Progesterone - Conception, Pregnancy, Miscarriages & Post Natal Depression (PND)

Natural progesterone has been established as a safe and effective means of contraception. The foundational research on progesterone's contraceptive use was conducted by the late Dr. Katherina (Kittie) Dalton. She was a remarkably knowledgeable and compassionate individual who aided countless individuals through progesterone therapy. I have incorporated insights from her book, "PMS: The Essential Guide to Treatment Options."

It is widely recognized that individuals experiencing PMS typically do not encounter symptoms during pregnancy, particularly in the latter half. This phenomenon occurs because the placenta generates significant amounts of progesterone, which is vital for sustaining the pregnancy. Progesterone levels in the blood of pregnant women can be 40 to 50 times higher than those in women who are not pregnant. Nevertheless, some women may still experience PMS symptoms during the later stages of pregnancy, and these individuals are at an increased risk of developing pre-eclampsia (refer to Page 150 in Dr. Dalton's book). The term PMS was first introduced by Dr. Kittie Dalton in the 1950s.



During pregnancy, maintaining hormonal balance is essential for both the mother's and the baby's health. Progesterone, a crucial hormone for the maintenance of pregnancy, naturally rises to support the developing fetus. Given its importance, it's not surprising that some women contemplate using progesterone cream, particularly when dealing with hormonal imbalances or a history of miscarriages.

Contraception

I want to begin by highlighting the risks associated with Contraceptives. They significantly contribute to difficulties in conceiving as they disrupt a woman's natural biological rhythm. Upon cessation, they can lead to substantial irregularities in the monthly cycle. All pharmaceutical contraceptives carry the potential for adverse effects. It’s crucial to allow sufficient time for synthetic estrogens and progestins to clear from the body before trying to conceive. An increasing number of young women are feeling desperate as they struggle to conceive after discontinuing birth control pills (BCP).

Contraception can frequently pose challenges for women, and those dealing with PMS face an especially tough period as well.

All birth control pills (BCP) include progestogens, which may also be referred to as progestagens or gestagens. This class of steroid hormones attaches to and activates the progesterone receptor (PR). While progesterone is the primary and most crucial progestogen in the body, progestins are synthetic versions of these hormones. These artificial progestogens can reduce natural blood progesterone levels, leading to an increase in the severity of PMS symptoms. It is advisable to avoid BCP at all costs.

* Sterilization increases PMS symptoms and should also be avoided no matter how popular this method is.

The intra-uterine device (IUD) is not recommended for women who have a history of pelvic infections or for young girls who have never been pregnant.

* Withdrawal is very unreliable not to mention stressful.

In addition to progesterone contraception, we have condoms, the diaphragm (often referred to as the Dutch Cap), and vasectomy as alternatives.

If you have any questions about Natpro Progesterone Cream

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Progesterone as a Contraception

Progesterone is just as safe as a contraceptive as the IUD or BCP, but without the side effects PROVIDED it is used as follows:

It must be used before ovulation, generally half way through the follicular phase, and continued until bleeding. There is no harm in using it daily, but it can upset the cycle. The amount should be no less than 100mg per day, preferably 200mg per day. But, and it is big but, Stress drops progesterone levels, which could leave you unprotected. Extra precaution needs to be taken during stressful times. It is actually very effective at stopping ovulation, it works in the same way as the synthetic version, but without the side effects.

This is exactly how Dr Kittie Dalton advises to use progesterone as a contraceptive.

"Start on Day 8 of the cycle with a low dose of progesterone, and keep it up until menstruation or - for PMS sufferers - the day when you start on the bigger, anti-PMS dose. A daily dose of 100 mg (half a 200 mg suppository) or a 400 mg suppository are equally effective. (Many women who will use 400 mg of progesterone two to six times daily from ovulation onward prefer to take one 400 mg suppository in the follicular phase rather than having to get 200 mg suppositories as well").

Progesterone as a Contraception for PMS

As per Dr Kittie Dalton ....

