From the Research
The recommended dose of vaginal progesterone for recurrent pregnancy loss is 400 mg twice daily, as supported by the most recent and highest quality study 1. This dose has been shown to increase live birth rates in women with a history of recurrent miscarriage, particularly in those with three or more previous miscarriages. The treatment should begin as soon as pregnancy is confirmed and continue through the first trimester, usually until 10-12 weeks of pregnancy. Common formulations include vaginal suppositories or gel, which should be inserted deep into the vagina, preferably at bedtime to minimize leakage. Progesterone supplementation works by supporting the endometrial lining and potentially modulating immune responses that might otherwise lead to pregnancy rejection. Some key points to consider when prescribing vaginal progesterone include:
- Starting treatment as soon as pregnancy is confirmed
- Continuing treatment through the first trimester
- Using a dose of 400 mg twice daily
- Monitoring for side effects, such as vaginal irritation, discharge, drowsiness, and breast tenderness
- Considering the patient's history of recurrent miscarriage and adjusting the treatment plan accordingly. It's also important to note that while other studies have suggested different doses or formulations of progesterone, the study by 1 provides the most recent and highest quality evidence to support the use of 400 mg twice daily. Additionally, other studies such as 2 and 3 have also shown the effectiveness of progesterone in preventing miscarriage in women with recurrent pregnancy loss, but the dose and formulation used in these studies were different. However, the study by 1 provides the most robust evidence to support the use of 400 mg twice daily, and therefore, this dose is recommended.