Progesterone (Oral and Vaginal)

Why would you be taking progesterone supplements?

There are a few reasons why one may be taking progesterone supplements, which can be delivered orally, through vaginal suppositories, or via intramuscular injection (commonly referred to as PIO).

Some examples:

1. You have low progesterone levels. This is usually diagnosed by having a blood test done 7 days post-ovulation.
2. You have a short luteal phase regardless of the results of the 7 dpo progesterone results.
3. Even if your progesterone level and luteal phase are fine, if you are doing IVF (and depending on the RE, IUI) you will probably be prescribed progesterone supplements. Taking the supplement just covers your bases.

Oral vs Vaginal

Progesterone vaginal is also used in fertility treatment as part of Assisted Reproductive Technology (ART) for women unable to get pregnant due to a lack of natural progesterone in the body. The oral supplement is definitely less invasive than vaginal. However, when you take progesterone orally, it must be metabolized by the liver, which makes the delivery system inefficient and less effective. For most women, there seems to be no noticeable difference in the results. Clinics use the suppositories because they feel after all the pre-procedure injections they just don’t want to prescribe more injections. There is also word that when they switched to suppositories their pregnancy rates increased. However, there does seem to be evidence that some women have a better response with the injections.

What To Expect

You can expect to take the supplements until you take your beta. If it is negative, you will stop and your period will arrive. If it is positive, you will continue taking the supplements for at least a few more weeks and possibly through the entire first trimester. If you are having blood tests done after insemination or transfer and are using vaginal supplements, your blood tests may not reflect high progesterone levels. Do not worry if your level seems low compared to your someone else doing injections. The vaginal suppositories are not systemic – all the progesterone stays right around your uterus and does not show up in blood tests. That doesn’t mean it isn’t there. The common oral supplement is prometrium. If you are taking this, expect to feel tired… fast.

There are two vaginal forms: suppository and suspended in gel. The suppositories can be either prometrium (yes, the exact same pill you can take orally) or they can be pharmacy compounded. Whether you use prometrium or the compound suppositories, your dose will typically be 2 to 3 times per day. Expect to feel like you have constantly wet your pants. The prometrium is like a vitamin E– a softish gel capsule. Prometrium can be kept at room temperature. The pharmacy compounded suppositories are very oozy. When you take it out of the wrapper, it feels kind of waxy. But if you let it rest in your hand, the surface feels slick and oily. This is only the outer coating–if you look at the non-pointy end, you can see there is white goo inside the waxy shell. The suspended in gel supplement (Crinone and similar products) comes in a pre-filled applicator.

Common side effects may include:

• dizziness, confusion, drowsiness, tiredness;
• headache, mood changes, feeling nervous or irritable;
• stomach pain, nausea, diarrhea, constipation;
• bloating, swelling in your hands or feet;
• breast pain, swelling, or tenderness;
• cramps, pelvic pain; or
• vaginal itching, burning, or discharge.

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