This information explains more about using vaginal progesterone to reduce the risk of having your baby early.
We can never know exactly when your baby is going to arrive.
Babies born preterm (before 37 weeks) can need more care at first. This is more likely if they are born before 34 weeks (6 weeks early). They may need to go to the special care baby unit. We also call this the Neonatal Unit.
What is progesterone?
Our bodies make chemicals called hormones. They carry messages that control how our bodies work. Progesterone is one of these.
Your body normally makes progesterone when you have a period (menstrual cycle). It also makes it during pregnancy. Progesterone supports your uterus (womb) as it grows. It may also stop you from getting contractions.
What is vaginal progesterone?
Vaginal progesterone is a pessary (small tablet) that goes into your vagina. It is smaller than a tampon and dissolves quickly.
It increases the amount of progesterone in your womb.
How does vaginal progesterone lower my risk of an early birth?
We don’t know exactly how progesterone prevents early birth. But we know that it can:
- have an anti-inflammatory effect
- delay the changes in your cervix (neck of your womb) that lead to labour
Who is vaginal progesterone helpful for?
We may suggest having a vaginal progesterone pessary if:
- an ultrasound between 16 and 24 weeks shows that your cervix is shorter than it should be
- you have had a preterm baby in the past
- you have had a miscarriage between 16 and 24 weeks in the past
Sometimes we give vaginal progesterone to people who also have a cervical stitch. Some studies suggest that this lowers the risk of preterm birth more than the stitch alone.
Only take progesterone pessaries if they have been prescribed for you.
How do I use vaginal progesterone?
Wash your hands before and after inserting the progesterone pessary.
It is easier to insert the pessary if you are lying down or squatting. Place the pessary between the lips of your vagina and push the pessary upwards and backwards using your finger.
Progesterone pessaries may also be inserted into your rectum (back passage) as an alternative. Wash your hands before and after. Gently push the pessary about 2.5 centimetres (1 inch) into your rectum. Your muscles help to make sure the pessary is in far enough. Squeezing your buttock muscles together for a few seconds will ensure that the pessary does not come out.
When do I use it?
Insert 1 pessary every evening before bed. This means it is more likely to stay in place and be absorbed effectively. Sometimes your doctor may prescribe pessaries twice a day, in this case you would insert 1 pessary in the morning and 1 in the evening.
When do I start using it?
Most people start between 16 to 20 weeks of pregnancy. We tell some people to start at 12 weeks.
How long will I use it for?
We recommend using it until 36 weeks and 6 days of pregnancy. The following day you are 37 weeks, which is ‘term’.
Is it safe to take progesterone in pregnancy?
Yes. There is no evidence that progesterone will harm you or your baby.
Are there any side effects?
There are minimal side effects. Your vaginal discharge may change, there may be more of it or it may be a different consistency.
Other common (1 to 10 in 100 people) side effects may include:
- headaches
- breast tenderness
- feeling or being sick
- a cough
- soreness in your vagina
If you are worried about anything after you start taking the pessary, contact your maternity assessment unit.
Do I have to take vaginal progesterone?
No. It is your choice whether you take it or not.
What could I do instead?
Watch and wait
You can choose to wait and see what happens. If this is what you want, we will monitor you with ultrasound scans. This is so we can keep measuring your cervix and check if it is getting shorter.
Cerclage (cervical stitch or suture)
Putting a stitch around the cervix sometimes helps. This operation has its own risks and benefits. If we think it may be useful for you, we will talk to you about this.
Please ask your doctor or midwife if you want to know more.
You may also find information about having a cervical stitch by the Royal College of Obstetricians and Gynaecologists useful.
How to contact us
Early Pregnancy Assessment Unit (EPAU)
01709 427072
8am to 4pm, Monday to Friday
Labour Ward and Triage
01709 424491 available 24 hours a day.
You can also email rgh-tr.rotherhampretermmidwives@nhs.net for none urgent enquires. You will receive a response within 7 days.