Restoring Cycles With (Real) Progesterone in PCOS: A Patient Case
Of the many things that I wish I had learned in medical school and residency about women’s health, at the top of this list is the crucial role of progesterone in the treatment of so many disorders that women face in their reproductive years. In my training I was briefly introduced to this hormone and when it was mentioned there was no distinction made between the authentic version and the counterfeit version that is so widely prescribed in many forms of birth control and hormone replacement therapies. Because most doctors are unaware of the differences, many women are also uneducated and therefore accept the counterfeit version as acceptable treatment. Those women often show up in my office because the artificial hormones have not only failed to help them but they’ve caused significant harm.
What’s the Difference?
Simply put, progestins (chemicals that are not progesterone but have similar activity) shut down ovulation and progesterone encourages ovulation. This may seem like a minor difference until you consider how important ovulation is in the overall health of a woman throughout her reproductive years. (https://www.larabriden.com/the-secret-powers-of-ovulation/)
Ovulation is a sign of health that every woman should learn to recognize each month. When it isn’t happening, a woman should be curious and begin to look for reasons why so that health can be restored.
Common reasons why a woman may not ovulate:
· Not eating enough
· Insulin resistance
· Polycystic Ovarian Syndrome
· Thyroid disorders
· Chronic stress
· Immaturity of the reproductive hormone system (teen years)
· Peri-menopause (women in their 30’s, 40’s and beyond)
Many women are unaware of the benefits of healthy ovulation due to the widespread use of birth control over the past fifty years or so. Because we don’t understand our bodies and the benefits of ovulation, we have blindly accepted birth control as the answer to many of our problems. But now that we know better we can choose differently!!
Recently I saw a woman in clinic who in now in her late 20s, trying to conceive but has had infrequent periods since her period started. She was prescribed birth control in high school, which artificially gave her regular withdrawal bleeds (not real periods since she was not actually ovulating). She took birth control for about 7 years and stopped when she got married. When she stopped the birth control pill, her cycles returned to their original pattern – very long cycles, rare periods and continuous mucus. She saw an OBGYN doctor who diagnosed PCOS (polycystic ovarian syndrome) based on an ultrasound of the ovaries and lab tests. No treatment was initiated. She and her husband were able to conceive but then went on to suffer a miscarriage. She was introduced to the Creighton Model method of fertility awareness and began charting her cycle. I met her and her husband after charting for a few months. Her chart was challenging because of the abundance of mucus that made determining peak day (time of ovulation) very difficult. Because of the history of miscarriage, I suspected that she was not making enough progesterone to sustain a pregnancy. We discussed her treatment options and I recommended starting progesterone.
As a Naprotechnology medical consultant, I learned that in cases such as this (infrequent periods/ovulation), the best course of action is to treat with cyclic progesterone in order to improve the efficiency of ovulation and to support the uterine lining so that healthy implantation of an embryo can be encouraged. She saw me on cycle day 18 and started progesterone that day. Two weeks later, she called our clinic to inform us that she had a positive pregnancy test! Not surprisingly, her progesterone level was suboptimal once she had stopped the progesterone supplementation so she is being supported with progesterone and her progesterone levels are being monitored/treated according to the St. Paul VI Institute Protocol developed by Dr. Thomas Hilgers. I am very encouraged and hopeful that her current pregnancy will be healthy!
Why Is Progesterone Therapy So Important In a Case Like This?
In patients with PCOS, infrequent periods and continuous mucus, it is likely that the patient’s ovaries are making excessive estrogen (results in lots of mucus and thick uterine lining that is not yet receptive to implantation of an embryo) but not much progesterone (results in controlling the growth of the lining stimulated by estrogen and prepares the uterine lining for healthy implantation). Since the patient likely has too much estrogen and not enough progesterone, she should be given progesterone that is chemically identical to the hormone that her ovaries should be making. It should be given during the luteal phase of the cycle (after ovulation) if possible (for approximately 10 days beginning 3 days after ovulation, known as “cooperative progesterone therapy”). Since this patient could not identify the time of ovulation (due to excessive mucus), she was treated with “cyclic progesterone therapy” given from cycle day 18-27 of the cycle.
In summary, patients with long cycles (infrequent periods) should be treated with cyclic (monthly) progesterone for several reasons
1. To enhance the efficiency of ovulation so as to promote regular cycles (periods every 28-35 days
2. To prevent uterine cancer by assuring that the uterine lining is shed regularly through the use of progesterone
3. To reduce the risk of miscarriage in women who may not be able to make enough progesterone naturally.
Unfortunately, the standard of care for women with long cycles and/or PCOS is as follows:
If the woman wants to conceive she is given a medication to induce ovulation (such as clomid or letrozole). This sounds good on the surface but these women are not being treated with progesterone to support the uterine lining in the event of pregnancy.
If she wants to avoid pregnancy she is given birth control.
I see many women in my clinic who are looking for a different approach. If you or someone you love are looking for a different approach, I would encourage you to find a Creighton Model FertilityCare System practitioner or a NaproTechnology medical consultant for a second opinion. I would also encourage you to share this post with your OBGYN who may be looking for a different way to treat his/her patients.
Hilgers, Thomas (2004) The Medical & Surgical Practice of Naprotechnology Omaha, NE: Pope Paul VI Institute Press.