Oct 242012
 

“There is no evidence that progesterone helps with pregnancy. We usually just give it to moms for peace of mind.” – OB to mother who believed her miscarriage was a result of low progesterone.

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 October 24, 2012  informed consent, OB, pregnancy loss  Add comments

  22 Responses to ““…We Usually Just Give It To Moms For Peace Of Mind.””

  1. Um…. Wow, which direction to take this?

    1) If it’s not harmful, you allow moms to have medications and procedures for their peace of mind? Does that mean you allow women to push in an upright position for their peace of mind? Birth in a tub for their peace of mind? Eat during labor? Decline screening tests with high false positive rates because otherwise they’d get worried?

    2) Or does it go the other way, that you routinely prescribe things that have no medical value just because of routine? So women all have to be NPO even though there’s no evidence that this helps?

    3) And in this case, doctor, why did you not give it to this mom? Or are you diverting her question because you don’t want her to accuse you of not properly managing her pregnancy, when instead you could have tested her progesterone levels and supplemented if they were low?

  2. Speaking as someone who miscarried, possibly d/t low progesterone, and who supplemented early on with this pregnancy (22 weeks now!)…

    I don’t think there’s *conclusive* evidence (studies) that prove progesterone supplementation prevents miscarriage (i.e., not sure that low progesterone leads to m/c), rather than that a non-viable pregnancy produces less progesterone.

    That said… What Jane said.

    • My one sister had progesterone deficiencies and miscarried about 6 times before they “figured it out”. Meaning they finally tested her properly.

      Once they knew the problem, when she becomes pregnant she takes progesterone injections and now has 6 healthy beautiful children.

  3. If the woman has low progesterone, what can supplementation hurt?

  4. I didn’t have “low” progesterone according to labs but, apparently, I needed it anyway. Thankfully my doctor treated me as a person and didn’t treat me out of a textbook.

  5. I clicked through to the link above. This is a quote from the clinical notes: “Remember, even if the miscarriage rate is reduced from 25% to 20% with treatment, should your patient miscarry, her miscarriage rate is 100%!” In other words it, doesn’t matter how much it lowers the risk of miscarrying, she will be devastated if she miscarries. Why can’t everyone understand that?

  6. I had 8 m/cs in a row where my progesterone levels were very low. 8 IN A ROW! I was emotionally devastated!! My awesome OB actually listened to me and started me on progesterone right after ovulation and kept me on it until 13 weeks along. And lo and behold, my 2 year old is runnning around today. I know, without a shadow of a doubt, she would not be here without the progesterone. I just didn’t produce enough.

  7. This is my submission, and there’s a little more to it.

    I indicated to my OBGYN that I had very short cycles. Around 25 days. According to my charts, I wasn’t even ovulating until around day 15 or 16, which meant that my luteal phase was pretty short, plus I was spotting days before my cycle started. So, I was concerned before I had even miscarried, and then to have it happen had me extremely motivated to find an answer.

    I know that sometimes you don’t get an answer :(

    What my OB said was that she didn’t think progesterone levels were really connected to miscarriage, but that she would consider testing for it in a patient that had 3 or more miscarriages (I believe she was referencing the article Ethel linked.)and even then, it was for the mother’s peace of mind.

    I said, “I am not going to go through three miscarriages to prove there is a problem.”

    Although she was otherwise compassionate and thorough, this seemed like a very strange response. It is just a blood test, and I wanted the information. This OB will give you as many ultrasounds as you want, why not a blood draw?

    My coworker recently had a loss and her doctors were monitoring her progesterone levels very closely. The day before she m/c, they dropped dramatically. It may be anecdotal, but it’s hard to think “oh, there’s no connection.” Especially when there are obstetricians who take progesterone levels seriously.

    I used progesterone for the next few months after my loss, and increased my cycle length before getting pregnant with my now-10month old.

    • It makes me so cross that there are two things that can be done to prevent needless pregnancy loss, just a simple blood test and then either aspirin or progesterone but they don’t seem to take it seriously! I was “fortunate” that my baby survived birth at 19+6 so they knew something was wrong with me and I didn’t have to lose the beautiful little girl I had next before diagnosis!

