Progesterone cream (prescription and OTC) improved my Creighton NFP charting of cycles and now NFP is tolerable instead of intolerable

Progesterone cream (prescription and OTC) improved my Creighton NFP charting of cycles and now NFP is tolerable instead of intolerable February 20, 2014

This is my story of how progesterone cream made NFP tolerable, instead of intolerable.

The following post is purely in the interest of public service, and is not especially entertaining, amusing, or edifying (hence the Google-friendly title).  I am not offering medical advice! I am just telling my story, in hopes that it will encourage other women to talk to their doctors, too.  I wish I had done it a lot sooner, because now my cycles became intelligible, and NFP became endurable.

This post is all medical, and not for the squeamish.  I will be using the words “cervix,” “mucus,” and “period.”

Background

PIC Lasciate ongi speranze voi ch’entrate

We use the Creighton Model of NFP.  I do not seem to be able to take my (bizarrely low) temperature consistently, and I am too technophobic and mistrustful to try a monitor.   Creighton was a good choice for us because you can use it while breastfeeding.  But still, it was pretty awful for many years.  If Creighton is “an authentic language of a women’s health and fertility,” then my charts were clearly saying, “Wha?  Hasenpfeffer.  I think!  Potrzebie!  Huh?” and occasionally, “Ow.”  In other words, I never really knew what was going on, except that we did not have a lot of days available for sex.  Some months, we had a grand total of one day (and I would be deep in the throes of PMS, so, super sexy with all the crying and screaming and paranoia).  This was no good.

My Fertility Care Practitioner knew I was frustrated and kept on encouraging me to call this NFP-only doctor she knows, but I was sure it would just be a waste of time and money, because nothing will help, I’m doomed to suffer, etc.


The problem before progesterone cream

My main problem was continuous mucus.

  • I never had dry days, even when my cycles were fully established and regular after night-weaning.  
  • There was just never a very strong distinction between peak-type (more fertile) and non-peak-type (less fertile) mucus, and that made charting almost useless, and a source of constant anxiety.  
  • To accommodate these ambiguities, I got yellow stamps, but the “is this essentially the same?” question hit me right in one of my weakest spots:  I’m a compulsive second-guesser, especially when I’m tired, and the strain was enormous.  We had so, so, so few available days, and I was never sure that they were actually okay to use.  And saying “end of the day on alternate days when you’re — well, do you think you’re fertile?  Trust yourself!” — well, that ain’t sexy talk.

Also, I could never do the seminal fluid elimination properly, no matter what ridiculous contortions I tried or how much water we both drank; so even once we were post-peak, there was always some uncertainty about what I was seeing.

So finally I went for a check-up.  The doctor expected that I would have a cervical eversion from eight vaginal deliveries in 11 years, which can cause  chronic irritation of the cervix, causing superfluous and confusing mucus.  They can do simple treatment right in the office.  But no, it turns out my cervix is (inexplicably) fine.  So he gave me a prescription for progesterone cream, but I didn’t fill it for several months, because nothing will help, I’m doomed to suffer, etc.

 

Benefits

So I finally filled the Rx, and within a month of starting to use a dab of cream for a week or so per month, I started having cycles like in the manual.

  • The longer I used the cream, the more dry days I saw.  
  • The peak-type (more fertile) mucus is more abundant, and very distinct from non-peak-type.  
  • And most importantly, we now we have what seems like a luxuriously long post-peak phase.  We can even have a fight post-peak, and still have time to make up and have sex again!  It’s pretty sweet.

There are more available days pre-peak, too, but since most unexpected pregnancies seem to come from pre-peak conception, we are pretty conservative.

Seminal fluid is easy to eliminate, and even if I don’t do it, it’s very distinct from any cervical mucus.

I’ll say it again: my cycles now look like the ones in the manual.

