Natural Progesterone and Pregnancy
The pro-gestational hormone supports healthy pregnancy in more ways than one.
by Melissa Block
Like many women, I have had the devastating experience of miscarriage. In fact, I've had it twice: the first time at about eight weeks' gestation, and the second time - after giving birth to a healthy, nearly ten-pound baby girl in 2000 - at sixteen weeks. After the second miscarriage, I went on to get pregnant again and gave birth to my (nearly nine-pound) son in 2003.
There were major differences between the pregnancies that "took" and those that didn't. The first time, I was under enormous stress, and the fact that it happened so early suggested to me that there was a problem with the fetus. The second time, the pregnancy loss was most likely due to an infection. Following each pregnancy loss, however, I did the same thing: as soon as I had conceived again, I began to use natural progesterone cream.
Progesterone supplementation also shows promise for the prevention of toxemia, a life-threatening complication that is often associated with pre-term delivery.
Was this the reason I went on to have successful pregnancies? Perhaps perhaps not, but the research on the subject points to a powerful effect of supplemental natural progesterone on a woman's ability to maintain a healthy pregnancy, particularly through the first trimester. Progesterone has also been found to help prevent preterm delivery, increase birth weight, prevent toxemia, support in vitro fertilization (IVF), and prevent or alleviate postpartum depression. Some anecdotal reports even suggest that natural progesterone used during pregnancy enhances physical and intellectual development in the child.
Miscarriage prevention. The mainstream medical research is mixed on whether natural progesterone helps to prevent early miscarriage. It is said that one in three pregnancies ends in miscarriage before 12 weeks' gestation, and this is most likely Mother Nature's way of optimizing the considerable effort of pregnancy and mothering. There is some evidence that the decreased progesterone production in women who eventually miscarry is not a cause of the miscarriage, but a result of a pregnancy that - for reasons we don't always understand - didn't "take."
Women who habitually miscarry, having three or more miscarriages in a row, have a more complex situation. Some of these women turn out to have luteal phase failure, where the corpus luteum chronically makes insufficient progesterone to maintain the pregnancy through the early weeks, before placental progesterone kicks in. Estrogen dominance and thyroid dysfunction can both adversely affect the ability of luteal progesterone to get women through the first trimester. In all three of these scenarios - luteal failure, estrogen dominance, and thyroid function - natural progesterone can restore balance and support healthy pregnancy.
According to John Lee, MD, in women who have three or more miscarriages in succession, only 15 percent of those miscarriages can be traced back to maternal disease. Women are conceiving later in life, when they are more likely to have missed ovulations and estrogen dominance; this makes the probability of luteal phase failure a more significant cause of miscarriage than it was when women had children while in their teens and 20s. In many instances, a woman who is trying to conceive her first child at 35 or 38 is already well into perimenopause, and natural progesterone can do her a world of good.
A recent article in a French gynecological journal points out that women who have repeated miscarriages have an immune profile that differs from women who don't. Studies of mice show that increased levels of one type of cytokine (immune system bio-chemicals) signify an immune response to pregnancy that tends to lead to spontaneous abortion. Levels of these cytokines rise in response to stress, and this could be the connection between high stress levels and pregnancy loss. Supplementing with natural progesterone causes a rise in other cytokines that counteract the effects of the first type, balancing the immune system in a manner that supports the pregnancy. (Arck P, "Stress and implantation: role of immune mediators, hormones and neurotransmitters," J Gynecol Obstet Biol Reprod (Paris) 2004 Feb;33(1 Pt 2):S40-2.)
In a small subset of women, repeat miscarriage is due to anti-phospholipid antibodies (aPL) that react against the fetus. These women have immune reactions that cause their bodies to reject each pregnancy. Treatment for women who are aPL-positive usually involves the steroid drug Prednisone, which greatly increases risk of gestational diabetes and hypertension. Therapy with progesterone, immunoglobulins and human chorionic gonadotropin (hCG) are currently being studied as alternatives.
A fetus is foreign tissue in the mother's body, part mother and part father. Were it not for the changes in immune reactivity brought about by progesterone, the mother's body would reject the fetus every time, whether she were aPL positive or negative.
Research by Hungarian scientist Julia Szekres-Bartho illustrates that immune cells called lymphocytes develop progressively more receptors for progesterone through the course of a pregnancy, and that spontaneous abortion and preterm labor are associated with fewer of these receptors. Dr. Szekres-Bartho describes a substance - Progesterone Induced Blocking Factor, or PIBF - that is created during pregnancy and has been demonstrated to have abortion-preventative effects in mice. (Szekres-Barthe J, "Duphaston® (Dydrogesterone) in the maintenance of successful pregnancy receptor mediated immunomodulation at the fetal-maternal interface," presented at International Society of Gynecological Endocrinology 2001 Symposium, Hong Kong .)
In a study by Chinese researchers, 23 aPL-positive women with a history of spontaneous abortion were treated with a combination of Chinese herbal medicine, hCG, and natural progesterone, with stunning results. Twenty of the aPL-positive women became aPL-negative; 95 percent of those who became aPL-negative went on to have successful pregnancies, as did 82.6 percent of the entire treatment group. In a control group of 18 women, only three (16.7 percent) had normal pregnancies. (Shu J, Miao P, Wang RJ, "Clinical observation on effect of Chinese herbal medicine plus human chorionic gonadotropin and progesterone in treating anticardiolipin antibody-positive early recurrent spontaneous abortion," Zhongguo Zhong Xi Jie He Za Zhi 2002 Jun;22(6):414-6.)
