Q: My periods didn't occur on their respective due date. So I took HCG pregnancy test, which came out positive. But after two days, I saw some spotting. Doctor gave me HCG 5000 injection and advised complete bed rest. After that, on the advise of another doctor I took Susten 200 mg twice a day and folic acid + becosoule thrice. I am scared of a miscarriage. The same problem happened to my elder sister twice. First time she had to abort but second time she delivered successfully. Second time she took Susten 500 mg. Please advise.

A:I presume this is your first pregnancy. The use of HCG (brand names: Corion or Profasi) is quite appropriate. However progesterone (such as Susten) is not approved for use during pregnancy in any advanced country such as US, UK etc. In US, it is permitted for use in old post-menopausal women with intact uterus receiving another female hormone called oestrogen. Its use during pregnancy is prohibited (contraindicated). In UK it is used for Premenstrual Syndrome (PMS) in non-pregnant women. Some authorities in the past used to recommend its use in recurrent miscarriage or threatened abortion but now there is now no evidence of any benefit from such practice and recommend against the use in early pregnancy unless there is proven deficiency. One problem with this medicine is that female baby may suffer from hirsutism (unwanted hair on face, chest etc). Therefore if at all progsterones have to be given when there is documented deficiency, it is preferable to give dydrogesterone (sold as Duphaston) or medroxyprogesterone (sold as Meprate). Unfortunately, some pharma manufacturers undertake aggressive and unethical promotion of their products and doctors do not review the non-commercial, scientific evidence before prescribing such products. We are aware of atleast one company which is promoting progesterone for vague conditions like to help pregnancy. Such an indication is not permitted in any advanced country.