Dear Rachel et al - 

Prometrium is sometimes prescribed to pregnant women here in the US when 
they are found to have low serum progesterone, corpus luteum defect/cyst, 
or with histories of multiple/recurrent miscarriages that were preumably 
attributed to low progesterone.  My limited review of the literature, and 
discussion with a few local OBs, finds that it is a controversial topic 
(imagine that!), with some prescribing it "just to be safe" and others 
feeling that it is unwarranted.  I went through this recently with my own 
pregnancy, and was amazed and appalled at the lack of clinical evidence 
given to support the recommendation that I take the prometrium, which is 
why I quickly weaned myself off of it (and low and behold, remained 
pregnant - 20 weeks now).  I emailed Ellen personally and asked her the 
following questions: What is this mom's serum progesterone level?  Why 
were the meds. prescribed?  Has she experienced previous pregnancy losses 
attributed to low progesterone?  Is her doctor concerned about continued 
nursing because of its possible effects on the nursling (a quick look in 
Hale reassured me) or because of nursing's possible effects on the mother 
and fetus (which is questionable at best).  One big question I have is 
this:  since any reference I have found to support progesterone 
supplementation suggests that it can/should be removed by 11-13 weeks or 
so, why is this mom is already ten weeks pregnant and just starting the 
meds?  Her own placenta should be taking over production soon, and if she 
has been nursing this whole time without issue, the advice to wean 
abruptly at this point does not seem well thought-out.  I am quite 
surprised that a woman who is seeing a fertility specialist has just 
discovered she is pregnant at ten weeks - usually moms with fertility 
issues know that they have conceived before they even miss a period!

And the questions I always ask a pregnant mom of a current nursling:  How 
will she feel if she does not wean, and loses the pregnancy?  How will she 
feel if she DOES wean, and loses the pregnancy?  I agree that she needs 
another medical opinion, and a lot of support for whatever decision she 
makes.

Karen Pogge, MD, LLLL
Enjoying being back on Lactnet after a long break

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