Obstetrics & Gynaecology/Progesterone (luteal/pregnancy support)

Micronised progesterone

also: Utrogestan · vaginal progesterone · luteal support

Overview

Natural progesterone for early-pregnancy support and luteal support — distinct from the synthetic progestogens used for contraception.

Mechanism

Provides progestational support to the secretory endometrium — maintains decidualisation and reduces uterine contractility, supporting an early intrauterine pregnancy.

Indications

Threatened miscarriage: bleeding + a PREVIOUS miscarriage (NICE NG126 — 400 mg BD vaginal, continue to 16 weeks if FH seen)
Luteal-phase support in assisted conception
Endometrial protection as the progestogen in HRT (cross-reference)

Adverse effects

Drowsiness/dizziness (oral)common

Vaginal irritation, breast tendernesscommon

Cautions & contraindications

Undiagnosed vaginal bleeding (non-pregnancy)all

Active VTE, severe liver diseaseall

Interactions

Enzyme inducers reduce levels

Monitoring & kinetics

Scan to confirm intrauterine pregnancy + viability before/while treating

Vaginal capsule (preferred for pregnancy support) or oral.

Choosing it

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Source: NICE NG126 — Miscarriage (vaginal progesterone) · BNF — Progesterone