September 14, 2011

Weaning: Progesterone Dropped Like a Rock

My next post was going to be about how I am enjoying this pregnancy (a lot, honestly, I promise!) despite my worries. But then I got the call from RE's office about the latest P4/E2 results, so enjoyment is once again taking a back seat to concern.

The weaning had been going well. For some reason, I haven't ever been nervous about the E2, only the P4. They've been weaning me very slowly. I was on 3 progesterone suppositories per day and 1cc of PIO per day. We started by going to 2 suppositories a day, still doing the 1cc every day. Tested a few days later, P4 was at 35. Then went to 2 supps and 1/2 cc every day. After a few days, P4 was at 39. I was excited - I thought this meant my placenta was taking over.

Then we dropped down to 1 supp a day and 1/2 cc every day. P4 went back to 35, but the nurse assured me that it fluctuates, so I still didn't worry about it. (That was Friday.) Then we went to 1 supp a day and 1/2 cc every other day.

Today's test result showed P4 at 19.7.

The nurse said RE wants to see it above 20, but from what I'm reading online, the typical P4 level at 12 weeks (today is 11w5d) is around 33. And my P4 would be even lower than 19.7 if I wasn't on the supp and 1/2 cc.

For some reason, I've just always been nervous about my body's ability to produce an adequate amount of progesterone without supplementation, so I asked the peri about it during our first appointment. I've read a lot of information online about supplementation during the 2nd and 3rd trimesters being necessary for some women and that it's totally safe. However, it also sounds like there are a lot of OBs/peri's who don't believe in it.

I think my peri falls into the second camp - she basically said she doesn't use it after the first trimester and that if the placenta isn't producing an adequate amount, that's a sign of a bigger problem with the placenta that would likely jeopardize the pregnancy. But it seems like there are a lot of women out there who had second trimester losses, and then when they were on progesterone in subsequent pregnancies (including during the second and third trimester), they went on to have healthy babies. So obviously their placenta didn't completely fail them...

The plan is to continue with the 1 supp and 1/2 cc every other day for now, and then re-test P4 on Friday to see if it's increasing. If not, I'm going to insist on going back up to a higher dosage. I asked the nurse what happens if it stays low, and she said she'd have to talk with RE.

On the other hand, it seems my E2 is perfectly fine. I'm down to 2 patches every other day and no estrace at all, and my level was just under 1,200 today. The nurse said that level was totally normal, and it's up slightly from just under 1,100 when I first started weaning. I couldn't find much info online regarding what normal E2 levels should be at this point, but the couple of charts I did see seemed to indicate it should be closer to 2,000 at 12 weeks. So not sure what to think on that one either.

To top it all off, yesterday on and off and for most of today, I've had a resting heart rate of 100-120 bpm (tachycardia). It finally seems to be easing up this evening. I'm not sure it's pregnancy-related, though. That used to happen a lot when I was in a hyperthyroid state before my thyroidectomy, so I have assumed it was thyroid-related, especially because it didn't happen for quite a while after the surgery.

But then it started happening again last summer and really started to become annoying last fall, so I assumed my thyroid meds were too high and asked my family doc to lower my dosages. If you recall some of my posts from spring, that didn't work out well - I wound up in acute kidney failure (resolved by increasing my dosages back to what they were), and the tachycardia went away on its own.

Peri just checked my thyroid levels last week and free T3 and T4 were a little lower than mine normally are (but still within the normal range) and T4 was up to 4.45 (it had been 1.something a couple weeks before transfer), so she's increasing my Syn.throid from 125 to 138, but I haven't started the 138 yet.

It looks like we'll have lots to discuss during my appointment on Friday...


Libby said...

You DO have a lot to discuss, but I know you will stand your ground. You have worked so hard for this. If the supplemental progesterone doesn't hurt, why not?

I don't know a ton about thyroid other than my thyroid nodule that I'm told is fine even though I suspect I have hyperthyroid symptoms at times. I just know it can be very tricky and many times the patient knows more about what's really going on than the doctor does. Sometimes you have to go with your gut, right! Try to hang in there!

Nico said...

I will never stop wondering if my last pregnancy failed - normal baby according to chromosomal typing - because i wasn't on progesterone. I see no reason whatsoever to stop it if your levels aren't where you feel comfortable, and if your peri won't go with that, i'd find someone else. Hopefully she will be on board though!

I'm supposed to stop mine next Weds; I am definitely planning on getting my progesterone checked when I go on Monday before I do. You have worked so hard and waited so long for this pregnancy that you need to do whatever it takes and whatever YOU feel best to keep it.

Sue said...

My P4 was at 19 when I stopped it entirely this time. I think it was close to that last time too...maybe 20? I never looked up what was normal but my nurse said it was fine and that the placenta produces other forms of progesterone to hold the pregnancy but they only measure P4 (not p2,or whatever the other is), so, I just went with it. There are major concerns with keeping you on P4 after the first tri b/c it can interfere with sex organ developement etc...or so they say. I was too worried and thought I'd go with the 19 and everything was fine. Of course, that is easy for me to say now...since things already turned out fine both times. I'm just saying that 19 is not unusual at all. I think I went down to 19, they kept me there, and it went back up to 21 and they fully weaned me, not even checking after that. I was the opposite, with my last miscarriage before I had DD, my E2 plummeted during weaning and I knew it was a sign that I lost the baby even though the doctors all told me it was fine...I went a few days later to my 10 week u/s and the baby had already passed I had a tendency to obsess about the E2 and let them deal with the P4.

About the TSH- I usually have to increase my dose at the end of the first tri b/c the hormones being produced by the placenta (E2 specifically, I think) interferes with the production of TSH. So, I go up during the pregnancy both times...and then after some time after delivery, they try to bring it back down to what I was prior. So, I'm guessing you are doing great...and all those hormones your placenta is actually producing is messing with your meds...except you don't have a thryoid maybe it just interferes with the absorption of synthroid and not production of TSH? I have no idea...but it seems normal.

I think you are doing great. Hang in there. I am so glad you are enjoying it b/c honestly, I think this is going to be a wonderful time...and in about 6 months, you are going to be downright blissful.

Sue said...

sorry...I wrote a book.

Anonymous said...

I'm a lurker who has been reading and cheering you on for a long time. I just wanted to jump in to say that my heart would frequently race while I was at rest during my pregnancy. Sometimes, I thought I was having a heart attack, and other times I could actually see my chest pounding. My ob/gyn said it's normal during pregnancy. It started late in the first trimester and tapered off mid 2nd trimester.

I am thinking of you and rooting for you.

Silver said...

Over here in the UK they just don't test your progesterone. My clinic indulged me in letting me go on with mine a bit longer than usual and then taper off but not once were my levels checked. They upped my thyroxine during the pregnancy and checked my T4 and TSH levels at fairly regular intervals. I too had a fast resting heart rate - never went below 90 after the first trimester and that was even while I was on beta blockers - like Anonymous, by ob/gyn said this is normal during pregnancy (partly to do with the much-increased blood volume) and mine went back down again nicely after the birth but stayed pretty high throughout the pregnancy and seemed to be totally unrelated to the thyroxine. You're like me, in that you've got a fairly complicated set of issues and it's really hard not to worry - please, at least, don't give yourself a hard time about the worrying ;-)!

Thalia said...

I would definitely ask for a conversatoin about the progesterone before you stop given several women prone to miscarriage have reported it helping - I hvae seen the studies but cannot recall them now. I remember Aurelia was a huge fan of this, not sure if you ever 'knew' her on line. She doesn't blog any more but you can find her on twitter.