Updated guidance on progesterone in pregnancy

NICE has today published updated important guidance on the diagnosis and initial management of ectopic pregnancy and miscarriage[1].

Based on a systematic review of research studies[2], including the PRISM trial, it includes new recommendations on the use of progesterone for women[3] who have vaginal bleeding in early pregnancy and have had one or more previous miscarriages.

The recommendations are very specific:

• It is for women who have vaginal bleeding and have previously had at least one miscarriage
• They need to have had a scan that shows that there is a pregnancy in the uterus
• The treatment is with micronised progesterone[4], 400 mg, twice a day
• If a fetal (baby’s) heartbeat is seen on scan, treatment is continued until 16 completed weeks of pregnancy.

A bit more information

The NICE guidance does not recommend progesterone treatment for

• Women who have vaginal bleeding in early pregnancy but have not had a previous miscarriage
• Women who have had one or more previous miscarriages but don’t have any vaginal bleeding during early pregnancy.

It does, however, recommend further research into

• The possible benefits of progesterone for women with unexplained recurrent miscarriage
• Research into the effectiveness of other progesterone preparations

If you have any questions or concerns about the research or about possible treatment with progesterone, please do consult your GP or Early Pregnancy Unit.

If it might help just to talk, please do get in touch.  You’ll find information about how we can help here.

Notes and references:

[1] www.nice.org.uk/guidance/ng126

[2] A Cochrane’s network meta-analysis – a review that combines data from several different studies

[3] The term ‘women’ is used in the guidance based on the evidence used in its development. These recommendations will also apply to people who do not identify as women but are pregnant.

[4] Micronised progesterone is identical in structure to naturally produced progesterone