Progesterone - Conception, Pregnancy, Miscarriages and Post Natal Depression (PND)

Natural Progesterone has been proven to be a safe and effective method of contraception. The initial research on progesterone's use as a contraceptive was documented by the late Katherina (Kittie) Dalton. She was an extremely knowledge and caring lady who helped so many with progesterone therapy. I have included information from her book "PMS The Essential Guide to Treatment Options'.

It is a known fact that those suffering from PMS do not suffer from symptoms while pregnant, or at least for the second half of pregnancy. The reason for this is that the placenta produces huge amounts of progesterone to help sustain pregnancy. Levels of progesterone found in the blood of pregnant women have been found to be as much as 40 to 50 times greater than levels found in non-pregnant women. There are some women however, who do experience PMS symptoms during later pregnancy. These women are most at risk of developing pre-eclampsia. (Page 150 in Dr Dalton's book).  Dr Kittie Dalton coined the phrase PMS back in the 1950's.

Contraception

Let me first start off by expressing the dangers of Contraceptives. They are largely responsible for failure to conceive as they interfere with the natural cycle of a woman's body. They can cause severe disruptions to the monthly cycle after discontinuing them. All drug based contraceptives have the potential to cause harm. It is very important to give enough time for the synthetic estrogens and progestins to work out of the system before attempting conception. More and more young girls are desperate as they cannot conceive after stopping contraceptives (BCP).

Contraception is often a problem for women, those suffering with PMS experience a particularly difficult time too:

* All birth control pills (BCP) contain progestogens, also sometimes spelled progestagens or gestagens. They are a class of steroid hormones that bind to and activate the progesterone receptor (PR). Progesterone is the major and most important progestogen in the body, while progestins are synthetic progestogens. These artificial man-made progestogens lower the blood progesterone level and so increase the severity of PMS. BCP should be avoided at all costs.
* Sterilization increases PMS symptoms and should also be avoided no matter how popular this method is.
* The intra-uterine device (IUD) is best not used by any woman suffering from or who has experienced pelvic infections or by young girls who have not been pregnant. 
* Withdrawal is very unreliable not to mention stressful.

So, apart from progesterone contraception, this leaves condoms, the diaphragm (Dutch Cap) and the vasectomy.

Progesterone as a Contraception

Progesterone is just as safe as a contraceptive as the IUD or BCP, but without the side effects PROVIDED it is used as follows:

It must be used before ovulation, generally half way through the follicular phase, and continued until bleeding. There is no harm in using it daily, but it can upset the cycle. The amount should be no less than 100mg per day, preferably 200mg per day. But, and it is big but, Stress drops progesterone levels, which could leave you unprotected. Extra precaution needs to be taken during stressful times. It is actually very effective at stopping ovulation, it works in the same way as the synthetic version, but without the side effects.

This is exactly how Dr Kittie Dalton advises to use progesterone as a contraceptive.

"Start on Day 8 of the cycle with a low dose of progesterone, and keep it up until menstruation or - for PMS sufferers - the day when you start on the bigger, anti-PMS dose. A daily dose of 100 mg (half a 200 mg suppository) or a 400 mg suppository are equally effective. (Many women who will use 400 mg of progesterone two to six times daily from ovulation onward prefer to take one 400 mg suppository in the follicular phase rather than having to get 200 mg suppositories as well").

Progesterone as a Contraception for PMS

As per Dr Kittie Dalton ....

  • A low dose (100-200 mg) of progesterone from Day 8 of the cycle
  • Increase to optimum progesterone dosage at ovulation
  • Continue progesterone until menstruation

A study of progesterone contraception in women with severe PMS showed 15 failures in 253 women who had used progesterone contraception for an average of 5.82 years. This means a failure rate of 2.66 per 100 women/years (women/years is a ratio that encompasses 100 women using a method of contraception for one year, 50 women using it for two, etc.), which compares favourably with the recognized failure rate of the condom of 14, diaphragm of 12, rhythm method 24, and intra-uterine device of 2.5 per 100 women/years.

