Investigators of this well-designed, randomized, controlled trial conclusively demonstrated that progesterone supplementation does not reduce the risk of early pregnancy loss in women who experience first trimester bleeding.
SYNOPSIS: A recent indirect comparison meta-analysis has shown that vaginal progesterone is as useful in decreasing preterm birth and its associated adverse outcomes as cervical cerclage in patients with a history of preterm birth and short cervices.
A recent randomized study suggested that vaginal progesterone is at least as good as, and may be superior to, intramuscular 17 alpha-hydroxy progesterone caproate in preventing recurrent preterm birth, but shortcomings in the study indicate that more investigation is needed.
After a lost decade, increasing numbers of women and providers are recognizing the benefits of postmenopausal hormonal therapy. For women with an intact uterus, endometrial protection is required when systemic estrogen therapy is used. Since activity at the glucocorticoid and androgen receptor may lead to adverse health effects in some women, use of pure progesterone receptor agonists may offer advantages. However, the use of natural progesterone is problematic due to low potency and poor bioavailability with oral dosing. Local therapy with the levonorgestrel intrauterine device (off-label) may be an excellent choice for many women.