Should women take Prometrium to ward off miscarriage?

To sustain a healthy pregnancy, women must maintain healthy levels of progesterone at all times.

As a woman’s body prepares for ovulation, progesterone levels go up. The corpus luteum can stimulate the production of progesterone for about two weeks and if a conception occurs, the pregnancy itself takes over the stimulation of progesterone. With no pregnancy, the lining of the uterus deteriorates and a period begins.

If a newly pregnant woman’s progesterone level begins to diminish, then miscarriage would be imminent.

Many women who have experienced one or more miscarriages or are known to have a luteal phase defect (LPD) are being presented with a new option by their providers.

Prometrium, a synthetic form of progesterone that may help maintain a pregnancy and ward off miscarriage. Normally prescribed to menopausal women requiring hormone therapy and/or women experiencing abnormal periods, Prometrium can also be prescribed to women experiencing spotting or bleeding early in the first trimester or women with a history of recurrent miscarriage.

Available in tablet form a doctor will generally prescribe a 100-200mg dose to be taken orally once or twice a day. Suppositories and cream are available as well.

To determine the efficacy and safety of progestogens like Prometrium as a preventative therapy against miscarriage, a recent study (by Haas DM, Ramsey PS ‘Progestogen for preventing miscarriage’ Cochrane Database of Systematic Reviews 2008, Issue 2) was conducted on 2118 women who participated in 15 trials. The study revealed no significant difference between progestogen and placebo or no treatment groups for a majority of the participants.

However, in a subgroup analysis of three trials involving women who had recurrent miscarriages (3 or more), treatment showed a statistically significant decrease in the miscarriage rate compared to placebo or no treatment.

Additionally, no significant adverse effects from taking Prometrium were reported regarding mother and child at this time, however many people feel there are not enough facts supporting its safety and warranting its overuse.

According to their own website, the most common adverse events reported in (postmenopausal) women receiving prometrium 200 mg were: breast tenderness, dizziness, abdominal bloating, vaginal discharge, chest pain, and diarrhea.

And most importantly, they actually warn not to use while pregnant. 

Further research indicated the long-term maternal and neonatal/fetal adverse effects of progestogen administration in early pregnancy also warrant further investigation.

Until then many non-supporters feel it is imperative Progestogen be removed from the treatment list for preventing miscarriage. Increasing awareness among policy-makers, health-care providers and patients about the fact that the practice is not based on evidence is a good start.

GetPregnant.org