However, some women find that by starting progesterone early they start bleeding at, or shortly after, ovulation. They should be advised to lower the dose of daily progesterone from Day 8 to 100 mg daily and start their usual higher dose of progesterone about two days after ovulation. If extra bleeding still occurs, then it is best to use a condom or diaphragm until the normal time of starting their course of progesterone. Should attacks of diarrhoea occur when using progesterone, then contraception cannot be guaranteed and alternative methods are advised. .....

Another common cause is PCOS. Please read my page on this syndrome and how it can be treated.

Conception and Miscarriages

Progesterone plays a major role during the 2 weeks after ovulation, prior to the fertilised egg implanting in the uterus. It is also vital for maintaining pregnancy.

The first half of the monthly cycle is known as the follicular phase, and it can range from 7 days to 21 days. Progesterone is present in extremely small amounts, estrogen and follicle stimulating hormone (FSH) being the dominant hormones.

At the beginning of this phase, in response to FSH made by the pituitary gland, eggs start developing. Each egg is contained in a cyst called a Graafian follicle, which starts making estrogen, this in turn causes the egg to grow and mature. Estrogen also stimulates the endometrium (lining of the uterus) to grow and thicken. When 1 or 2 eggs are fully developed they rise to the surface of the ovary and appear as small 'blisters’.

When the egg has reached maturity, another hormone called lutenising hormone (LH) is released by the pituitary. Approximately 24 hours later this causes the Graafian follicle to rupture releasing an egg, known as ovulation. The follicle, which is now called the corpus luteum starts to produce progesterone for the next 14 days making progesterone the dominant hormone.

All women, irrespective of the length of their cycle, should start ovulating about 14 days before their next menstruation. If shorter, there is insufficient time for the endometrium to be readied for the embryo to implant, this is known as a defective luteal phase. If the corpus luteum does not make sufficient progesterone during these 14 days, it will result in a defective luteal phase. This seems to be a problem found in many women now and could well be due to the large amounts of estrogen in the environment.

The Surge

At the beginning of the cycle,  .i e.  day 1 of bleeding, estradiol production either drops slightly or is flat for the first 2-4 days. It then rises slowly for the next 6-10 days, and then sharply for 2-5 days. This is the preovulatory peak, after which it drops.

During the 50 hours prior to the mid-cycle surge, estradiol, progesterone and another pituitary hormone secreted by the anterior pituitary gland called LH (luteinising hormone) begin rising, while FSH declines.

The cells forming the outer layer of the Graafian follicle are called thecal cells. LH is required for both the growth of preovulatory follicles and ovulation of the dominant follicle. Under the influence of LH they secrete testosterone. LH causes proliferation, differentiation, and secretion of androgens by the theca cells which surround the ovum, giving rise to androgen levels.

The androgens, notably androstendione, migrate from the theca cells to the granulosa cells where they are converted by the enzyme aromatase into estrogen, particularly estradiol. The theca cells also produce estradiol without the need for conversion. This rise in the androgens is responsible for the acne, oily skin, facial hair, loss of scalp hair etc. that some women experience.

12 hours prior to the mid-cycle surge, progesterone rises rapidly. This surge is produced by brain cells, and has nothing to do with the surge that occurs after ovulation. It is thought to initiate the LH surge which begins 12 hours after the progesterone surge. FSH rises again at the same time as LH. This preovulatory surge in progesterone is now known to be essential for the facilitation of feminine sexual behaviour too.

The surge of the gonadotrophins causes estradiol levels to rapidly fall, while progesterone continues to rise. The gonadotrophins plateau for about 14 hours after which they drop sharply.

Androstenedione (A) and testosterone (T) increase at a slow rate before the surge, rising faster when the mid-cycle surge begins. Then about 14 after initiation of the surge, they decline, but at a slower rate than estradiol. In spite of the significant increase in A and T, estradiol still drops sharply. It is thought that the rapid rise in progesterone may inhibit aromatase activity.

Defective Luteal Phase

Progesterone is the pregnancy hormone. If there is too short an interval between ovulation and menstruation, then this is known as a defective luteal phase. A short interval of less than 12 days, means that progesterone level was not high enough resulting in an early miscarriage. This is due to fertilised egg not embeding itself in the lining of the womb. This can be overcome by ensuring that there is sufficient progesterone after ovulation and until the placenta has started to produce its own progesterone. Progesterone therapy should be continued until the fourth month of pregnancy.

How to use Progesterone to Extend the Luteal Phase

  • A low dose of progesterone will not help. Research has shown that between 100-200mg of progesterone should be used, which is 3-6ml of Natpro, more maybe needed. It should not be used before ovulation, as that will prevent it occurring and therefore prevent any chance of falling pregnant. In other words, progesterone can act as a contraceptive.
  • It must only be used at ovulation if pregnancy is the aim.

How to check when Ovulation has occurred

Taking temperature readings or using a mini microscope will help to check for ovulation, the mini microscope is more reliable, as temperature can vary from as little as 0.5 degrees to 5 degrees.

Saliva or vaginal mucus is used for the test, by dabbing a small amount on the end of the microscope. During the follicular phase, the pattern formed by the saliva/mucus is spotty, as ovulation draws near a fern like pattern starts emerging, becoming completely fern like when ovulation has occurred, returning to the spotty pattern almost immediately. For more information see Ovulation Microscope.

Normal oral body temperature in adult men and women ranges between 33.2-38.2°C (92-101°F). Typical average temperatures are 37.0°C (98.6°F).

In women it varies between the follicular and the luteal phase. During the follicular phase, i.e. from the first day of menstruation to ovulation, it ranges from 36.45 to 36.7°C (97.6 to 98.1°F).

During the 12-14 day luteal phase, i.e. after ovulation to menstruation, temperature increases by 0.15 - 0.45°C (0.2 - 0.9°F) due to the increased metabolic rate caused by rapidly rising levels of progesterone. Temperature ranges between 36.7 - 37.3°C (98.1 - 99.2°F) during the luteal phase, but drops down to follicular levels within a few days of bleeding.

Fertilisation

One of the most important things to remember about conception is the life span of the sperm and ovum. The average life of the sperm appears to be 2 to 3 days, sometimes longer, but the ovum only lives 12 hours and in rare cases 24 hours.

Research points to a greater success in conception if intercourse takes place in the one to two days prior to ovulation, when the fern like pattern is almost complete. This allows time for the sperm to travel through the uterus and up the Fallopian tubes to meet the egg before it becomes over mature or it dies.

One of the problems with an over mature egg is it diminishes the chances of fertilisation, can result in a miscarriage or result in foetal abnormalities. The health of the future child is dependent on these factors.The nearer intercourse takes place to ovulation, the greater the chances of conception.

In Vitro Fertilisation

Some women have difficulty conceiving naturally and need in vitro fertilisation (IVF) will also need progesterone from the time of implantation until the placenta is producing enough progesterone to keep the embryo going. There are several different types of IVF treatment today, but they all need plenty of progesterone in the first few weeks.

