Elizabeth Petrucelli

Author, Blogger, Educator

Tag: progesterone supplementation

Study on Progesterone Supplementation to Prevent Recurrent Miscarriage

I want to talk about this study. The study that states: A Randomized Trial of Progesterone in Women with Recurrent Miscarriages and how the news media organizations have deemed progesterone supplementation in pregnancy futile.

Here they are with their titles:

Studies unveiled Progesterone (Miscarriage preventer) Medicine is vain
Women In First Trimester Of Pregnancy Don’t Benefit From Progesterone
Progesterone Does Not Prevent Recurrent Miscarriage

And at least this headline shares the words “may not help” instead of making people believe that in all cases progesterone supplementation “does not help.”

Progesterone May Not Help Prevent Repeat Miscarriage, Study Finds

In 2012, I thought we were making some headway towards progesterone supplementation in pregnancy especially when this article came out: Progesterone test could reveal miscarriage risk but it seems we may be taking a step backward. I have needed progesterone supplementation for every one of my pregnancies. I just don’t make enough to sustain a pregnancy (viable or not). The study which just released on November 26, 2015, states the following: Progesterone therapy in the first trimester of pregnancy did not result in a significantly higher rate of live births among women with a history of unexplained recurrent miscarriages.

Bereavement DoulaThe women in the study had a history of recurrent miscarriage (3 or more miscarriages which did not have to be consecutive). The women were given 400mg of micronized vaginal progesterone suppositories which they administered twice daily throughout the 12th week of pregnancy. That equates to 800mg of progesterone supplementation daily. This seems like alot and much more that I was ever prescribed during my pregnancies where I fought for progesterone supplementation. In fact, with Gus’s pregnancy, I blogged about this experience and how the first doctor gave me such a small dose that didn’t even last until the 2nd trimester.

At first glance, it definitely seems there was no statistically significant findings on progesterone supplementation but upon further examination, there is a flaw in the study. Many would never see it and unfortunately, doctors will pick up on the titles of these articles and continue to use them as an excuse not to supplement women with progesterone.

What is the flaw exactly? “In general, we find that when it comes to recurrent miscarriage management, there is ‘normal’ and ‘abnormal,’ but no ‘super normal.’ If an abnormality is identified, such as thyroid disease or a uterine anomaly, it should be corrected, but interventions not targeting an abnormality are rarely helpful and may be harmful,” he added. (He being Zev Williams, MD, PhD, director, Program for Early and Recurrent Pregnancy Loss).

So, if an abnormality is identified, it should be corrected. Absolutely! Dr. Williams mentions thyroid disease as well as uterine anomaly as reasons for intervention. Thus, we would say that a woman with thyroid disease should have her thyroid disease treated before, during, and after pregnancy. We know that the thyroid is very important to conception, maintaining a pregnancy, and maintaining milk supply following birth. What isn’t mentioned here is progesterone deficiency.

Progesterone deficiency is an actual phenomenon. This would fall under an abnormality which should be treated. But the study above doesn’t show progesterone supplementation in women with progesterone deficiency is effective because this wasn’t explored. The reasons for miscarriage in the women within this study were not explored. Their reasons for miscarriage were all across the board. Some with uterine anomalies or other disorders, and others with genetic abnormalities (which “they” always cite as the #1 reason for miscarriage) as well as progesterone deficiency.

So it’s clear to see that supplementing women with progesterone, regardless of the reason for previous miscarriages, is probably not effective. Not all women should be treated with progesterone. Only those needing progesterone should have been studied. A follow up study would be how much progesterone would be needed? So in actuality, we need at least two more studies on progesterone supplementation needs in pregnancy to prevent miscarriage.

This study did share with us a few positive things.

  • Not all women should be treated with progesterone.
  • 60% of the women with recurrent miscarriage went on to have a full term live birth.
  • Cytogenic testing should be completed following miscarriage.
  • If not genetic abnormality is found, further testing should be completed.

It was upsetting for me to personally read, “The final point is that this study is a reminder of how easy it is to mistakenly come to believe that a therapy has benefit, as over 60% of those women who had three or more miscarriages went on to have a healthy pregnancy, and therefore we need to be cautious to practice evidence-based treatments and avoid interventions, particularly ones that can be potentially dangerous, that have only anecdotal reports of success,” Dr Williams explained.”

