Understanding and Managing High Risk Pregnancy with Bioidentical Progesterone Suppositories

Author: Sheena H
Reviewed by Michael Hua, Pharm D

The joy of finding out you are pregnant can be exhilarating, but when you find out your pregnancy is at risk or you may be prone to preterm delivery, your days of gestation can be filled with worry. According to the latest available data from the Centers for Disease Control and Prevention, preterm birth is now so common that 1 in 10 babies are born before 27 weeks of pregnancy. Even more alarming, roughly 10 to 15 percent of pregnancies result in miscarriage.

Many preterm deliveries and miscarriages occur due to risks associated with the pregnancy or the health of the mother. Therefore, the key to reducing the number of preterm deliveries and miscarriages is looking at how high-risk pregnancies could be better understood and managed. Bioidentical progesterone suppositories may just be one effective tool doctors can use to lower the risks and better sustain the pregnancy full term.

Understanding and Managing High Risk Pregnancy with Bioidentical Progesterone Suppositories

Progesterone suppositories are vaginally inserted medications that contain the bioidentical hormone progesterone. Progesterone is necessary during pregnancy because it:

  • Supports the growth of the womb

  • Prevents the uterus from contracting

  • Prepares the breasts for milk production

  • Helps the lungs gather and use more oxygen to support the growth of the baby

Even though progesterone is available in different forms, some research has shown that vaginal suppositories seem to be more effective for the prevention of preterm labor (labor before 37 weeks).

What happens with progesterone production during pregnancy?

Even though the female body always produces progesterone, during pregnancy, the levels produced by the body should increase substantially. While progesterone levels may be anywhere from 0.1 to 25 ng/nL normally, pregnancy levels should be as much as 44ng/nL depending on the trimester.

How do you know progesterone is low during pregnancy?

Low progesterone levels during pregnancy are thought to be one of the biggest driving forces behind problems with miscarriage or preterm labor. Low progesterone during pregnancy may lead to a host of symptoms, such as:

  • Spotting

  • Extreme fatigue

  • Vaginal dryness

  • Low blood sugar

  • Abdominal pain

If you suspect that your levels are low, a doctor can test your progesterone levels with a basic blood test to determine if you may need bioidentical hormone support to sustain the pregnancy.

A few risk factors for high risk pregnancy include:

  • Being pregnant over the age of 35

  • Smoking, drinking alcohol, or using drugs

  • History of preterm labor or miscarriage

  • Maternal health issues, such as diabetes, high blood pressure, or infection

  • Carrying multiples (twins, triplets, etc.)

  • Short cervix diagnosis

A high-risk pregnancy is essentially any pregnancy that has a heightened risk of health problems for either the baby or the mother during gestation, during labor, or even after delivery. Low progesterone levels are also sometimes identified as a factor when considering whether or not a pregnancy is considered high risk. In many cases, a high-risk pregnancy can also mean a heightened risk of miscarriage or preterm delivery.

Short Cervix: Another Major Risk Factor

A short cervix is also a major risk factor during pregnancy. If a woman has a cervix that is less than 25 to 30mm in length, this can be considered a short cervix. The cervix is highly important to support the pregnancy to full term, but women who have this condition may be as much as six times more likely to experience either a miscarriage or preterm labor. The cervix may thin and dilate early and cause early labor. One study actually found that very short cervixes (15mm or less) may account for as much as 86 percent of preterm labor events before 28 weeks.

When to start progesterone suppositories to prevent preterm labor will depend on a few factors, such as the extent of your risks of preterm labor or when you start to experience symptoms of preterm labor. The usual plan is to start with vaginal progesterone starting at 16 to 24 weeks and continue treatment until about 34 weeks of pregnancy.

What's the average dose of progesterone to prevent miscarriage?

The dosage of vaginal suppositories is usually anywhere between 100 and 200mg. If prescribed a vaginal gel with an applicator instead of suppositories, the typical dose is 90mg of progesterone. In either case, the dose is inserted once a day, usually at bedtime. Even though this dose may not be effective for every pregnancy, the pre-term birth rate dropped considerably with 100mg of progesterone compared to a placebo in a controlled study.

Who is a good candidate for treatment?

The best candidates for progesterone replacement during pregnancy tend to be those who have a short cervix and are carrying only one baby. The doctor will also likely look at your natural progesterone levels before prescribing the hormone to help. Unfortunately, you may not be a good candidate for treatment if:

  • You are carrying multiples

  • You have experienced membrane rupture early

  • Have experienced a positive test result with a fetal fibronectin analysis

  • You have already experienced preterm labor, but labor was successfully stopped

When it comes to short cervix progesterone suppositories seem to be one of the more effective treatment options available. However, doctors may choose to offer progesterone therapy for other reasons just the same, such as if you are at risk of early miscarriage due to already low progesterone levels.

Could you use progesterone for recurrent miscarriage protocol?

Recurrent miscarriages may be more common than researchers know. However, some studies suggest that 1 in 100 women will experience a recurrent miscarriage at some point in their life. This essentially means you have two or more miscarriages in a row. Even though 65 percent of women will experience a successful pregnancy after having a miscarriage, these pregnancies are considered high risk because there is a greater likelihood of having a miscarriage if you have already experienced the issue in the past.

If you have had a prior miscarriage, your doctor may follow a specific protocol because of your history from the time you start getting treatment. For some women, vaginal progesterone may be a part of that protocol, but it does depend on the situation.

Looked at individually, the studies on progesterone for preterm labor have shown some efficacy. However, when looked at collectively, the studies of more than 40 randomized trials observing over 11,000 women found that vaginal progesterone therapy for the prevention of preterm delivery is the only "consistently effective" option. While more research may need to be carried out to get more definitive numbers, the research is so promising that progesterone suppositories are already being recommended by many doctors to prevent preterm labor.

How Progesterone Helps with Short Cervix

In studies of women with a short cervix and at risk of preterm labor, patients that were treated with intravaginal progesterone gel were found to have significantly fewer issues with a shortened cervix. Remember, progesterone helps to prepare the womb during early pregnancy, which includes the growth of the uterus and cervix to support the growth of the fetus. Therefore, it is easy to speculate that supplementing the critical hormone that could be lacking may support the growth of the cervix to better protect the pregnancy.

Progesterone Suppositories Side Effects

One of the best things about pretty much any form of bioidentical hormone replacement is the low potential of adverse or undesirable side effects. Some of the most common side effects include:

  • Skin irritation

  • Changes in mood

  • Appetite increase

  • Low back pain

  • Bloating

  • Nausea

Because the medication is considered bioidentical to the hormones the body already produces, the risks for the fetus are also very low, especially in comparison to the risks that would be involved with preterm labor.

If you believe you are at risk of preterm labor or could have low progesterone levels, be sure to speak openly with your doctor early in your pregnancy. Early intervention may be the key to making sure your body is prepared to carry your baby to full term. If you would like to know more about progesterone and pre-term delivery prevention, reach out to us at Harbor Compounding Pharmacy to get information.

Progesterone Suppositories at a Compounding Pharmacy

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