Progesterone supplementation in the first trimester

[HP07]

Hi,

Today I had my 2nd ultrasound scan as I have had brown spotting throughout my pregnancy so far. I had one scan at 6w 5d and today I am 10w 5d. After the scan I was asked if I would like to enrol on a trial for women who have experienced spotting in the first trimester. It would involve taking vaginal pessaries of progesterone twice daily until 16 weeks, as there is some thought that suggests that a falling progesterone level in early pregnancy can lead to spotting and miscarriage.

I suppose my questions are, would you enrol on the trial? It's a double blind study so I would not know if I was getting the progesterone or a placebo. I believe that it is very safe but does anyone know any reasons why it wouldn't be advised? Also I have had spotting every cycle since I came off the pill 2 years ago when we started ttc, so perhaps spotting is normal for me, even during pregnancy.

I have been shown to have borderline progesterone levels at day 21 of cycle on several occasions so it's possible I do have a lower level than other woman which may or may not have contributed to my infertility.

The baby looks healthy and is measuring exactly right for me dates, is moving around and has a strong heartbeat. The sonographer said she can't see any clots or reasons for bleeding so maybe this spotting is due to cervical irritation. Should I just leave well alone as I am almost at the end of my first trimester now? Or should I enrol and possibly improve the spotting and maybe help other women in the future?

Thanks for any input you may have.

[novemberchild]

I was asked this as well. I declined, mainly because it wouldn't be certain whether or not I would be getting any actual hormone or just a placebo so I didn't see the point.

I also don't like the idea of being 'tested on', tbh.

[HP07]

Can I ask what gestation you were when you were offered? We're you also experiencing spotting? Is everything going ok for you?

[Donnadoon]

Im on that very trial..I am 10.5 too I have been on them for exactly two weeks at 8.5. I have had no problems at all, I just lie down for half hour if I can after inserting pessary, this avoids too much mess in pants after. (sorry tmi)
Anyway I obviously have no idea if Im on the dummy or the real thing think Ive tricked myself into thinking its the real thing because I have had no more spotting since Ive been on them.
Ive got to stay on them until 16 weeks.

[Jemimapuddleduk]

I had progesterone suppositories in my pregnancies. My understanding is that for it to be effective it should be taken from first positive pregnancy test (or if having assisted conception from iui or ivf date). I think I took it until 14 weeks. I found less discomfort if taken anally rather than vaginally. No side effects just slightly greasy and messy.

[novemberchild]

I was six weeks, and this was literally last week.

I had brown spotting, then actual blood one day. It cleared up, but they scanned me because I had a miscarriage in December (no spotting with that, though).

All seems well, so far, so good. Fingers crossed, and all that.

I think I would take them if I knew it was not a placebo.

[ffauxlivia]

I was given the suppositories as soon as I found out I was pregnant this time due to previous losses. They are also given as standard to people who have conceived on IVF I think? So considered perfectly safe. My doctor wasn't even convinced I needed them as my progesterone test at 4 weeks was good, but he said he didn't want to regret not trying. (i'm pregnant in the US this time)

They told me to stop taking them at about 10 weeks as the placenta starts taking over production of progesterone about then. I think I took them until 12 weeks as I was paranoid! Like jemima said I was told they are most effective in the first couple of weeks, so I don't really know what use they would be to you now, especially as you have such a positive strong heartbeat at 10.5 weeks. However I have read a lot of conflicting information about when to stop and when the placenta actually takes over, so if this study is contributing to that then maybe it's a helpful thing to be a part of?

But one thing to consider is that they are also a pain - messy (I would leak oil everywhere and have to wear pantyliners everyday) and I worried a lot about infection after putting my hands inside myself a couple of times a day!!

[Lesbecky]

I take these until 12 weeks as part of my Ivf treatment. I'm not sure how I'd feel about not knowing if I had a placebo or not. It would be weird.

[Seekingmiracles]

I would take them. Having suffered recurrent miscarriages myself these trials are REALLY important in improving the care of women who do suffer from miscarriages.
I'm currently 6 weeks and am on a whole host of drugs to try to keep hold of this pregnancy. Progesterone supplements included. The only real side effect is I swing from being constipated to having the runs.
What ever you decide - good luck

[Seekingmiracles]

I'd also like to add that without doing a double blind trial - so with placebos these kinds of drugs will never become routinely available to those who need them.
If it's between not doing the trial and and taking it and potentially having the placebo. Do the trial. If you end up with the placebo you're getting exactly what you would get if you didn't take part - No progesterone. If you get the actual drug the great.

[HP07]

I guess my other thought is that it might benefit someone who is earlier on in their pregnancy more and I am taking a valuable slot in the trial when I am nearly at the end of my first trimester/my placenta is starting to take over.

