Women with a higher risk of miscarriage are to be offered a hormone drug to help prevent pregnancy loss. 

The National Institute for Health and Care Excellence (Nice) has released guidance that progesterone can be given to some women to help prevent miscarriage.

Researchers say that 7,200 miscarriages could be prevented each year.

The UK pregnancy and baby loss charity Tommy’s said the move will “help save babies’ lives and spare parents heartache”.



What is progesterone?

Progesterone is a key hormone that controls all things fertility and menstruation.

It is a steroid hormone that belongs to a class or homes called progestogens which are produced by a mass of ovary cells called corpus luteum.

Progesterone is the hormone that triggers the uterus lining to thicken and prepares the body to accept a fertilized egg while stopping muscle contractions in the uterus from rejecting it.

The corpus luteum dictates when and if a woman becomes pregnant and is what breaks down into menstruation every month when an egg is not fertilized.

If the body is producing a high level of progesterone, it won't ovulate or produce any more eggs.

Progesterone is also the hormone that prepares the breasts for milk.

Signs of an early miscarriage

Vaginal bleeding is the most common sign of miscarriage, according to the NHS.

The bleeding can carry from light spotting or brownish discharge to heavy bleeding and bright-red blood or clots which can often come and go over several days.

Light vaginal bleeding is considered common during the first three months of pregnancy which does not necessarily mean that it is a miscarriage.

The NHS recommends that if you're experiencing vaginal bleeding then you should contact your GP or maternity team as soon as possible.

Other signs of miscarriage include:

  • cramping and pain in your lower tummy
  • a discharge of fluid from your vagina
  • a discharge of tissue from your vagina
  • no longer experiencing the symptoms of pregnancy, such as feeling sick and breast tenderness

If you've had 3 or more miscarriages in a row which is known as a recurrent miscarriage, you should go to an early pregnancy unit.

For more information and guidance around miscarriages, visit the NHS website.

How is progesterone being used to prevent pregnancy loss?

Under its news guidance, Nice recommends that pregnant women should be offered 400mg of micronised progesterone twice daily if they:

  • have previously had a miscarriage,
  • have a pregnancy confirmed through a scan
  • and experiencing vaginal bleeding 

If a foetal heartbeat is confirmed, Nice recommends that this progesterone treatment should continue until 16 weeks of pregnancy.

Nice estimates that around 7,200 women with prior miscarriage and bleeding in early pregnancy could be eligible for treatment every year.

Although, Tommy’s has said the move could prevent as many as 8450 miscarriages a year.

Commenting on the update, Tommy’s chief executive Jane Brewin said: “It’s great to see Nice taking our progesterone research on board in their new miscarriage care guidelines, which will help save babies’ lives and spare parents heartache.

“Miscarriage is often dismissed as ‘one of those things’ we can’t do anything about – even by some healthcare professionals, who may not specialise in this area to know the latest evidence.

“We hear from women who were denied progesterone treatment when they should have been eligible, simply because their doctor wasn’t familiar with it, so we hope Nice’s recommendation will help end some of these inequalities in miscarriage care that add more pain to an already unbearable experience.”

Professor Arri Coomarasamy, director of Tommy’s National Centre for Miscarriage Research at the University of Birmingham, said: “The miscarriage care guidelines from Nice include a very welcome change, after many years researching the use of progesterone and working to make treatment more accessible.

“Our research has shown that progesterone is a robust and effective treatment option but we know it’s not yet reaching everyone who might benefit.

“This new recommendation from Nice is an important step in tackling the current variation in miscarriage services across the country and preventing these losses wherever possible.”

When should Progesterone not be used around pregnancy?

Nice's independent guidelines committee has said that the hormone should not be offered to women who:

  • are experiencing early pregnancy bleeding but no previous miscarriage
  • have had a miscarriage before but are not experiencing bleeding now

However, the health watchdog has called for more research in these two areas.

Nice has affirmed that there is no evidence of harm to the mother or baby when progesterone is used but at the moment, there is insufficient evidence to rule out the possibility of rare events.

Read the full research and guidance via Nice's website.