What is Hydroxyprogesterone Injection: Uses, Dosage, Side Effects and More

Hydroxyprogesterone injection is a synthetic hormone medication that helps prevent premature birth in women who have had a preterm delivery before. This medication works by mimicking the natural hormone progesterone, which plays a crucial role in maintaining pregnancy and keeping the uterus relaxed during the later stages of pregnancy.

If you're expecting and have concerns about preterm labor, understanding this medication can help you make informed decisions with your healthcare provider. Let's explore everything you need to know about this important pregnancy medication.

What is Hydroxyprogesterone Injection?

Hydroxyprogesterone injection is a man-made version of progesterone, a hormone your body naturally produces during pregnancy. The medication comes as an oil-based injection that's given into the muscle of your hip or upper arm once a week.

This synthetic hormone is specifically designed to stay in your body longer than natural progesterone. The injection delivers a steady dose of the hormone over seven days, which helps maintain the protective effects throughout your pregnancy week after week.

The medication is also known by its brand name Makena, though generic versions are available. Your doctor will determine which formulation is best for your specific situation.

What is Hydroxyprogesterone Injection Used For?

Hydroxyprogesterone injection is primarily used to reduce the risk of preterm birth in women who have delivered a baby prematurely before. If you've had a spontaneous preterm delivery in a previous pregnancy, this medication can help lower your chances of it happening again.

Your doctor may recommend this treatment if you delivered a baby between 20 and 37 weeks of pregnancy in the past. The medication is most effective when you're carrying a single baby, rather than twins or multiples.

In some cases, doctors may prescribe this medication for other pregnancy-related conditions, but preventing recurrent preterm birth remains its main approved use. Your healthcare provider will carefully evaluate your pregnancy history to determine if this treatment is right for you.

How Does Hydroxyprogesterone Injection Work?

Hydroxyprogesterone injection works by supplementing your body's natural progesterone levels during pregnancy. This hormone helps keep your uterine muscles relaxed and prevents them from contracting too early, which could lead to premature labor.

Think of progesterone as nature's way of telling your uterus to stay calm and hold onto your baby until the right time. When progesterone levels are adequate, your cervix remains firm and closed, creating a protective barrier for your developing baby.

This medication is considered a moderately strong hormone replacement therapy. It doesn't completely eliminate the risk of preterm birth, but studies show it can reduce the risk by about 35% in women who have had a previous preterm delivery.

The weekly injections ensure that your progesterone levels remain consistently elevated throughout the critical weeks of your pregnancy, typically from 16 to 36 weeks of gestation.

How Should I Take Hydroxyprogesterone Injection?

Hydroxyprogesterone injection is given as a weekly shot in your doctor's office or by a trained healthcare provider. The injection goes into the muscle of your hip or upper arm, and the process typically takes just a few minutes.

You don't need to fast or avoid food before receiving the injection. In fact, having a light meal beforehand can help you feel more comfortable during the procedure. Some women find it helpful to bring a snack or drink for after the injection.

The injection site may feel sore or tender for a day or two afterward. Applying a warm compress to the area can help ease any discomfort. You can also take acetaminophen if your doctor approves it for pain relief.

It's important to keep your weekly appointment schedule consistent. Try to receive your injection on the same day each week, as this helps maintain steady hormone levels in your body.

How Long Should I Take Hydroxyprogesterone Injection?

Most women receive hydroxyprogesterone injections from around 16 weeks of pregnancy until 36 weeks, which means you'll likely need about 20 weekly shots total. Your doctor will determine the exact timing based on your individual pregnancy and medical history.

The injections typically stop at 36 weeks because babies born after this point are considered full-term and don't face the same health risks as premature babies. Continuing the medication beyond this point doesn't provide additional benefits.

If you go into labor naturally before 36 weeks, your doctor will stop the injections since the medication's purpose is to prevent preterm labor. Similarly, if complications arise during your pregnancy, your healthcare provider may adjust or discontinue the treatment.

Never stop the injections on your own without discussing it with your doctor first. Sudden discontinuation could potentially affect your pregnancy outcomes.

What Are the Side Effects of Hydroxyprogesterone Injection?

Like all medications, hydroxyprogesterone injection can cause side effects, though most women tolerate it well. The most common side effects are usually mild and manageable with proper care.

