Question: Hello Dr., Just some quick background - My wife had an endometriotic cyst (measuring a little less than 3 centimeters). But luckily we were able to conceive withing 3-4 months after the cyst(s?) was detected. Now we are in the 10th week with heartbeat seen at 6 weeks :) In the 6th week scan, though the impression was that there was CLC (12mm). (A) Hope this CLC etc. is no cause of concern? Have been advised the following medicines: 1. Fol 123 (Folic acid supplements) 2. Susten VT 200 (progesterone suppositories; 1 in the morning & to be taken only if going out for work) 3. Gestofit SR 300 (1 tablet in the night, orally) 4. Ecosprin 75 (1 in the morning) 5. Ondem MD 4 (30 minutes before food; only if vomiting sensation exists) 6. Some anesthetic antacid (to be taken only if there's acidity etc.) (B, 1) Need your approval on these medicines please: We saw some spotting (approx. 2 drops of red color blood came along with the white discharge). There were thankfully no other complications like pain etc. Next day the pelvic scan showed that all was fine with no internal bleeding & the baby growth was on track. Susten VT almost never dissolved beyond 50% and made my wife mildly uncomfortable. (C) Could this spotting be because of the taking Susten VT or it could be something else? Don't think there were any tests to infer that the progesterone levels were low! (D) So needed to check with you if there's any harm in taking these progesterone tablets especially Susten VT? After this spotting episode the doc has prescribed HCG 5000 mg injection per week for 3 weeks. Except for the first HCG level test, it wasn't done later to infer that it's low. (B, 2) Hope this medicine/dosage is ok too? Looking forward to your expert opinion. Thanks! XXXX

Hello Doctor, Thank you so much for your insightful and detailed answers. Just to clarify about what you said, have not used Susten VT 200 in the night but (as per the doc’s advice) used it in the morning (that too) if we were going out of the house. And it’s never dissolved beyond 50%. But anyway this isn’t being used now since my wife has taken a break from her work after the spotting episode & also that she is taking bed rest as advised by the doctor. The spotting happened in the 10th week. So not sure if it was implantation bleeding which I understand typically happens at the time when one is expected the next period after conception. (A-1) And if not for Susten VT, what could be the reason of the spotting then? Could it be that she was working and it involved some amount of climbing (slowly) up and down a flight of stairs some 2-3 times a day & a bit of walking (approx. 500 meters walk in the morning and 500m walk early evening)to work? (Was actually hoping to zero down the spotting issue to the use of Susten VT. This was after I researched on the internet & found that there were plenty of women mentioning on various message/discussion boards that their doc was against progesterone suppositories because they are known to cause spotting etc.) (A-2) Climbing up and down 2 flights of stairs once in two days, is ok? Our plan of action will be this: - Will get the level of progesterone tested – and determine if Susten VT 200 or its equivalent is to be taken. (Right now will just stick to Gestofit SR 300 (oral) taken in the morning. - Will also test the HCG levels . And then let you know about the results so that you could suggest what dosage is right. (B) Hope the plan is alright. And doctor, lastly, over the last 2-3 days, i.e. after the spotting episode, my wife has been complaining more about lower backache, weakness, sleepiness, hunger and throwing up sensations. Though all of these were there from week 5-10, severity of weakness and lower backache seem to have increased. (C) Is this related to spotting or could it because she doesn’t feel like eating much & even if she does she feels hungry again quickly… or is it something else? Should we be worried? (Just to repeat – the pelvic scan showed that the baby growth was fine with no internal bleeding)