Why have I been offered this treatment?
You have been offered progesterone pessaries because you may have a higher chance of giving birth early (before 37 weeks of pregnancy).
Progesterone is a hormone naturally made by the body during pregnancy. Extra progesterone may help reduce the chance of labour starting too soon in some pregnancies.
Research shows this treatment can be especially helpful for people who:
- have had a previous premature birth
- have had a late miscarriage
- have a shorter cervix seen on scan during pregnancy
What is a progesterone pessary?
A progesterone pessary is a small medication placed inside the vagina.
The pessary:
- is smaller than a tampon
- dissolves after insertion
- is used once a day
Most people find it simple to use after the first few times.
The most common brand prescribed is called Cyclogest.
Who may be offered progesterone pessaries?
You may be offered this treatment if you have:
- had a previous premature birth
- had a late miscarriage after 16 weeks
- been told your cervix is shorter than expected on scan
You may also be offered progesterone if you have:
- had your waters break early in a previous pregnancy
- had a cervical stitch before
- had previous surgery to your cervix
- certain differences in the shape of your womb
- had a previous caesarean birth when the cervix was fully open
Your doctor or specialist midwife will discuss whether this treatment is suitable for you.
Sometimes progesterone is also used alongside a cervical stitch, as this may further reduce the risk of early birth.
Only use progesterone pessaries if they have been prescribed for you.
How do I use the pessary?
You will usually use:
- one pessary in the evening
Treatment usually starts between 16 and 24 weeks of pregnancy and continues until 34 weeks.
Your doctor or midwife will tell you exactly when to start.
How to insert the pessary
- Use the toilet before inserting the pessary
- Thoroughly wash and dry your hands
- Remove the pessary from the plastic covering
- Lie down or stand in a comfortable position.
- Gently insert the pessary into the vagina as far as is comfortable
- Lay down on your back for about 10-15 minutes following insertion
How does progesterone help?
The exact way progesterone helps to reduce the chance of early labour is not fully understood. Research and evidence suggests it may:
- help relax the womb
- reduce inflammation linked to preterm labour
- help support the cervix and pregnancy tissues
Are there any side effects?
Most people do not experience serious side effects.
Common side effects can include:
- increased vaginal discharge
- watery or creamy discharge
- headaches
- breast tenderness
- nausea
Because the pessary dissolves inside the vagina, some discharge is normal.
When should I seek advice?
Please contact Maternity Triage if you:
- are worried about symptoms
- think your waters may have broken
- have bleeding
- develop abdominal pain or contractions
- notice reduced movements from your baby
- are unsure whether to continue treatment
Maternity Triage: 01270 273116
Is progesterone safe in pregnancy?
Progesterone has been used safely in pregnancy for many years.
Research has not shown evidence that progesterone harms you or your baby.
Studies suggest progesterone can reduce the chance of premature birth in some pregnancies, particularly in people who:
- have had a previous premature birth
- have a short cervix during pregnancy
Large research reviews, including a Cochrane review of over 8,000 women, found that progesterone treatment was linked with:
- a lower chance of early birth
- fewer complications for babies born prematurely
- reduced need for neonatal intensive care
Some individual studies have shown mixed results, but overall, the evidence suggests progesterone may be beneficial for people at higher risk of preterm birth.
Further information
If you have questions or concerns, please speak to:
- your midwife
- your consultant
- the antenatal clinic team
Useful websites
NICE guidance:
https://
NIHR evidence summary: