Could Progesterone Help Reduce The Risk of A Miscarriage?

Whether you have experienced a miscarriage or are currently experiencing first trimester bleeding, the idea of losing your baby can be extremely traumatic.Now, like most women, we would like to be able to tell our patients exactly why they are experiencing first trimester bleeding or have experienced a miscarriage but, the reality is, there is still so much we need to learn about the cause and prevention of miscarriages. That being said, we are learning that progesterone, a naturally occurring hormone, appears to play a particular beneficial role in reducing the risk of miscarriages and may be something to discuss with your doctor. So, what are the benefits of supplemental progesterone? Who should be considered for progesterone treatment and are there any early signs we should be evaluating for to proactively use progesterone to help reduce the risk of a miscarriage?

Let’s dive in.

Progesterone is a naturally produced hormone that helps with the development of a fetus. It also appears to play a role not only in implantation of a fertilized egg but also, keeping a pregnancy viable. Although our body naturally produces progesterone, researchers have seen that progesterone may play other critical roles in pregnancy including supporting immune function. That being said, the use of supplemental progesterone is best used after a proper evaluation by your doctor. Remember, the most important way to help reduce the risk of a miscarriage is to evaluate for possible causes. Getting to the root cause is the most important and is the reason why progesterone supplementation doesn’t reduce the risk of miscarriage in all pregnancy and should not be used as a “cure-all” for all patients. Women should all be properly monitored and evaluated by their doctor first.

Now, what if your previous miscarriage was unexplained? Doctors weren’t sure why you miscarried, could progesterone therapy be helpful? According to researchers, it could. In fact, progesterone therapy appears to be most valuable in reducing the risk of miscarriages in women with unexplained miscarriages. Researchers believe this may be due to the underlying benefits progesterone has on a new pregnancy.

Some of the important benefits progesterone has on your fertility and pregnancy journey include: 

  • Induces endometrial changes in the uterus in preparation for a fertilized egg to properly implant. 
  • Regulates the balance of immune cells including the balance of cytokines and can even influence the activity of natural killer cells. 
  • Suppress uterine contractions in the uterus by enhancing nitric oxide production. 

Based on the latest research, we are learning that progesterone doesn’t just help the lining of the uterus but, may have a significant role in immune modulation that is key in promoting fetal development. (Deng 2020). This is extremely valuable, especially in women with unexplained miscarriage, because although we would like to better understand our immune system at the level of the uterus, there are currently no blood tests available to provide us an adequate understanding of our immune system’s response at the level of the uterus. In other words, immune dysfunction is likely a major cause of miscarriages in women who have been previously diagnosed as experiencing “unexplained miscarriages”.

According to both the PRISM and PROMISE trials, researchers found progesterone therapy to be most helpful for women with a history of recurrent miscarriages and/or those experiencing early pregnancy bleeding.

The Importance of Early Progesterone Blood Test in Pregnancy 

Once you have taken that amazing at-home pregnancy test and see those two pink lines, chances are, your next step will be to schedule an appointment with your OBGYN for your first prenatal and ultrasound appointment. This can be on extremely exciting and nerve racking time, whether you have experienced a previous miscarriage or not. At NMD Wellness of Scottsdale, we make sure that patients are evaluated for their Hcg as well as progesterone levels within the first few weeks of their pregnancy. This can happen even prior to their first appointment with their OBGYN. The reason we believe so strongly in the importance of early testing is based on the latest research that found that even slight fluctuations in progesterone in early pregnancy may be a red flag that a woman is at a  significantly higher risk of experiencing a miscarriage. In fact, according to researchers (Kim 2017), women who had underwent IVF with a progesterone of less than 7 ng/mol during the first few weeks of pregnancy were at a significantly higher risk of experiencing a miscarriage. Other researchers, (including Lek 2017), also found similar findings in women who didn’t undergo assisted fertility treatments like IVF. In fact, Lek found that women with a progesterone <11ng/mol in their first few weeks of pregnancy were at a predicatively higher risk of miscarriage than women with progesterone levels higher than 11ng/mol. Researchers also found that women who had a serum progesterone level >15ng/ml appeared to have a reduction in their risk of experiencing a miscarriage. Pretty fascinating right?

Can I just order progesterone online? 

The short answer is no.  Although some supplement companies will claim their products support or contain progesterone, most supplements companies have limited safety and quality standard evaluations to support their claims. Also, it is important to note that all of the research previously mentioned in this article was done with prescribed physician grade progesterone. So again, don’t go buying your progesterone online. Please take a moment to consult with your doctor and allow him/her to prescribe progesterone in the form and dosage that will be most suitable for you.

How long do I need to take progesterone in my pregnancy to reduce my risk of a miscarriage? 

Most studies were performed by providing women progesterone anywhere between the 2 to 28th week of pregnancy. Most will supplement progesterone for at least the first trimester allowing the placenta plenty of time to develop and take over progesterone production. Again, this will depend on your particular case and what your doctor believes will be most beneficial for you.

I had a miscarriage in the past, should I start progesterone prior to my next pregnancy? 

According to the latest research, supplementing progesterone prior to a positive pregnancy test does not appear to have a significantly beneficial impact on reducing the risk of miscarriages in pregnancy. This is where having good communication with your doctor during preconception and early in your pregnancy is important. It is also the reason, we at NMD Wellness of Scottsdale, see our patients within 1-2 weeks after their positive at-home pregnancy test. 


About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...