From the Research
Progesterone supplementation may help prevent first trimester miscarriage in specific situations, particularly for women with a history of recurrent miscarriage and current pregnancy bleeding. For women with recurrent pregnancy loss or those with threatened miscarriage (vaginal bleeding in early pregnancy), progesterone supplementation has shown benefit, as evidenced by the PRISM trial 1, which found a 5% increase in live birth rate with progesterone compared to placebo in women with a history of one or more miscarriages and current pregnancy bleeding. The typical regimen involves vaginal micronized progesterone 400 mg twice daily, as used in the PRISM trial 1. It's essential to note that the benefit of progesterone supplementation is more significant for women with multiple previous miscarriages, with a 15% increase in live birth rate for those with three or more previous miscarriages and current pregnancy bleeding 1. Progesterone works by supporting the endometrial lining, promoting placental development, and modulating the maternal immune response to prevent rejection of the embryo. Side effects may include drowsiness, dizziness, and vaginal irritation. It's crucial to consult with a healthcare provider before starting any progesterone therapy during pregnancy, as the decision to use progesterone should be based on individual risk factors and medical history. Key points to consider include:
- The PRISM trial 1 found a significant benefit of progesterone supplementation in women with recurrent miscarriage and current pregnancy bleeding.
- The PROMISE trial 2 also found a trend towards increased live birth rate with progesterone, although the result was not statistically significant.
- A Cochrane review 3 found moderate-quality evidence to support the use of progestogen therapy to reduce the rate of miscarriage in women with unexplained recurrent miscarriages.
- The use of progestogens has been associated with a higher rate of live births or ongoing pregnancy in various studies 4. However, it's essential to weigh the potential benefits against the potential risks and consider individual patient factors when making a decision about progesterone supplementation.