Pregnancy

  • 12 to 14 days is necessary for the lining to mature enough to receive a fertilised egg. If bleeding does occur, it means the egg has not been fertilised or the luteal phase was not long enough.
  • Progesterone should then be stopped and only started again at next ovulation. If bleeding does not start 14 days later, it is possible that fertilisation has occurred.
  • On no account must the cream be stopped at this stage, otherwise it could cause a miscarriage.
  • If pregnancy is confirmed, continue using the cream. 100mg/3ml - 200mg/6ml of cream should be used each day until the fourth month after the critical stage has passed.
  • Progesterone can be continued till birth, this is particularly important if pre-eclampsia is a possibility.
  • Continue using the cream after birth, particularly if post natal depression occurs. It is far better to stay on progesterone if possible, but if you wish to discontinue please reduce slowly over a month or two depending on the amount used ie. if 100mg/3ml is being used reduce to 2 ml over the first 2 to 3 weeks and to 1ml over the next 2 to 3 weeks.
  • Symptoms should be monitored and if spotting, headaches, water retention or nausea occurs, increase the dose and continue using it till birth. In some women water retention and a rise in blood pressure sometimes occurs in the last 1 to 2 months, please increase the dose if this should happen.
  • The first 3 to 4 months are critical. 25% of miscarriages occur during the first 6 weeks when the child is still in the embryo stage. The risk drops to 8% after 8 weeks, when the child is now termed a foetus.
  • During this time the placenta is growing and after about 2 months starts making progesterone, while ovarian production starts declining. If at this point placental production is insufficient to meet the demands of the growing foetus a miscarriage can occur. It is therefore advisable to continue using progesterone until at least the third or fourth month. All being well the placenta continues to make progesterone in increasing amounts until birth, when it drops abruptly with the expulsion of the afterbirth, as the placenta is now generally termed. It is essential to continue the cream over this critical phase.
  • Stress can cause a miscarriage. The rise in cortisol in response to the stress, results in a drop in the progesterone level, this in turn can lead to spotting or a miscarriage. To prevent this, as soon as any stress is felt, increase the amount of cream till it has passed.

Nausea or Morning Sickness

If you have only started using progesterone at conception and experiencing terrible nausea or morning sickness you need to use nothing less than 400mg/12ml of progesterone cream per day. If severe, 800mg per day can be used. Never use the cream all at once - use morning and night - you can use during the day as well. It you use it all at once it will spike your progesterone level, levels  should be kept as stable as possible. Stay on this amount for about a month or until your morning sickness starts to ease up or disappear. Once this happens, you can start to reduce the cream very slowly by 1/2ml at a time.  Stay on the reduced amount for about 4 to 5 days, then reduce again by another 1/2ml and so on. If you reduce too fast and by too much your symptoms will return. Reduce until you find a level that suits you. Once you have found a level/dose you must stay on that dose through out your pregnancy. If you discontinue you could have a miscarriage!!

Breastfeeding

Menstruation is not likely to return until after breastfeeding has finished, so if the mother is feeling well and plans to continue breastfeeding for many months, progesterone can be stopped after 2 months but, if the symptoms come back, the use of progesterone should be restarted. When progesterone was first isolated in 1934, researchers thought that its job in the body was to prepare the breasts for breastfeeding. Progesterone helps breastfeeding and mothers need not worry that it will upset their babies. 100-200mg is the recommended amount of progesterone to use.

Attention needs to be paid to your diet which as always, is so important to good health. A low carb diet is important, reducing carbohydrates and boosting protein intake can significantly improve the chance of conception - see references.

Habitual Miscarriages

When a woman has had several miscarriages, she is naturally anxious that everything medically possible is done to ensure that she has a normal full-term pregnancy. Not surprisingly, she will often be given progesterone therapy to ensure this. There are many causes of miscarriages, including chromosomal defects, about which little can be done at present, but they may be due to anatomical abnormalities such as a lax cervix (opening to the womb), which can be stitched up until labour starts. There are also women who suffer from excessive vomiting and pregnancy symptoms immediately they become pregnant, and these are the ones most likely to benefit from progesterone given in a dose high enough to remove their symptoms. Among many patients treated over the years, Dr Dalton has treated two women who both had nine previous miscarriages and who were both given progesterone therapy, both were later delivered successfully of healthy babies at the City of London Maternity Hospital.

