Updated NICE guidance on miscarriage using progesterone to help prevent pregnancy loss

on 25 November 2021

The National Institute for Health and Care Excellence (NICE) has published updated guidance on miscarriage, stating that women at a high risk of pregnancy loss should be offered the hormone drug progesterone.

NICE recommends progesterone to lower the risk of miscarriage in women who experience bleeding in early pregnancy and those who have experienced at least one miscarriage.

The guidance has also stated that progesterone may not prevent every miscarriage and that more research should be conducted in this area.

NICE Chief Executive, Professor Gillian Leng, said: “It is devastating for a woman to experience a miscarriage, so we are pleased to recommend progesterone for those women who experience bleeding in early pregnancy and who have had at least one miscarriage as a new treatment option.

“The research evidence is clear that progesterone will not be able to prevent every miscarriage, and therefore our committee has called for more research to be carried out in this area. However, it will be of benefit to some women and as an inexpensive treatment option can be made available to women on the NHS from today.”

Women who have previously had a miscarriage and have their pregnancy confirmed by scan will be offered 400mg of progesterone to be taken twice daily.

Pregnant women are recommended to take progesterone up until 16 weeks of pregnancy.

The Royal College of Obstetricians and Gynaecologists (RCOG) has also welcomed the updated guidance on miscarriage: “The advice in the new NICE guideline on ectopic pregnancy and miscarriage reflect what we are proposing in our draft green-top guideline on recurrent miscarriage, which is that women who experience early pregnancy bleeding and who have a history of one or more previous miscarriages be given progesterone for up to 16 weeks.

“It is positive that NICE has acknowledged the latest evidence available from the Prism trial and how these findings can translate into tangible action for women experience recurrent miscarriage. We do, however, still have a way to go before understanding the best treatments for women experiencing unexplained pregnancy loss, and would welcome further research in this area,” President of RCOG, Dr Edward Morris said.

The updated guidance can be found here.