Where does progesterone fit in early pregnancy support?

Progesterone can reduce miscarriage risk in early pregnancy for women with a history of recurrent losses or early bleeding, based on individualized monitoring and dosing within restorative care.

Progesterone plays a crucial role in maintaining early pregnancy by supporting the uterine lining and creating optimal conditions for implantation and early fetal development. However, not all women need progesterone supplementation, and the approach must be individualized based on specific risk factors and clinical presentation.

Evidence for Progesterone in Threatened Miscarriage

The landmark PRISM trial provides the strongest evidence for when progesterone helps prevent miscarriage. This large randomized controlled trial found that progesterone significantly reduces miscarriage risk in two specific groups: women with a history of one or more prior losses and women experiencing early pregnancy bleeding. For women with both risk factors, the benefit was even more pronounced.

• PRISM trial (Coomarasamy et al., 2019): Progesterone reduced miscarriage risk by 3-5% in women with prior losses and early bleeding
• Women with 1+ previous losses showed significant benefit from progesterone supplementation
• Early pregnancy bleeding combined with loss history showed the greatest protective effect
• No benefit demonstrated in women without these specific risk factors

RRM Approach to Progesterone Support

Within Restorative Reproductive Medicine, progesterone support is part of comprehensive early pregnancy monitoring rather than routine supplementation. We focus on identifying couples who would specifically benefit from luteal support based on their individual risk profile, cycle patterns, and previous pregnancy outcomes.

The RRM approach emphasizes precise timing and dosing based on natural cycle cooperation. Rather than standard protocols, we monitor individual progesterone levels and adjust support accordingly. This allows us to provide targeted intervention for couples who need it while avoiding unnecessary medication for those who don't.

Progesterone supplementation in early pregnancy should be based on specific risk factors like prior losses and early bleeding, not given routinely to all women.

This information is educational and not a substitute for individualized medical care. Consult your RRM clinician or healthcare provider for guidance specific to your situation.