The hormone progesterone (named for its ability to “promote gestation”) is essential for a healthy pregnancy. Indeed, research over the last several years suggests that low levels of this hormone may be the most common reason for preterm labor. This has been an important finding, allowing doctors to prescribe progesterone to women at risk of a premature delivery (they’ve already had a preterm birth). This week, the New England Journal of Medicine published two articles that can help physicians more accurately target women that can be helped by progesterone.
One study found that when women with a shorter than normal cervix—the funnel shaped transition between the womb and vagina—were given progesterone starting late in the second trimester, it reduced the risk of a preterm delivery by about 50 percent. The other study found, however, that women carrying twins did not appreciably reduce their risk with this same strategy. That’s not surprising since there is probably a different triggering event in these two scenarios. Women with a shortened cervix may have a uterine muscle that isn’t able to stretch rapidly enough to accommodate the growing baby. Progesterone helps relax the muscle fibers so that they can stretch more easily. In a twin pregnancy however, it is more likely that the placenta is unable to meet the nutritional needs as the babies enter the accelerated growth phase of their third trimester. If you’re pregnant with twins, your best strategy is to promote uterine blood flow through good nutrition and regular exercise as well as good prenatal care to monitor the growth of your babies. For many others, progesterone remains an excellent strategy to reduce the incidence of preterm births.
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2 comments:
My doctor does not believe in progesterone. I have had 2 mc at 6 and 7 weeks. I don't want to have another one. I have read so many articles about this and my doctor said he would be willing to give me a shot a week. I know if I am going to try Progesterone, it should be more than 1x per week. What should I ask my doctor to do? Any advice? I need to feel like I am doing something next time I get prg.
This is a true dilemma. As a provider that also gives many continuing education lectures to other doctors; I also encounter similar comments. Debate is important in any science but medicine is bit different. I remind detractors that medicine is not about "belief" but about evidence. I have thoroughly researched medical references in peer-reviewed journals to determine the safety and accuracy of my recommendations. Toward that end, I suggest you set up an appointment with your doctor to discuss this further. Gather evidence like those attached to this post or provided in PERFECT HORMONE BALANCE FOR PREGNANCY. I can tell you with confidence that when it comes to progesterone—the evidence is solid. If that does not resolve your conflict, request a referral to a board certified reproductive endocrinology and infertility specialist.
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