Progesterone Treatment in Pregnancy to Prevent Miscarriage

Progesterone is a hormone that naturally occurs in the human body. During the menstrual cycle, progesterone levels rise after ovulation to help build and sustain a lining in the uterus. This lining is where the fertilized egg will implant. The ovaries will produce progesterone during the first trimester, until the placenta takes over this function around the 9-10th week of pregnancy.

When looking at miscarriage, we know that some women have a lower progesterone level and then miscarry. The question is truly, did the low progesterone levels cause a miscarriage or did the impending miscarriage cause the low progesterone levels? In trying to help prevent miscarriages, some doctors began prescribing progesterone supplements in pregnancy to prevent miscarriage.

Studies show that progesterone supplements do not really help prevent miscarriage in the average pregnancy, even when there is a threatened miscarriage. There is evidence that progesterone supplementation is imperative in pregnancies that have resulted from certain assisted reproductive technologies (ART), like in vitro fertilization (IVF). There may also be benefit to a woman who has suffered from three or more miscarriages.

The hesitation comes not from having proof that there is risk, but in no proof of benefit and no proof of safety for the average woman. Doctors and women who choose to use progesterone supplements say that this is simply helping the body with a hormone it's already producing. They believe that there is little risk and only potential benefit to using the progesterone supplements. Those who are concerned and decide not to use the supplements point to the fact that there is no proof that they work. Some doctors are concerned that using progesterone may simply delay a miscarriage that will happen any way.

There is a call for more research to be done as both women and those that care for them look to help prevent miscarriage from happening in pregnancy. In the end, you need to have a frank discussion with your doctor or midwife as to what is right for your pregnancy. Together, you can make a decision that is appropriate for you and your care.

_Sources:

_{Haas DM, Ramsey PS. Progestogen for preventing miscarriage. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD003511. DOI: 10.1002/14651858.CD003511.pub2 Last accessed April 14, 2011.}

_{Wahabi HA, Abed Althagafi NF, Elawad M, Al Zeidan RA. Progestogen for treating threatened miscarriage. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD005943. DOI: 10.1002/14651858.CD005943.pub3 Last accessed April 14, 2011}