Progesterone In Pregnancy:
Progesterone is a hormone produced in the ovaries that helps maintain gestation until the baby is born.
It plays a key role even before pregnancy and in the preparation of the uterus to receive the embryo.
In some situations, your doctor may recommend hormone supplementation during pregnancy.
Progesterone supplementation in any situation, however, is not a consensus among experts. The most common cases in which it continues to be used are:
- In vitro fertilization (IVF)
- Short cervix
- Repeat abortion history
- Initial pregnancies with detachment / hematoma images
What is progesterone supplementation for?
Among the “tasks” of progesterone is to assist in relaxing the uterine musculature, to prevent premature expulsion of the fetus, and to regulate the transport of nutrients to the baby.
Prenatal blood tests can help measure whether progesterone in the body is at the appropriate level.
“In addition to the dosage by examination, it is possible to do a biopsy of the endometrium (the inner lining of the uterus), but the diagnosis of low progesterone production is difficult,” says Marcelo Nomura, an obstetrician at the Women’s Hospital. Dr. José Aristodemo Pinotti (CAISM / Unicamp).
Therefore, the detection of the problem is more based on medical observation.
Insufficient production of the hormone in early pregnancy can have several causes, such as a deficiency in the so-called luteal phase. It is the corpus luteum – formed from the empty follicle from which the egg leaves – that initially releases progesterone.
After fertilization, the task of producing the hormone is gradually being “transferred” to the placenta.
Who should do progesterone supplementation in pregnancy?
In vitro fertilization (known as IVF), progesterone treatment is always used, usually until the end of the first trimester of pregnancy.
Progesterone is an important part of the process because it helps in implanting the fertilized egg.
Medications used in assisted reproductions sometimes affect the body’s ability to produce progesterone. In certain cases, there is no production of the hormone by the ovaries.
History of repeat abortions or premature births:
Among the main actions of progesterone in these situations is the relaxing effect on the muscles of the uterus and the ability to block the effects of the hormone oxytocin, linked to labor.
Doctors believe there is a history of repeat abortion when the woman has had three or more episodes of her baby’s loss.
Supplementation usually occurs early in pregnancy and may be discontinued sometime between 12 and 36 weeks, depending on the situation.
The shorter, the greater the possibility of premature delivery or late abortion.
Most experts believe that the cervix is short when it measures less than 2.5 cm, although there are 2 cm references in the medical literature.
Progesterone therapy is performed from the time the problem is identified – usually on transvaginal ultrasound in the second trimester. It can be kept until the 36th week of pregnancy.
Pregnancy from twin or triplets alone does not require progesterone supplementation. Studies show that treatment does not appear to reduce the incidence of preterm delivery in multiple gestations.
How is progesterone supplementation during pregnancy?
In Brazil, the drug for supplementation comes in the form of gelatinous capsules of natural progesterone taken orally or inserted through the vagina. Elsewhere in the world, there are injections.
The recommended treatment time varies from doctor to doctor. Some indicate weekly doses of progesterone; daily doses inserted into the vagina. Supplementation may extend up to the 36th week of pregnancy.
Talk to your doctor to discuss the best option and dosage for your case.
I’m pregnant and with a little bleeding. Should I use progesterone?
First, not all slight bleeding indicates a risk situation. It is not uncommon for so-called escape bleeding to occur at the beginning of pregnancy.
If you have bleeding, seek immediate help because only a doctor can assess what is happening to your pregnancy and what steps should be taken.
In situations of abortion already in progress many doctors end up prescribing progesterone, although the use is increasingly questioned due to the lack of proof of positive results.
“Progesterone helps little in ongoing abortion cases,” says obstetrician Rosiane Mattar of the Paulista School of Medicine.
But, according to her, progesterone is prescribed because of a kind of reassuring effect for many pregnant women – who, therefore, do not feel that they are taking no action in the case.
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