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Progesterone Helps Prevent Reoccurring Miscarriage

The hormone decreases the risk of bleeding during pregnancy and is now available as an affordable fertility treatment nationwide

A new method to protect the most vunerable pregnancies 

Women who have had miscarriages and bleeding in the first trimester may find help preventing subsequent miscarriages in new research on the use of the hormone progesterone to prevent pregnancy loss during the first twelve weeks (the most common time for a miscarriage to occur). Doctors can now prescribe a vaginal progesterone cream or suppository for women to use through the end of the first trimester.

How common is miscarriage?

One in three women report experiencing a miscarriage at some point in their lives, and that number is considered a low estimate. A large number of early miscarriages are not counted, either because they happen so early that the woman having the miscarriage may not realize that she is pregnant, or because until recently, miscarriage has been considered a private burden that many women do not share with anyone, not even their doctor. Twenty percent of women also experience bleeding in the first trimester. Though bleeding during pregnancy is not always a sign of miscarriage, it can be, and so it is important to alert your doctor as soon you notice it.

Promising evidence for women at high risk for repeat miscarriages 

Two new studies – the PROMISE study which was conducted with women with early recurrent miscarriage, and the PRISM study which focused on women with early pregnancy bleeding – published in January in the American Journal of Obstetrics and Gynecology – determined that progesterone is a potential treatment for women whose previous miscarriage or bleeding was the result of low or fluctuating progesterone.

The first study looked at more than 800 women in the United Kingdom and the Netherlands. The study authors found that treatment with progesterone led to a 3% greater live birth rate among those treated than those who were not. Over 4000 women participated in the second largescale British study on progesterone to prevent miscarriage, which produced similar results. Both trials reported that improvement was higher among those who had more miscarriages, with the PRISM study finding a 15% benefit among women with three or more miscarriages and current pregnancy bleeding. Most women who have had one miscarriage are still able to conceive on their own, so women who have had multiple miscarriages and bleeding during pregnancy are also the group most likely to benefit from this new treatment.

Widespread acceptance and clinical availability

“Before our trial was published only 12% of clinicians would consider using progesterone in women at risk of having a miscarriage, but now the majority of them either use progesterone or intend to use progesterone in high risk women seeking help to prevent miscarriage,” says Dr. Arri Coomarasamy, a professor of Gynecology at the University of Birmingham in England.

However, as this is a new option for treatment, some risks may remain unknown. Dr. Peter Ramsey, an obstetrician at the University of Texas Health Sciences Center in San Antonio, who worked on a comprehensive review of the studies, says the newness of the research is a reason to remain cautious when deciding whether or not to seek this treatment.

No risks found

There is tremendous interest in finding ways to prevent miscarriage, says Dr. Ramsey, and there are ongoing studies in multiple countries that are looking at both the use of progesterone, as well as other potential avenues for helping women bring pregnancies to term. “I think women can consider the evidence we have now when deciding whether to try the treatment, but we still need to do more for it to be conclusive,” says Dr. Ramsey.

Dr. Coomarasamy says it’s a promising new treatment option to consider if you have early pregnancy bleeding and a history of previous pregnancy loss.

 

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