Threatened Miscarriages

Bleeding in early pregnancy is always a worry. The patient is naturally wondering whether it is the end of the pregnancy or not. If bleeding is scanty and does not contain clots or fetal tissue, then with rest, there is a chance that all will be well and that a normal pregnancy will continue. This applies particularly if the bleeding comes at the expected time of the first missed period. If it is accompanied by excessive vomiting and early pregnancy symptoms, then again the patient will benefit from progesterone therapy in a dose sufficient to ease the symptoms. However, after the delivery the doctor is left wondering if the pregnancy would have continued even if progesterone had not been given.

Post Natal Depression (PND)

Progesterone does help severe PMS, or as the doctors now prefer to call it, PMDD. It also stops post natal depression (PND) which is worse, and post natal psychosis which is the most severe form. High amounts of progesterone is needed for this.  Dr Kittie Dalton would give 800mg per day for severe PMS/PND and 2400mg per day for post natal psychosis.  It really is the wrong name for an illness which affects 10 per cent of new mothers after their baby's birth, because depression is rarely the first symptom to appear and in many cases there is never any depression at all. Women who have suffered from PND can give much better descriptions of how they felt at the beginning of their illness, describing the sleeplessness and feeling:

  • not with it
  • distant
  • shattered
  • confused
  • losing touch
  • muddled
  • out of control
  • high, gloriously high
  • mind going round
  • couldn't talk/wouldn't go out/kept the curtains drawn each day
  • spent money like there was no tomorrow
  • angry
  • panicky

It can be a horrifying experience for a partner to come face-to-face with the changed personality of the new mother who was previously calm and is now so anxious, previously alert and active but now dull and speechless, previously a successful career woman and now frightened to be left alone, previously carefree and now obsessional. Postnatal depression, and its more severe cousin puerperal psychosis, are hormonal diseases which have a lot in common with PMS and frequently turn into PMS as time passes. As a PND sufferer gradually improves, she will find that her symptoms get better after menstruation, only to get worse again before the next menstruation, and with further progress she gradually reaches the stage when there is absence of symptoms after menstruation but many of the symptoms premenstrually. At this point the illness has changed to PMS.

PND tends to occur in women who have suffered from severe PMS and in those who have already suffered from PND or puerperal psychosis after a previous pregnancy, and it may come unexpectedly after a perfectly normal pregnancy and delivery. It can be successfully avoided if arrangements are made during the pregnancy with the general practitioner, obstetrician and midwife. After the baby has been safely delivered, the mother should be given the first of seven daily progesterone injections: of 100 mg followed by 400 mg progesterone suppositories twice daily for the next two months or until normal menstruation returns. Menstruation is not likely to return until after breastfeeding has finished, so if the mother is feeling well and plans to continue breastfeeding for many months, the progesterone can be stopped after two months, if the symptoms come back, the progesterone should be restarted. 

Progesterone for Postnatal Depression

Immediately after delivery, progesterone injections 100 mg daily for seven days, followed by progesterone suppositories 400 mg twice daily until the return of menstruation or for two months. Some good News - when PMS sufferers have had adequate progesterone during pregnancy so that there have been no symptoms of pregnancy, no hyperemesis or rise of blood pressure, and if progesterone has been given after the delivery to prevent any postnatal depression, then there is about a 50:50 chance that the PMS will not return.

To Recap

  • progesterone must only be used at ovulation if pregnancy is the aim
  • take temperature readings or use a mini microscope to help check for ovulation
  • on no account must the cream be stopped if conception is suspected, otherwise it could result in a miscarriage
  • it is essential to continue the cream over the first 2-3 month critical phase, particularly the first 2 months
  • it is also essential to bear in mind that stress can cause a miscarriage
  • the nearer intercourse takes place to ovulation, the greater the chances of conception
  • use between 100/3ml - 200mg/6ml of progesterone cream, the cream must contain 33.3% progesterone concentration, or adjust accordingly if using a weaker one
  • chronic nausea and morning sickness use nothing less that 400mg/12ml of progesterone per day until symptoms improve, more maybe needed
  • have a Vitamin D3 test done, it is vital!! Please take the time to view this interesting video on the importance if Vitamin D3 and pregnancy
  • cut back on carbs and increase protein in your diet

Please read my page on Miscarriages.