  • A low dose (100-200 mg) of progesterone from Day 8 of the cycle
  • Increase to optimum progesterone dosage at ovulation
  • Continue progesterone until menstruation

A study of progesterone contraception in women with severe PMS showed 15 failures in 253 women who had used progesterone contraception for an average of 5.82 years. This means a failure rate of 2.66 per 100 women/years (women/years is a ratio that encompasses 100 women using a method of contraception for one year, 50 women using it for two, etc.), which compares favourably with the recognized failure rate of the condom of 14, diaphragm of 12, rhythm method 24, and intra-uterine device of 2.5 per 100 women/years.

However, some women find that by starting progesterone early they start bleeding at, or shortly after, ovulation. They should be advised to lower the dose of daily progesterone from Day 8 to 100 mg daily and start their usual higher dose of progesterone about two days after ovulation. If extra bleeding still occurs, then it is best to use a condom or diaphragm until the normal time of starting their course of progesterone. Should attacks of diarrhoea occur when using progesterone, then contraception cannot be guaranteed and alternative methods are advised. .....

Another common cause is PCOS. Please read my page on this syndrome and how it can be treated.

Conception and Miscarriages

Progesterone plays a major role during the 2 weeks after ovulation, prior to the fertilised egg implanting in the uterus. It is also vital for maintaining pregnancy.

The first half of the monthly cycle is known as the follicular phase, and it can range from 7 days to 21 days. Progesterone is present in extremely small amounts, estrogen and follicle stimulating hormone (FSH) being the dominant hormones.

At the beginning of this phase, in response to FSH made by the pituitary gland, eggs start developing. Each egg is contained in a cyst called a Graafian follicle, which starts making estrogen, this in turn causes the egg to grow and mature. Estrogen also stimulates the endometrium (lining of the uterus) to grow and thicken. When 1 or 2 eggs are fully developed they rise to the surface of the ovary and appear as small 'blisters’.

When the egg has reached maturity, another hormone called lutenising hormone (LH) is released by the pituitary. Approximately 24 hours later this causes the Graafian follicle to rupture releasing an egg, known as ovulation. The follicle, which is now called the corpus luteum starts to produce progesterone for the next 14 days making progesterone the dominant hormone.

All women, irrespective of the length of their cycle, should start ovulating about 14 days before their next menstruation. If shorter, there is insufficient time for the endometrium to be readied for the embryo to implant, this is known as a defective luteal phase. If the corpus luteum does not make sufficient progesterone during these 14 days, it will result in a defective luteal phase. This seems to be a problem found in many women now and could well be due to the large amounts of estrogen in the environment.

The Surge

At the beginning of the cycle, .i e. day 1 of bleeding, estradiol production either drops slightly or is flat for the first 2-4 days. It then rises slowly for the next 6-10 days, and then sharply for 2-5 days. This is the preovulatory peak, after which it drops.

During the 50 hours prior to the mid-cycle surge, estradiol, progesterone and another pituitary hormone secreted by the anterior pituitary gland called LH (luteinising hormone) begin rising, while FSH declines.

The cells forming the outer layer of the Graafian follicle are called thecal cells. LH is required for both the growth of preovulatory follicles and ovulation of the dominant follicle. Under the influence of LH they secrete testosterone. LH causes proliferation, differentiation, and secretion of androgens by the theca cells which surround the ovum, giving rise to androgen levels.

The androgens, notably androstendione, migrate from the theca cells to the granulosa cells where they are converted by the enzyme aromatase into estrogen, particularly estradiol. The theca cells also produce estradiol without the need for conversion. This rise in the androgens is responsible for the acne, oily skin, facial hair, loss of scalp hair etc. that some women experience.

12 hours prior to the mid-cycle surge, progesterone rises rapidly. This surge is produced by brain cells, and has nothing to do with the surge that occurs after ovulation. It is thought to initiate the LH surge which begins 12 hours after the progesterone surge. FSH rises again at the same time as LH. This preovulatory surge in progesterone is now known to be essential for the facilitation of feminine sexual behaviour too.

The surge of the gonadotrophins causes estradiol levels to rapidly fall, while progesterone continues to rise. The gonadotrophins plateau for about 14 hours after which they drop sharply.

