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:
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.”
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.
The 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.