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Bio-identical progesterone thinning uterine lining?

Hi,

I'm new here so I apologise for just diving in asking for help.

Husband and I have been ttc for 17 months and have conceived many times but all have resulted in very early losses. All bloods returned fine. Asked for progesterone check which was messed up but was put on Cyclogest anyway as many of my symptoms pointed to low progesterone. It helped my mood swings and anxiety during my luteal phase hugely. I then had another progesterone check which wasn't messed up this time and at 9dpo it was 105.7nmol/L, so just above average.

I then had a pelvic scan on CD33 (cycles are usually about 27 days but I had positive HPTs so I carried on with Cyclogest hence the longer lp), before I started period, which sbowed my uterine lining to be only 5mm. I was told that it should be at least 7-10mm and that my using progesterone may be thinning my lining.

So I don't know what to do. I haven't had any input from my doctor yet as she's been too busy. I'm due to ovulate in about six ish days, and I don't know whether I should lower the dose of Cyclogest or stop it completely. It really helps my anxiety and shortens the time I'm launched into a pit of depression for, which is absolutely brilliant, but if it's responsible for thinning my lining then I'm unsure as to whether I ought to just lower my dose or not use it. My doctor said my progesterone levels were right where we want them to be, so it seems odd the sonographer would say it's probably the cause of my thin lining.

I also had a polyp come out on its own the cycle before last, so I don't know how much impact this would have had on my lining, if any. Although I'm aware it can stop implantation happening properly and could have been the cause of the chemicals we have had.

Anyway, sorry for such a long post. If anyone has any experiences they can share I'd be grateful

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Do you start the progesterone after ovulation? I doubt very much it will be that causing your lining to get thinner, if you look at my previous posts it's something I've been suffering with. Maybe worth getting you doc to scan you a day or two before ovulation to see what your womb lining thickness is then as that will give a far better indication. Thin womb lining is linked to recurrent miscarriage so def something that you should get your doc to do. I'm lucky if mine gets up near 7mm. They will also be able to see if it has the 3 layers that are required for a good lining, but again the best time for this to be seen is just before ovulation x

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Thank you for your reply :)

Yes, I track everything using Fertility Friend and temp, so once it confirms ovulation usually by 3dpo, I start the Cyclogest.

I've read a lot of mixed opinions about progesterone and what it does to uterine lining, but the majority of what I read is that it helps maintain it rather than thins it. However, I did read that you can be progesterone dominant and this can lead to a thin lining but there does seem to be much more to say that progesterone supplementation doesn't usually do any harm.

I'm assuming the polyp probably did the most harm before but I can't understand why my lining is so thin if my oestradiol levels returned fine. I'm using red clover at the moment and thinking about upping my intake of vit E, I'm only using what's in my prenatal, do you know how much I can increase it to?

Thanks so much again

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My tablets of vitamin E are the high strength ones from Superdrug at 800 strength. I thought it helped get my lining up to 9mm last year, however have not had it that thick again.

Progesterone does not tend to decrease lining, just prepare it for an embryo and keep it where it is.

If your bloods were ok I'd suggest that your progesterone levels are all ok. I think the anxiety comes from knowing your are trying and once ovulated it's like going through the ivf 2week wait waiting to know if your pregnant or not. I used to be the same when trying naturally, was ok for the first 2 weeks but after ovulation I wanted the next few weeks to fly by, but instead they dragged and caused me anxiety.

When you've had your kisses have you passed them naturally it via a d&c? As a risk of a d&c is damage they can potentially cause which can cause thin lining, like wise there have been several studies to say that women who have suffered a missed miscarriage are at a higher risk of having their lining becoming thinner, although it's not sure why this happens.

Def ask if you can have a scan just prior to ovulation, this will answer a lot of your worries over the progesterone x

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Thanks :)

I decided to buy some vitamin E to get a little extra in.

Can't remember if I said but I'm using red clover too, which I think is having some impact as things are a little different this cycle thus far.

My doctor called back to say maybe halve the dose of progesterone (so instead of 2x 400mg, 2x 200mg daily), I'm happy to go with this.

I hear you on the TWW anxiety, it certainly doesn't help that's for sure. However, I was like this before ttc. I have suffered generalised anxiety disorder since early childhood, possibly because I have high functioning autism, but I noticed a change in mood and anxiety before ttc, particularly about ten days before af was due. It was a nightmare until a couple of days into af when symptoms would lessen. It got to the point I was having some rather dark thoughts so I looked into it and found it was likely PMDD. A doctor, not my usual, prescribed Microgynon which made it worse so I didn't start taking it after the week break but went to see my usual GP who prescribed Cyclogest instead. I started to feel more evened out after the nightmare from taking the pill, so I left it for ages but when we decided to try and it became apparent we were struggling, my symptoms of PMDD had already started to return, which led me to look into low progesterone more thoroughly and I decided to try the cream first as it was a much lower dose and I'm a little paranoid when it comes to new things, but that stopped working after a few cycles so started the Cyclogest and that has been amazing at lifting my mood and decreasing anxiety. Although, having loss after loss does nothing for one's mood.

I have always passed everything naturally, thankfully. But they have all been very early losses, right when af would be due or shortly after, so I suspect this has much to do with it

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I'll second the vitamin e tablets, recommended to me by baby2016

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I cant really offer too much advice on this. I too have suffered with a poor lining when doing IVF. My consultant was adamant that a lining of around 9mm was required in order to give me the best chance of pregnancy and have never been given progesterone to thicken the lining, only to maintain.....havent hear too much about the lining thinning due to progesterone. I defo think you need your lining issues looked into as this may well be linked to not maintaining pregnancies. Best of luck!xx

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Thanks :)

I think I spotted a post of yours re lining from about three months ago?

