For most women experiencing bleeding in early pregnancy, there is no real benefit to using progesterone; however, there is also no evidence that its use causes harm.
Attention expectant mothers! Progesterone is not necessarily a magic bullet for preventing miscarriage!
A recent study published in the New England Journal of Medicine indicates that using progesterone vaginal suppositories on pregnant women experiencing bleeding in early pregnancy is no more effective than a placebo!
Let's talk about "bloody show" and progesterone separately.
One in five pregnant women will experience spotting in early pregnancy.
Bleeding during pregnancy is actually a relatively common occurrence. About one-fifth of pregnant women will experience spotting of varying degrees in early pregnancy, and up to one-third of those who experience spotting will eventually miscarry.
Early pregnancy bleeding refers to a small amount of bloody discharge from the vagina within 12 weeks of pregnancy, similar to the bleeding at the beginning or end of menstruation. The bleeding may be pink, red, or brown. Miscarriage can lead to complications such as bleeding and infection, and even serious psychological harm, including anxiety, depression, and post-traumatic stress disorder. Therefore, vaginal bleeding in early pregnancy is bound to cause panic among expectant mothers.
Let's talk about what progesterone is.
If vaginal bleeding occurs during pregnancy and miscarriage is suspected, doctors may sometimes prescribe progesterone to prevent it. So what is progesterone? Progesterone, produced by the corpus luteum in the ovary, is essential for the uterine lining to prepare for embryo implantation. Also known as luteal hormone, it is a hormone indispensable for a successful pregnancy. Additional progesterone is produced when the embryo implants in the uterine lining and the early placenta develops. Subsequently, from about 12 weeks of pregnancy, the placenta becomes the primary source of progesterone. Because of the physiological importance of progesterone, doctors and patients may consider progesterone supplementation in early pregnancy to prevent miscarriage.
Regarding this study published in the New England Journal of Medicine
Researchers conducted a multicenter, randomized, double-blind, controlled trial to evaluate the effects of progesterone versus placebo in women with vaginal bleeding in early pregnancy. Women were randomly assigned to receive either vaginal suppositories containing 400 mg of progesterone or placebo twice daily, starting at the onset of bleeding within 16 weeks of pregnancy. The endpoint was the delivery of a live birth at least after 34 weeks of gestation. The findings were evaluated using various analytical methods.
A total of 4,153 women were recruited from 48 hospitals in the UK and randomly assigned to receive either progesterone (2,079 women) or a placebo (2,074 women). The results showed that the live birth rate after at least 34 weeks of gestation was 75% in the progesterone group and 72% in the placebo group (95% CI: 1.00–1.07; P = 0.08). There was no significant difference in the incidence of adverse events between the two groups. These results indicate that progesterone provides no real benefit for most women experiencing early pregnancy bleeding; however, there is also no evidence that progesterone use causes harm.
In addition, a small percentage of women do benefit from this treatment. Within a more specific subgroup, researchers found that high-risk women (those with bleeding in early pregnancy and a history of miscarriage) benefited from progesterone-guided suppository therapy, experiencing a 5% higher live birth rate compared to placebo.
What's the significance of this research?
This study examined progesterone use in greater detail than previous studies, whose findings were often questionable due to insufficient patient numbers or inadequate methodologies. Furthermore, this study provides the first systematic and comprehensive disproven initial principles of progesterone therapy: the observed drop in pregnancy hormone levels prior to miscarriage is actually a consequence, not a cause of pregnancy failure.
Therefore, when a pregnant woman experiences bleeding in early pregnancy, besides advising her to rest well, avoid exercise, and pay attention to her diet, doctors currently don't have many effective treatments. For low-risk individuals or first-time mothers, progesterone treatment is almost ineffective in preventing miscarriage, but it may be somewhat effective for those with a history of multiple miscarriages.
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