NICE guideline: Ectopic pregnancy and miscarriage [NG126, issued 2019, updated 2021] has been updated following an evaluation of progesterone for miscarriage:

• Vaginal micronised progesterone is recommended for women with early pregnancy bleeding and a history of miscarriage (see entry below). There was no evidence of benefit for other preparations or doses of progesterone for this patient group.
• The guidance does not support the use of vaginal micronised progesterone or other preparations or doses of progesterone for women with:
  • early pregnancy bleeding but no previous miscarriage, or
  • previous miscarriage but no early pregnancy bleeding in the current pregnancy

For further information, see NICE NG126 Rationale and Impact: Progestogens for preventing miscarriage.

Utrogestan

(Micronised progesterone)

• Vaginal capsule 200mg (£21.00 = 21 capsules with applicator)

Indication and dose:

• Threatened miscarriage in women with a history of miscarriage (in line with NICE guideline NG126) (off-label):
  • Offer vaginal micronised progesterone 400mg twice daily to women with an intrauterine pregnancy confirmed by a scan, if they have vaginal bleeding and have previously had a miscarriage
  • If a fetal heartbeat is confirmed, continue progesterone until 16 completed weeks of pregnancy

Notes:

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. First prescription (minimum 2 weeks supply) to be provided by the Early Pregnancy Unit. Prescribing may be continued in primary care until 16 completed weeks of pregnancy.
3. Utrogestan vaginal 200mg capsules contain soya lecithin and may cause hypersensitivity reactions (urticarial and anaphylactic shock in hypersensitive patients). Patients with peanut or soya allergy should avoid using Utrogestan vaginal 200mg capsules. Specialists may prescribe an alternative vaginal progesterone for patients who should avoid using Utrogestan vaginal capsules.