Progesterone treatment in pregnancy

BY PENDA HONEYGHAN

Monday, November 12, 2018

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PROGESTERONE, or the pregnancy hormone as is it is commonly called, is a hormone that is naturally produced by the ovaries following conception. The hormone, according to Obstetrician-Gynaecologist at ICON Medical Centre, Dr Keisha Buchanan, has a function to thicken the lining of the uterus in order to create the ideal supportive environment necessary to help it prepare for the embryo and to help maintain the pregnancy.

“During the female menstrual cycle and after the release of the egg, a corpus luteum is formed in the ovary. If the egg is fertilised by the sperm and the embryo formed implants in the wall of the womb, the corpus luteum produces progesterone that helps to keep the embryo attached to the lining of the womb,” Dr Buchanan explained.

“Progesterone is important to help the lining thicken and prepare the lining of the womb for implantation of the embryo. If the lining of the womb is too thin at implantation, there is a higher chance of miscarriage,” she explained.

She pointed out that outside of the possibility of a threatened miscarriage, there are other instances when a medical practitioner may recommend progesterone supplementation — referred to as Progestin, which is artificially produced — as part of a woman's course of treatment. These include helping a woman become pregnant, during fertility treatment, and to prevent premature labour.

“Progesterone supplementation is used in in vitro fertilisation — it is commenced before the pregnancy at the time of egg retrieval and if pregnancy is confirmed it is continued for 38 days or longer. This helps to ensure that the pregnancy remains attached to the uterine lining and prevents miscarriage,” Dr Buchanan said.

Another instance where this option is explored is where women have low progesterone levels. This, Dr Buchanan said, is sometimes the case in patients with Polycystic Ovarian Syndrome, women who are underweight, those who have irregular cycles, excessive weight loss, do excessive exercise, have extreme stress, brain injuries that damage the pituitary gland or hypothalamus in the brain, or elevated prolactin levels.

“Other women who have diminished ovarian function include those who had chemotherapy or radiotherapy to the ovaries such as from cancer treatment, or from damage to the blood supply to the ovaries at surgery. These women may require progesterone supplementation while trying to get pregnant and progesterone supplementation during pregnancy to prevent miscarriage,” Dr Buchanan advised.

She said that a medical practitioner may not prescribe progesterone supplementation immediately if he or she recognises that the body can produce sufficient levels naturally if certain lifestyle choices are altered, for example, if a woman destresses, or cuts back on the intensity of her exercise regimen.

Dr Buchanan said progesterone supplementation may also be very beneficial in pregnancy if a woman shows signs of pre-term labour because of its ability to prevent premature contractions, which would have otherwise progressed labour.

“Premature labour can be triggered by many factors — most episodes of premature labour are difficult to predict and many times the causes are unknown. Progesterone supplementation can be used to prevent premature contractions and prevent premature birth when continued until 36 weeks. When this happens, it is important to screen the patients for infections such as chlamydia, gonorrhoea and bladder infections that can be treated to prevent premature labour,” Dr Buchanan shared.

She pointed out that women who have had premature delivery in the past are often prescribed progesterone inserts until 36 weeks of pregnancy to prevent premature birth. The woman should be screened for causes of premature labour and if any underlying factor is found it should be treated where possible.

“Some patients may have cervical insufficiency, for example, which puts them at risk of premature cervical dilatation that can lead to miscarriage or premature delivery. Progesterone can be continued as late as 36 weeks to prevent miscarriage or premature birth. In addition, it also helps to keep the womb quiet and prevents premature contractions of the womb,” Dr Buchanan advised.

Progesterone supplements are available in several forms, including the pill, vaginal suppository, injection, gels and creams. However, it is most commonly prescribed as pills or vaginal suppositories in pregnancy.

“Progesterone supplementation may be tablets that are inserted in the vagina or rectum and usually the dose is 100mg but can be used as high as 400mg per day. It is usually used until the end of the first trimester, that is 12 weeks of the pregnancy, but may be continued until 36 weeks depending on the patient's need,” Dr Buchanan instructed.

Dr Buchanan warned that like all medications, there are possible side effects of using progesterone supplementation. However, she said that its use is generally safe in pregnancy, debunking a common myth that it increases the possibility of birth defects.

“Usually the side effects are rare or mild, such as vaginal discharge, vaginal itching, nausea, vomiting, tiredness or weakness, or breast tenderness. All of these symptoms (except vaginal itching) are also regular complaints in pregnancy so it may be hard to say if it is the medication or the pregnancy that is causing these complaints and one may not know until the progesterone course is completed,” Dr Buchanan explained.

She outlined that sometimes there are rare but serious side effects, including stroke, blood clots in the legs or lungs. Dr Buchanan warned that not only should you stop taking the supplements straight away, but medical attention should be sought immediately if any of these symptoms occur.

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