Duphaston and Utrozhestan are two popular drugs that are recommended for diagnosed infertility due to luteal insufficiency or at risk of miscarriage (when tests show an insufficient amount of progesterone in the blood).
When planning a pregnancy, Duphaston, like Utrozhestan, is designed to restore the necessary balance of this hormone for successful conception and fetal development.
Progesterone and pregnancy
Progesterone is the main hormone for a pregnant woman. It is responsible for creating favorable conditions for fertilization and further fixation of the embryo on the wall of the uterus. Lack of progesterone can be one of the causes of female infertility, and is also the main cause of miscarriages during the first trimester.
Normally, progesterone is produced by the ovaries and is responsible for the “comprehensive” preparation of the body for conception and the successful development of pregnancy (ensures the development of the mammary glands, informs the immune system about the onset of pregnancy, so that antibodies do not attack the fetus).
Medicine learned to isolate progesterone in the 60s of the 20th century, after which it began to be actively used in obstetric practice. However, for several decades, technology did not allow obtaining pure high-quality hormone, so cases of complications were not uncommon. But today these problems have already been solved, many drugs have appeared that successfully cope with the tasks assigned to them.
The most popular of them are Duphaston and Utrozhestan.
First visit to the gynecologist
The first visit to the doctor at the antenatal clinic will be longer than subsequent ones. Pregnancy is confirmed during a gynecological examination and during ultrasound diagnostics. A gynecological examination will help the doctor assess the condition of the mucous membrane of the vagina and cervix, determine the position and size of the uterus and more accurately calculate the duration of pregnancy. During an initial gynecological examination, your doctor will take a smear from your cervix to check for sexually transmitted infections (STIs). In addition to this, the woman’s height and weight are recorded, blood pressure is monitored, the condition and development of the mammary glands is assessed, and the size of the pelvis is determined. Urinalysis allows you to determine sugar and protein in the urine, infectious and inflammatory processes in the kidneys and hormonal abnormalities. A blood test is necessary to identify inflammatory processes in the body, diagnose anemia, determine blood group and Rh factor, check blood clotting ability, determine the presence of antibodies to syphilis, hepatitis B and C, and conduct HIV screening.
Blood test during pregnancy
With an ultrasound examination, the doctor diagnoses the pregnancy itself, assesses possible risks for the mother (for example, an incipient miscarriage, an ectopic pregnancy or a multiple pregnancy condition) and the fetus: checks for the presence of malformations (for example, clubfoot, bifurcation of the spine, cleft palate), the doctor can diagnose intrauterine retardation development, pays attention to the development of parts of the fetal body, checks the condition of amniotic fluid and the umbilical cord. Ultrasound examinations are performed three times throughout pregnancy: at 11-12 weeks, 20-24 weeks and 30-32 weeks. The doctor may recommend additional ultrasound examination if abnormalities are detected during pregnancy.
Expert opinion
One of the optional but desirable tests is prenatal genetic screening. This is a non-invasive screening test that helps determine how high the risk of genetic abnormalities and defects in the fetus is (Down syndrome, trisomy 18, Patau syndrome, neural tube defect).
Obstetrician-gynecologist of the highest category Oksana Anatolyevna Gartleb
This test is usually carried out at 12 weeks of pregnancy. Positive screening tests require further investigation. If the risk of genetic defects is higher, doctors prescribe chorionic villus sampling, and if the risk is relatively low, they perform amniocentesis. Both tests are safe. The chorionic villus sampling test is more informative as it is performed slightly earlier than amniocentesis.
Management of complicated pregnancy
Duphaston during pregnancy
Duphaston is an artificially synthesized analogue of natural progesterone. It practically does not differ in properties from the natural one, it is also absorbed by the body, and interacts well with the receptors responsible for sensitivity to this hormone. Unlike all previous synthetically produced progesterone analogues, Duphaston is not a derivative of testosterone, so it does not have the side effects that are typical for other drugs: it does not impair blood clotting, does not have a noticeable effect on liver function, does not cause the development of “male » signs in a female fetus. Over the many years of practice of using Duphaston, not a single case has been recorded in which this medicine would lead to fetal pathologies. Among the clinical effects, it can be noted that the drug taken during pregnancy halves the risk of fetoplacental insufficiency, reduces the risk of premature birth, and brain damage due to hypoxia is much less common in newborns.
