Question about Cyclogest and Bleeding in Early Pregnancy (10w6d)

[KNissa]

Dear Wonderful Community,

Seeking your thoughts and experiences! After undergoing a fresh round of IVF at age 41, I am now 10 Weeks 6 days pregnant. After one miscarriage 6 months ago, this is my first pregnancy that has got this far. Distressingly, I have had two big unexplained bleeds that are very heavy and last for about 1-2 hours. Each time there is enough blood to soak through 1 pad in the space of about 30 minutes and then it slows down. The first happened at 9w5d just as I was about to go on stage for a music performance and I had to run to A&E instead The second happened yesterday at 10w5d just as a former dear teacher from o/s was about to arrive at my house for dinner. Both kind of stressful, performative moments I guess. There's no actual pain, just a sudden and intense gush of blood, including clots.

Thankfully the scans at my Early Pregnancy Unit (EPU) following these episodes shows the baby/foetus wiggling away furiously and happily. So the doctors really can't pinpoint what the cause of the bleed actually is. Though today at the scan she said she could see a small haematoma of about 2cm. My EPU doctor said that this has perhaps happenned because I came off cyclogest at 9 weeks and my body probably just needs the extra progesterone support . Anyway I went back on cyclogest after the first bleed - 400mg x twice daily. But the second bleed still happened despite being back on cyclogest pessaries

I rang my fertility clinic and asked whether I should actually increase the dose of cyclogest I am taking. While the pessaries that my fertility clinic gave ran out at 9 weeks, I got more prescribed from my EPU - who said they couldn't comment on increasing the dose as they are not a fertility unit. Anyway my ferility clinic's response was: At this stage of pregnancy there is no evidence that more than 400mg x twice daily progesterone pessaries are useful. But I know that different clinics have different protocols, so my questions are:

1. has anyone out there experienced medium/heavy bleeds of the sort that I am describing a few days after stopping cyclogest?

2. do other clinics suggest to "up" the dosage of cyclogest when this happens?

Each time this happens and I end up in A&E, it just chips away my confidence in my own body and my mental health really. I am now basically scared to leave the home incase the sudden intense gush of blood happens on the street and I start bawling... I just want it to stop. The days till the 12 week scan are dragging. I never knew time could move so slow.

A big thankyou for reading.

[JA-fnuk Partner Nurse Fertility Network UK]

Can be a worrying time - hope bleeding will settle down It may be due to the small haematoma seen on scan and hopefully it will resolve . Rest when you can and no heavy lifting

Take care of yourself

Janet

[KNissa in reply to JA-fnuk]

Thanks so much Janet for this reassuring message.

[CornflowerMoon]

I can only imagine how worrying this must be for you. I haven't been in your position, and it might seem obvious but I just wanted to ask if you lie down for 20 minutes after inserting the cyclogest? When I first used the pessaries, my clinic never said anything about lying down and it was only through my own reading that I found out this is the recommendation. I hope your baby keeps being wriggly ❤️

[KNissa in reply to CornflowerMoon]

Thanks for replying CornflowerMoon. Definitely lying down (and snoozing) after the progesterone pessaries.

[CornflowerMoon in reply to KNissa]

I hear you on the snoozing!!

[IVFat40]

I'm so sorry for what you've been through hun. I just thought, if you wanted to double check your Progesterone levels there are companies like Medichecks that you can use to do it yourself via post/online. Congratulations.

[KNissa in reply to IVFat40]

Thankyou. And thankyou for the congratulations - its bizarre how quickly I keep forgetting forget that this is actually a really good, if stressful, place to be that should be celebrated xxx

[Twiglet2]

I had a subchorionic hematoma and had these huge bleeding episodes a few times I called them ‘crime scenes’ there was so much blood and clots! I also bled brown blood and red spotting in between from 4-10 weeks pregnant. The cyclogest won’t stop the bleeding is what I was told (my clinic did up mine for my peace of mind) but it is a bruise basically in your womb with blood in it and the blood is coming out sometimes this happens as it heals though. Mine was between placenta and uterine wall so put us at a higher risk of miscarriage in case it detached so I had to rest. At 8 week scan they couldn’t see it anymore (originally they said it was about 3-4cm) but I did continue to bleed it out for a few more weeks. I’m not sure if coming off the progesterone can cause them I haven’t heard of that in my hundreds of hours of googling or chats with our clinic but once you have it I think it’s common to bleed despite still being on the pessaries as the blood has to go somewhere (although can be absorbed by the body too) so often they can cause bleeding until fully resolved. I was terrified to see the bleeding so I’m sending you a big hug and some reassurance that after it healed for me it was a normal pregnancy and everything was okay xx

[KNissa in reply to Twiglet2]

Hi Twiglet2, I can't thank you enough for sharing your experience. "Crime scene" is so right! And in my case, because each time the crime scene has happened so extremely publicly, its the thing that outs my pregnancy because I start weeping dramatically and blurt everything out. Perhaps perhaps it will make a funny story one day if wiggly and I both make it through this...

