Progesterone Absorption

[jacey430]

I am 6w4d pregnant... third pregnancy after two m/c's in the first trimesters... and I am concerned about my progesterone levels.  My initial labs showed a progesterone level of 15.5, and my hcg more than doubled.  My OB prescribed Prometrium 200mg, saying he wanted the progesterone level >20.  My concern is his refusal to check my progesterone level after taking the Prometrium.  He says the results would not matter, as he would not prescribe any additional progesterone, saying the body "can only absorb so much."  

I have a friend whose OB tested her progesterone, and prescribed 200mg Prometrium for a level of 8.  This increased to 18, so he prescribed an additional 100mg.  Her level subsequently rose to >60, at which point she became extremely symptomatic (i.e. nausea, etc.)  He decreased her dosage back to 200mg, and her level fell back down to 39.  This seems to conflict w/ my doctor's theory that raising the dosage above 200mg will not increase your levels.

Should I accept this answer, or find a doctor willing to monitor my levels more closely?  If I miscarry due to low progesterone levels after accepting this answer, I would feel a great amount of guilt.

Thanks,

Jacey

[Elaine Brown, MD]

Hi!
My daughter's name is Jacey!  I wish you all the best!
A progesterone level of 15 is consistent with a viable pregnancy, so, that is good.
There is no set level that we aim for when we supplement, and there are a lot of different opinions about what to use, my RE didn't believe that Prometrium would work, so I got daily shots--ouch.  If you were my patient, I would probably re-check the progesterone level, for both of ours peace-of-mind.  I would also ultrasound you as soon as you reached 7 weeks.  Progesterone supplements can prevent a non-viable pregnancy from ending and prolong the agony.
Basically what I am saying is that I would probably do the test, but I am not sure what I would do with the results because there is no standard range to shoot for.  The good news either way is that at about 7 weeks the placenta kicks in and starts to produce progesterone by the gallon ( OK so I'm exaggerating a bit), but your levels should go way up naturally without the need for a lot of medication if the pregnancy is healthy.
I certainly hope that you take home a baby this time!
Good luck!
Dr B

[rebekah385]

My third pregnancy I had a miscarriage at 3 months, the doctor says that the baby did not implant right. I went back on birth control that week, but within six weeks after my miscarriage I was pregnant again ( the DR told me birthcontrol is not as effect after a miscarriage, because you are more furtile). Because of the miscarriage and how soon i became pregnant again my doctor put me on the same medication, but did retest later and my level was fine. I carried the baby to term and had a healthy baby. Your doctor probably knows what he is talking about, but its your body and your baby if you want it checked again your doctor should be willing to recheck it maybe you should tell him how important it is too you if he still won't listen and you still have those feeling maybe you should see another Dr for a second opinion, also if he won't listen to you on something little like this how is he going to be when your in labor?