In addition, Duphaston does not have a sedative effect, like many other hormonal drugs.
Side effects with this medicine are extremely rare. In some cases, uterine bleeding may occur. If you notice this symptom, you should contact the doctor responsible for your pregnancy management as soon as possible, and the medicine will need to be replaced with another one.
Utrozhestan® (Utrogectan®)
Utrozhestan® should not be used for contraception.
The drug should not be taken with food, since food intake increases the bioavailability of progesterone.
The drug Utrozhestan® should be taken with caution in patients with diseases and conditions that may be aggravated by fluid retention (arterial hypertension, cardiovascular disease, chronic renal failure, epilepsy, migraine, bronchial asthma); in patients with diabetes mellitus; liver dysfunction of mild to moderate severity; photosensitivity.
Patients with a history of depression should be monitored, and if severe depression develops, the drug should be discontinued.
Utrozhestan® contains soy lecithin, which can cause hypersensitivity reactions (urticaria and anaphylactic shock).
Patients with concomitant cardiovascular diseases or a history of them should also be periodically observed by a doctor.
The use of Utrozhestan® after the first trimester of pregnancy may cause the development of cholestasis.
During long-term treatment with progesterone, regular medical examinations (including liver function tests) are necessary; Treatment should be discontinued if abnormal liver function tests or cholestatic jaundice occur.
When using progesterone, it is possible to reduce glucose tolerance and increase the need for insulin and other hypoglycemic drugs in patients with diabetes mellitus.
If amenorrhea occurs during treatment, pregnancy must be excluded.
If the course of treatment begins too early in the menstrual cycle, especially before the 15th day of the cycle, shortening of the cycle and/or acyclic bleeding is possible. In case of acyclic bleeding, the drug should not be used until the cause is determined, including a histological examination of the endometrium.
If there is a history of chloasma or a tendency to develop it, patients are advised to avoid UV irradiation.
More than 50% of spontaneous abortions in early pregnancy are caused by genetic disorders. In addition, the cause of spontaneous abortions in early pregnancy can be infectious processes and mechanical damage. The use of the drug Utrozhestan® in these cases can only lead to a delay in rejection and evacuation of a non-viable fertilized egg. The use of the drug Utrozhestan® to prevent threatened abortion is justified only in cases of progesterone deficiency.
When conducting MHT with estrogens during perimenopause, it is recommended to use the drug Utrozhestan® for at least 12 days of the menstrual cycle.
With a continuous MHT regimen in postmenopause, it is recommended to use the drug from the first day of taking estrogen.
When conducting MHT, the risk of developing venous thromboembolism (deep vein thrombosis or pulmonary embolism), the risk of developing ischemic stroke, and coronary heart disease increases.
Due to the risk of developing thromboembolic complications, the use of the drug should be discontinued if: visual disturbances such as loss of vision, exophthalmos, double vision, vascular lesions of the retina occur; migraine; venous thromboembolism or thrombotic complications, regardless of their location.
If there is a history of thrombophlebitis, the patient should be closely monitored.
When using Utrozhestan® with estrogen-containing drugs, you must refer to the instructions for their use regarding the risks of venous thromboembolism.
The results of the Women Health Initiative Study (WHI) clinical study indicate a slight increase in the risk of breast cancer with long-term, more than 5 years, combined use of estrogen-containing drugs with synthetic gestagens. It is unknown whether there is an increased risk of breast cancer in postmenopausal women when undergoing MHT with estrogen-containing drugs in combination with progesterone.
The WHI study also found an increased risk of dementia when starting MHT after age 65 years.
Before starting MHT and regularly during it, a woman should be examined to identify contraindications to its implementation. If clinically indicated, a breast examination and gynecological examination should be performed.
