Dr Sanli Erkan, a specialist in obstetrics and gynaecology based in London, shares insights into the use of micronised bioidentical progesterone in various clinical scenarios.
Medical Chronicle recently hosted a CPD-accredited webinar on Recent Updates on the use of Micronised Bioidentical Progesterone. This was presented by Dr Sanli Erkan and was sponsored by Cipla. To watch the recording and still earn a CPD point, go to: https://vimeo.com/event/4185174
Dr Sanli Erkan, specialist in obstetrics and gynaecology based in London, shares insights into the use of micronised bioidentical progesterone in various clinical scenarios prevalence ranging from 12% to 18% of the population.
His presentation looked at recent updates on the role of progesterone in fertility treatments, miscarriage management, and preterm birth prevention.
PROGESTERONE’S ROLE IN REPRODUCTIVE PHYSIOLOGY
Progesterone plays a pivotal role during both the luteal phase and pregnancy, exerting multifaceted effects on the endometrium and uterine environment. Dr Erkan elucidated how progesterone facilitates endometrial receptivity, promotes embryo implantation, and maintains uterine quiescence throughout pregnancy. This hormone also modulates maternal immune responses and improves utero-placental circulation, crucial for foetal development and pregnancy success.
ROUTES OF PROGESTERONE ADMINISTRATION: CHOOSING THE OPTIMAL APPROACH
Dr Erkan discussed various routes of progesterone administration, highlighting the advantages and limitations of each. While intramuscular injections and oral formulations are common, vaginal progesterone emerges as a preferred option due to its targeted delivery to the endometrium, stable plasma concentrations, and minimal systemic side effects. Micronised bioidentical progesterone, administered vaginally, offers superior efficacy and safety compared to synthetic alternatives.
LUTEAL PHASE SUPPORT IN FERTILITY TREATMENTS
For patients undergoing fertility treatments, adequate luteal phase support is essential for successful embryo implantation and pregnancy maintenance. Dr Erkan outlines strategies for managing cases with low serum progesterone levels, emphasising dose optimisation and individualised approaches. By tailoring progesterone therapy to each patient's needs, clinicians can enhance treatment outcomes and improve pregnancy rates.
MANAGEMENT OF MISCARRIAGE WITH MICRONISED PROGESTERONE
Miscarriage remains a challenging aspect of reproductive medicine, often posing diagnostic and therapeutic dilemmas for clinicians. Dr Erkan discusses the role of micronised vaginal progesterone in preventing recurrent miscarriages, citing compelling evidence from clinical trials and meta-analyses. Recommendations from NICE guidelines advocate for the use of micronised progesterone in women with a history of miscarriage and early pregnancy bleeding, offering hope for improved pregnancy outcomes.
PREVENTION OF PRETERM BIRTH
Preterm birth represents a significant global health burden, necessitating effective preventive strategies. Dr Erkan underscores the role of micronised bioidentical progesterone in reducing the risk of preterm birth, particularly in high-risk populations. Drawing from NICE guidelines, he provides clear recommendations for initiating vaginal progesterone therapy in women with a history of preterm birth or cervical insufficiency, emphasising the importance of early intervention and continued treatment until at least 34 weeks of gestation.
KEY MESSAGES
- Luteal phase support with progesterone is obligatory in IVF fresh and artificial cycles, and the vaginal route is the most preferred option among clinicians globally. UK guidelines recommend micronised vaginal progesterone 400mg twice daily to women with a history of one or more miscarriages and early pregnancy bleeding to
treat miscarriage - Treatment should be started immediately at the time of presentation and if foetal heartbeat is confirmed, progesterone should be continued until pregnancy week 16. The benefit of micronised bioidentical progesterone increases as the number of miscarriages increase
- Preterm birth is a global problem affecting millions of babies and it is the single biggest cause of mortality in children under the age of five
- A prior history of preterm birth and a short cervical length (<25mm) are the strongest predictors of recurrence of preterm birth
- This benefit of natural micronised bioidentical progesterone pessaries cannot be extrapolated to other progesterone preparations, doses, or routes
- Micronised bioidentical progesterone will not do harm to the mother or to the baby.