Drawbacks

  • When I’m using the cream, my cycles shortened from a typical 29-30 days, to 26-27 days.  My practitioner says that that is unrelated to the progesterone cream, but it sure is an amazing coincidence, because I never in my life had a cycle shorter than 28 days until I started using the cream; and now I rarely have a cycle longer than 26 days.
  • My period is more “efficient,” which means it takes 5-6 days, but most of it happens over two extremely heavy flow days.  They are no more painful than usual, but much more messy; but it is kind of nice to get it over with all at once, instead of having a gradual build-up and gradual wind-down that goes on and on.
  • You can only use the progesterone cream if you are certain that you have already ovulated; otherwise, it may prevent ovulation.  So if you suspect a double or split peak, you can end up waiting and waiting for the actual peak day to come, and then it turns out you just get your period anyway (and then your next cycle might not be as spiffy, because you haven’t had the benefit of the progesterone cream from the previous cycle).  Obviously, that’s not a drawback of the progesterone cream itself, but could happen any time – – it’s just something that adds a slight layer of uncertainty, because you’re not just waiting to see what happens in the cycle, but also waiting to see if you should use the cream.

Details

I rubbed the prescription cream into my inner wrist, inner elbow (is there a name for that part?) or abdomen once a day, starting on day P+3 and continuing until the end of the cycle.  It hasn’t caused any type of rash or irritation, or dizziness or nausea.

In order to know exactly how much progesterone you’re getting, you need a prescription, and you need to get it at a compounding pharmacy.  The only local one here does not accept insurance, and the cream costs $40 for two pre-filled syringes, which last me nearly three months.

However, after several months, I decided to try an over-the-counter version of progesterone cream called Emerita Pro-Gest, and it works exactly the same for me.  It’s much cheaper and I just order it from Amazon.  I use it in the same way at the same part of the cycle, but twice a day (morning and night).

However, I am probably going to go back to the prescription kind, because I want to make sure I’m getting the right dose if/when we go for another baby.
For goodness sake . . . 

Please, please, please, do not try progesterone cream without talking to a doctor first!  Strange cycles can be caused by any number of things, some of them quite serious. Progesterone cream is a hormone, and just because it’s sold OTC doesn’t mean it’s safe or appropriate for everyone!

Many people use progesterone cream to alleviate PMS symptoms. It hasn’t helped me with that at all.  However, at least my cycles are intelligible enough that we can say, “Yep, it’s PMS” and we know I’ll be back in my right mind in 48 hours.
But you may not be doomed to suffer

If your cycle looks anything like mine did, maybe you should ask your doctor about progesterone cream.  It couldn’t hoit!  It does make some people feel terrible, and it doesn’t work for some people.  Some people are allergic to it, and some people, as I said, have serious conditions that won’t be helped by progesterone, so talk to your doctor talk to your doctor talk to your doctor.  You are much more likely to be taken seriously if you talk to a doctor who understands NFP.  One More Soul has a directory of NFP-only practices.

I wish I had emphasized this more in my book:  there are lots of kinds of NFP, and there are often things you can do to make your cycles more manageable.  So don’t be a fatalist like I was! Look into your options, and make the investment of time, effort, and money to improve things, if you possibly can.  Marriages are not meant to be sexless.  NFP is hard, but sometimes it’s harder than it needs to be.

But for goodness sake, please, seriously, talk to your doctor. 

 


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  • ThereseZ

    That was pretty vivid, but totally and completely necessary. That’s the kind of detail people need to know about. Thank you!

  • Laura Rydberg

    Thank you, Simcha! Can you believe it, our diocese (St. Cloud, MN) offers education in only ONE type of NFP (Billings). Your book, that NFP quiz and this have encouraged me to keep trying to find the RIGHT answer for us. Once Baby #3 is born, of course.

    • Callie Langworthy

      Hey, Laura! Callie from FUS here (small Catholic world, eh?). Anywho, saw your comment, and just wanted to give a shout out for sympto-thermal method. I’m getting married in April, so we’ll see how it goes, but my charts have been very easy to interpret so far, even with my temperature going wacky one month – I like the back-ups that are built in. Our diocese only offered Billings method as well. Allen and I ended up going through the Couple to Couple League at the recommendation of Cate and John Levri, and really had a good experience: http://www.ccli.org/

      • Kristi Landis

        Couple to Couple also does some online classes. (I’m an instructor for them.)

        • Laura Rydberg

          Thank you so much to all of you! We are leaning towards CCL and we’re more than willing to drive down to St. Paul for it. I’m just angered that the diocese doesn’t give NFP the full show it deserves: rather, we’re told that since “Billings gives you more days [for sex], it’s the best.”

