Progesterone in early pregnancy and early loss: Why it matters and how midwives can support it

Dr Haleema Sheikh, a specialist in integrative women’s health and bioidentical hormone balancing for the Marion Gluck Clinic, discusses progesterone in early pregnancy

Progesterone is one of women’s vital reproductive hormone and plays a key role throughout pregnancy. It is often overshadowed by more widely discussed hormones such as beta hCG and oestrogen. For midwives working in early pregnancy care, fertility support, or the recurrent miscarriage pathways, understanding progesterone’s functions and how it can be supported can have a potentially profound impact on clinical practice and women’s experiences.

In this article we will explore the origins of the name progesterone, its essential physiological role on our organs and tissue, contributing factors to suboptimal levels, and evidence-informed approaches including lifestyle, nutrition, supplements, and body identical/bioidentical progesterone support.

The word progesterone is derived from ‘pro gestation’ literally meaning in favour of pregnancy and points to the hormones central purpose in preparing the body for pregnancy and sustaining it in its early stages. Progesterone is produced in the second half of the cycle after ovulation when a mature follicle in the ovary releases an egg. The remnant of the follicle, the corpus luteum is responsible for the rise in progesterone which plays a foundational role in creating the conditions in the womb for a successful implantation and a healthy first trimester. After this the placenta takes over the production of ongoing progesterone for the rest of the pregnancy.

Progesterone is a steroid and a nuclear hormone which means its impact on cells is multifaceted, and it can act as a classical nuclear hormone to regulate long-term gene expression while also using rapid non-genomic pathways to quickly influence cellular activities, particularly in the nervous and immune systems.

It has multiple physiological roles in early pregnancy

1. Preparing the endometrium- in the second half of the cycle progesterone transforms the endometrium from a proliferative lining under the influence of oestrogen to a secretory, nutrient rich environment. This change in the womblining is essential for the implantation of the blastocyst allowing it to anchor and develop. If there is inadequate progesterone the implantation may be shallow or unstable which increases the risk of biochemical pregnancy loss or very early miscarriage
2. Supporting Immune modulation- in order to tolerate the growth of ‘foreign’ foetal tissue which contains genetic material from the father the maternal immune system must be modulated to become tolerant and anti inflammatory. Progesterone promotes T-helper 2 immunity which reduces the risk of immune-mediated pregnancy loss. However, this shift in immunity can make women more vulnerable to infection risks which is important to be aware of.
3. Reducing uterine contractility- progesterone relaxes smooth muscle including that of the uterus. This prevents early uterine irritability and contractions that might interfere with embryo implantation or placental development. Many women who experience spotting or early cramping during pregnancy have progesterone levels that are borderline or low for their gestational age.
4. Supporting Early Placental development- in the first trimester progesterone promotes the growth and function of trophoblast cells (outer layer of the early embryo) that encourage angiogenesis (production of blood vessels) which supports the developing placenta until the placenta can take over progesterone production at around the 9–10-week mark. Thus, insufficient progesterone in this early phase is being acknowledged as a potential contributor for recurrent early pregnancy loss.
5. Preparing the breast for lactation. Progesterone also works in synergy with oestrogen and prolactin hormones. It stimulates the physical development of the breast as well as inhibiting the production and release of milk till post-partum.

Given these diverse roles, it is not surprising that poor progesterone production as a result of poor ovulation, luteal phase issues, or individual variations can increase the risk of early pregnancy loss.

Progesterone is very sensitive to stress and when women have excessive pressures for whatever reason such as mental, physical, over exercising, emotional, financial etc it can result in the body not feeling safe to procreate and it lowers progesterone production. This is a protective response by the body to focus on survival and cortisol production.

This knowledge can help us support women trying to get pregnant have healthy ovulation and a ‘strong’ corpus luteum response to produce progesterone. It is also important to screen for thyroid dysfunction which can impact women’s overall reproductive health.

As women age their egg health can deteriorate as a result of exposure to toxins over the years, oxidants and metabolic stress from modern day nutrition. Thus, it is important to support women with their diet and lifestyle which has a profound impact on ovarian health and the ability to conceive and sustain a healthy pregnancy with adequate progesterone production.

Strategies midwives may use to support early pregnancy and progesterone production can include:

1. Stress reduction by encouraging practices such as gentle breathing exercises, mindfulness, adequate rest and gentle movement.
2. Blood sugar regulation- insulin resistance can impair ovulation and reduce progesterone. Encouraging balanced meals which produce stable blood sugars can be helpful particularly for women with PCOS.

3. Consider nutritional support for progesterone production and regulation such as:

• Vitamin B6 found in poultry, chickpeas, salmon
• Magnesium for hormone synthesis and relaxation of the nervous system found in leafy greens, nuts, seeds, legumes
• Zinc – essential for healthy follicle development, ovulation and hormone signalling- found in meat, pumpkin seeds, shellfish
• Omega 3 fatty acids which reduce inflammation- found in oily fish, walnuts and flaxseed.
• Vitamin C which has been shown in some studies to increase luteal progesterone- found in citrus fruit peppers, berries.

There is also the option of considering support with body identical/bioidentical progesterone most commonly in the form of microionised progesterone which is identical in molecular and chemical structure to endogenous progesterone. In clinical practice, it is used as luteal phase support increasingly in early pregnancy care for women with a history of recurrent early miscarriage, early pregnancy bleeding, diagnosed luteal phase deficiency and in assisted reproductive cycles (IVF) where the ovulation induction process does not allow the follicle to transform into a fully functional corpus luteum that secretes hormones normally.

Research supports the use of progesterone in early pregnancy for these specific patient populations, and Midwives may encounter women who have been prescribed progesterone or who are seeking advice about it, and therefore understanding its indications, benefits, and limitations is clinically valuable

In conclusion Progesterone lives up to its name—pro-gestation and in fact its actions begin even before conception, shaping the endometrial environment, guiding immune adaptation, calming uterine activity, and supporting early placental growth. When progesterone levels fall short, the foundations of pregnancy may be compromised.

Midwives are uniquely positioned to guide women in understanding how lifestyle, nutrition, stress management, and overall cycle health influence progesterone production. For those experiencing recurrent loss or undergoing assisted conception, targeted supplementation or body identical progesterone may offer additional support.

In a landscape where early pregnancy loss remains common and emotionally devastating, empowering women with knowledge and evidence-informed support for progesterone can make a significant difference physiologically and psychologically at one of the most vulnerable moments of a woman’s life.

About The Marion Gluck Clinic

https://www.mariongluckclinic.com/

The Marion Gluck Clinic is the UK’s leading medical clinic that pioneered the use of bioidentical hormones to treat menopause, perimenopause and other hormone related issues. Founded by Dr. Marion Gluck herself, the clinic uses her method of bioidentical hormonal treatment to rebalance hormones to improve wellbeing, quality of life and to slow down ageing.

Staff Writer