Cramping and Pressure at 9 Days Post-Ovulation on Progesterone Supplementation
Cramping and pelvic pressure at 9 days post-ovulation while taking 200 mg oral progesterone twice daily is a normal physiological response and does not indicate progesterone failure or inadequate dosing. 1, 2
Why This Occurs
Your symptoms are likely due to one or more of the following mechanisms:
Progesterone itself causes uterine smooth muscle effects that can manifest as cramping sensations, particularly as the endometrium undergoes secretory transformation in response to adequate progesterone levels 2, 3
Your current dose of 400 mg daily oral progesterone is appropriate and therapeutic for luteal phase support, as studies demonstrate that 200 mg three times daily (600 mg total) provides adequate endometrial transformation and pregnancy support 4, 3
Oral progesterone undergoes significant first-pass hepatic metabolism (>90%), which creates progesterone metabolites that can cause various physical sensations including uterine cramping, though these metabolites also produce the drowsiness and dizziness commonly reported with oral formulations 2
What Your Dose Achieves
200 mg oral micronized progesterone twice daily provides endometrial protection when used sequentially for 12-14 days per month, as confirmed by international expert panels 5
This dosing regimen produces adequate secretory endometrial changes despite maintaining subphysiologic plasma progesterone levels, because oral progesterone still exerts local tissue effects 2, 3
Your symptoms at 9 DPO coincide with peak endometrial secretory activity, when the uterine lining is maximally responsive to progesterone and undergoing the changes necessary for potential implantation 2
Important Caveats
Cramping does NOT indicate you need higher doses—increasing beyond 200 mg twice daily offers no additional benefit and may increase side effects like drowsiness 3, 6
If cramping becomes severe or is accompanied by bleeding, contact your provider, as this could indicate other issues unrelated to progesterone dosing 7
Oral progesterone has lower implantation rates per embryo (18.1%) compared to intramuscular progesterone (40.9%) in IVF cycles, though your specific indication for progesterone may differ 6
Do not confuse your oral micronized progesterone with injectable 17P (17-alpha-hydroxyprogesterone caproate), which is dosed at 250 mg IM weekly and used only for preterm birth prevention starting at 16-20 weeks, not for early pregnancy support 7, 1
What to Monitor
Mild cramping and pressure are expected side effects and do not require dose adjustment 2, 3
Take your doses at consistent times, ideally with the evening dose at bedtime to minimize drowsiness 3
Continue your current regimen as prescribed unless you develop severe pain, heavy bleeding, or other concerning symptoms 7