          • Kristi Landis

            It’s not always the fault of the diocese. There’s a shortage of people volunteering to instruct. Even here in Mpls area there are not enough teachers for CCL. I’ve been doing it for 15 years and I’m ready to “retire” but even as big as the TC is, we only get about one or two interested couples per year, and they don’t all complete the process of certification. We may get 1 new teaching couple every 2-3 years. 🙁 Pray for more people to teach and for young couples who can relate more to engaged couples than us “older folk” 🙂

          • Shannon Marie Federoff

            We’d LOVE to be an NFP teaching couple… but when people find out we have 1 children, it dampens their enthusiasm for NFP! LOL! (All except the first were expected pregnancies!)

      • Laura Rydberg

        Congrats Callie! I’m so happy for you. We’ll be praying for you during this time of engagement. (It’s really not awesome, is it?)

    • Ann Lanari

      Hey Laura, there are CCL classes available in St Paul MSP and Creighton is available in the Duluth/Iron Range area. So if you’re willing to take the drive there are more options 🙂 we had a great teaching couple in MSP St. Paul. One of the CCL instructor couples is from St Cloud. They would love to meet you and your family.

      • Laura Rydberg

        Thank you Ann! Would you be able to facebook me and give me their info? If we need to drive down to the Cities we will, but it’d be so much easier on the budget and the babies if we didn’t.

        • Ann Lanari

          Alas, I don’t have Facebook! But the MSP/STP diocese should have info as well as CCL’s website. I also know that you can do an at home program with access to instructors through CCL.

  • Anna

    Thank you for this! For some reason, “lady problems” seem to be ones that we all think are normal and we’re just doomed to, but I sure wish I’d gone to a Creighton-trained doctor in high school or college. It would have made many people’s lives (as in, anyone I happened to interact with during certain times) much easier. Now that I’m on HCG shots, no more depression and fury and headaches for a week as a signal a new cycle will soon begin; no more cramps and ridiculously long periods now that I’ve had outpatient surgery for endometriosis; and three babies when we thought for a long time we’d have none!

  • Jennifer Hartline

    Bless you! Your candor is appreciated.

  • Blobee

    I am post-menopausal, so this post doesn’t really apply to me, but honestly, I just don’t know why this information is not readily available to women of child bearing years. I never married, and so never needed to plan (because abstinence is 1000 % effective :-)) but I did notice changes to the mucus, and sometimes got worried something was wrong or if I had an infection. OH, MAN!!! Why, in this modern scientific age DO WOMEN NOT KNOW EXACTLY WHEN THEY ARE OVULATING and what NORMAL looks like????? I never knew, though it didn’t matter, but I only knew very general things like “about halfway through your cycle you ovulate.” I wonder how many women would love to get off the Pill, or the IUD, or the diaphragm, and practice this, even if not for religious purposes. I mean, it must be so much healthier and better for you. Geez. Wouldn’t it be nice if Planned Parenthood made THIS their primary focus of services, instead of abortion? Would make more sense, given their name.

    • Jordan

      Wouldn’t make more sense to them; they wouldn’t get any money.

  • Laud

    I am pretty fatal right now! My cycle returned 6 months post partum and you sound exactly as I did before baby #7. Now I am having the same symptoms again and I need to get this figured out. Thank you for this 🙂

  • I’m aghast that anyone could think this kind of post was objectionable. This is entirely tame, excellent information, but not salacious in any fashion. Is this because I’m a biologist?

    I guess it would explain why Himself’s female coworkers are unable to gross him out with their deliberate TMI conversations. (Much to their irritation.) He’s acclimated to me, I guess.

    As for the heavier, messier periods, you might try a menstrual cup. My periods are very heavy for two days (>100mL per day), followed by a week of light to very light. But using a cup completely eliminated the associated vulvar pain. And even when it leaks it’s much less messy. Also they have milliliter volume markings which I <3.

    • visitor

      where do you get the cups from?