Here are the side effects you might experience, and it's completely normal to feel concerned about them:

• Pain, swelling, or tenderness at the injection site
• Nausea or mild stomach upset
• Headaches
• Dizziness or feeling lightheaded
• Fatigue or feeling more tired than usual
• Mild mood changes or emotional sensitivity
• Breast tenderness
• Bloating or mild fluid retention

These common side effects usually improve as your body adjusts to the medication over the first few weeks of treatment.

Some women may experience less common but more concerning side effects that require medical attention. While these are rare, it's important to be aware of them:

• Severe allergic reactions with difficulty breathing or swelling
• Blood clots in legs or lungs (leg pain, chest pain, shortness of breath)
• Severe depression or mood changes
• Yellowing of skin or eyes (jaundice)
• Severe abdominal pain
• Unusual vaginal bleeding

If you experience any of these serious side effects, contact your healthcare provider immediately or seek emergency medical care.

Who Should Not Take Hydroxyprogesterone Injection?

Hydroxyprogesterone injection isn't suitable for everyone, and your doctor will carefully review your medical history before prescribing it. This medication may not be right for you if you have certain health conditions or pregnancy complications.

You should not receive this injection if you have any of the following conditions, as they could make the medication unsafe for you:

• Current or history of blood clots in your legs, lungs, or other organs
• Active liver disease or liver tumors
• Breast cancer or other hormone-sensitive cancers
• Undiagnosed vaginal bleeding
• Severe allergic reactions to progesterone or the injection ingredients
• Current pregnancy with multiple babies (twins, triplets, etc.)

Your doctor will also consider other factors that might affect your safety, such as a history of depression, diabetes, or heart problems.

Additionally, this medication is specifically for women who have had a previous spontaneous preterm birth. If this is your first pregnancy or if your previous preterm birth was due to medical interventions rather than spontaneous labor, this medication may not be appropriate for you.

Hydroxyprogesterone Injection Brand Names

The most well-known brand name for hydroxyprogesterone injection is Makena, which was the first FDA-approved version of this medication. Makena comes in pre-filled syringes and single-dose vials for easy administration.

Several generic versions of hydroxyprogesterone injection are now available, which can be more affordable than the brand-name version. These generic formulations contain the same active ingredient and work just as effectively as Makena.

Your doctor or pharmacist can help you determine which version is best for your situation, taking into account factors like insurance coverage and availability. All FDA-approved versions of this medication meet the same safety and effectiveness standards.

Hydroxyprogesterone Injection Alternatives

While hydroxyprogesterone injection is the main FDA-approved medication for preventing recurrent preterm birth, there are other approaches your doctor might consider. These alternatives may be discussed if you can't tolerate the injections or have medical reasons to avoid them.

Vaginal progesterone suppositories are sometimes used as an alternative, though they're more commonly prescribed for women with a short cervix rather than those with a history of preterm birth. These suppositories are inserted daily and may be easier for some women to manage.

Other supportive measures include cervical cerclage (a surgical stitch to keep the cervix closed), bed rest in certain situations, or closer monitoring throughout pregnancy. However, none of these alternatives have shown the same level of effectiveness as hydroxyprogesterone injection for preventing recurrent preterm birth.

Your healthcare provider will work with you to determine the best approach based on your specific medical history and current pregnancy situation.

Is Hydroxyprogesterone Injection Better Than Other Progesterone Medications?

Hydroxyprogesterone injection has specific advantages over other forms of progesterone when it comes to preventing preterm birth in high-risk women. The weekly injection provides more consistent hormone levels than daily pills or suppositories, which can be forgotten or irregularly absorbed.

Compared to oral progesterone medications, the injection bypasses the digestive system entirely, ensuring that the full dose reaches your bloodstream. This makes it more reliable and effective for maintaining the hormone levels needed throughout your pregnancy.

The injection form also eliminates concerns about proper insertion or absorption that can occur with vaginal progesterone suppositories. Once you receive your weekly shot, you can be confident that the medication is working in your system.

However, the injection does require weekly medical appointments and can cause injection site discomfort, which some women find challenging. Your doctor will help you weigh these factors against the proven benefits for your specific situation.