- Micronized vaginal progesterone shows potential benefit in women with a history of miscarriage experiencing vaginal bleeding in the first trimester.
Why this matters
- Withdrawal of progesterone, naturally (corpus luteum defect) or via antiprogesterone drugs (mifepristone), induces abortion.
- Small but positive treatment effect in women with bleeding and history of prior miscarriage; dependent upon the number of miscarriages.
- No benefit for women with bleeding but no history of miscarriage.
- No evidence of increased risk for congenital anomalies or increased harm.
- These authors recommend that women with a history of miscarriage and vaginal bleeding should be offered micronized vaginal progesterone (400 mg BID) from presentation until 16 weeks.
- Review and expert commentary.
- Evaluation of results from the PROMISE (PROgesterone in recurrent MIScarriagE) and PRISM (PRogesterone In Spontaneous Miscarriage) trials.
- The PROMISE trial examined the use of micronized vaginal progesterone in women with unexplained recurrent miscarriage.
- The PRISM trial examined the use of micronized vaginal progesterone in women with threatened miscarriage.
- Funding: PROMISE and PRISM were funded by the National Institute for Health Research and Tommy’s charity support of the UK Miscarriage Research Network.
- Validation of results needed.