      • I bought mine years and years ago, seven I think. and had to buy it from an internet drug store because I couldn’t find it anywhere else. But Amazon sells them now. It’s a washable and reusable medical grade silicone cup, so you only need one. There are several different brands, and each brand has pre and post vaginal birth sizes. Since I’ve had only c-sections, I haven’t needed to replace mine with a larger size.
        This is the one I use (but in the post childbirth size): http://www.amazon.com/gp/aw/d/B000FAG6XA?cache=b19f165c6b23cb7759c1301a065b738f#ref=mp_s_a_1_1&qid=1392996543&sr=8-1

      • Suzanne

        I’ve used the Keeper menstrual cup since the late 90s, and I love it. You had to order from the company back then (by mail–it was like the Dark Ages!), but now you can get it from Amazon. They’re a real bargain.

  • Mrs. Amen

    Thank you for this post, Simcha! I am an NFP instructor for 2 different methods in our diocese and I always try to emphasize to the couples we teach, that if one method is not working out for them, to try another method. I have referred people all over the place to find them a method that works for their particular circumstances. I teach STM and ovulation methods, but use Creighton or nothing at all.

    Oh, and I’ve always called them elbow pits…like arm pits and knee pits.

  • Anonymous

    Inner elbow = antecubital fossa if you feel like being fancy! First time commenter, but long time reader. Love the blog! NFP helped us avoid x 4 yrs and now we’re expecting our first in June. : )

  • bluebird2b

    Belatedly adding my 2 cents, but in my late 30s/early 40s, my fantastically regular 28 day cycle started getting shorter and shorter and more “efficient” (but my first two days were *insanely* heavy), but it turned out it was due to my thyroid. My TSH was fine, but my T4 was wonky. Might be worth checking out, just in case.

  • Thank you! What’s a compounding pharmacy?

    • ThereseZ

      They make up custom prescriptions, special recipes. They are a wonderful resource, very caring and interested in your health. I find they will discuss the right OTC medications, too. There are national compounding pharmacies, but most of them are local, and I have learned a lot from the one near me.

  • sd

    I am kind of confused about how progesterone cream works. If you only use it in the post-ovulatory phase, how does it help your mucus to become more clear pre-ovulation?

    I have PCOS, cycles that range from 40 days to 80 days, and very confusing mucus. Do you think progesterone cream would help make my signs more clear?

    • Jennifer V.

      I believe it’s because of the interaction of progesterone and estrogen. Increased progesterone in the latter half of the cycle creates a stronger signal to the body to produce estrogen in the beginning of the next cycle. Think of a wave, higher progesterone means higher wave, bigger drop to the “bottom”, so there’s a greater pull for estrogen to fill the void. Something like that anyway. It’s been a while since I read about the interaction. But yes, progesterone can help with PCOS. As can better nutrition. I’ve used both and had shorter cycles, more normal mucus patterns, easier to interpret charts, etc. Check out Marilyn Shannon’s “Fertility, Cycles and Nutrition,” from the Couple to Couple League for more help with the nutrition/supplement part.

  • Karyn

    This is good to know. I’m currently pregnant but these sound like my cycles (except mine can be as long as 40 or more days). It’s interesting that you have been so fertile, as I think low progesterone can make it difficult for the embryo to have time to implant. God must have wanted those cute babies around 🙂

  • anna lisa

    How great that you’re laying it all out there so other human beings might not suffer in a similar way. That’s really generous, and a BLOW to the conspiracy of silence.
    As far as the lady-plumbing part of the equation goes, my favorite time of life was when I didn’t have a single stinking period between babies. That put me at YEARS without having to deal with the mess or that miserable personhood sucking PMS. That’s probably why I’m still married.
    Hey, you know what? That saying: “it gets better” has been getting maybe too much press lately, AND I’m going to sound like a Centrum Silver ad AND I could be pregnant right now, but my forties have been increasingly better and better in this whole hormone/lady woes department. I don’t know if I would have believed it if some woman sprouting gray hairs had told me that a decade ago.
    It hasn’t just been better, it’s VASTLY better.
    … I know you said your post wouldn’t be funny, but you just can’t help yourself. Making us chuckle over misery seems to be your forte.

  • anna lisa

    Ok, I just can’t help myself, “seminal fluid elimination?” I’ve never even heard of that. (that’s how long it’s been since I read the manual.) That’ll be a fun Google. I’ve always called it “the gift that keeps on giving”.
    .
    Her: “You’d think gravity would take care of that.”
    Him: “They’re swimmers honey, they’re *supposed* to do that.”
    Her: sigh. “What timing.”