Androstenedione (A) and testosterone (T) increase at a slow rate before the surge, rising faster when the mid-cycle surge begins. Then about 14 after initiation of the surge, they decline, but at a slower rate than estradiol. In spite of the significant increase in A and T, estradiol still drops sharply. It is thought that the rapid rise in progesterone may inhibit aromatase activity.

Defective Luteal Phase

Progesterone is the pregnancy hormone. If there is too short an interval between ovulation and menstruation, then this is known as a defective luteal phase. A short interval of less than 12 days, means that progesterone level was not high enough resulting in an early miscarriage. This is due to the fertilised egg not embedding itself in the lining of the womb. This can be overcome by ensuring that there is sufficient progesterone after ovulation and until the placenta has started to produce its own progesterone. Progesterone therapy should be continued until the fourth month of pregnancy.

How to use Progesterone to Extend the Luteal Phase

  • A low dose of progesterone will not help. Research has shown that between 100-200mg of progesterone should be used, which is 3-6ml of Natpro, more maybe needed. It should not be used before ovulation, as that will prevent it occurring and therefore prevent any chance of falling pregnant. In other words, progesterone can act as a contraceptive.
  • It must only be used at ovulation if pregnancy is the aim.

How to check when Ovulation has occurred

Taking temperature readings or using a mini microscope will help to check for ovulation, the mini microscope is more reliable, as temperature can vary from as little as 0.5 degrees to 5 degrees.

Saliva or vaginal mucus is used for the test, by dabbing a small amount on the end of the microscope. During the follicular phase, the pattern formed by the saliva/mucus is spotty, as ovulation draws near a fern like pattern starts emerging, becoming completely fern like when ovulation has occurred, returning to the spotty pattern almost immediately. For more information see Ovulation Microscope.

Normal oral body temperature in adult men and women ranges between 33.2-38.2°C (92-101°F). Typical average temperatures are 37.0°C (98.6°F).

In women it varies between the follicular and the luteal phase. During the follicular phase, i.e. from the first day of menstruation to ovulation, it ranges from 36.45 to 36.7°C (97.6 to 98.1°F).

During the 12-14 day luteal phase, i.e. after ovulation to menstruation, temperature increases by 0.15 - 0.45°C (0.2 - 0.9°F) due to the increased metabolic rate caused by rapidly rising levels of progesterone. Temperature ranges between 36.7 - 37.3°C (98.1 - 99.2°F) during the luteal phase, but drops down to follicular levels within a few days of bleeding.

Fertilisation

One of the most important things to remember about conception is the life span of the sperm and ovum. The average life of the sperm appears to be 2 to 3 days, sometimes longer, but the ovum only lives 12 hours and in rare cases 24 hours.

Research points to a greater success in conception if intercourse takes place in the one to two days prior to ovulation, when the fern like pattern is almost complete. This allows time for the sperm to travel through the uterus and up the Fallopian tubes to meet the egg before it becomes over mature or it dies.

One of the problems with an over mature egg is it diminishes the chances of fertilisation, can result in a miscarriage or result in foetal abnormalities. The health of the future child is dependent on these factors. The nearer intercourse takes place to ovulation, the greater the chances of conception.

In Vitro Fertilisation

Some women have difficulty conceiving naturally and need in vitro fertilisation (IVF) will also need progesterone from the time of implantation until the placenta is producing enough progesterone to keep the embryo going. There are several different types of IVF treatment today, but they all need plenty of progesterone in the first few weeks.

