Progesterone Prescribing at 6 Weeks Gestation
For a 6-week pregnant patient, progesterone is NOT routinely indicated unless there is early pregnancy bleeding with a history of prior miscarriage(s), in which case prescribe vaginal micronized progesterone 400 mg twice daily. 1
Clinical Context and Indications
At 6 weeks gestation, progesterone supplementation has limited evidence-based indications:
When to Prescribe Progesterone at 6 Weeks
Early pregnancy bleeding with prior miscarriage history: Vaginal micronized progesterone 400 mg twice daily is appropriate for women presenting with bleeding who have had previous miscarriage(s). 1
Alternative regimens for early pregnancy bleeding: Vaginal progesterone 90-mg gel daily or 200-mg suppository daily can be used instead of the 400 mg twice daily regimen. 1
When NOT to Prescribe Progesterone at 6 Weeks
Routine pregnancy without risk factors: There is insufficient evidence to recommend progesterone in singleton gestations with no prior preterm birth and unknown cervical length. 2
Multiple gestations: No evidence supports progesterone use for twin or triplet pregnancies at any gestational age. 3
Important Distinctions Between Progesterone Formulations
Do not confuse different progesterone preparations, as they have distinct indications and dosing:
17-alpha-hydroxyprogesterone caproate (17P) 250 mg IM weekly is indicated for preterm birth prevention starting at 16-20 weeks in women with prior spontaneous preterm birth, NOT for early pregnancy support at 6 weeks. 1, 3
Oral micronized progesterone has different dosing and indications compared to injectable 17P. 1
Vaginal progesterone is the preferred route for early pregnancy bleeding and recurrent miscarriage scenarios. 1
Practical Prescribing Details
For Early Pregnancy Bleeding with Prior Miscarriage
- Medication: Micronized progesterone vaginal suppositories or capsules
- Dose: 400 mg twice daily (total 800 mg/day)
- Route: Vaginal administration
- Duration: Continue until at least 12 weeks gestation, though specific duration for this indication requires clinical judgment based on bleeding resolution and viability confirmation 1
Common Pitfalls to Avoid
Do not prescribe 17P at 6 weeks: This formulation is only indicated starting at 16-20 weeks for women with prior spontaneous preterm birth. 2, 3
Do not use progesterone for threatened preterm labor: Progesterone works as prevention when started early (16-24 weeks), not as treatment for active labor or threatened preterm labor. 3
Do not switch formulations mid-pregnancy: There is no evidence that switching between progesterone preparations provides additional benefit. 3
Monitoring and Follow-up
Standard early pregnancy care should continue alongside progesterone therapy, with no specific additional monitoring requirements identified for progesterone supplementation itself. 1
Progesterone level testing is not routinely indicated at 6 weeks gestation; testing recommendations apply later in pregnancy (16-24 weeks) for specific high-risk populations. 4
Side Effects of Vaginal Progesterone
When prescribing vaginal micronized progesterone, counsel patients about potential side effects including mild dizziness, somnolence, and vaginal dryness, though these are generally well-tolerated. 5