prepared that I may never experience the joys of a full term pregnancy again and may need to look into getting someone else to carry it for us. As a woman especially at 26 told she cannot have children is heartrenching. I have a history of Cervical Cancer after my daughter was born which was treated, Endometriosis, which has been fixed, and I have a flipped and contorted cervix which has to make it hard for me to hold a pregnancy. I hope this stuff works for me. Thank you for your support and prayer. I hope all goes well and look forward to talking with you soon.
Wow You have been through so much you deserve to be given some really good news. I had a very early sonogram too and what we saw was the small sac with nothing in it. That was several weeks ago and obviously way too soon but now we hear the heartbeat and see a growing baby but I was put on bedrest because of the sudden bleeding so I am still worried plus I am using the progesterone 2x a day. I am also an old lady lol. I am considered high risk because of my age and I am a smoker. Hopefully for you today you will get some answers and feel better. When you were pregnant with your daughter how did that pregnancy go? Did you carry full term? Well I hope to hear from you and you get good news. You deserve good news.
Yeah I have been through hell and back a few times. When I was pregnant with my daughter everything was fine. I had an awsome pregnancy, full term baby and an all natural birth. However my current husband is not her father and the problems started when we wanted to have children. He has a low and abnormal sperm count and I have my issues, which makes it hard to get pregnant, but when we do I cant seem to carry. We have had our chromo's tested everything is fine there, we havent been given many answers. I am glad I prepared myself for the worst because I didnt get good news yesterday. You would think after 6 of them it would get easier but I was a wreck yesterday. Doc said to keep trying and he is sure I will eventually carry full term. I am sceptical however. We are back on our vitamins and other junk so hopefully we will be pregnant again soon. I thought at 26 I was running out of time but you have given me hope. It's just that my daughter is already turning 10 and we have been trying for 7 years and the age gap is huge. I dont want to be raising young children for the next twenty years. She is at an age where I am slowly starting to enjoy myself again and having her at such a young age I expected to be done by now so I could enjoy my 40's. Oh well, life goes on, we'll keep trying and keep you posted. Thank you for all your support, and good luck with everything, keep in touch.