Executive summary
- Recurrent miscarriage is the loss of three or more pregnancies before 24 weeks of gestation.
- Offer referral for investigation and management rather than repeatedly treating each loss as an isolated event.
- In a new pregnancy with early vaginal bleeding and a previous miscarriage, NICE NG126 includes a specific progesterone recommendation — but only in the right clinical context.
Primary care role
- Acknowledge the diagnosis explicitly once the threshold is met. Normalising repeated loss as “bad luck” after three losses is not good enough.
- Arrange specialist referral for structured investigation and ongoing planning, and provide clear advice about how future pregnancies should access early assessment.
- Do not miss ectopic pregnancy in anyone with a positive test plus pain, abdominal tenderness, pelvic tenderness, or cervical motion tenderness — those features require immediate early-pregnancy assessment.
Where progesterone fits
- NICE does not recommend progesterone for everyone with past losses.
- If a woman has vaginal bleeding in early pregnancy and has had a previous miscarriage, offer vaginal micronised progesterone 400 mg twice daily once an intrauterine pregnancy is confirmed.
- If a fetal heartbeat is then confirmed, continue progesterone until 16 completed weeks of pregnancy.
- If there is no bleeding in the current pregnancy, that specific NICE progesterone recommendation does not apply.
Frequently asked questions
When does recurrent miscarriage officially begin?
NICE CKS defines it as three or more pregnancy losses before 24 weeks of gestation.
Should all women with recurrent miscarriage automatically get progesterone in a future pregnancy?
No. NICE ties progesterone to a specific situation: early pregnancy bleeding plus a previous miscarriage, after confirmation of an intrauterine pregnancy.
What is the progesterone regimen in that situation?
Vaginal micronised progesterone 400 mg twice daily; if a fetal heartbeat is confirmed, continue until 16 completed weeks of pregnancy.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.