From the Guidelines
Low progesterone during pregnancy may require supplementation under medical supervision, and the most recent evidence suggests that vaginal progesterone is the preferred treatment option. According to the most recent study 1, vaginal progesterone has been shown to reduce the risk of preterm birth and perinatal morbidity and mortality in women with a short cervix. The recommended dosage is typically 90-200mg once or twice daily, and treatment usually begins when low levels are detected and continues through the first trimester, around 10-12 weeks, when the placenta takes over progesterone production.
Key Points to Consider
- Progesterone is crucial during early pregnancy as it helps maintain the uterine lining, supports embryo implantation, and prevents premature uterine contractions.
- Symptoms of low progesterone may include spotting, abdominal pain, or a history of early miscarriages.
- Regular monitoring of progesterone levels through blood tests will help your doctor adjust dosages as needed.
- While supplementing, be aware of potential side effects including drowsiness, dizziness, or injection site pain.
- It's essential to follow your healthcare provider's instructions precisely and attend all follow-up appointments to ensure appropriate management of your pregnancy.
Treatment Options
- Vaginal progesterone: 90-200mg once or twice daily, typically in the form of vaginal suppositories (such as Endometrin or Crinone 8% gel) or vaginal tablets (Prometrium, 100-200mg).
- Intramuscular injections: progesterone in oil, 25-100mg daily, although this is not the preferred treatment option according to the most recent evidence 1.
Special Considerations
- Women with a history of preterm birth: 17-alpha-hydroxy-progesterone caproate (17-OHPC) 250 mg intramuscularly weekly, starting at 16-20 weeks, may be recommended 1.
- Women with a short cervix: vaginal progesterone is the preferred treatment option, although the optimal dosage and treatment duration are still being studied 1.
From the Research
Low Progesterone in Pregnancy
- Low progesterone levels can increase the risk of miscarriage and preterm birth in pregnancy 2, 3, 4.
- Progesterone supplementation has been shown to reduce the risk of recurrent miscarriage and preterm birth in high-risk pregnant women 2, 5.
Progesterone Supplementation
- Progesterone supplementation can be administered through various routes, including vaginal, oral, and intramuscular injections 6.
- The optimal dose, route, and timing of progesterone supplementation are still unclear and require further research 2, 6.
- Progesterone supplementation has been shown to be efficacious in reducing the risk of preterm birth in women with a history of spontaneous preterm delivery 5.
Luteal Phase Support
- Luteal phase support with progesterone can improve implantation rates and pregnancy outcomes in assisted reproductive technology (ART) cycles 6.
- The addition of other substances, such as estrogen or hCG, to progesterone supplementation does not seem to improve outcomes 6.
- Synthetic progesterone may be more effective than micronized progesterone for luteal phase support 6.
Prevention of Preterm Birth
- Progesterone supplementation has been approved by the US FDA for the prevention of recurrent preterm birth in women with a history of spontaneous preterm delivery 5.
- The optimal formulation and route of administration of progesterone supplementation for preterm birth prevention are still unclear and require further research 5.
- Progesterone supplementation may reduce the risk of preterm birth by reducing uterine contractions and promoting fetal growth 5.