Pregnancy

  • 12 to 14 days is necessary for the lining to mature enough to receive a fertilised egg. If bleeding does occur, it means the egg has not been fertilised or the luteal phase was not long enough.
  • Progesterone should then be stopped and only started again at the next ovulation. If bleeding does not start 14 days later, it is possible that fertilisation has occurred.
  • On no account must the cream be stopped at this stage, otherwise it could cause a miscarriage.
  • If pregnancy is confirmed, continue using the cream. 100mg/3ml - 200mg/6ml of cream should be used each day until the fourth month after the critical stage has passed.
  • Progesterone can be continued till birth, this is particularly important if pre-eclampsia is a possibility.
  • Continue using the cream after birth, particularly if post natal depression occurs. It is far better to stay on progesterone if possible, but if you wish to discontinue please reduce slowly over a month or two depending on the amount used i.e. if 100mg/3ml is being used reduce to 2 ml over the first 2 to 3 weeks and to 1ml over the next 2 to 3 weeks.
  • Symptoms should be monitored and if spotting, headaches, water retention or nausea occurs, increase the dose and continue using it till birth. In some women water retention and a rise in blood pressure sometimes occurs in the last 1 to 2 months, please increase the dose if this should happen.
  • The first 3 to 4 months are critical. 25% of miscarriages occur during the first 6 weeks when the child is still in the embryo stage. The risk drops to 8% after 8 weeks, when the child is now termed a foetus.
  • During this time the placenta is growing and after about 2 months starts making progesterone, while ovarian production starts declining. If at this point placental production is insufficient to meet the demands of the growing foetus a miscarriage can occur. It is therefore advisable to continue using progesterone until at least the third or fourth month. All being well the placenta continues to make progesterone in increasing amounts until birth, when it drops abruptly with the expulsion of the afterbirth, as the placenta is now generally termed. It is essential to continue the cream over this critical phase.
  • Stress can cause a miscarriage. The rise in cortisol in response to the stress, results in a drop in the progesterone level, this in turn can lead to spotting or a miscarriage. To prevent this, as soon as any stress is felt, increase the amount of cream till it has passed.

Nausea or Morning Sickness

If you have recently begun using progesterone at conception and are dealing with severe nausea or morning sickness, it's essential to use no less than 400mg (12ml) of progesterone cream daily. In cases of severe symptoms, you may increase the dosage to 800mg per day. It is crucial to avoid applying the cream all at once; instead, use it twice a day—once in the morning and once at night. You may also apply it during the day if needed. Using it all at once can lead to a spike in progesterone levels, so maintaining a stable level is important. Continue with this amount for approximately a month or until your morning sickness begins to improve or subsides. Once you notice relief, you can start to reduce the cream gradually, Remain on each reduced dose for about 4 to 5 days before reducing again. If you reduce too quickly or decrease too much at once, your symptoms may reappear. Continue this process until you determine the right level for you. Once you find an appropriate dose, it is vital to maintain that dosage throughout your pregnancy. Stopping suddenly could risk a miscarriage!

Breastfeeding

Menstruation typically does not resume until after breastfeeding has concluded. Therefore, if a mother feels well and intends to breastfeed for several months, she can discontinue progesterone after two months. However, if symptoms reappear, it is advisable to restart progesterone. When progesterone was first isolated in 1934, researchers believed its primary role was to prepare the breasts for lactation. In fact, progesterone supports breastfeeding, and mothers need not be concerned about any adverse effects on their infants. The recommended dosage of progesterone is 100-200mg.

It's essential to focus on your diet, as it plays a crucial role in maintaining good health. Emphasizing a low-carb diet by cutting back on carbohydrates and increasing protein consumption can greatly enhance the likelihood of conception—see references.

Habitual Miscarriages

When a woman experiences multiple miscarriages, it is natural for her to be anxious about ensuring that all possible medical measures are taken to achieve a healthy, full-term pregnancy. Consequently, she is often prescribed progesterone therapy as a precaution. Miscarriages can occur for various reasons, including chromosomal abnormalities, which currently have limited intervention options. However, they can also stem from anatomical issues, such as a weakened cervix (the opening to the womb), which can be surgically reinforced until labour begins. Additionally, some women experience severe nausea and other pregnancy symptoms as soon as they conceive, and these individuals are most likely to benefit from sufficiently high doses of progesterone to alleviate their symptoms. Among the many patients Dr. Dalton has treated throughout the years, two women with nine previous miscarriages each received progesterone therapy and subsequently gave birth to healthy babies at the City of London Maternity Hospital.

