Expert: Scott Roseff, MD, FACOG - 10/29/2008

Question
I take natural bio-identical progesterone cream from day 14-18 of my cycle, but something seems to be off and not only did I have a 12 day period last cycle, but when I began taking the cream again, on day 22 I began to see a brown spotting.
Usually once I see this I stop the cream and wait 14 days to start again, but this time I am confused.  Is this due to a lack of progesterone?  If so, should I take the cream until day 28 or until the brown becomes a regular period?

Or is this from too much progesterone?  I get the progesterone from a compounding pharmacy and it is metered in serenges, so that I take the right amount twice a day...

I am concerned that I won't be able to get pregnant if this keeps up and I want to understand how to know what is going on a little better.

Thank you!

Answer
Hi,

Several pharmaceutical companies produce "natural", bioidentical vaginal progesterone supplements, and these are strictly controlled by, and overseen by, regulatory agencies to assure the quality of those products.  So, when they say they contain a certain amount of progesterone per application, one can be assured they are getting what they are supposed to be getting.

Pharmacies that compound their own progesterone vaginal products do so potentially without the same quality control and oversight, so one can't be absolutely certain they are getting what they are supposed to be getting.  IF this is the case, then one can imagine that unexpected bleeding may occur.

IF someone is ovulating on cycle day 16, then starting progesterone on day 14 can "throw a total wrench" into the system, as starting it before ovulation is not appropriate.  Finally, if it's being prescribed due to a hormone imbalance, just taking progesterone alone sometimes is not the best treatment for the condition, and correcting the underlying abnormality may be more effective.

If you're not seeing a board certified RE, consider doing so.

I hope this helps,
Dr. Roseff, Director - Palm Beach Center for Reproductive Medicine
PERSONALIZED/Individualized Successful care by a Board Certified Reproductive Medicine specialist in a warm and caring setting....  Visit us in Wellington, Florida!
www.reproendo.com/different.htm
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