During this phase, you will be instructed to take pre-treatment medications. Specifically, vaginal estrogen (called Lupin-Estradiol) starting on day 3, 4 or 5 of your period, and later adding in vaginal progesterone (called Prometrium). These medications help coordinate the growth of the follicles and support a stronger response to ovarian stimulation medications.
Phase 1 typically lasts approximately 3 weeks and is followed by a week washout (see below for more info about the washout). Your clinical team will provide you with a calendar of important dates to outline your medication instructions, clinic visits, and timelines.
Cycle orientation
You will have a virtual appointment with a nurse via Zoom to discuss the next phases of treatment, review injectable medications, general information about the cycle, and to answer questions you may have.
This appointment will take place during the last week of pre-treatment medications.
Prior to the appointment, you will receive materials to review, including videos that will guide you through how to administer injectable medications. You will also be asked to submit the required consent forms and provide payment for your cycle by this date.
Washout phase
At the end of the pre-treatment phase, you will be asked to stop your pre-treatment medications and you will not start ovarian stimulation medications for another week. This is known as the ‘washout phase’ and during this time you may experience a period.
MEDICATION DETAILS
Lupin-Estradiol and Prometrium
LUPIN-ESTRADIOL DIN 02-449-064 / PROMETRIUM DIN 02-166-704
As part of the pre-treatment phase of your stimulation cycle, you will be asked to take Lupin-Estradiol, which is estrogen, and Prometrium, which is progesterone, before starting Phase 2: Ovarian Stimulation.
The purpose of these pre-treatment medications is to help coordinate the growth of the follicles to support a stronger response to ovarian stimulation medications, and to assist with scheduling the cycle.
Lupin-Estradiol is traditionally used to treat symptoms of menopause, and Prometrium is used as an adjunct to postmenopausal estrogen replacement to protect the uterus. In this case, these medications are used in a mix of on- and off-label use as part of pre-treatment.
Even though these medications work to suppress ovulation, there is a small risk that your body may still ovulate through them. Therefore, if there is a chance you could get pregnant, you must use a form of birth control, ie. condoms, while taking these medications.
Use
These medications will start in the pre-treatment phase on the days your nurse has instructed. Note: Lupin-Estradiol will start a week or two before Prometrium starts.
Dose
Lupin-Estradiol comes in the form of a pill that is inserted vaginally. You will be prescribed Lupin-Estradiol 2 mg (1 tablet) inserted vaginally twice daily (morning and evening) for a total of 2 tablets per day. You can choose the time but stay consistent throughout the cycle.
Prometrium 200 mg (2 x 100 mg tablets) inserted vaginally two times a day (morning and evening) for a total of 4 tablets per day is started later in the cycle.
There is no applicator required for Lupin-Estradiol or Prometrium. To insert, use your fingers and insert the tablets as high as you can into the vagina. Once Prometrium is added, you may take it at the same time as Lupin-Estradiol medication. However, most patients prefer to separate the vaginal insertion of these two medications by 30 minutes.
Missed Dose
Take missed dose as soon as remembered, then continue regular schedule. If closer to next dose, Skip missed dose and return to standard time.
Side Effects
Side effects can include headache, breast tenderness, nausea, and swelling and irritation of the vagina. These medications do increase vaginal secretions and they may be green tinged, so you may choose to wear a liner during this phase of treatment. These medications can also increase the risk of blood clots or, very rarely, stroke.
Storage
Room temperature, protect from light.