The strange thing is at my 7 week scan at the fertility clinic they said they could see a small haematoma far away from the pregnancy sac. And then I had a 8 week scan because of spotting they couldn't see haematoma anymore, and when I had my giant bleed at 9 weeks at that scan they also couldn't see haematoma. Only at the 10 week scan has haematoma been seen again - they said 2cm and behind the placenta. Its like its lurking in there, invisible, waiting to strike everytime I go to a public gathering or invite people over for dins.

But your e-hug goes a long way in reassuring me. I have been following the stories of people roughly about our age and so have been reading lots about your journey. Wishing you all the very best and thanks again. xxxxx

[Twiglet2 in reply to KNissa]

you are more than welcome 💜 lots of rest and Netflix for a few weeks and hopefully it settles down I will be looking out for your update. Thank you for your encouragement too 🤗 xx

[Eloquentia]

Hi! I had a large bleeding episode too and they discovered a large subchorionic hematoma. I was advised to work from home and take it easy (no standing up or walking for more than 15-20 minutes) until it resolves. At the time, I was also taking baby aspirin, which they told me to stop immediately. The hematoma was gone by the 12-week scan. Very best of luck! I hope it resolves soon.

[KNissa in reply to Eloquentia]

Thankyou so much for responding and sharing your experience. Body is definitely saying stay still and sleep even though doctors haven't given me the kind of instructions that you got. 12 week scan in seven days so fingers and toes crossed xxxx

[PoonamK]

Please share some tips on your success

[HoneyB11]

I’ve just read your post and it offers some comfort because I’m bleeding at five and a half weeks and presumed it’s a MC but it is good to know it could be hematoma.

One thing that your post did flag to me though is whether I should be taking progesterone… as this miraculously happened naturally after a failed round of ivf I haven’t been on any meds. But I still have some Cyclogest left so do you think I should start taking it now or is it a lost cause?

[KNissa in reply to HoneyB11]

Dear HoneyB11 , I am just so so so sorry to hear what you are going through. I have been following your story and this must just be so terrifying. So, the NICE guidelines and Tommy's both say that progesterone is the only thing that is proven to lower the chance of miscarriage if you are having a bleed in early pregnancy - see here: tommys.org/baby-loss-suppor...

The thing is if you were to go to your GP right now and ask them for Progesterone they likely wouldn't prescribe it to you as they want to see that the pregnancy is in the right position via a scan and not an ectopic before they put you on Progesterone. The NICE guidelines basically say: give women who are bleeding in early pregnancy progesterone if they (1) have had a previous miscarriage (2) scan has confirmed the baby is in the right place. As the Tommy's link above will tell you, you need to push doctors to give you progesterone before the first scan...

But given you have progesterone at hand (!!!), if I was in your situation this is what I would do: I would just take the progesterone given all the evidence out there that it can prevent miscarriage. And I would try and get my scan moved earlier by ringing my EPU and telling them that I was bleeding. Or I would just get a private scan as early as possible. I would also try my GP and see whether they would be willing to prescribe the progesterone asap.

What a scary place you are in - please know that you are not alone. xxxx

[HoneyB11 in reply to KNissa]

thank you so much… it is confusing as the Cyclogest guidance is not to take in early pregnancy unless it’s been prescribed but if it can’t harm then I think I may as well as you say. The only risk I suppose is that if it’s already too late then by taking the progesterone I may just be prolonging the inevitable? So hard to know what to do and because it’s a weekend I can’t speak to anyone until monday.

[KNissa in reply to HoneyB11]

A difficult decision HoneyB11 . I guess I would take it because I DO have a history of early miscarriage. Given that you don't have a history of miscarriage, I think I should take a good read of the Tommy's guidelines here and just do what feels right for you given doctors unavailable because of weekend now: tommys.org/pregnancy-inform...

The relevant bit of the pamphlet above is "If you are asked by the Early Pregnancy Unit of the GP to wait for an ultrasound scan to confirm the pregnancy in the womb, ask them to prescribe enough progesterone for you to take until then. Some may insist you have the scan first, but it is worth asking."

Is there a maternity emergency number at your hospital you can call for advice over the weekend? That would be the quickest way to talk to a professional I imagine.

Thinking of you xxxx

[Kichwaa]

Sorry to hear about that.I had 2 big blood with clots.They stopped Aspirin and I was put on Progestrone in Oil the injection then it stopped.

[KNissa]

An update for anyone who reads this thread later: My 12 week scan was last week. All was fine And yet the spotting/light flow of dark brown blood continues. Sonographers said that this bleeding will just stop once the embryo expands into the entire womb cavity. Thankyou all for your support at an uncertain moment xxx

[Toffeepudding99]

Hi there- I know your post is a few months old so I’m hoping you’re still available to read this. I am 5w 2 days and have quite heavy bleeding. It started with a couple of brown spots and over two days has increased. I suppose I liken it to my first day of my period. Blood is not bright red but is red and I do have some discomfort on my right side. Did you have any discomfort with your bleeds? I’m obviously too early to scan and the sight of blood is just devastating- how much blood did you actually have- did it feel like a period?