Progesterone to prevent miscarriage

When a woman is pregnant, she is actually eating for two. Every food, drink, supplement and medicine affects her growing baby. Her body also produces different levels of hormones to support pregnancy. Each month, a woman’s body cycles through a variety of hormones that regulate the accumulation of blood in the uterus to support pregnancy, egg maturation, and the withdrawal of hormones that lead to menstruation.^first

Progesterone is one of those hormones and is often referred to as the “pregnancy hormone.”² because of its important role, from embryo implantation to delivery of the baby. After the egg is released from the ovary, the corpus luteum produces progesterone to sustain the early stages of pregnancy.³

The corpus luteum is a group of cells that form soon after the egg leaves the ovary. Progesterone makes the uterus a healthy environment for a fertilized egg to implant and begin to develop.⁴ When the fertilized embryo implants, progesterone stimulates further growth of blood vessels and triggers the endometrium to secrete nutrients to support growth.

During these early weeks, progesterone is essential to establish the placenta. Once the placenta is formed, it takes over the production of progesterone around Week 12. During the remaining two trimesters, progesterone levels continue to rise and play a role in strengthening the pelvic wall muscles, preventing lactation and mother’s breast tissue development.

Scientists have not identified the serious medical consequences of producing too much progesterone,⁵ However, taking progesterone supplements when you’re not pregnant is associated with a small risk of developing breast cancer.⁶ However, without enough progesterone, women can experience irregular and heavy periods, and decreased progesterone levels can lead to miscarriage.

Progesterone can help prevent an early miscarriage

The National Institute for Health and Care Excellence (NICE) has recommended that women who experience bleeding early in pregnancy and have had at least one miscarriage should take progesterone supplements to reduce their risk of miscarriage. .⁷ This guideline is based on research evidence that women who have had more miscarriages have better outcomes with progesterone supplements.⁸

According to the BBC article,⁹ 1 in 5 pregnant women experience bleeding during the first 12 weeks of pregnancy. This is light bleeding that occurs intermittently. If bleeding occurs along with pregnancy, this is called threatened miscarriage. Today, most women with bleeding are sent home and asked to wait and see what happens.

However, new guidance from NICE recommends using progesterone pessary vaginally twice a day as a pregnancy-supporting progesterone supplement.^ten A trial conducted at Tommy’s National Miscarriage Research Center found that people who had bleeding and had not had previous miscarriages did not benefit from progesterone supplementation.

Previous research has evaluated the use of progesterone to support pregnancy. Research¹¹ published in 2005 reviewed randomized controlled trials of women who received progesterone supplements before 34 weeks of gestation. Data indicates that it reduces the rate of preterm birth in high-risk women.

A second article^twelfth published in 2013 showed the results of 17 trials showing no evidence to support the use of progestagens to treat threatened miscarriage. A third animal study¹³ published in 2020, analyzes the use of progesterone during early pregnancy on fetal development.

They found that taking the drug could alter pituitary and testicular function in male children. The results suggest that progesterone has sex-specific effects in early pregnancy and should only be used “when there is clear evidence of efficacy and for a limited time if necessary.”¹⁴

Progesterone can prevent 8,450 miscarriages a year

The NICE guidelines are based on studies published in 2020, showing that progesterone given to women with bleeding in early pregnancy could prevent 8,450 miscarriages each year. Both studies were published on January 30, 2020. The study was published in the American Journal of Obstetrics and Gynecology.¹⁵ reviewed the results of two large clinical trials led by Tommy’s National Center for Miscarriage Research and the University of Birmingham.

Clinical trials of Progesterone in the Recurrent Miscarriage (PROMISE) trial¹⁶ and Progesterone in the Natural Miscarriage (PRISM) trial.^17,18 The PROMISE trial studied 836 women at 45 hospitals in the Netherlands and the UK¹⁹ The data revealed that those with consecutive miscarriages had a 2.5% higher live birth rate when supplemented with progesterone.²⁰

In the PRISM trial,²¹ 4,153 women from 48 hospitals in the UK were given progesterone injections during early pregnancy bleeding. The data showed a 5% increase in live births compared with children given a placebo. In women who had three or more miscarriages, the data showed a 15% increase in the number of babies born to those given progesterone.²²

The second study based on the NICE guidelines was published in BJOG: An International Journal of Obstetrics & Gynecology.²³ This paper looked at the economics of the PRISM trial and concluded the average treatment cost was £204 ($272.19) per pregnancy. They concluded that:²⁴

“The results show that progesterone has a small positive effect and a small additional cost. Given the available evidence, progesterone could be a cost-effective intervention, especially for women who have had a previous miscarriage.”

Women who are not pregnant may have symptoms of low progesterone including irregular menstrual cycles, vaginal dryness, mood swings, headaches or migraines. Progesterone helps replenish estrogen during the normal menstrual cycle.²⁵ Without the effects of progesterone, estrogen can increase the risk of weight gain, breast engorgement, fibroids, and gallbladder problems.

Different forms of Progesterone administration

Not all forms and types of progesterone are created equal. Doctors prescribe progesterone to regulate the menstrual cycle, treat hyperplastic preeclampsia lesions in the endometrium, and as a contraceptive.²⁶ Synthetic Progesterone²⁷ may be associated with birth defects, so it is important to make sure you are using natural sources and always consult a healthcare provider when using progesterone, whether are you pregnant or not.

Progesterone can be in the form of a vaginal gel, suppository, suppository, oral capsule, or injection.²⁸ The vaginal lubricant is used once a day and is the only product approved by the FDA for assisted reproduction, such as in vitro fertilization. More than 40 million doses have been prescribed to date in the past decade.

Vaginal suppositories come in wax form and are inserted two to three times a day. However, leaks can be messy, and although they are widely used, they are not approved by the FDA. Vaginal devices are approved to supplement, but not replace, progesterone.

Although they are not formulated or approved by the FDA for intravaginal use, progesterone oral capsules have been used vaginally, up to three times a day, because they have fewer side effects when used through vaginal route compared with oral administration.

Finally, progesterone can be injected as an oil. This is the oldest method of childbirth and is injected into the buttocks once daily. Because it is oily, the injection site can be painful and skin reactions are common.

Women who take progesterone supplements during early pregnancy may experience some side effects. These side effects should be reported to their healthcare professional as soon as possible.^{29,30,thirty first}

More challenges if you’re pregnant during a pandemic

Pregnant women during a pandemic have several additional challenges to staying healthy and keeping their babies healthy. Pregnancy places higher demands on lung functions. As a result, women with underlying medical conditions such as heart disease, diabetes, high blood pressure, or lung problems may have a higher risk of infection and more severe illness.

It’s important to tell your doctor about any changes, such as decreased fetal movement, or if you believe you are showing signs of preterm labor. Researchers believe that up to 80% of people with COVID-19 will have mild symptoms or no symptoms.³² This is similar to studies done with flu in the UK, which showed that the majority of these people had no symptoms.³³

This means you need to take care even with people who seem healthy. An important step in prevention is to wash your hands thoroughly for at least 20 seconds and avoid touching your face.

You should also be aware that using supplements or medications during pregnancy can affect your developing unborn baby which is not always well understood or documented. Even commonly accepted over-the-counter medications and supplements can have long-term consequences.

For example, there is evidence that acetaminophen, commonly sold under the brand name Tylenol, can double the risk of autism.³⁴ and increased risk of attention deficit disorder in children.³⁵

It is also important to maintain healthy vitamin D levels during your pregnancy. In a systematic review by Cochrane,³⁶ The authors found evidence that vitamin D may reduce the risk of preeclampsia, low birth weight, and preterm birth. It also plays a functional role in reducing the risk of upper respiratory tract infections,³⁷ including flu and COVID-19.

Vitamin C plays a role in the treatment of COVID-19, but large doses should not be used for prevention. To protect your health, look for foods high in vitamin C,³⁸ such as bell peppers, kiwi fruit, strawberries, broccoli, tomatoes and snow peas.

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