Taking progesterone in early pregnancy

What is progesterone?

Progesterone is a hormone that plays an important role in the menstrual cycle and in maintaining a pregnancy in the early stages.

It is produced in the ovaries and tells the lining of the womb to grow. If you get pregnant, the fertilized egg attaches to this thickened lining. If you do not become pregnant, the lining of the womb sheds, which is your period. 

Progesterone helps the body maintain the pregnancy in the early stages and helps to prevent miscarriage. 

This hormone occurs naturally in the body, but it is also available as a supplement used to increase your progesterone levels. 

Can progesterone treatment prevent miscarriage?

Taking progesterone in early pregnancy (within the first 16 weeks) is recommended for women and birthing people with a high risk of early miscarriage who are having any vaginal spotting or bleeding. However, it may not prevent every miscarriage. 

We have a Miscarriage Support Tool that you can use to get personalised support and find out your chance of a successful next pregnancy.

Who can progesterone help?

Research has shown that taking progesterone may prevent a miscarriage if you:

• are bleeding in early pregnancy and
• you have had 1 or more miscarriages before.

This research also showed that progesterone is not effective if you take it:

• before you get pregnant
• during pregnancy if you not having vaginal bleeding and a history of miscarriage. 

Can progesterone be prescribed for other reasons?

If you are under the care of a recurrent miscarriage clinic, your doctor may offer progesterone supplements from day 21 of your menstrual cycle. If your pregnancy test is positive during that cycle, the progesterone supplements will be continued until 12 weeks. 

How effective is progesterone treatment?

If you have had 1 or 2 miscarriages, taking progesterone in early pregnancy may increase your chances of having a successful pregnancy by roughly 5%.

If you have had 3 or more miscarriages (recurrent miscarriage), taking progesterone in early pregnancy may increase your chances of having a successful pregnancy by roughly 15%. 

Progesterone treatment is safe to use in pregnancy.

How do I get progesterone?

The National Institute for Health and Care Excellence recommends that you should be offered progesterone if:

• you are bleeding in pregnancy and
• you have had a miscarriage before and
• your pregnancy is seen in the right place in the womb (uterus) by an ultrasound scan.  

Your healthcare professional needs to confirm the pregnancy is in the right in the womb.  

Progesterone is not an effective treatment for people with an ectopic pregnancy or a pregnancy of unknown location (when there is a positive pregnancy test but the pregnancy cannot be detected (seen) either inside or outside the womb on a scan). Sadly, it is not possible to save these types of pregnancies. 

Where can I get progesterone treatment?

If you are bleeding in early pregnancy, contact your GP surgery or local GP walk-in service. You can also contact your nearest Early Pregnancy Unit if they offer a self-referral or walk in service. Tell them you have miscarried before.

You can also contact NHS 111 at any time of day and they will refer to the most appropriate service.

If you are seen by your GP, they may refer you to an Early Pregnancy Unit if needed. The EPU should be able to prescribe progesterone for you. 

We have developed a simple and clear guide that you can bring with you that clearly explains the benefits of the treatment.

If you are bleeding heavily 

Go to your local accident and emergency department if you are bleeding heavily or in a lot of pain.

If you are bleeding and are more than 12 weeks pregnant

Some people may experience bleeding later on in their pregnancy. This does not necessarily mean there is a serious problem, but you should always contact the hospital maternity unit immediately so you can be checked, just in case.

What happens at the hospital or Early Pregnancy Unit

Your healthcare professional will talk to you about your symptoms and explain what will happen next. They will also carry out tests, including an ultrasound scan. This is to check that the pregnancy is in the womb and if there is a heartbeat.

To avoid delay in starting progesterone treatment, an ultrasound scan should be arranged as soon as possible. The NICE guidelines say that progesterone could be started before a heartbeat is detected (if a scan has confirmed the pregnancy in the womb).  

If you are asked to wait for an ultrasound scan to confirm the pregnancy in the womb, ask your healthcare professional to prescribe enough progesterone for you to take until then. Some may insist you have the scan first, but it is worth asking. 

Sometimes you may need more than one scan if the result is inconclusive (unclear). For example, if there are signs of a pregnancy in the womb (uterus) but it’s not measuring as expected according to your menstrual cycle, or if the heartbeat can’t be seen clearly. 

If this happens, you will be offered another scan in 2 weeks time. The EPU should prescribe progesterone until just after this scan is booked. 

At that point, they will either give you another prescription until you are 16 weeks pregnant or they will write to your GP and ask them to prescribe it. To avoid missing any doses, ask your EPU for a copy of the letter before you leave and take it to you GP surgery, just in case.

If you are bleeding and are more than 12 weeks pregnant.

Some people may experience bleeding later on in their pregnancy. This does not necessarily mean there is a serious problem, but you should always contact the hospital maternity unit immediately so you can be checked, just in case.

How do I take progesterone and when do I start taking it?

You will likely be given progesterone taken as vaginal pessaries (400mg twice daily) from the time you have vaginal bleeding up to 16 weeks of pregnancy. After around 12 weeks of pregnancy, the placenta becomes the main source of progesterone (not your uterus) and your hormone levels will continue to rise throughout your pregnancy. This is why you will not need to take any more progesterone supplements. 

What if I am not offered progesterone?

Tell your healthcare professional at the Early Pregnancy Unit about this information and ask why you are not being offered progesterone.  

You could tell them that National Institute for Health and Care Excellence (NICE guidelines) recommends that people with your pregnancy history should be given progesterone.

If you are still being refused treatment, you can:

• ask to speak to another healthcare professional (your GP or another clinician at the unit)
• ask to be referred by your GP to another EPU close to you