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Can progesterone really prevent miscarriage?

Understand how progesterone treatment impacts your body during pregnancy.

Losing pregnancy before reaching 20 weeks is called a miscarriage. It is very common. According to a recent study published in the Lancet in 2021, 23 million miscarriages are reported worldwide annually and the overall risk of miscarriage is 15.3%. According to NHS, every 1 out of 8 pregnancies in the UK ends in miscarriage.

Irrespective of the cause, this loss can be devastating for a person's emotional and biological well-being. The situation is particularly painful in case of recurrent miscarriages. Those searching for the treatment often look into the female reproductive hormone progesterone, which is responsible for the maintenance of pregnancy.

What is progesterone?

Progesterone is a steroid hormone of the progestogen class of hormones. The corpus luteum secretes it which is the leftover of ovarian follicle after the release of an egg. This sex hormone is involved in embryogenesis, pregnancy and regulating the menstrual cycle in humans and animals.

Its levels persist throughout the pregnancy. Its falling levels, combined with the increasing levels of corticosteroids, signal the onset of birth. Can this hormone help if you are losing pregnancy? To answer this, you should understand its functions in pregnancy.

How does progesterone work in pregnancy?

This hormone is named due to its 'pro-gestational' functions. It has a role in the maintenance and termination of pregnancy. Its pro-pregnancy functions are;

• Before pregnancy, it stimulates the development of the internal lining of the uterus (endometrium), making it receptive to the incoming foetus.

• In the early phases, it maintains the pregnancy by suppressing birth signals.

• In the subsequent 2nd and 3rd trimesters of pregnancy, it keeps the uterus quiescent by suppressing the immune responses that can result in premature delivery.

By 7-9 weeks of pregnancy, the placenta becomes the main progesterone source. Therefore, removing the corpus luteum past 9 weeks doesn't cause abortion.

Progesterone deficiency leaves many signs. Click here to know if you have a progesterone deficiency.

Progesterone supplementation and pregnancy

The role of progesterone hormone in pregnancy has urged many scientists and clinicians to believe that the deficiency of progesterone is responsible for miscarriage in early pregnancy and recurrent miscarriage and that its supplementation can reduce the miscarriage risk.

Despite the role of progesterone in pregnancy, the use of progesterone supplementation to reduce miscarriage has produced variable results. Let's understand what the research says about progesterone therapy's role in preventing miscarriage.

What does the research say?

The scientific investigations on the topic have produced variable results. Let's summarise the results of some studies.

Vaginal micronized progesterone treatment

A 2020 study published in the American Journal of Obstetrics and Gynaecology found that women with early pregnancy bleeding and miscarriage can benefit from twice daily use of 400mg vaginal micronized progesterone. The review study covered two trials. In the PROMISE trial, 836 women attending 45 different hospitals in the UK and Netherlands showed a 3% increase in the live birth rate following progesterone use. The results were, however, statistically inconsistent.

In the PRISM trial, 4153 women attending 48 different hospitals in the UK also showed a 3% increase in the live birth rate. The results were, however, statistically inconsistent. The study also noted that the benefit of using vaginal micronized progesterone treatment was greater in women with three or more previous miscarriages.

Treatment with vaginal pessaries containing natural progesterone

A 2012 study published in the Journal of Human Reproductive Sciences investigated the effect of progesterone supplements on women having a history of unexplained recurrent miscarriages. This cohort study covered a period of 9 years. The women enrolled in the study had at least three or more miscarriages in the past. The women were given vaginal pessaries containing 400mg of natural progesterone twice daily until the 12th week of pregnancy.

Compared to the history, A decrease in the miscarriage rate was noted in the women having 4 miscarriages in the past. A 10% reduction in the miscarriage rate was observed. However, there was no control group in the study, and the data was compared to the historical records.

Prophylactic progesterone therapy

A 2018 research published in the Cochrane Library assessed the safety and efficacy of progesterone treatment in the pregnant women having recurrent miscarriages. The study reviewed the data of 12 survey studies involving 1856 women. The study noted a slight benefit in 1411 women receiving progesterone. However, no significant improvements were observed in the secondary outcomes, e.g., stillbirth, foetal genital abnormalities, neonatal death, etc.

The rate of miscarriage in women with previous recurrent miscarriages was reduced to 20.1% from 27.1%. The study noted that the prophylactic use of progesterone treatments reduced the miscarriage rate.

Progesterone treatments for threatened miscarriage

A team of researchers studied progesterone therapy to treat threatened miscarriages in 2018. The findings of their miscarriage research were published in the Cochrane Library. The study involved 696 participants in 11 trials. It was found that using progesterone reduced the risk of threatened miscarriage in women. The moderate quality evidence suggested that the use of oral progesterone also produced a minor decrease in miscarriages.

However, vaginal progesterone treatments produced little to no improvement in the miscarriage rate. The results were not strong enough to recommend the use of progesterone supplementation.

Conclusion

The available evidence suggests that progesterone supplementation provides some help to women with recurrent or threatened miscarriages. The vaginal micronized progesterone administration has shown better results in improving the live birth rate than the oral progesterone supplementation for women having a history of miscarriages or bleeding in early pregnancy. The safety and effectiveness of all other alternatives are debatable.

If you want to measure the progesterone level in your blood to diagnose progesterone deficiency, our Progesterone Test kit can help you. Click here to place your order.

If you are not interested in progesterone therapy, there are many natural ways to boost your progesterone naturally. Click here to read about it.

If you are concerned about your reproductive health, our sexual health experts can guide you. Click here for online consultation with our health experts.