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  • Anna Murphy, FCP

The Deal With Progesterone, Part II

In an earlier post, we discussed what progesterone is and why’s it’s important throughout your cycle. Symptoms of progesterone dysfunction are starting to be more understood, but what kind of progesterone to take and what dosage can be confusing.


I'll explain the difference and importance of the various forms.


Oral progesterone

This progesterone is taken via oral route, and is often prescribed as a first route for those who are found to be low in progesterone. It is relatively inexpensive (around $7-15 with insurance), and in my experience is the most commonly prescribed progesterone. Large dosages of this form of progesterone can be problematic due to the increased risk of side effects. Please see this study for more research on this.

N.B. This form of progesterone DOES contain both soy and peanuts.


Oral progesterone taken vaginally

Sometimes, when doctors find that oral progesterone is not having the impact that they’re anticipating (charting impact not being made, progesterone blood levels aren’t improving, or other reason) doctors will recommend taking the progesterone that is prescribed orally in either an oral and vaginal suppository combination, oral route, or just vaginal route. At times, this can increase effectiveness.

Compounded vaginal cream

This form of progesterone cannot be found in commercial stores (such as Rite Aid, CVS, or Walgreens) and needs to be compounded at a compounding pharmacy. Because the route does not contain allergens, and bypasses the stomach for processing, some find success in using this form of progesterone.

Troches

Perhaps the least known of the forms of progesterone, this form of progesterone bypasses the stomach in part and is processed by the liver (if the USP form) primarily. This form can be especially helpful in those with stomach or other processing issues. Changing routes that your body processes the progesterone can be helpful for clients. It dissolves in your tongue over a period of at least 15-20 minutes and come in varying flavors if desired.

Injections

These can be the most effective form of progesterone in terms of effectiveness in raising progesterone levels (because it is injected directly into the muscle, and most times not subcutaneously) these injections do have higher risks associated with them. Some risks include: swelling at injection site, bruising, pain, and nerve damage. Injections are often used for women with known low levels of progesterone during pregnancy, especially those who miscarry due to low progesterone or whose progesterone levels drop dangerously low.

HCG

In place of progesterone, HCG has been shown to increase levels of progesterone as well. I am not as well researched on the mechanism of action for HCG, however, because HCG is the hormone found in pregnancy (which requires progesterone to increase to sustain the thickening of the liking of the uterus) some clients have found success in taking HCG injections (subcutaneously, not intramuscular). Further studies are still needed to show long terms side effects, especially in single, non genitally active women.

So why do I mention this? It is important and necessary to discern the severity of the condition that you and your doctor are addressing problems with progesterone for, and decide together with your doctor which form and dosage of progesterone best suits your needs.

I have had clients have success with changing forms of progesterone and seeing impacts in their charting. Before you “throw the baby out with the bath water” if you’re at the end of your rope with progesterone protocols or are not seeing the impact of progesterone on your chart, considering asking your doctor about the above mentioned forms of progesterone and taking a look at the impacts of forms of progesterone.

You do not need to stick with the same form of progesterone while using it throughout your life. You might find that during pregnancy your body benefits from progesterone injections, while post partum take oral progesterone, for example. There is flexibility with being able to change forms and doses as needed. (Always under the direction and supervision of your medical provider.)

Assess the pros and risks in the form of progesterone you decide to use. This is essential as one form of progesterone may be more or less effective or more or less harmful for you than others. As with all decisions and outcomes, nothing is without potential risk or benefit, and progesterone is no exclusion.

Some conditions progesterone can assist with (with the help, guidance, and diagnosis of your doctor as they see appropriate):

-tail end brown bleeding

-miscarriage

-heavy menstrual bleeding

-short post peak phases

-PMS

-spotting

-and many others!


You can talk with your doctor about best forms of progesterone for you, and your Creighton Practitioner can answer questions you have! Reach out to one of us for help or to discuss how progesterone may impact your chart!

N.B. If you cannot find a compounding pharmacy near you, Kubat, the compounding pharmacy often used by the Pope Paul VI Institute, will often make and ship compounded medications to you. Some states are excluded from this.

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