  • Blobee

    Simcha, you’re like the Dr. Oz of the NFP set! I love it!

  • Liz

    I know I’m later on this, but do you have any experience breastfeeding while using the cream? I’m still nursing my 12 month old and don’t want to stop, but my charts have always shown symptoms of low progesterone, and I’d like to get back to a regular cycle now that she’s a little older. I used b6 supplements to lengthen my luteal phase to conceive both of my babies, but I’ve read that it can reduce supply, so I don’t want to start taking it again just to improve my cycle (though I of course will before we actively try to conceive again in order to help maintain a pregnancy).

    • simchafisher

      I have always been nursing while using progesterone cream.

      • Liz

        Thank you so much! I will order a tube now (using your link, of course!).

  • EG

    I’m glad this helped you, but I’m afraid too many ladies will get false hopes from your successful use of progesterone cream. I have the exact same problem you did/do: continuous peak type mucus, 3 day post peak phases. My Napro doctor put me on progesterone pills post-peak. It gave me a 7 day post peak phase, but if anything I made more mucus and it was clearer and nicer-ALL the time. As our current youngest baby got older, we got brave and used LH strips to catch ovulation, so we could count the three days after the last positive strip and use the last three nights of the post peak phase-wow, 3 nights out of every 30.

  • Kate OurEpicLife

    I realize this post is two months old, but I just stumbled across it and wanted to give you a shout out. This is great! Excellent information; I think there’s a lot of the “I must suffer, poor me” mentality in the NFP world, because most people (like you and like me) take forever to go see a doctor and get ourselves fixed up. Honestly, charting is not that hard, and if it is, something is wrong; why this is a difficult concept, I have no idea, but it is, and you did a great job handling it! Glad everything’s working out for you, and I’ll keep this in mind as I head off to see my NFP doc tomorrow…a year and a half after my Creighton instructor told me to. 🙂

  • sneakierbiscuit

    “So if you suspect a double or split peak, you can end up waiting and waiting for the actual peak day to come, and then it turns out you just get your period anyway (and then your next cycle might not be as spiffy, because you haven’t had the benefit of the progesterone cream from the previous cycle).”

    Just a PSA for people like Simcha for whom temping doesn’t fit, and who sometimes worry about split/double peaks and that adversely affects their NFP experience. There is a mucus-only method that claims to distinguish genuine peak (where ovulation occurs) from a false (or “practice”) peak. In the Billings Ovulation Method, there’s no such thing as a double peak, for example. You can see a build up of fertility, and you may even have “peak type” mucus, but it is not marked as peak unless there’s been a specific sort of mucus build up followed by a specific sort of rapid dry-up.

    Now, I’m not in the business of suggesting people change methods, most especially when they’re happy with the method they have (although I have made that suggestion for some clients when the fit of the method I teach wasn’t good, and that’s because I’m not married or blindly loyal to the method I teach.) Nor do I think any particular NFP method is objectively better than any of the others. They all have their potential benefits and drawbacks. Method choice is a very personal decision that encompasses all sorts of circumstances and personalities and preferences, and I’m just grateful that the choice is expanding and more available to greater numbers of people. I’m a former Creighton user, currently use Marquette, and teach a form of sympto-thermal method, so I have no vested interest in promoting Billings. I just thought it worth mentioning. Billings does share some similarities with the Creighton Model in their charting layout and abstinence rules, but takes a different approach to observing and charting mucus (more reliance on sensation through the day rather than finger-testing and looking every single time on a bathroom visit, and non-standardized mucus descriptions. You can use 6PC, 10KL type stuff if you want, but if you prefer to call it “pasty creamy goop” and “egg white slippery stuff” on your chart instead, you can. Or even give the mucus types cutesy names. Whatever.

    So, in the spirit of Simcha’s reminder that there are lots of forms of NFP, I thought I’d offer a shout-out to the BOM in this case. Where the cycle’s in good shape, like Simcha’s now is, that may eliminate the “is it an ovulatory peak or is another peak coming?” concern that can poorly affect progesterone treatment of cycles. However, if a woman has a hormonal issue that means her mucus build-up is patchy, and the dry up is extended and/or incomplete, that could mess with the system and make it harder to confidently declare “that was it! Definitely phase 3 now!”

