Progesterone And Recurrent Miscarriage
If you have bleeding in your current pregnancy after one or more previous miscarriages, recent research has shown that progesterone can be beneficial. This research was published in 2019 and showed that the more previous miscarriages, the greater the benefit from progesterone treatment.
Progesterone is a hormone that helps thicken the lining of the womb and helps the mothers body accept the growing baby. It is given as pessaries and taken twice daily in the vagina .
The study that showed that progesterone can be an effective treatment was a large, multi-centre, randomised controlled trial, which is the gold standard of research trials.
4,153 women with early pregnancy bleeding from 48 hospitals across the UK participated in the study. Around half the women were given vaginal progesterone tablets and the other half were given placebo tablets. The findings were:
- For women with no previous miscarriages: the live birth rate was 74% in the progesterone group and 75% in the placebo group, ie no benefit.
- For women who have had 1 to 2 previous miscarriages: the live birth rate was 76% in the progesterone group and 72% in the placebo group, ie some benefit.
- For women who have had three or more previous miscarriages: the live birth rate was 72% in the progesterone group and 57% in the placebo group, ie substantial benefit
The study did not find any safety concern from progesterone treatment.
Do Offer To Help Spread The Word
After a miscarriage, people often want concrete things they can do to help. For women who told friends and family about their pregnancy, or who were physically showing, one possibility is to offer to tell others for them. Basically, you can offer to help be the messenger so she doesnt have to be, Kreiter said.
And that can extend not just to friends, family or co-workers you have in common, but also people in her day-to-day life who she might not even have explicitly discussed her pregnancy with, but who might have noticed, Kreiter said, like the mail carrier. Making the offer to help have those conversations can take a bit of weight off her shoulders.
What Causes Miscarriage And Repeat Miscarriages
We dont know what causes every miscarriage. But some miscarriages and repeat miscarriages can be caused by:
Problems with chromosomesAbout half of all miscarriages are caused when an embryo gets the wrong number of chromosomes. This usually happens by chance and not from a problem passed from parent to child through genes. Chromosomes are the structures in cells that holds genes. Each person has 23 pairs of chromosomes, or 46 in all. For each pair, you get one chromosome from your mother and one from your father. Examples of chromosome problems that can cause miscarriage include:
- Blighted ovum. This is when an embryo implants in the uterus but doesnt develop into a baby. If you have a blighted ovum, you may have dark-brown bleeding from the vagina early in pregnancy. If youve had signs or symptoms of pregnancy, like sore breasts or nausea , you may stop having them.
- Intrauterine fetal demise. This is when an embryo stops developing and dies.
- Molar pregnancy. This is when tissue in the uterus forms into a tumor at the beginning of pregnancy.
- Translocation. This is when part of a chromosome moves to another chromosome. Translocation causes a small number of repeat miscarriages.
Problems with the uterus or cervix.The cervix is the opening to the uterus that sits at the top of the vagina. Problems with the uterus and cervix that can cause miscarriage include:
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Things That Increase Your Risk
An early miscarriage may happen by chance. But there are several things known to increase your risk of problems happening.
Your age can also have an influence:
- in women under 30, 1 in 10 pregnancies will end in miscarriage
- in women aged 35 to 39, up to 2 in 10 pregnancies will end in miscarriage
- in women over 45, more than 5 in 10 pregnancies will end in miscarriage
A pregnancy may also be more likely to end in miscarriage if you:
- are obese
Medicines that increase your risk include:
- misoprostol used for stomach ulcers
- retinoids used for eczema and acne
- methotrexate used for conditions such as rheumatoid arthritis
- non-steroidal anti-inflammatory drugs such as ibuprofen these are used for pain and inflammation
To be sure a medicine is safe in pregnancy, always check with your doctor, midwife or pharmacist before taking it.
Read more about medicines during pregnancy.
Dont Assume You Know How Shes Feeling
This one is almost painfully simple, but experts say it trips up well-meaning friends and family time and again. People react to miscarriages in very different ways. Some women feel a profound sense of loss. Some women experience serious grief and depressive symptoms. Some women grapple with those feelings for a long time. Some dont. Some women might not feel hit particularly hard by the miscarriage. Some might feel ambivalent about it. Some might feel relieved.
Dont assume you know what a woman is going through after a miscarriage, and dont say things like, You must be so XYZ.
Oftentimes were projecting, Zucker said. Instead, simply give women space to feel whatever it is theyre feeling, she urged, and let them know you are holding that space for them for as long as they need.
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Do You Need Any Medical Tests After A Miscarriage Or Repeat Miscarriages
If you miscarry in your first trimester, you probably dont need any medical tests. Because we dont often know what causes a miscarriage in the first trimester, tests may not be helpful in trying to find out a cause.
If you have repeat miscarriages in the first trimester, or if you have a miscarriage in the second trimester, your provider usually recommends tests to help find out the cause. Tests can include:
- Chromosome tests. You and your partner can have blood tests, like karyotyping, to check for chromosome problems. Karyotyping can count how many chromosomes there are and check to see if any chromosomes have changed. If tissue from the miscarriage is available, your provider can test it for chromosomal conditions.