The use of progesterone may affect the results of some laboratory tests, including liver and thyroid function tests; coagulation parameters; pregnanediol concentration.
Utrozhestan during pregnancy
Utrozhestan, unlike Duphaston, is not synthetic, but natural progesterone obtained from plant materials.
The plant progesterone molecule duplicates all the properties of the hormone produced in the woman’s body. We can say that their chemical structure is completely identical. It is prescribed not only when planning pregnancy, but also in cases where a woman is diagnosed with an excess amount of male hormones in the blood. Utrozhestan restores hormonal balance and has a positive effect on the development of the child.
Utrogestan can also suppress the activity of oxytocin - an excess of this hormone causes the uterus to contract, which, in turn, leads to miscarriage. And when planning pregnancy, Utrozhestan helps solve one of the common causes of infertility.
Side effects of this medication include fever, sedation, and mild dizziness.
Instructions for use UTROZHESTAN® (UTROGESTAN)
The duration of treatment is determined by the nature and characteristics of the disease.
Oral route of administration
The drug is taken orally with water.
In most cases, with progesterone deficiency, the daily dose of Utrozhestan® is 200-300 mg, divided into 2 doses (morning and evening).
If there is a threat of spontaneous abortion and premature birth or to prevent recurrent miscarriage:
200-600 mg/day daily until the 16th week of pregnancy. Further use of the drug is possible as prescribed by a doctor based on an assessment of clinical data, placental function and the level of progesterone in the blood of a pregnant woman.
For luteal phase deficiency
(premenstrual syndrome, fibrocystic mastopathy, dysmenorrhea, premenopause),
the daily dose is 200 or 400 mg for 10 days (usually from the 17th to the 26th day of the cycle).
For hormone replacement therapy
in peri- and postmenopause
while taking estrogen, Utrozhestan® is used at a dose of 200 mg/day for 10-12 days.
Vaginal route of administration
Capsules are inserted deep into the vagina.
Complete absence of progesterone in women with non-functioning (absent) ovaries
(egg donation):
against the background of estrogen therapy, 200 mg/day on the 13th and 14th days of the cycle, then 100 mg 2 times/day from the 15th to On the 25th day of the cycle, from the 26th day and if pregnancy is detected, the dose increases by 100 mg/day every week, reaching a maximum dose of 600 mg/day, divided into 3 doses. This dose can be used for 60 days.
Luteal phase support during an in vitro fertilization cycle:
It is recommended to use from 200 to 600 mg/day, starting from the day of human chorionic gonadotropin injection during the first and second trimesters of pregnancy.
Support of the luteal phase in spontaneous or induced menstrual cycle, in case of infertility associated with dysfunction of the corpus luteum
, it is recommended to use 200-300 mg/day, starting from the 17th day of the cycle for 10 days; in case of delayed menstruation and diagnosis of pregnancy, treatment should be continued.
In cases of threatened abortion or for the purpose of preventing habitual abortions
that occur due to progesterone deficiency: 200-400 mg/day daily in 2 divided doses until the 16th week of pregnancy. Further use of the drug is possible as prescribed by the attending physician based on an assessment of clinical data, placental function and the level of progesterone in the blood of a pregnant woman.
Premature cervical dilatation during pregnancy
Premature dilation of the cervix or isthmic-cervical insufficiency is a pathological condition that can lead to termination of pregnancy in the second and third trimesters of pregnancy. With this pathology, the cervix begins to shorten, becomes softer and thinner, losing the ability to hold the fetus in the uterus for up to 36 weeks. Due to this pathology, about 20% of miscarriages occur in the second trimester of pregnancy.
Causes of premature cervical dilatation during pregnancy:
- Organic. They are the result of previous injuries to the cervix during a previous birth, abortion, miscarriage, or treatment of certain diseases, for example, erosion using the cauterization method. The injury leads to the replacement of muscle tissue in the cervix with scar tissue, which is less elastic in its properties and is unable to hold the fetus inside the uterus.