  • Godsaves70

    I know this blog is a bit old, but I do hope someone sees this and answers it. We have been trying to conceive our second ones for years. I have been charting for the last three. My NFP instructor said I had a short post peak phase (always nine days, rarely more) and so I went on Progesterone. It does nothing to lengthen, and still does not. I was once on clomid for a while and while I was ovulating, no baby yet! What gives? What can I do to length the post peak phase? Help! Nobody, not even my doctor, seems to be able to help me with this.

    • Anna

      HCG shots should give you a longer post-peak phase. It’s a custom compounded medication and not all insurance will cover it (since HCG is often used as a weight-loss drug), but some insurance plans will help with the cost, especially if you have some major PMS going on too; the HCG will help a lot with the depression and headaches and that sort of cycle-related misery. I don’t know if you are going to a NaPro-trained doctor or not, but Pope Paul VI Institute does distance consultations (and their nurse practitioner also works at Sancta Familia, a family-practice office), so you might be able to get a prescription through them if your doctor isn’t familiar with the HCG treatment.
      Also, progesterone cream won’t be as effective as progesterone shots if you have a major deficiency (which, with 9 days post-peak, it sounds like you do). Puts quite a hitch in your giddy-up (though not being shy about asking hubs to massage the injected area helps a good bit), but might help more than cream or suppositories. So that could be something to try if HCG proves hard to come by.

      • Godsaves70

        HI, Anna!
        Thanks for your reply! I don’t know if my doctor knew about HCG shots or not, but maybe not if she never said anything about it. Isn’t too much hyperstimulation not good for the ovaries, especially after getting (I think) six rounds of Clomid? Just curious. Anyway, I didn’t realize that PP VI Institute will do distance consultations. That would be helpful to me. Also, you said about low Vitamin D levels. I did find out a few years ago that I did have low D. I tried some vitamins that helped, but maybe it wasn’t enough. It is rather strange that my cycle is perfect all the time, except for the post peak. Might be connection there after all. The progesterone my doc put me on was prometrium, progesterone pills, not cream. Also, if this shot is good for me, how long will it last? Do you have to keep getting it every cycle?

        • Anna

          I don’t think HCG stimulates the ovaries; I was always on it along with the Clomid. I took it on… hmmm, peak + 3,5,7 I think, every cycle. (I’m at 37 weeks right now, so it’s been a while since I was on it and I can’t remember exactly.) I was on the HCG mainly due to awful PMS, but it does lengthen your cycle enough that they wouldn’t do a pregnancy test until peak +17 (you have to do pg tests at the dr’s office since a home test will always be positive if you’re on HCG).

          Depending on what kind of charts and such you have, you could do a consult with PPVI, or contact Teresa at Sancta Familia and see if she could work with you long-distance. She’s much easier to work with than Dr. Hilgers, in my experience…

          • Godsaves70

            Hi, Anna!
            Thanks again for your reply! Then HCG shots probably doesn’t stimulate ovaries then. That is helpful to know. I can give PPV VI institute a call if someone can help me over there. I always felt that maybe my instructor with Creighton Model should have been a little more knowledgeable about things. Getting more info is better would be great for me. Do I just call the main number and ask for Teresa? Will it cost me anything to get the advice? Sorry about the back and forth questions, but I need to get to the bottom of thing with me soon. Thanks again.

          • Anna

            No problem – having been through it all myself, I know how awful it is when you’re ttc and it just isn’t working! That roller coaster is the worst. PPVI has a website, as does Sancta Familia. PPVI does charge for consults; I don’t remember what the charge is, though it is probably different if you are just doing a chart review with the nurses rather than having Hilgers look at your entire history.
            Here it is:
            http://www.popepaulvi.com/ncfwh-evaltreat.htm#help
            under “Getting Help.” I’m sure calling and asking to talk to Teresa about what you could do in your particular situation would work too.

          • Godsaves70

            Anna,
            Thanks again for your message. I’ll look into PPVI and see if they can help me somehow. It can’t hurt. Thanks again!

  • Ginkgo100

    What blew my mind about this has nothing to do with NFP… it’s that you think $40 for a three-month supply is an “expensive” medication! Oh, you should see our Rx bill… we are the ones keeping our local CVS in business.