Progesterone and Miscarriage
Why is Progesterone so Important during Pregnancy?
As a result of talking to many women going through miscarriage scares. I have learned a bit about the importance of progesterone and how this hormone affects pregnancies. As a result, I believe that a number of doctors downplay the significance of supplements during the first trimester and, for some pregnancies, progesterone supplements may be needed to save that pregnancy.
I am hoping the information on this page will educate women on the importance of progesterone, whether it might be an issue in their own pregnancy and whether they should discuss this issue with their physicians.
Progesterone, Why is it so Important?
the keep-it-simple version
After reading the stories at Saving Babies Online (an older site and no longer maintained), I found myself really interested in the role progesterone plays in miscarriage. I would just like to pass on a bit of what I've learned in hopes it may help somebody else.
The Importance of Progesterone:
Progesterone is important not only to keeping a pregnancy but also may determine whether or not you conceive. During your cycle, the uterine lining grows thicker in anticiption of a fertilized egg and progesterone helps ensure the endometrium (lining) is ready. Progesterone is responsible for preparing the uterus for implantation. If you have low progesterone, chances are the baby will not be able to implant which may result in a chemical pregnancy. And, low progesterone may keep you from ovulating. Keep in mind that once both estrogen and progesterone levels drop, your body prepares to break down the lining and thus your period begins. If your progesterone is dropping during pregnancy, you are in danger of losing the baby.
Some symptoms of low progesterone:
If you have any of these symptoms of low progesterone, your doctor should check your progesterone:
- Short cycles (25 days or under)
- In your 30s or older. By age 35, I have read that up to 50% of women have low progesterone
- Severe PMS and weight gain
- Stress, which stimulates cortisol production, will also decrease progesterone production making conception more difficult and could jeopardize a pregnancy. Progesterone actually produces a more calming effect than cortisol which increases stress
Natural or Synthetic (man-made) Progesterone:
Although I'm reading a lot on the benefits of both synthetic and natural progesterone in maintaining a pregnancy, there does seem to be some consensus that synthetic progesterone may cause some birth defects. I haven't really seen that those studies are reproducible and am unsure how valid they are, but the risk of birth defects should be taken into consideration. Natural progesterone, however, looks to be much safer with no side effects as long as you don't overload yourself with it. Also topical progesterone and injected progesterone seems to be more effective than progesterone taken orally. This is definitely a topic of discussion for you and your physician.
What it boils down to is this:
If you have short cycles, have suffered from infertility or are a bit older than the average mother, you may want to have your progesterone checked. The best time to get checked is around the time of ovulation so you can begin taking supplements if needed. Natural progesterone seems to be a safer than synthetic progesterone and can aid in both achieving and maintaining a pregnancy. Take what you've learned about progesterone to your doctor. If you have a doctor who is not open to testing for progesterone, it may be time to find a new doctor.
Hope this helps.
What are Typical Progesterone Levels?
(taken from fertilityplus.org 's website)
5+ ng/ml -- A level of 5 indicates some kind of ovulatory activity, though most doctors want to see a level over 10 on unmedicated cycles, and over 15 with medications. There is no mid-luteal level that predicts pregnancy.
10-90 ng/ml -- Average is about 20 at 4 weeks LMP, and 40 at 14 weeks LMP. It is important to note that while a higher progesterone level corresponds with higher pregnancy success rates, one cannot fully predict outcome based on progesterone levels.
25-90 ng/ml Average is 40 at beginning, 90 at end.
Third Trimester 49-423 ng/ml Usually peaks at about 175.
One note, FertilityPlus has some wonderful information, however, they do take the stance that beginning progesterone supplements after a positive test is unlikely to do much. I've been able to find studies online to contradict that opinion. I'll be sharing some of those studies on this page as well.
Progesterone Testing Poll
Do you think doctors should routinely check progesterone levels?
Important New Guidelines for Diagnosing a Miscarriage
The UK is the first to acknowledge that misdiagnosed miscarriages are indeed a problem. The Royal College of Obstetricians and Gynaecologists has revised its guidelines. If your gestational sac is more than 25mm and/or the CRL is 7mm or more, you should wait a week to verify (if there are no complications). If the measurements are less, you are too early to diagnose. For more information (and something to take to your doctor), please, see my new page:
Need to contact the author? You may e-mail Cari_Kay at firstname.lastname@example.org
Studies involving Progesterone
why progesterone may be more important than you or your doctor realize
Some studies I have stumbled across in my quest for more information on progesterone in pregnancy. I'll post the conclusions of the studies. Feel free to take a look at the links and then take this information and discuss it with your healthcare provider.
more to follow...
This study shows that luteal progesterone supplementation during the luteal phase decreased miscarriage rate and improved the live birth rate. While most women are not going through this procedure, it once again points to the importance of progesterone.
In a nutshell, this study found that taking this combination resulted in a much higher rate of live births (77% vs. 35% in the group who were not treated) in women who have had recurrent miscarriages.
Synthetic progestogen was begun no earlier than 7 weeks in women who were 7 to 16 weeks pregnant and experiencing a threatened miscarriage. Of those studied, approximately 8% miscarried, 9% experienced preterm birth and 82% gave birth 'normally'.
This study found that the use of vaginal progesterone diminished pain and contractions in women with threatened abortion. They also found that the placebo group had twice the miscarriage rate of the supplemented group.
I am not a medical professional. The information I share is meant to supplement the information given you by your doctor. If you feel your doctor is not doing enough for you or not willing to listen to your concerns, I strongly encourage you to take what you've learned here and get a second opinion.