- Functional. It occurs due to an imbalance in the ratio of muscle and connective tissue in the cervix or due to disruptions in its hormonal regulation. As a result, the cervix becomes too susceptible to fetal pressure and begins to dilate as it enlarges. It occurs in women with ovarian dysfunction or may be congenital.
Pregnancy calendar 34 week
Starting from this week of pregnancy, the born child is no longer considered premature and is officially born prematurely. A baby born at 34 weeks of gestation differs from a baby born at term in having an insufficient amount of subcutaneous fat. Due to lack of fat, the baby's body is not able to retain heat properly. That is why children born at this stage are placed in a warm environment. One and a half months before the due date, the amount of cheese-like lubricant on the baby’s body, which is produced by the sebaceous glands, increases to facilitate the movement of the fetus along the birth canal. The cheese-like lubricant lingers on the body thanks to the thick fluff that covers not only the child’s head, but also his limbs, back and even ears. This fluff will be present on the baby’s body for several more weeks after birth, and then gradually disappear.
The 34th week of pregnancy is characterized by the following achievements: fetal weight - 2.3-2.4 kilograms, height - 43-44 centimeters. The child continues to gain weight, grow and develop. His body has already taken a certain position in the uterus, which will most likely remain until birth. The baby's face and body become rounded and pretty.
The child's skin is no longer red, but pink. Hair and nails continue to grow. The formation of most organs and systems has been completed. The exception is the respiratory system: the accumulation of surfactant, a substance so necessary for the first breath, continues in the lungs. It is the surfactant that will prevent the alveoli, which look like tiny sacs at the ends of the bronchioles, from sticking together.
The development of the pancreas and liver continues. These organs contribute to the proper processing of nutrients entering the newborn's body with mother's milk. The liver takes on the function of disinfecting toxic substances, which are then eliminated from the body by the kidneys and lower parts of the digestive system. The muscles continue to develop, and the cartilage in the joint area becomes ossified.
If the doctor leading the pregnancy has reason to doubt the normal development of the fetus, a biophysical test is prescribed to assess vital functions. Based on the test results (scale from 0 to 2), five important parameters are assessed: heart rate, motor activity, movement of the respiratory muscles, tone, volume of amniotic fluid. This test is performed using ultrasound equipment, which evaluates the amount of amniotic fluid, the number of respiratory movements and fetal movements. External monitors are used to determine the heart rate. They are also used to assess changes in heart rate associated with the motor activity of the fetus. Fetal tone is diagnosed by the movements of its limbs on ultrasound. The results of the biophysical test are summarized with the results of other studies. If overall indicators are low, then urgent delivery may be scheduled. If any indicators in the test raise doubts in the doctor’s mind, he can prescribe a repeat examination on the same day. A biophysical test is informative in diagnosing intrauterine growth retardation, decreased fetal activity, and a mother with diabetes mellitus.
A biophysical test is not prescribed for all pregnant women, but the last ultrasound examination is mandatory. It is necessary to determine the presentation of the fetus and establish the placenta attachment site. Also, ultrasound at a later stage allows you to detect the entanglement of the fetus with the umbilical cord and determine the degree of maturity of the placenta. Based on the results of the ultrasound and parametric data of the fetus (diameter of the head, length of the femur, etc.), the doctor determines the weight of the child.
Sexual activity should be avoided in the thirty-fourth week of pregnancy. During this period, the birth canal is being prepared for childbirth. The fetus has already taken the required position before birth (usually with an occipital presentation) and it is not recommended to disturb it so that it does not change it to a position that is inconvenient for childbirth.
This period of pregnancy is a good time to remember, repeat and consolidate the skills learned in courses for expectant mothers. Train your breathing skills for 10-15 minutes every day and this will help ease the contraction at the right time.
If you have not yet chosen a maternity hospital where the baby will have his first cry, then you can’t put it off until later. When calling the nearest maternity hospitals, ask what pain-relieving techniques are offered by doctors, whether they have an intensive care unit for newborns, and whether the presence of loved ones during childbirth is allowed.