      Prof Hughes doesn’t believe in the whole 3 miscarriages thing, or one of those things or normal before 12 weeks and he’s right, it shouldn’t be! We shouldn’t be forced to go through losing our precious babies before anyone takes us seriously!

      I’m glad to hear you’ve had a good outcome.

      • “Baby survived birth at 19+6″ I apologize if this is seen as a crash question, but was this a mircopremie that survived to go home or what doctors seem insistant upon calling a ‘stillbirth’ even when the baby is born alive and then passed shortly there after? I ask because I used to have a link to an OB’s article where he described surviving mircopremies at below 21 weeks, but lost it with a computer crash and it’s super hard to find anything on the handful of 21 and under week micropremies that have survived.

        • “Crass” question, not “crash”

        • She lived for three hours. At that age they usually give the baby to the parents and leave the room. I do have a birth and death certificate for her, if I hadn’t she would have been too young for a stillbirth certificate here. We nearly didn’t get one because she was born/ died either side of midnight and the doctor got confused and wrote the same date!

    • I had two miscarriages before my first full term pregnancy, and was told they’d only start doing tests if I had three in a row. This summer I had my third miscarriage, followed by a pregnancy that so far I’m still carrying. My midwives referred me to the doctor they work with, who is a perinatologist. He was concerned enough about my history to order a whole battery of tests. He’s testing hormone levels and clotting, and said those would be the easiest to treat if anything shows up. He said that any miscarriages needed to be treated seriously. :) I LOVE this doctor. He is completely awesome, and I kind of wish all you you wonderfull ladies lived near my so you could use him too. ;) He also said there was absolutely no reason that I should need a repeat section, unless of course we have something EXTREMELY serious happen. But he said my chances of that are very low. He also has no problem with me going over 42 weeks, and refuses to induce me based just on dates. (See? You should all move to Atlanta…)

      • We have one of these in the Philly suburbs. :) I birth at home with midwives, but this one OB takes his patients seriously, treats them with respect, gives them information in a non-scary, non-coercive way, and practices evidence-based medicine. Love him.

    • I haven’t been in quite this same situation, but I have had a miscarriage. So I think a good question to ask this doctor would be ‘what are the risks of complications in miscarriage? physically? emotionally? incidence of ppd? hemorrage? Now, what are the risks in drawing blood and doing the test I am telling you I want? hmm? hmm?!!! And you want me to go through this 2 more times? Why? Give me One good reason! Ok, now put it in writing, if you are still set on this course, and don’t you dare charge me for this appointment!

    • I was given progesterone after my 2nd loss. It didn’t help, unfortunately. I have 4 kids now, but I lost about 6 between ds1 & ds2, at least one of which was multiples, then another 6 or so (honestly, I had to stop counting) between ds2 & ds3. After convincing a dr to put me on thyroid meds, I accidentally got pregnant. By the time I realized, I was actually past the point I lost all the others. He’s sleeping on my lap now. :)

      My TSH tests were “normal” all those years, but there was clearly an issue. He was also nearly 3lbs bigger than my 3rd baby, since they’d been getting smaller each time, and I had/have tons of milk this time.

      Sometimes, we really need to push to get the treatments we need, but it shouldn’t be that way.

  8. Progesterone saved my last pregnancy.

  9. First of all, it’s clearly proven that progesterone can help maintain a pregnancy, so this doctor is kind of nutty. But let’s play along for a minute… he believes otherwise, which means he’s willing to prescribe an unnecessary medication. All meds, no matter what they are, have side effects. It’s very poor practice to prescribe unnecessary medications!

    • It’s not proven, unfortunately. I’ve had 7 miscarriages, and 3 were on progesterone. I’ve had 2 lives births and have made it to my second trimester with #3, and only for one did I have progesterone.

      Progesterone MAY help with a few specific problems. MAY. A doctor should proscribe it for conditions that it seems likely to help for. A short luteal phase is one of those.

  10. Wow, thanks to charting I now know my “normal” cycles aren’t normal at all! I bleed every 28 days. I ovulate between 19-21 days and start spotting 7 days later and full flow on 10 dpo. I researched this in reference to m/c and everything I came across discussed progesterone shots. Cant afford that out of pocket but discovered B6 so I started that one cycle and I didn’t spot until 10-11 dpo! I’m now 6 weeks and religiously take my B6 every day :) cross my fingers its a sticky baby!

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