- Hormone tests. You may have your blood tested to check for problems with hormones. Or you may have a procedure called endometrial biopsy that removes a small piece of the lining of the uterus to check for hormones.
- Blood tests to check your immune system. Your provider may test you for autoimmune disorders like, APS and lupus.
- Looking at the uterus. You may have an ultrasound, a hysteroscopy or a hysterosalpingography .
Recurrent Miscarriage Treatment Options
First, remember to take care of yourself. If you need to talk to a mental health specialist about how youre feeling , your doctor will contact the hospitals social work team to connect you with counseling and/or support groups.
As far as your options for optimizing a future pregnancy and delivery, theres no single slam-dunk treatment. It really depends on what the doctors think is causing your recurrent pregnancy loss. We do have doctors who are committed to helping those experiencing multiple miscarriages by searching for definitive answers. They are very open to having patients participate in ongoing research studies.
Depending on your medical history, you can still have a successful pregnancy after multiple miscarriages.
Your doctor might recommend:
- An evaluation of your uterine cavity.
- Surgery to address uterine anomalies.
- Testing for antiphospholipid autoimmune syndrome , when your immune system mistakenly creates antibodies that make your blood much more likely to clot. Theres no cure for APS, but medications can reduce the severity of your symptoms.
- Genetic counseling as two to three percent of recurrent pregnancy loss is linked to genetic problems in either you or your partner. The most common condition is translocation, which doesnt usually have any physical signs or symptoms. If an embryo gets too much or too little genetic material, it often leads to a miscarriage. Testing is a low-risk option to discover or rule out contributing loss factors.
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What Are The Signs And Symptoms Of Miscarriage
Signs of a condition are things someone else can see or know about you, like you have a rash or youre coughing. Symptoms are things you feel yourself that others cant see, like having a sore throat or feeling dizzy.
Signs and symptoms of miscarriage include:
- Bleeding from the vagina or spotting
- Cramps like you feel with your period
- Severe belly pain
If you have any of these signs or symptoms, call your provider. Your provider may want to do some tests to make sure everythings OK. These tests can include blood tests, a pelvic exam and an ultrasound. An ultrasound is a test that uses sound waves and a computer screen to show a picture of your baby inside the womb.
Many women have these signs and symptoms in early pregnancy and dont miscarry.
Support For Women Who Are Trying To Get Pregnant Or Are Already Pregnant After A Miscarriage
Miscarriages and other pregnancy losses can bring up complex emotions, even once youve decided to try conceiving again or youve already gotten pregnant. Talking with others can make it easier to process your feelings and remind you that youre not going through this alone.
Start by telling your partner whats on your mind remember, youre in this together.
Try talking to others whove suffered losses and have gone on to have healthy pregnancies too. Friends and family members who miscarried have been in your shoes and will understand what youre dealing with. The same is true of women in a local support group or online community in terms of offering help and comfort to those who are trying to conceive after a miscarriage.
If you feel like youre alone or arent getting the emotional support you need, consider talking to your doctor, who might be able to refer you to a therapist specializing in recovery after a pregnancy loss.
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How Is A Miscarriage Diagnosed
Your pregnancy care provider will perform an ultrasound test to confirm a miscarriage. These tests check for fetal heartbeat or the presence of a yolk sac .
You may also have a blood test to measure human chorionic gonadotropin , a hormone produced by the placenta. A low hCG level can confirm a miscarriage.
Finally, your provider may perform a pelvic exam to check if your cervix has opened.
Pregnant Easily But Always Miscarry
I recently read this thread on another forum of people who get pregnant very easily, but continuously miscarry. And I definitely feel this applies to me and now I am trying to find others who may be in a similar situation.
I have a 3.5 year old son that I had at 36, but I went off the pill in March and by mid April was pregnant with him so I got pregnant very quickly. A very easy, lucky pregnancy and a beautiful little boy now.
But fast forward to trying to have our second, and I have been pregnant 6 times in the last 12 months.
The first 2 were early chemicals which ended between 4-5 weeks, the next two ended between 6 and 6.5 weeks and the last two were missed miscarriages between 8-9 weeks.
After the first 4 I found out I had a severe b12 deficiency and had to have shots.
I read a lot online of studies where b12 deficiencies caused failure to implant so once my b12 was at a decent level I had hoped things would work out but unfortunately they havent.
I have read a lot about having an unfussy womb which implants everything including abnormal zygotes. I have also ready that perhaps people who implant every time have an issue with their implantation window being longer and that is what causes issues.
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How Do I Know If Im Having A Miscarriage
You may not be aware youre having a miscarriage. In people who have symptoms of a miscarriage, the most common signs are:
- Bleeding that progresses from light to heavy. You may also pass grayish tissue or blood clots.
- Cramps and abdominal pain .
- Low back ache that may range from mild to severe.
- A decrease in pregnancy symptoms.
Contact your pregnancy care provider right away if youre experiencing any of these symptoms. They will tell you to come into the office or go to the emergency room.
Tips On Getting Pregnant After A Miscarriage
When youre ready to try again, there are plenty of steps you can take to support your efforts to conceive and have a healthy pregnancy:
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Address any underlying health problems. Get a complete preconception checkup if you havent already. When untreated, health problems like diabetes, high blood pressure, thyroid problems and STDs can make it harder to get pregnant.
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Achieve or maintain a healthy weight. Being under- or overweight can slightly increase the chance for miscarriage.
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Try to manage your stress. Very high stress might make it harder to get pregnant. If youre feeling really anxious or tense, try to find ways to relax. Exercising, yoga or meditation, deep breathing, visualization and even acupuncture can all be beneficial. If youre having trouble managing your stress levels on your own, consider talking to a professional.
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Look at your caffeine and alcohol intake. Stick to 200 mg of caffeine or less daily , since high caffeine intake could potentially up the risk of miscarriage. If you drink, cut out the booze. Alcohol can negatively affect fertility, and it may increase the chances of having a miscarriage.
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If you smoke, quit. Try your best to steer clear of second- or third-hand smoke too. You and your partner, if you have one, should also steer clear of marijuana since some studies show it may interfere with both male and female fertility.
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What Treatment Is Available For Recurrent Pregnancy Loss
Recurrent Pregnancy Loss Treatment
The treatment recommendations for patients with recurrent pregnancy loss are based on the underlying cause of recurrent pregnancy loss. No matter what the results of the work-up are, the chance for a successful future pregnancy is high: 77% if the work-up showed no abnormalities, and 71% if an abnormality was found.
Individuals in whom a karyotypic abnormality is found are often referred for genetic counseling. There, a specialist can discuss what the genetic abnormality is and the likelihood of having a chromosomally normal or abnormal pregnancy in the future. Some affected couples may choose to undergo prenatal genetic studies during pregnancy to check the genetic make-up of the offspring with either 1) chorionic villus sampling , in which a piece of placenta is biopsied late in the first trimester or early in the second trimester, or 2) amniocentesis, which removes some of the amniotic fluid for analysis. In vitro fertilization with preimplantation genetic diagnosis can also be done. With this process, the woman takes shots for several days so that many eggs grow in her ovaries. The eggs are then retrieved from the ovaries in a minor surgical procedure one sperm is then injected into each egg and the embryo is allowed to grow. One cell of the embryo is then biopsied and the genetic make-up is analyzed to avoid the transfer of an affected embryo.
Unexplained Recurrent Pregnancy Loss
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Common Causes Of Miscarriages
The most common reason for a miscarriage is a called chromosomal abnormality, which means something was wrong with the chromosomes in the egg and/or sperm, or something went wrong when the egg and sperm were busy dividing during those first several weeks of pregnancy.
The most common causes of miscarriage after chromosomal abnormalities include:
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What Else Can You Do
Its important to understand that you cannot necessarily prevent miscarriage. Some 50 percent of losses happen due to what are called chromosomal abnormalities.
Women over 35 are also more likely to have miscarriages because eggs tend to have more chromosomal abnormalities with age.
Still, following a healthy lifestyle can help foster a healthy pregnancy.
- Try drinking plenty of water and eating a balanced diet. Experts recommend that women drink 10 cups of fluids and eat an additional 300 calories each day starting in the second trimester to support pregnancy.
- While youre at it, be sure to take a daily multivitamin with folic acid to help maintain your nutrient stores.
- Exercise moderately for at least 150 minutes each week. Walking/jogging, swimming, yoga, and Pilates are good choices. Youll want to avoid certain activities, like contact sports, activities with risk of falling, or ones, like hot yoga, where you can become overheated. .
- Avoid substances like alcohol, nicotine, and drugs. Caffeine is another thing to keep in check. Its fine to drink coffee, but try to stick to one 12-oz. cup of any caffeinated beverage daily.
- Keep up with your prenatal appointments and call your doctor with any concerns you have regarding your health or your babys health.
- Keep the rest of your health in mind as well this means managing any chronic conditions you have and taking your medications as directed.
Was It Because Im On Anti
If you needed to take any medication for a mental health condition during your pregnancy, it is not your fault if you miscarried. Mental health conditions need treatment in the same way that physical conditions do.
For some women, the potential risks of taking antidepressants will outweigh the risks of not treating their condition. Most women with mental health problems have healthy babies, with the right treatment and care.
It is also worth remembering that even if you were taking anti-depressants, this does not mean this caused your miscarriage. Even if something increases your risk of a miscarriage, it doesnt mean that it was the cause.
Never stop taking any medication for mental health problems before talking to your doctor. This can lead to withdrawal symptoms. It could also make your symptoms come back or get worse.
Find out more about taking antidepressants in pregnancy.
If you have or had a mental health problem in the past and youre planning to have a baby, its ideal to talk to your doctor before you become pregnant. Find out more about planning a pregnancy with a pre-existing mental health condition.
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