I was initially given progesterone to help with PMDD. We weren't ttc back then but I decided against using it for a year. We conceived our two together easily and quickly so after the first couple of early losses and quite a few months into trying I started researching low progesterone more thoroughly and decided to start with cream as it seemed 'safer' to me, but that didn't work after about three cycles so I started the pessaries instead which have been amazing regarding anxiety and mood swings, however this is only during my lp and my mood and anxiety hits like a train during my follicular phase. I started it because I was desperate to help my anxiety lift a little and I thought there may be a good chance it could help with holding onto a pregnancy. But I didn't know I had a polyp until it came out. So that's been working against us and since they messed up my progesterone check the first time I don't know what the level was before using Cyclogest but it's my understanding it doesn't affect blood results when using it. I don't know what's going on tbh.

I feel our chances are somewhat improved with the polyp gone at least, but I really don't know why my lining is so thin. The most obvious cause I'm assuming is hormonal imbalance but everything now appears to be ok. Having said that, my moods do seem to be dictated largely by my cycle, so I wonder if it's worth repeating bloods. I'm not 100% convinced all is really ok in this department. I suffer with GAD anyway so it is hard to know what the cause is, it's like the chicken and the egg scenario, I don't know what came first

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Yes, you did! I did get there in the end but took me ages. Im actually having a hysteroscopy on Thursday to check if there is any underlying issues causing my thin lining and why I never seem to be able to get pregnant, my hormones all seem to be ok too. Glad to hear that you've had your polyp removed as Im sure that wont have helped with implantation. Its good that the progesterone has helped with your PMDD. Have you been seen in Gynae at all to have any investigations or would your GP refer you? Its all so frustrating isnt.xx

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Oh I have heard of this procedure, is this where they use dye to look at everything?

So your lining is ok now? Have they looked into NK cells? I think it's something that has to be paid for here. I can't remember the name of it but if that's the issue they have used a particular steroid to try to sort that problem out. Prednisolone? I can't remember!

Oh that polyp decided to remove itself one day during my lp which was a somewhat scary thing to find! My doctor thought it was a decidual cast but I wasn't convinced, sonographer confirmed it was indeed a polyp which is what I thought it was as it looked identical to one. Thankfully there weren't anymore seen on the scan. I'm lucky it decided to remove itself, they don't usually do this from what I can gather.

My GP keeps saying she's referring me to the fertility clinic but I don't know if she's done the referral yet. She's always so busy and always booked so most of my contact with her is via phone or email. I have emailed her about the scan and asked if I should keep on with the Cyclogest or whether I should lower it or leave it altogether. I know some start it once they have a positive HPT but I worry it would be too late to help by then.

It is frustrating. Do you already have children? I think the most frustrating thing for me is the fact I have three children which I had no issues conceiving and I completely took my fertility for granted and assumed if we decided to have more in the future it would be easy, like it had been before. Kind of annoyed at myself for thinking like that now.

One huge difference between then and now is I'm so much more aware of everything, tracking every sign, analysing everything and generally driving myself insane. In some ways it's done me a favour otherwise I wouldn't be aware of any issues, but on the other hand it's causing a lot of stress.

I just received a letter asking me to book in with the fertility clinic. Earliest they can do is May

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Oh that's good you have a letter, that is a bit of a wait but will be worth it to see someone with more expertise. No I dont have any kids so far unfortuately. The test Im having is a camera through my cervix to have a look around my uterus and to have some biopsies taken for various things. You're right about the NK cells, its a mild steroid. Here's hoping you have success with the clinic!xx

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Have they tested you for NK cells?

I hope it goes well for you and you get some answers! It's frustrating knowing something is amiss but not knowing what or how to deal with it. Do they put you under for that or is it just a local?

Definitely good to know I now have an appointment, although it feels a little daunting. It's weird how things have changed so much in the space of five years. We weren't able to really focus on our previous pregnancies and missed out on a lot worrying about various other things that were happening at the time, so if we are lucky enough to have another, I'm making damn sure we cherish every single moment, even the moments which seem so undesirable like early symptoms and stuff, even if I get SPD again which is likely, I don't care, I will love every moment of it all

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Getting tested for lots of things, they're doing biopsies and heaps of bloods so fingers crossed. Yes when you've tried so hard for a little one you know that you'll cherish every moment!x

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I'm sorry you're having to go through such a barrage of tests, it must be incredibly stressful. I know I was extremely anxious just having my bloods and the scan done as I was convinced they'd find something awful! It's silly really but your mind just goes round and round.

Oh to be completely naive again, it was such a simpler time

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I know what you mean although i do think knowledge is power! Im ok with having the tests done, would rather that and find something to fix than keep plodding on with treatment to find out later there is something up. Gotta keep positive!x

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Yes I do completely agree. I just wish it could be simple. But then I guess everyone wishes that!

It's this that keeps me testing early. People say not to, but if I hadn't then I wouldn't be aware of a problem. I would just be sat here thinking it's just taking longer because I'm a little older than I was before. Just the same as if I wasn't tracking things, I wouldn't know that my temps would consistently fall too early, which can indicate a problem.

Sometimes ignorance is bliss, but only in the case where you actually get and stay pregnant! Otherwise it isn't

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