In the "normal" course of events, progesterone levels begin to rise at the time of ovulation. The egg is released from a sack, called the corpus luteum. This emptied sack stimulates the production of progesterone. Progesterone is made from the words PRO (meaning "for" or "in favor of") and Gestation (pregnancy). Progesterone levels are quite high during pregnancy.

The corpus luteum can stimulate the production of progesterone for about 2 weeks. If there is a pregnancy, the new baby takes over the stimulation of progesterone. If there is not a pregnancy, the lining of the uterus is lost and the period begins. Falling levels of progesterone stimulate the beginning of a period.

Progesterone is necessary for maintaining a pregnancy. Prometrium® is a commercial brand of progesterone. It seems to be an adequate source for some women. However, there are a number of things about it I don't like. For one, it contains peanut oil. Many people are sensitive to all peanut products. Second, the presence of the oil causes a dramatic spike in progesterone level shortly after the capsule is swallowed. This is followed by a sharp fall in levels. This is not the progesterone levels one would see in a normal cycle. Falling levels look to the body like the END of a cycle (in some situations) and the woman's body reacts just as it would in a normal period, clearing the uterus with a period. The speedy rising and falling level of progesterone caused by Prometrium is one of the reasons "they" say not to use if you're pregnant. As the falling levels of progesterone trigger a period, the same falling levels could stimulate clearing of the uterus even when a baby is present. Another reason for the warning is that most drug companies fear allowing their products to be used during pregnancy (if you recall, thalidomide was once consider safe for all people, but caused serious birth defects). Prudence is the order of the day when recommending drugs for a pregnant woman.

The idea of using progesterone to maintain a pregnancy is an excellent one. It is providing the mother's body with the hormone she is lacking. However, the progesterone ought to be used differently (much different from the dosing of Prometrium). If the normal rise and fall or progesterone follows a cycle, then using it as a supplement should also follow a cycle. 

Progesterone Levels. When women suffer from low progesterone, we usually suggest a topical progesterone cream. The dose is 20mg daily for the first couple of weeks of a cycle. This is increased to twice daily during the last half of a cycle. Then the dose is stopped until a period begins. This mimics the normal cycling of progesterone.

Progesterone levels are usually very high during pregnancy so it seems reasonable to use quality natural progesterone. This is used according to a cycle (as above) until pregnancy begins. Then the dose is maintained at 20mg (or more) twice daily. The absolute levels are less important than the results being obtained. The usual dose is around 20mg twice a day but it is not uncommon for some women to use 100mg or more. When these levels are needed, the doctor usually recommends a suppository instead of the cream. It can get messy slathering the progesterone cream in those doses.

Safety. Progesterone is very safe for the baby. In fact, each of us literally swam in a sea of progesterone before we were born. The doctors who specialize in high-risk pregnancies always insist on substantial doses of natural progesterone, usually by suppository.

After a baby is born the mother's progesterone levels fall rapidly (there is no longer a baby stimulating the production of progesterone). Some women do not start making their own progesterone in sufficient amounts. I believe this lack of progesterone is what is sometimes referred to as "post partum blues." Instead of prescribing all sorts of chemical antidepressants, I think a balanced dose of progesterone would be more helpful. However, few doctors would agree with me.

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