Threatened Miscarriages

Bleeding in early pregnancy can be a source of concern. Naturally, the patient may be anxious, contemplating whether this indicates the end of the pregnancy. If the bleeding is light and does not include clots or fetal tissue, there is a possibility that, with adequate rest, everything will turn out fine and that the pregnancy can proceed normally. This is especially true if the bleeding coincides with the anticipated timing of the first missed period. If the bleeding is accompanied by severe nausea and other early pregnancy symptoms, the patient may benefit from progesterone therapy at a dosage sufficient to alleviate these symptoms. However, after delivery, the doctor may ponder whether the pregnancy would have continued even without the administration of progesterone.

Post Natal Depression (PND)

Progesterone is effective in alleviating severe PMS, now more commonly referred to by doctors as PMDD. It also plays a crucial role in preventing postnatal depression (PND), which can be more debilitating, as well as postnatal psychosis, the most severe manifestation. To achieve these benefits, a high dosage of progesterone is necessary. Dr. Kittie Dalton recommends 800mg per day for severe PMS/PND and up to 2400mg daily for postnatal psychosis. The term 'depression' is a misnomer for an illness that impacts around 10 percent of new mothers postpartum, as depression is seldom the first symptom to manifest and, in many instances, may not occur at all. Women who have experienced PND often provide far more insightful accounts of their initial feelings during the illness, highlighting issues like sleeplessness and emotional distress.

  • not with it
  • distant
  • shattered
  • confused
  • losing touch
  • muddled
  • out of control
  • high, gloriously high
  • mind going round
  • couldn't talk/wouldn't go out/kept the curtains drawn each day
  • spent money like there was no tomorrow
  • angry
  • panicky

Encountering the transformed personality of a new mother can be a distressing experience for her partner. The calm demeanor she once had has given way to overwhelming anxiety; her previous alertness and activity have turned into dullness and silence; the accomplished career woman is now afraid of being left alone; where once she was carefree, now she grapples with obsessive thoughts. Postnatal depression (PND) and its more severe counterpart, puerperal psychosis, are hormonal conditions that share similarities with PMS and often evolve into PMS over time. As a woman suffering from PND begins to recover, she may notice that her symptoms improve post-menstruation, only to reappear more intensely as her next cycle approaches. With continued progress, she may reach a point where symptoms are absent after menstruation but become pronounced in the premenstrual phase. At this stage, the condition has shifted to PMS.

PND often arises in women who have experienced severe PMS or who have a history of PND or puerperal psychosis following a prior pregnancy. It can unexpectedly manifest after a seemingly normal pregnancy and delivery. However, it can be effectively prevented by coordinating with the general practitioner, obstetrician, and midwife during pregnancy. Once the baby is safely born, the mother should receive the first of seven daily progesterone injections of 100 mg, followed by 400 mg progesterone suppositories twice daily for the ensuing two months or until normal menstruation resumes. Since menstruation is unlikely to return until after breastfeeding is completed, if the mother is feeling well and intends to continue breastfeeding for an extended period, progesterone may be discontinued after two months. Should any symptoms reoccur, the progesterone treatment should be resumed.

Progesterone for Postnatal Depression

Immediately after delivery, progesterone injections 100 mg daily for seven days, followed by progesterone suppositories 400 mg twice daily until the return of menstruation or for two months. Some good News - when PMS sufferers have had adequate progesterone during pregnancy so that there have been no symptoms of pregnancy, no hyperemesis or rise of blood pressure, and if progesterone has been given after the delivery to prevent any postnatal depression, then there is about a 50:50 chance that the PMS will not return.


Preeclampsia  

Once again, progesterone and Vitamin D3 play a crucial role and prove to be highly beneficial. Research indicates that low levels of these substances may contribute to elevated risk for certain individuals. One study revealed that progesterone levels were 'pathologically and statistically' lower in affected subjects. Additionally, serum allopregnanolone—a powerful metabolite of progesterone—was found to be significantly diminished as well. In this context, the Th1 (inflammatory cytokines) and Th2 (anti-inflammatory cytokines) pathways are significant. The prevalence of Th1 cells and the Th1:Th2 ratio in preeclampsia is notably higher than in a typical pregnancy. Both progesterone and Vitamin D3 serve to elevate levels of Th2.


Nonetheless, several additional factors have been identified as influential. Women experiencing insulin resistance, elevated malondialdehyde, and homocysteine levels face a heightened risk of developing preeclampsia. Furthermore, insufficient selenium and low glutathione levels, along with other antioxidants, also contribute to this increased risk.


