Progesterone Deficiency: Symptoms, Treatment, and Concerns

Luteal phase deficiency

Hello, Doctor.
Previously, I would experience light bleeding 5 to 7 days before my period, consistently every month.
However, when my period arrives, it is not very painful and the flow is not heavy.
This symptom has persisted for nearly a year.
Later, I visited a gynecologist who diagnosed me with luteal phase deficiency and prescribed 10 days of Provera.
Due to insurance reasons, I was given a one-month supply.
During the medication period, I experienced a little bit of light bleeding (I researched online and found that light bleeding is normal when supplementing progesterone if not pregnant), so I used panty liners just in case.
However, the last few days of the ten-day treatment coincided with the days I usually experience bleeding before my period, so I am not sure if there has been any improvement.
1.
Should I supplement with progesterone for another 10 days after ovulation this month?
2.
Given that my symptoms have persisted for nearly a year, can I continue taking the additional 10 days of progesterone this month to help restore my levels, since I am currently trying to conceive?
3.
My menstrual cycle is 31 days, so I should start taking the medication on the 18th day after the first day of my period, correct?
4.
If my symptoms do not improve and I have had an ultrasound that showed no tumors or significant abnormalities, and I consistently experience light bleeding a few days before my period, could it simply be an early shedding of the endometrium before menstruation?
Thank you for your valuable advice, Doctor.

Tiāntiān, 30~39 year old female. Ask Date: 2022/09/16

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
This should first rule out whether there are other factors involved.
2.
If you are trying to conceive, it is recommended to stop the medication and observe.
3.
In fact, you can start taking it after the 14th day.
4.
Yes, then just monitor the situation.

Reply Date: 2022/09/16

More Info

Understanding progesterone deficiency is crucial for women experiencing irregularities in their menstrual cycle, particularly when symptoms like premenstrual spotting occur. Progesterone is a vital hormone in the menstrual cycle, primarily produced by the ovaries after ovulation. It plays a significant role in preparing the uterine lining for a potential pregnancy. When there is a deficiency in progesterone, it can lead to various symptoms, including irregular menstrual cycles, spotting before menstruation, and difficulty in maintaining a pregnancy.

In your case, the spotting you experienced 5-7 days before your period could indeed be linked to low progesterone levels. This is often referred to as luteal phase deficiency, where the body does not produce enough progesterone after ovulation. The recommendation to take Provera (medroxyprogesterone acetate) for ten days is a common treatment to help regulate the menstrual cycle and support the uterine lining.

1. Should you continue taking progesterone after ovulation? Yes, if your doctor has advised you to take Provera for ten days after ovulation, it is typically recommended to do so in subsequent cycles, especially if you are trying to conceive. This supplementation can help stabilize the uterine lining and may improve your chances of pregnancy.

2. Can you take Provera for an extended period? While it is essential to follow your doctor's guidance, if you have been experiencing symptoms for nearly a year, it may be beneficial to discuss with your healthcare provider the possibility of continuing the progesterone supplementation for another cycle. However, it is crucial to have a clear plan and monitoring in place, especially when trying to conceive.

3. When to start taking Provera? For a 31-day cycle, you would typically start taking Provera on day 18 of your cycle, which is after ovulation. This timing allows the medication to support the luteal phase effectively. Taking it for ten days would mean you stop around day 27, just a few days before your expected period.

4. Could the spotting be a sign of early endometrial shedding? Yes, it is possible that the spotting you experience is due to the early shedding of the endometrial lining, which can occur if progesterone levels are insufficient. This can happen even in the absence of significant hormonal imbalances or structural abnormalities. If your ultrasound has shown no tumors or significant abnormalities, this could be a benign issue related to hormonal fluctuations.

In summary, addressing progesterone deficiency involves a careful balance of treatment and monitoring. It is essential to maintain open communication with your healthcare provider, especially as you are trying to conceive. They can provide personalized recommendations based on your specific situation, including whether to continue with Provera or explore other treatment options if symptoms persist. Regular follow-ups and possibly further hormonal evaluations may be warranted to ensure that your reproductive health is on track.

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Hello, it seems that there hasn't been any improvement. I recommend returning to your original clinic for treatment. Wishing you good health.