Progesterone & Pregnancy
Progesterone is a crucial hormone for women's health, particularly during pregnancy. Often referred to as the "pregnancy hormone" and literally means pro-gestation, progesterone plays a vital role in fertility and maintaining a pregnancy to a full term, live birth. In this article, we explore the importance of progesterone in early pregnancy and its potential impact on threatened miscarriage, recurrent miscarriage, and preterm birth.
Progesterone plays a critical role in the process of reproduction. After conception, it assists in modulating the maternal immune response, suppressing the inflammatory response, and decreasing the maternal defence strategies. This allows a developing embryo not to be seen as a "foreign body" by the immune system. Progesterone also decreases uterine contractility and counteracts prostaglandin production and oxytocin to inhibit the uterus from expelling the foetus. It improves utero-placental circulation, allowing better blood supply from the mother to the foetus, and supports the developing foetus until the placenta develops.
Threatened miscarriage is the most common gynaecological emergency, occurring in 15-20% of pregnancies, with 15% of women progressing to complete spontaneous miscarriage. Low progesterone levels are predictive of spontaneous and recurrent miscarriages. Despite this correlation, there is still no standard practice or routine testing of progesterone in early pregnancy in obstetrics or gynaecology practice.
However, studies have shown that women with recurrent pregnancy loss who are prescribed vaginal, micronised progesterone after ovulation have improved pregnancy success. This benefit was not found if the progesterone was started in weeks 5 or 6 of the pregnancy, as implantation had already occurred. Progesterone is not only essential for maintaining a healthy pregnancy but also for the luteal phase of a normal menstrual cycle. Progesterone is referred to as "nature's valium" because of the calming, sedative effect it should exert following ovulation. It is made by the corpus luteum of the ovary only after ovulation has occurred. If a woman is not ovulating, she will not make adequate progesterone!
Low progesterone levels are extremely common, if not one of the most common hormone imbalances seen in practice. This is due to the high-stress environments women are now exposed to, as progesterone is used as a building block for cortisol and other stress hormones. For any patients wanting to conceive, especially those with a history of miscarriage, reviewing progesterone levels, supporting pathways for better progesterone production, and managing stress is essential for better pregnancy outcomes.
Progesterone plays a crucial role in early pregnancy, preventing threatened miscarriage, recurrent miscarriage, and preterm birth. It is an essential hormone for women's health, fertility, and maintaining a healthy pregnancy to a full term, live birth. Reviewing progesterone levels and managing stress are essential for women wanting to conceive and have better pregnancy outcomes.
UNTIL NEXT TIME, BE WELL
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REFERENCES
Di Renzo, G. C., Giardina, I., Clerici, G., Brillo, E., & Gerli, S. (2016). Progesterone in normal and pathological pregnancy. Hormone Molecular Biology and Clinical Investigation, 27(1), 35-48. https://doi.org/10.1515/hmbci-2016-0038
Bloch, M., Daly, R. C., & Rubinow, D. R. (2003). Endocrine factors in the etiology of postpartum depression. Comprehensive Psychiatry, 44(3), 234-246. https://doi.org/10.1016/S0010-440X(03)00034-8
Ku, C. W., Allen, J. C., Malhotra, R., Chong, H. C., Tan, N. S., Østbye, T., Lek, S. M., Lie, D., & Tan, T. C. (2015). How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage? Gynecological Endocrinology, 31(8), 647-651. https://doi.org/10.3109/09513590.2015.1031103
Schindler, A. E. (2016). Present and future aspects of dydrogesterone in prevention or treatment of pregnancy disorders: An outlook. Hormone Molecular Biology and Clinical Investigation, 27(2), 49-53. https://doi.org/10.1515/hmbci-2016-0028