For those of you who missed it, towards the end of last year, NICE (National Institute for Health and Care Excellence) finally issued updated guidance on the use of progesterone in pregnancy that could lead to 8,450 more successful births a year.
Based on a systematic review of research studies including the PRISM trial, it includes new recommendations on the use of progesterone for women who experience vaginal bleeding in early pregnancy and have had one or more previous miscarriages. The specific recommendations are that:
- The guidance is for women who have vaginal bleeding and have previously had at least one miscarriage
- A scan needs to have shown that there is a pregnancy in the uterus
- The treatment is with micronised progesterone, 400 mg, twice a day
- If a fetal heartbeat is seen on a scan, treatment is continued until 16 completed weeks of pregnancy.
Disappointingly, the guidance doesn’t recommend progesterone treatment for women who have vaginal bleeding in early pregnancy but have not had a previous miscarriage, or women who have had one or more previous miscarriages but don’t have any vaginal bleeding during early pregnancy.
But there is reason to be optimistic that NICE does recommend further research into the possible benefits of progesterone for women with unexplained recurrent miscarriage, and research into the effectiveness of other progesterone preparations.
I took micronised progesterone in this way with both my successful pregnancies but key to this was that I also took it during the second half of my cycle before I became pregnant as I had proven low levels of progesterone anyway. And it was still difficult to get it prescribed.
It’s clear that much more research needs to be done in general on the effects of hormonal issues on a whole host of conditions, not least for those experiencing recurrent miscarriage. In the future, I hope we can move away from the mind-numbing slowness of NICE in keeping pace with new research and start truly listening to and supporting patients more effectively.
You can read the update NICE guidance here.
Image from Pixabay