January 27 2014 - Progesterone In Pregnancy is a Major Consideration

Progesterone In Pregnancy is a Major Consideration
 
I frequently get questions on patients having the inability to get pregnant or to go full term. Progesterone is essential in maintaining a pregnancy. I use Labrix Labs salivary testing (877-656-9596) to evaluate Estrogen, Progesterone, ratios, Testosterone and the cortisol four times during the day and evening.  This is extremely important to overall health and especially to a successful pregnancy.  It is important to also support the adrenals with MaX Adrenal, herbal or glandular, if indicated upon testing, which is the majority of the time.

Progesterone thickens and prepares the lining of the uterus, the endometrium, for implantation of a fertilized egg. After implantation, progesterone secreted by the corpus luteum maintains the pregnancy until the placenta takes over in the second and third trimesters.

During the first 14 days of the menstrual cycle, the endometrium is relatively thin and begins to thicken before ovulation.  After ovulation, the endometrium continues to thicken. If no pregnancy occurs in this cycle, the endometrium will shed during a woman's period and become thinner. If pregnancy occurs, the endometrium will remain thick to support the pregnancy.  The difference in the thickness of the endometrium varies depending upon the amount of progesterone in the body. The endometrium is thinnest during the first half of the menstrual cycle, when progesterone levels are low (the follicular phase). The endometrium becomes thickest after ovulation when progesterone levels rise (the luteal phase).

A common cause of early spontaneous abortion (SAB) is luteal phase deficiency. After an egg is spit out of an ovary, the follicle left behind involutes and becomes the corpus luteum. Luteal phase deficiency occurs when the corpus luteum fails to produce adequate amounts of progesterone. This can be diagnosed and monitored via salivary hormone testing. If progesterone levels test below range when the sample is taken 7-9 days after ovulation (approximately days 19-21 of a 28 day cycle), then a luteal phase defect may exist.  Supplementing with bioidentical progesterone can greatly increase a woman's chances of maintaining a pregnancy.
Much of the data on normal levels of progesterone during pregnancy, and its relation to a variety of pregnancy related complications, was generated in a study which was conducted from 1980-2001 at the Pope Paul VI Institute in Omaha, Nebraska. In this study, 610 patients were followed through 830 pregnancies and 8,545 progesterone levels were studied and statistically evaluated.  The patients were primarily being seen for infertility, and were receiving progesterone supplementation during the course of their pregnancy.  Infertility was either primary or secondary and some of the patients also had a history of previous spontaneous abortion and, in some cases, recurrent spontaneous abortion. This study showed that the endogenous progesterone levels were indeed statistically decreased during first and second trimester spontaneous abortions. We use Progensa 20 or Progensa Plus Topicals from XYMOGEN.

According to the Pope Paul VI Institute, progesterone use in pregnancy is not dangerous. In this report, over 2,000 pregnancies were reviewed or reported with the use of progesterone support in pregnancy with no increase in birth defects or genital anomalies.  They found that fetal serum progesterone levels are seven times maternal levels. Thus, the fetus is exposed to very high concentrations of progesterone in the natural state, much higher than could be accomplished even with the exogenous administration of progesterone. Progesterone support in pregnancy can be considered completely safe![i]

The Pope Paul VI Institute is not the only organization to have studied the use of progesterone in preventing SAB. In a study out of St. Mary's Hospital in Manchester, UK, it was shown that luteal phase defect is encountered in many cases of recurrent miscarriage.  They discovered that progesterone supplementation results in a trend towards improved ongoing and clinical pregnancy rates.[ii] A study by Szabo et al concurs: when luteal phase deficiency is present, "progesterone is the most important hormone for the maintenance of an early human pregnancy." [iii]

It is interesting to note that when a woman is undergoing in vitro fertilization, progesterone is routinely given to support the luteal phase and increase the chances of a successful pregnancy.[iv]

Because progesterone is so essential in maintaining a pregnancy, progesterone antagonists can be used when it is necessary to terminate one. The pharmaceutical Mifepristone (RU-486) blocks the hormone progesterone. Because this hormone is blocked, the uterine lining begins to shed, the cervix softens and bleeding may occur. (A second medication, misoprostol, is often given 24-72 hours later to cause the uterus to contract and expel the pregnancy).[v]
If salivary hormone testing reveals a progesterone deficiency, give your patient bioidentical progesterone. Then advise your patients, "If you think you may be pregnant and want the pregnancy, do NOT stop the progesterone until you have done a pregnancy test." A sudden drop in progesterone levels would signal the body to shed the uterine lining, possibly inducing an abortion. If a pregnancy test is positive and your patient wants to remain pregnant, tell her to continue to use progesterone cream to prevent the scheduled menstrual shedding and to protect the developing fetus from early miscarriage. Progesterone may be safely used throughout the pregnancy and into the postpartum period when it can protect Mom from experiencing the baby blues (commonly caused by crashing hormones after delivery).[vi] References

The thyroid and iodine levels are very important to overall health and pregnancy.  Consider MaX Thyroid and MaX Iodine.  Female glandular balance is very important, (MaX Female).  We highly recommend the Brimhall Advantage SBN blood and possible hair testing and supporting the nutrition that is indicated.  For the Male, the same nutrients are to be considered except for glandular balance, test for MaX Male.  All MaX Products are manufactured by XYMOGEN and are under the BioEnergX Label.