In the case of recurrent miscarriages, pre-term births, or preeclampsia, it may be advisable to use 200-600mg of Natpro progesterone cream daily. While some maintain that progesterone is ineffective in preventing these issues, evidence suggests that inadequate doses of progesterone were utilized in studies that did not yield successful outcomes. Please refer to the provided references.


To Recap

  • progesterone should be administered solely during ovulation when the goal is to achieve pregnancy.
  • use a thermometer to monitor temperature readings or utilize a mini microscope to assist in detecting ovulation.
  • under no circumstances should the cream be discontinued if conception is suspected, as this could lead to a miscarriage.
  • it is vital to persist with the cream during the crucial initial phase of 2-3 months, especially the first 2 months.
  • it is also crucial to remember that stress can lead to a miscarriage.
  • the closer intercourse occurs to ovulation, the higher the likelihood of conception.
  • utilize a dosage of 100/3ml to 200mg/6ml of progesterone cream, ensuring that the cream includes a concentration of 33.3% progesterone. If using a cream with a lower concentration, make the necessary adjustments.
  • chronic nausea and morning sickness require at least 400mg/12ml of progesterone daily until symptoms improve; higher doses may be necessary.
  • get a Vitamin D3 test—it’s essential! Please take a moment to watch this fascinating video about the significance of Vitamin D3 during pregnancy.
  • reduce your carbohydrate intake and boost the protein in your diet.

Please read my page on Miscarriages.

Additional information once pregnancy has occurred

Upon becoming pregnant, the developing fetus adds extra demands on the mother's body, making it essential to prioritize nutrition. Please consider incorporating the following into your daily routine:

  • A daily intake of 5,000 IU of Vitamin D3 (cholecalciferol) is essential for the developing fetus. It helps prevent epigenetic modifications, and rickets—which is unfortunately on the rise—heart failure, epilepsy, type 1 diabetes, and lower respiratory tract infections in newborns, while also reducing the risk of pre-eclampsia in the mother. Moreover, a deficiency in Vitamin D3 has been associated with autism.
  • A daily intake of 1000-2000mg of taurine can help prevent epilepsy, insulin resistance, impaired glucose tolerance, diabetes, compromised neurological function, vascular dysfunction, and growth retardation in developing fetuses and newborns. Taurine is an amino acid absent in grains, legumes, vegetables, nuts, and seeds. It is primarily found in animal protein, which poses a risk to vegetarians.
  • 5ml or 1 teaspoon of Omega 3 fish oil is essential for the developing brain.
  • Vitamin B complex enriched with additional folic acid, elevating the daily intake to 800mcg to help prevent neural tube defects. If you are a vegetarian, exercise caution, as excessive folic acid can obscure a B12 deficiency. Insufficient B12 levels in utero may raise the risk of insulin resistance in the child. Here’s some information on Gestational Diabetes.

VITAMIN A - Avoid consuming cod liver oil or any fish liver oil due to their high levels of vitamin A, which can hinder the absorption of vitamin D3 and potentially lead to toxicity. If you are deficient in vitamin A, consider taking beta-carotene instead.

To eliminate any misunderstandings, 'fish oil' is derived from the fish's muscle and is rich in Omega 3. On the other hand, fish 'liver' oil is extracted from the liver, providing substantial amounts of vitamin A and minimal amounts of vitamin D3. It’s essential to recognize the significant difference between the two.

A heartfelt thank you to the late Dr. Kittie Dalton, whose invaluable support has transformed the lives of countless women facing PND and striving to conceive. Her expertise has provided guidance to so many women today. I encourage you to explore her books.

Another book that merits attention was penned by one of her patients. Nicola Owen, whose troubles began at fourteen during her puberty, ultimately found herself in Holloway Prison for Women in the UK. Dr. Dalton prescribed progesterone, which effectively addressed the psychosis, facilitating her recovery and eventual release. Although it is currently out of print, secondhand copies can still be found on Amazon.

Nicola - by Nicola (with Sydney Higgins) Owen (Author)

Research Papers

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