The personal thoughts I had on this was that my reasons for wanting progesterone supplementation were not valid. While I know I have progesterone deficiency, not all women know this and women may mistakenly believe that progesterone supplementation (outside of progesterone deficiency) is a “catch-all” to prevent miscarriage. This study proves that it’s not a “catch-all” therapy but with the headlines and some of Dr. Williams’ statements, the medical community is likely to believe that progesterone supplementation has no benefit.

We know progesterone supplementation has benefits in women who need it and that there are other therapies that can be combined to help prevent miscarriage (HCG supplementation). Women experiencing miscarriage should have the support of their healthcare provider to determine cause of miscarriage but also in preventing miscarriage. Early testing of progesterone may assist in determining miscarriage risk. Not all women will want this testing and many women are far into the first trimester when they discover their pregnancy so this may not be a viable option. Women need that supportive healthcare provider and studies like this may make access to progesterone supplementation more difficult for women, leading to unnecessary miscarriages and further heartache.

Dear Doctor: What I Wish You Knew About Progesterone Supplementation

Dear Doctor (Part 1),

I heard you say, “You haven’t had enough miscarriages yet,” to warrant the progesterone supplementation my body and baby needs. How much heartache must I endure to receive what we already know is lacking? Why must you make this issue so difficult and painful? All it takes is a push of a button to create the prescription but for some reason, you believe I need to lose more babies before I am worthy of supplementation. Why isn’t my baby worth it? We saw that baby. YOU saw that baby.

Together, we explored the ultrasound monitor, listening to the baby’s heartbeat and measuring the baby’s length. You provided me with a due date yet if you don’t provide me with the supplementation, my baby might not make it to their due date. Why are you foolishly letting me believe everything will be okay? You even said you couldn’t  make any guarantees.

Thanks for sharing that too by the way…”no guarantees.” I am already aware that I am not guaranteed to take home this baby. I have already experienced that painful loss. What I don’t want is to experience another one because my body isn’t producing enough progesterone to sustain the pregnancy.

This isn’t the first time you have denied my need for progesterone supplementation. Five years ago, you said, “there isn’t enough evidence to support the use of progesterone to prevent miscarriage.” Where are you getting that nonsense? It didn’t matter though, I jumped through hoops to get the supplementation anyway but it was too late. WAY TOO LATE and my baby died. Could your lack of support have contributed to her death. ABSOLUTELY. What does that make you? We’ll let God decide.

Progesterone Injection

So let’s talk. Have you seen this research? Progesterone supplementation has been in use for at least 75 years! SEVENTY-FIVE!! There is plenty of research on this. If you take away the corpus luteum, which produces the progesterone, the baby will die. A baby with a heartbeat! A living human person! I am guessing you haven’t seen the research because you don’t act like you care about me or the survival of this baby.

I realize you probably don’t feel the way I do about this baby. Maybe you feel it’s natural selection or maybe you are judging me for my age or how many children I already have? Maybe you have some underlying reason as to why you don’t want to help this little person inside me? Whatever your reasoning, I want you to know that this is a person to me. This is my child. I feel the same way about this little person as I do about my children who are living outside my womb.

Would you treat my children (who are outside of my womb) in this same manner? If one of my sons needed a hormone, would you deny him that treatment? You absolutely would not, so why is this child any different? This child is relying solely on my body to receive what he/she needs and unfortunately, my body has failed time and time again to provide it reliably, without the help of medical technology and intervention. I have two beautiful boys to show for it.

So, while you refuse to return my calls and refuse to provide a supplement, I am desperately seeking care from someone who will provide it. Why I have to go outside my health insurance and network to provide something so basic is beyond me? Understand there is little risk involved and know that I am accepting that risk because I know the benefits outweigh those risks.

I don’t want to suffer through another loss because you won’t prescribe. It could happen anyway but I will know I did the best I could. I was the best mother to this baby that I could be. Are you going to be responsible for killing another one of my babies? I pray not.

– Breaking the silence on First Trimester Miscarriage

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