A group of in vitro fertilization mothers-to-be in Zhejiang used progesterone injection produced by Tianjin Jinyao Pharmaceutical Co., Ltd. and after stopping use for a period of time developed redness, swelling and pain in the buttocks, individually accompanied by fever.
On the 17th, the official website of Zhejiang Food and Drug Administration issued a notice asking the province to suspend the sale and use of the progesterone injection in question.
In addition to concern about the adverse reactions of progesterone, behind this incident also hides a neglected fact, the phenomenon of progesterone abuse in domestic hospitals is very serious.
The progesterone injections have become almost the most common treatment for everyone, but must you take progesterone for low progesterone? Is progesterone really the only choice to protect the fetus?
Let’s look at a few cases.
Case 1
A few days ago, a mother with multiple failed pregnancies came for her first check-up because she was afraid to have another problem until 24 weeks. However, during the examination, the problem was still found: the fetus had hydronephrosis in both kidneys and one ureter was severely dilated.
The patient later reported that she had experienced “birth control” during her early pregnancy and had been on bed progesterone injections and oral medication until 4 months of pregnancy. There was no bleeding or any abnormality during this period. When the doctor asked her why she did this, she said she was afraid of miscarriage.
Case 2
A pregnant woman who had been bleeding since she became pregnant came for a check-up on the 50th day of pregnancy: the cervical and ultrasound examination did not reveal any problem.
The doctor did not prescribe her any medication and told her to come back in a week for another check-up. She came back a week later for another ultrasound and found that it was a malformation of the uterus, one side of the uterus was pregnant and it was the other side of the uterus that was bleeding.
Case 3
A patient who had been infertile for many years and was almost 40 years old finally got pregnant. She had a blood test at around 6 weeks and her progesterone was low, but her hCG was always on a good upward trend and some doctors told her to be hospitalized.
So she was hospitalized and took progesterone and hCG alternately in large amounts. 2 weeks later, she was discharged from the hospital and her progesterone was still low.
She was later found to be at high risk for Down’s syndrome due to widened renal pelvis and abnormal serum test.
Case 4
A patient had IVF because of tubal incompetence. After she got pregnant, she kept applying progesterone and hCG on her own and was still afraid to stop taking the medication in the third trimester.
You should have a judgment in your mind whether these pregnant women really need progesterone supplementation or not.
Case 1: Multiple miscarriages should be considered first whether it is related to chromosomal abnormalities, after excluding chromosomal abnormalities, abnormal nail function, uterine fibroids and other causes, sex hormone examination, to determine the recurrent miscarriages caused by luteal insufficiency, before progesterone supplementation therapy can be carried out.
Case 2: Uterine malformation, with low progesterone and progesterone supplementation can be said to have no relationship at all.
Case 3: Despite the patient’s age, the hCG increased well after the pregnancy, indicating good embryonic development, again without the need for progesterone.
Case 4: Despite IVF, she also had good ovarian function and normal hCG due to tubal problems, and did not need progesterone supplementation. See what the data says
There is recent data to support whether progesterone should be used during pregnancy.
Dr. Martinez de Tejada B, from the Department of Obstetrics and Gynecology at the University of Geneva School of Medicine, conducted a large trial to study this topic.
The trial was conducted in Switzerland (9 centers) and Argentina (20 centers) and evaluated a total of 379 women (193 women on progesterone and 186 women on placebo).
It was found that preterm labor occurred in 42.5% of women in the progesterone group and in 35.5% of women in the placebo group.
It was concluded that when therapeutic preterm delivery was excluded, the risk of spontaneous preterm delivery was higher in the progesterone group.
In Switzerland, progesterone use increased the risk of spontaneous delivery within 14 days and preterm delivery before 37 weeks of gestation compared to the placebo group.
Therefore, on the basis of the available literature, progesterone should not be used as a method of settling the pregnancy in women with preterm labor.
At present, its benefits have not been identified and its harms have not been ruled out. New, large, randomized, placebo-controlled studies will be published soon and will help to draw further conclusions.
What are the dangers of blind hormone supplementation?
Causes of spontaneous abortion include chromosomal abnormalities, placental abnormalities, uterine abnormalities, sex hormone imbalances, infections, chronic diseases, and more.
According to the 8th edition of obstetrics and gynecology textbook, chromosomal abnormalities of the embryo or fetus are the most common cause of early miscarriage, accounting for about 50% to 60% of the cases, and excluding other causes, only a small percentage of patients have miscarriage due to hormone deficiency.
The application of exogenous hormones to promote the growth and development of the embryo should be in the case of insufficient hormone secretion in the pregnant woman’s own body. If it is not a hormone deficiency, too much hormone supplementation will only cause adverse effects to the fetus and the pregnant woman.
1. Excessive progesterone can cause dilated renal pelvis and even hydronephrosis, abnormal genital development in many male fetuses, and tumors of reproductive organs in female fetuses after puberty.
Excessive hCG can also affect the results of Down’s syndrome screening during pregnancy (turning a true high risk into a false low risk).
2. Excess progesterone can also affect the appetite of pregnant women and the metabolism of water in the body.
As the saying goes, “survival of the fittest”, in some cases, abnormal embryos (Down’s or other chromosomal abnormalities) may also lead to insufficient hormone secretion, and if large doses of exogenous hormones are used to protect the fetus, the result is that the embryo that should have been aborted survives, and the outcome can be imagined.
Therefore, whenever I talk to foreign colleagues about Chinese doctors’ love for progesterone and the large amount of progesterone used by Chinese pregnant women, I will see a pair of confused and bewildered eyes, and then I will hear “why?
But for some doctors, progesterone as a placebo to pregnant women is the easiest and safest way.
You can imagine that if a woman who is strongly disturbed and asks for birth control, if she is not prescribed the medication, she will definitely look for the doctor after the miscarriage to “settle the score” for not giving her birth control.
How to determine whether it is “low progesterone”?
After pregnancy, hCG is secreted during the development of the chorion, including the yolk sac and placenta, so generally speaking, if the growth of hCG is normal, it indirectly indicates that the embryo is developing normally.
If progesterone and hCG are combined, if progesterone is low but hCG is normal, it is likely that the test is inaccurate and should be repeated or based on hCG results.
In addition, the patient should be asked carefully about her menstruation and whether she has abnormalities such as short intervals (short cycles) and irregular menstruation, in order to exclude bleeding and low progesterone caused by luteal insufficiency.
It is also important to note that the progesterone secreted by the body is metabolized very quickly, and if the blood is not checked in a timely manner after the blood is drawn, the test results will be inaccurate.
Therefore, when you see such patients with “low progesterone”, you should also pay attention to the reporting time of the lab report and ask the patient when the blood was drawn. If the interval is too long, the patient should also be retested to clarify the results.
In conclusion, it is understandable that patients are eager to have a baby, but it is absurd to prescribe “birth control pills” indiscriminately.
Even if the bleeding is caused by low progesterone, there is no conclusive evidence that the use of progesterone or related hormonal drugs is effective.
In China, the so-called “birth control drugs” are commonly used, but in fact they are Chinese herbal medicines of unknown composition, and also outdated western medicines, which are a waste of money.
Gynecological and obstetric time
Follow the gynecology and obstetrics time, reply to “endocrine” on WeChat, and teach you how to understand the six sex items and play with contraceptives.
Reply to “surgery” to see more experience and operation methods of obstetrics and gynecology surgery.