Progestogen
Pregnancy: Used in pregnancy — not associated with fetal abnormalities in doses used for luteal support
Progesterone (Vaginal)
Brand names: Cyclogest (pessary), Utrogestan (capsule), Lubion (injection)
Adult dose
Dose: Luteal phase support (IVF): 400–600 mg intravaginally daily in divided doses. Threatened miscarriage/recurrent miscarriage: 400 mg BD vaginally.
Route: Vaginal pessary or capsule
Frequency: BD–TDS
Max: 1200 mg/day vaginally
PROMISE trial: vaginal progesterone did NOT reduce miscarriage in unselected women but showed benefit in women with previous miscarriage + subchorionic haematoma. PRISM trial (NEJM 2019): progesterone in early pregnancy vaginal bleeding — benefit in women with recurrent miscarriage.
Paediatric dose
Route: N/A
Frequency: N/A
Max: Not applicable
Not applicable in paediatric patients
Dose adjustments
Renal
No dose adjustment required
Hepatic
Avoid in hepatic impairment — hepatically metabolised
Clinical pearls
- PRISM trial: 400 mg BD vaginal progesterone in women with first trimester bleeding + previous miscarriage showed statistically significant increase in live birth rates
- IVF luteal support: commenced day of egg collection/embryo transfer, continued until 8–12 weeks gestation
- Utrogestan capsules used vaginally (off-label route but clinically standard)
- Do not use for routine threatened miscarriage in women with no previous loss — current NHS England guidance
Contraindications
- Unexplained vaginal bleeding (until ectopic and miscarriage excluded)
- Hormone-sensitive cancer
- Severe hepatic impairment
- Thromboembolic disease
Side effects
- Local vaginal irritation or discharge
- Somnolence (if oral route used)
- Nausea
- Bloating
- Breast tenderness
Interactions
- Rifampicin/antiepileptics — reduced progesterone levels (enzyme inducers)
Monitoring
- Serum progesterone (IVF cycles)
- Symptoms of threatened miscarriage
- Vaginal discharge/local irritation
Reference: BNFc; BNF; PRISM Trial (Coomarasamy et al, NEJM 2019); ESHRE ART Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.