Additional information once pregnancy has occurred

Once pregnant the growing foetus is an extra burden on the mother, it is therefore vital that nutrition is taken. Please consider taking the following each day:

  • 5 000iu's/day Vitamin D3 (cholecalciferol) which it vital for the growing foetus. It prevents epigenetic changes, rickets - which sadly is on the increase, heart failure, epilepsy, type 1 diabetes and lower respiratory track infections in the newborn, to reduce the risk of pre-eclampsia in the mother.  Autism has also been linked to a vitamin D3 deficiency.
  • 1000-2000mg/day taurine to prevent epilepsy, insulin resistance, impaired glucose tolerance, diabetes, impaired neurological function, vascular dysfunction and growth retardation in the developing foetus and newborn. Taurine is an amino acid which is not found in grains, legumes, vegetables, nuts, seeds or nuts. It is found in animal protein which puts a vegetarian at risk.
  • 5ml or 1 teaspoon of Omega 3 fish oil which is needed by the developing brain.
  • Vitamin B complex with extra folic acid bringing this up to 800mcg per day to prevent neural tube defects. If a vegetarian, please be cautious as excess folic acid masks a B12 deficiency. A lack of B12 in utero (the womb) increases the risk of insulin resistance in the child.

VITAMIN A -  Do not take cod liver oil or any fish liver oil. The excessive vitamin A it contains prevents vitamin D3 from being absorbed and can become toxic. Take beta-carotene if deficient in vitamin A.

 

To clear any confusion, 'fish oil' comes from the muscle of the fish and contains Omega 3. Fish 'liver' oil comes from the liver, it contains large amounts of vitamin A and very small amounts of vitamin D3. There is a huge difference between the two.

 

A big thank you to the late Dr Kittie Dalton who has helped so many women with PND and who are battling to conceive. Her knowledge has helped so many women today.  I urge you to read her books:

Depression after Childbirth: How to Recognise, Treat, and Prevent Postnatal Depression

Once a Month

Premenstrual Syndrome and Progesterone Therapy

Another book well worth reading was written by one of her patients. Nicola Owen, who's problems all started when she was fourteen and going through puberty, ended up in Holloway Prison for Women in the UK. Dr Dalton prescribed progesterone which corrected the psychosis, thereby helping her recover and obtain her release. It's now out of print, but Amazon do have second hand copies.

Nicola - by Nicola (with Sydney Higgins) Owen (Author)



Research Papers

Clomid - paper 1

Clomid - paper 2

Should you be taking Prozac or Paxil while pregnant? CDC finds link to birth defects

Higher vitamin D status during early pregnancy may reduce depressive symptoms in Brazilian women

Dr Mercola interviews Dr Holick on Vitamin D and pregnancy

Low-Carb Diet Improves In Vitro Fertilization

J Perinatol 20 Jn 2011 - Vitamin D supplementation during pregnancy : safety considerations in the design and interpretation of clinical trials

British Medical Journal 1947 - way back in 1947 it was suggested that 10 000 - 2 000iu's per day of vitamin D should be taken

Maternal Serum 25-Hydroxyvitamin D and Measures of Newborn and Placental Weight in a U.S. Multicenter Cohort Study

Vitamin D and fertility: a systematic review

Rate of Stroke Increasing Among Women During, Soon After Pregnancy

Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies

Low saliva progesterone concentrations are associated with spontaneous early preterm labour (before 34 weeks of gestation) in women at increased risk of preterm delivery

Human Chorionic Gonadotropin (hCG);The Pregnancy Hormone

Study Shows Why Synthetic Estrogens Wreak Havoc on Reproductive System