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Prometrium vs Provera


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#1

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Posted 28 July 2009 - 12:05 PM

I have been trying to get AF to start since my failed IVF in March.
I have done 3 rounds of progestone. 3 of Provera, and 1 of Prometrium. The Provera rounds resulted in AF... the Prometrium did not.

I am curious as to why.

I am also curious as to how/if this will effect the use of the Progesterone suppositories that I will take later in my FET cycle. If we can assume that Provera is a 'stronger' does of the hormone, then what are the suppositories made of and should I take a higher dose of them given that clearly my body doesnt respond to lower level doses.

I know this sounds a little obscure... but I like to look ahead and tweek things before hand so that I have 'all my ducks in a row' when the time comes.

Thanks everyone for your advice/experiences.

#2 Dr.S.P.Hudson

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Posted 31 July 2009 - 06:51 PM

I have been trying to get AF to start since my failed IVF in March.
I have done 3 rounds of progestone. 3 of Provera, and 1 of Prometrium. The Provera rounds resulted in AF... the Prometrium did not.

I am curious as to why.

I am also curious as to how/if this will effect the use of the Progesterone suppositories that I will take later in my FET cycle. If we can assume that Provera is a 'stronger' does of the hormone, then what are the suppositories made of and should I take a higher dose of them given that clearly my body doesnt respond to lower level doses.

I know this sounds a little obscure... but I like to look ahead and tweek things before hand so that I have 'all my ducks in a row' when the time comes.

Thanks everyone for your advice/experiences.


Although Provera and prometrium are both "progesterones" they have different charactaristics. If you are anovulatory ( not ovulating ) then your ovaries are producing estrogen only. The ovaries only produce progesterone after ovulation. To "bring on" a period in someone who is not ovulating we use either provera, prometrium or the BCP for a couple of weeks.

In order for Provera or Prometrium to be effective - you have to have been producing enough estrogen to stimulate the endometrium. Giving provera or prometrium for 7 - 10 days - acts on the endometrium converting it from a "Proliferative phase" to a "secretory phase". Once this has occurred, stopping the progesterone withdraws the hormone support the endometrium is relying on - and it sheds ( causing a menstrual flow)

Provera and Prometrium will only work on a uterus that has an adequate proliferative phase endometrium. If the endometrium is thin ( i.e. if there has not been enough estrgoen around ) then giving provera or prometrium will not result in any menstrual flow at all. ( because there is nothing there to shed !)

Now - to your question as to why provera is effective in making you bleed, but not prometrium. Provera is a "stronger" progesterone than prometrium. Prometrium is a milder gentler natural progesterone. In order for Proemtrium to help induce a bleed - you may just need a higher dose. The usual dose of prometrium to accomplish this is between 400 - 600 mg vaginally daily for at least 7 - 10 days. On the other hand - Provera only needs to be given in a dose of 10 mg daily for 5 -7 days.

This should not make any difference to the medication dosage prescribed for your IVF cycle. We cannot use provera for IVF/FETs - because it has mild androgenic effects ( male hormone like effects)on the baby and is therefore not good to take if you become pregnant.

If prometrium is used for an FET - the usual dosage is 200 mg intravaginally 3 x daily. You speak of "progesterone suppositories" - and I am not sure exactly what dosage and type of progesterone is being used -so I cannot comment on these.

If you are concerned about your progesterone levels during your FET preparation,you could ask your RE to measure your progesterone levels.

Good luck with your cycle

Regards


Dr.Stephen Hudson
Victoria Fertility Centre

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Posted 31 July 2009 - 10:04 PM

Thank you for your reply. Very informative.

Now, help me translate this please. It had been over 80 days between my last cycle. I took Provera to get a May period (which arrived one week after withrawl of 10 days of provera) then when the June period didnt arrive, I did 10 days of Prometrium. No period was achieved. I then did a round of 10 days Provera again, and got AF after a week withdrawl.

When I went to the clinic on day 7 after Provera withdrawl, they measured my endometrium lining at 16mm! Given the info you provided above, does this mean that my estrogen levels were very high (since you said low levels of E2 make thin linings) or does it mean my progesterone level was extreamly low. And, by knowing this... how should I proceed into my FET cycle now? I am taking Estrace now, and will be doing the progesterone suppositories (my label reads "200 mg Progesterone Suppository compound taken twice daily" - not any specific brand) Should i be asking for the name brand Prometrium or should I be taking a higher than usual dose?

Your advice is very helpfull. It makes the 43 seconds I get to speak to my RE go much smoother if I can go in there with answers and ideas for consideration already.

Looking forward to hearing from you.
Thanks