Sometimes, miscarriage is the result of infection that makes its way up the vaginal tract and into the pregnant uterus, spurring the production of inflammatory biochemicals. Preterm deliveries can be the result of infection that affects the amniotic membranes. A Croatian study of 140 patients with threatened miscarriage and 70 with uncomplicated pregnancies revealed that in those with lower genital tract infections, progesterone levels were significantly lower, and markers of inflammation were higher. Although this does not mean that low progesterone levels caused infection, progesterone's anti-inflammatory effects might be helpful - along with treatment of infection - to rescue this kind of at-risk pregnancy, or to prevent pre-term labor or rupture of the amniotic sac. (Mitreski A, Radeka G, "Prostacyclin and hormone levels in patients with symptoms of miscarriage and infection," Med Pregl 2002 Sep-Oct;55(9-10):371-9.)
Maintenance of in vitro fertilization (IVF). Progesterone is commonly used to maintain IVF pregnancies in their early stages. In a naturally conceived pregnancy, there is an abrupt rise in progesterone production, designed to facilitate the implantation of the embryo. While adding extra progesterone through transdermal cream may not rescue every IVF pregnancy, it has been demonstrated to help in most cases, and it certainly doesn't hurt.
How to use progesterone to prevent miscarriage. Women who wish to use progesterone cream to prevent miscarriage should do so as soon as they know they have ovulated. (Do not use it before confirming ovulation with a home test - otherwise, you could end up inhibiting ovulation with the supplemental progesterone.) Once a pregnancy test confirms that you have conceived, continue the progesterone cream for at least the first nine weeks of pregnancy, when the placenta begins to make the hormone. Taper off the supplemental progesterone to ensure that there's no sudden drop in levels.
Progesterone and conception. Those who are having trouble conceiving are probably having anovulatory cycles. Cyclical use of progesterone cream can move the body back into its normal menstrual pattern and facilitate ovulation.
Follicle-maturing drugs, used to stimulate ovulation in women who wish to conceive, often end up creating luteal phase deficiency, in addition to what physicians call a "hostile uterine environment," both of which increase the chances of miscarriage. Supplementing with natural progesterone may turn out to be the best way to protect pregnancies in women who use these drugs.
Preterm delivery. A study from New Zealand researchers demonstrates that progesterone helps women with history of spontaneous premature delivery to carry their babies to term. They were given injections of 17-alpha-progesterone caproate (17P), a natural form of progesterone, 250 mg per week, between the 16th and 20th week of gestation, or placebo until 36 weeks or delivery (whichever came first). In the 17P group, 36.3 percent had preterm delivery; in the placebo group, 54.9 percent had preterm delivery - a highly significant improvement. An unexpected benefit of progesterone was increased birth weight: only 27 percent of the progesterone users giving birth to babies weighing less than 2500 grams (about five pounds); 41 percent of the non-progesterone users gave birth to babies weighing less than 2500 grams.
Postpartum depression. As soon as the placenta is delivered after the birth of the baby, progesterone production falls from 350-400 mg a day to nearly zero. The adrenals are the sole source of progesterone at this point, and if a woman had an exhausting and stressful birth experience, her adrenals may be exhausted, too. Women with the highest progesterone levels during pregnancy and the lowest postnatal progesterone levels are at greatest risk for severe postpartum depression. Natural progesterone may be helpful for women who suffer from PPD.
Improved intelligence in babies exposed in utero to extra progesterone. Katharina Dalton, MD, the true pioneer of natural progesterone therapy, has administered progesterone to many women during their pregnancies. An informal survey of her patients has revealed that their babies are more likely to stand and walk by one year of age, and that by the age of nine or ten, they seem to have superior academic performance.
The amount of transdermal natural progesterone you use to get or stay pregnant is no more than the amount recommended for perimenopausal and menopausal women: 20 to 30 milligrams a day. The timing is important, however.
If you're trying to get pregnant, using progesterone cream can suppress ovulation. Don't use it until after you know you have ovulated. You can find out whether you've done so by taking your temperature each morning before you rise (it will go up slightly when you ovulate), or by using home ovulation tests available at drugstores.
After that, use the cream each day, smoothing it onto your neck, breasts, belly, and inner arms, rotating the application area. Once you've gotten through the first trimester, you can taper off (don't stop abruptly) - your body will soon be producing more than ten times what you use transdermally! You don't need to stop using it during the second or third trimesters, but it's really a drop in the bucket of what the placenta produces.
Women who have trouble conceiving can try Dr. John Lee's approach, described in his book, What Your Doctor May Not Tell You About Premenopause. For two to four months, use 20-30 mg of cream on days five through 26 of your cycle. Stop at the 26 th day to bring on menstruation. This will suppress ovulation, and if you have any follicles left in your ovaries, one will ripen after two to four months of suppression. At that point, stop the cream and do what comes naturally! You can resume the cream as soon as you have a positive pregnancy test. This approach worked in many of Dr. Lee's patients who had tried to conceive for years - in fact, many babies were named after him!
Women who suffer postpartum depression can use the same dosage, three weeks on and one week off. Since most will not resume normal menstrual cycles for at least a few months after giving birth, you may have to wing it to figure out when to start. Or, if your cycles were normal before you conceived, you can look back at your calendar and figure out where you'd be in your cycle if you had not gotten pregnant, and use the progesterone accordingly.
©Alternative Medicine Network 2009
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