Here's Why Khloe Kardashian Used Hormone Suppositories at the Beginning of Her Pregnancy
Khloé Kardashian revealed on Sunday’s episode of Keeping Up with the Kardashians that she went through some health issues early in her pregnancy. Kardashian, who is pregnant with her first child, explained that she was taking progesterone pills (vaginally) to increase her levels of the hormone, in the hopes of preventing a miscarriage. As People reported, she didn't find it particularly comfortable.
But while these pills may be prescribed in certain situations, the science behind them is somewhat controversial.
Progesterone is a crucial hormone for your body during pregnancy—especially at the beginning.
After you ovulate, the level of progesterone in your body increases. The progesterone helps prepare the endometrium (the uterine lining) for pregnancy by causing it to thicken, which allows for implantation of the fertilized egg, board-certified ob/gyn Shannon M. Clark, M.D., an associate professor of maternal-fetal medicine at the University of Texas Medical Branch and founder of BabiesAfter35.com, tells SELF.
After an egg has been released from an ovary, the ovarian follicle collapses to temporarily form the corpus luteum, which produces progesterone, the Mayo Clinic explains. If the egg is not fertilized, the corpus luteum decays, stops producing progesterone, and the whole cycle starts over again. But if it does get fertilized, the corpus luteum continues to produce progesterone until the placenta has formed enough to take over (in the second trimester).
“Progesterone levels help maintain the pregnancy,” Heather Frey, M.D., a maternal-fetal medicine physician at the Ohio State University Wexner Medical Center, tells SELF. Although it's most essential early in pregnancy before the placenta has fully developed, progesterone is also sometimes used later in a person's pregnancy if they have a repeat history of pre-term birth or if they have a short cervix, which can predispose them to pre-term birth, Dr. Frey says.
In some cases, like if you're going through IVF, progesterone supplements may be suggested because your body won't automatically be making the progesterone that's needed early in pregnancy, Jennifer Hernandez, M.D., maternal fetal specialist at Baylor Scott & White All Saints Medical Center—Fort Worth, tells SELF. Otherwise, taking progesterone supplements to prevent a miscarriage is "somewhat controversial," says Dr. Frey.
Because progesterone is so important for the implantation and development of a fertilized egg, one line of thinking suggests that not having enough progesterone early in a pregnancy may lead to a miscarriage. And, therefore, that supplementing with extra progesterone could help prevent a pregnancy loss. However, there's no accepted way to diagnose someone with low progesterone levels in early pregnancy (which are changing quickly at that time anyway), says Dr. Clark. So it's difficult to determine whether or not someone is truly "low" in progesterone and would benefit from supplementation.
So far, research looking at the possible benefits of progesterone supplements in early pregnancy has looked specifically at patients who have already had recurrent miscarriages. However, the results have been contradictory.
In one study published in the Journal of Human Reproductive Sciences in 2012, researchers tracked pregnancy cycles for 213 women with repeated miscarriages. Those who initially were not producing enough progesterone were given progesterone supplements vaginally for the first 12 weeks of their pregnancy. At the end of the nine-year study, researchers found that those who'd had four miscarriages and received the supplements were less likely to have a miscarriage than those who didn't get the supplements. However, this study was small, had no control group (they used historical data), and only included patients who visited one specific clinic, so it's not clear how much those results would generalize to the rest of us.
A larger randomized, double-blind trial published in the New England Journal of Medicine in 2015 had different results. That study followed 836 women with a history of recurrent miscarriages who received either progesterone or a placebo early in their pregnancy. Researchers found that the live birth rate was similar for both groups (65.8 percent in the progesterone group and 63.3 percent in the placebo group). So they concluded that taking the progesterone did not significantly decrease their chances of miscarriage.
“There have not been any studies with enough patients to make a definitive recommendation,” Dr. Clark says. “The current data do not support the use of progesterone to prevent early pregnancy loss or in the event of a threatened pregnancy loss.” However, she adds, a paper released by The Practice Committee of the American Society of Reproductive Medicine in 2012 noted: Although progesterone supplements for those who have sporadic miscarriages (rather than three or more in a row) is not effective, progesterone supplementation may be beneficial after someone has three or more consecutive early miscarriages prior to the current pregnancy.
Similarly, clinical management guidelines from the American College of Obstetricians and Gynecologists also note that the use of progesterone to prevent early pregnancy loss is controversial, but "women who have experienced at least three prior pregnancy losses, however, may benefit from progesterone therapy in the first trimester."
According to Dr. Clark, even if you haven't had three miscarriages, your doctor may prescribe progesterone because there's a chance it could help your pregnancy and, aside from the side effects (more on those later), it doesn't appear to be dangerous.
There are a few ways you can take progesterone supplements during your pregnancy.
It can be taken vaginally, like Kardashian mentioned, but it can also be taken as a shot or oral pill. And the method you use really seems to depend on the doctor. “Many physicians have their own personal preferences and many fertility centers have their own protocols that they follow,” Dr. Clark says.
Progesterone supplements are generally thought to be safe during pregnancy, Dr. Frey says, but it's not a total given. Aside from the early symptoms of pregnancy (such as fatigue, nausea, and tender breasts), taking extra progesterone can cause muscle and joint pain, changes in mood, and changes in vaginal discharge.
Although it’s easy to see this and assume that everyone should be taking progesterone early in their pregnancy as a precaution, that's not necessarily the case—it’s not known to be a magic pill for preventing miscarriage. “Women should not take progesterone in early pregnancy unless it is indicated and her physician recommends it," Dr. Clark says. "Progesterone is not a cure for early pregnancy loss.”
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