[riddles26]

I had early bleeding late last year and was offered to take part in the trial and I did enrol. Unfortunately, I went on to miscarry anyway but I am confident the trial played no part in that at all (I was too small for my dates at the point which they scanned so it didn't look good from the outset). As a medical professional, I researched multiple papers before agreeing to take part to confirm there would be no additional risk to the baby if I were to take part and I was satisfied with what I found.

Although I did question if it was too late to start any sort of progesterone, the lack of harm made me take part. As seekingmiracles has rightly said, without these trials showing positive results, treatment options for threatened miscarriages will never improve. If you are allocated a placebo, you are going to be no worse off than if you had turned it down but you will contribute to valuable research.

As a medical professional, I can confirm that there are no such thing as 'slots' in a trial - they will recruit as many as they possibly can within their timeframe without a cap on numbers. If there is an outstanding result of progesterone having a positive effect in preventing miscarriage, they will end the trial early and start offering it as a standard treatment.

[HP07]

Thank you guys for all of your input. I will discuss with my husband when he gets home from work and make a decision tonight. Then I can call the hospital in the morning.

[HP07]

Hi, just wanted to let you know that I decided to go ahead and take part in the trial. Thank you for the advice.

[Seekingmiracles]

That's a wonderful decision and personally id like to say thank you. With more people taking part in trials hopefully care will improve. Wishing you lots of luck with the rest of your pregnancy

[Blackpoollassy]

I'm on this trial too. Personally i think i've got the placebo as i've had cyclogest before. But i figured if i wasn't on the trial i wouldn't have had ANY chance of getting progesterone at all.
No side effects at all, apart from the waxy discharge and i've only forgotten once!
Hope it goes well for you

[Tollygunge]

Hi all, I'm under the care of A top teaching hospital for pre term birth/ repeated miscarriage. I will be taking the real deal until 16 weeks. I started off as soon as got positive test with private prescription for them- cost £60- but now I get them from GP. I honestly believe they've saved this pregnancy. I taken them rectally before bed. No problems at all.

[HP07]

Hi Tolly. I'm almost 100% convinced I have got the progesterone not the placebo. Ive not even had a hint of spotting since I started taking them on Tuesday and prior to this I had regular spotting. If Im lucky enough to ever carry again I will be asking for a private prescription as soon as I notice any spotting. This would have saved me a lot of stress and fear in the early week. Good luck with everything.

[Tollygunge]

It is worth noting that apparently according to the miscarriage association there is no link between progesterone and continuing pregnancy so according to that placebo or not wont matter! Good luck to you too x

[flumpybear]

I was on hCG injections til the end of the first trimester with two pregnancies - one ended in miscarriage and the next was my beautiful baby boy. I asked for progesterone and my consultant said the hCG supports all hormones in pregnancy til the placenta takes over ... Personally I would do the study, plus never underestimate the placebo effect!

[HP07]

Is that a hint of sarcasm there Tolly? ;) I think that is what this study is actually aiming to prove/disprove though as they don't have enough evidence yet. I agree that placebos can trick people into feeling better when they are unwell but I can't see for the life of me how a placebo could stop you from bleeding, that surely cannot be controlled by your mind?! Otherwise we would all stop ourselves from having pesky periods! ;) Well we shall see, only time can tell. Am super interested to see the results of the trial when they are released.

[Tollygunge]

Ah, if I were being sarcastic I wouldn't be taking it myself! I suppose I'm trying to make you feel better by saying it might not make any difference. Personally I feel as though even if there's no evidence I will take anything but if you're not don't worry as might not work anyways!

[flumpybear]

My
Comment on placebo was regarding miscarriage - there had been some research that TLC scans may help reduce miscarriage but not sure how far that got ... It's mysterious what biochemistry of the human body can do and how easily it can change

[HP07]

Oh I see, I understand both comments now :) I'm feeling quite positive at the moment as no spotting, scan at 10w 5d was good and I am now 11w 4d. Just keeping going as that's all you can do. Thanks to everyone for your input.

[Duckdeamon]

After recurrent mc in first trimester some years ago I had progesterone in the first trimester, right from a few days post ovulation each month. Had to PoAS every month and stop the treatment if BFN. The specialist advised that it MIGHT help prevent mc due to ovary/hormone issues, but could (sadly) also prolongue a non-viable pregnancy due to other issues (eg gene anomoly or uterine scarring). I did have one mc on the treatment, and then DD2!

I would not have agreed to be on a trial as was already very anxious and wanted actual treatment (or not, if the specialist had advised that was best).

Hope things work out well for you!