Low progesterone levels in pregnancy
Question
Three months ago I had a miscarriage on the 48th day. I’m pregnant again. I’m on my 42nd day now. The first day of the last menstruation was Jan 8th. My doctor has been monitoring my HCG and Progesterone levels. She has put me on prometrium 200mg. (During the second half of my cycle and once she did my first Beta test on Feb 14th).
My levels as of Feb 18th:
Beta – 1680 (It has been doubling as expected)
Progesterone – 12.1
My concern is for 6 weeks, my progesterone level looks very low. Is it something that I need to worry about?
My doctor says everything is alright, I have an appointment with her on Feb 24th. Is there anything I can ask her?
Thanks for your time.
Answer
Last Updated: July 23, 2013
It is reassuring that your HCG is doubling. Your progesterone level is low for 6 weeks gestation. However, this should not be a problem with adequate treatment. Although some physicians use oral Prometrium in your situation, to my knowledge there have not been any studies that prove that this is an adequate dose. The Pope Paul VI Institute, which has done quite a but of research on this topic, would recommend a dose of intramuscular injections of 200 mg every 3-4 days. This dose has been studied on large numbers of women. We usually teach the husband to give the woman injections. There is other literature that suggests that progesterone vaginal suppositories 50-100 mg.every twelve hours is sufficient. Oral prometrium is not as reliably absorbed as injections or suppositories.
In my office we order progesterone for intramuscular injection from Kubat pharmacy in Omaha Nebraska. They make a more concentrated injection of 100 mg./ml so that 200 mg can be injected in one injection (rather then two). They will ship it overnight with a doctor’s order. We do not discontinue progesterone until the woman maintains adequate levels on her own, as demonstrated after testing “trough” levels of progesterone after a four day period just before the next injection. Although many physicans believe the placenta always produces adequate progesterone after about eleven weeks, this is not always true; many women benefit from progesterone supplementation beyond this time, sometimes at reduced doses. Progesterone has been shown to prevent mid-trimester pregnancy loss and pre-term labor. A good protocol to use in prescribing propgesterone can be obtained from the Pope Paul VI Institute in their recent textbook. It can also be obtained from CANFP for use by your physician.
M. Davenport, M.D.
In my office we order progesterone for intramuscular injection from Kubat pharmacy in Omaha Nebraska. They make a more concentrated injection of 100 mg./ml so that 200 mg can be injected in one injection (rather then two). They will ship it overnight with a doctor’s order. We do not discontinue progesterone until the woman maintains adequate levels on her own, as demonstrated after testing “trough” levels of progesterone after a four day period just before the next injection. Although many physicans believe the placenta always produces adequate progesterone after about eleven weeks, this is not always true; many women benefit from progesterone supplementation beyond this time, sometimes at reduced doses. Progesterone has been shown to prevent mid-trimester pregnancy loss and pre-term labor. A good protocol to use in prescribing propgesterone can be obtained from the Pope Paul VI Institute in their recent textbook. It can also be obtained from CANFP for use by your physician.
M. Davenport, M.D.
Answered By:
Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over MyCatholicDoctor.com She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.
