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Progesterone

Progesterone is a hormone that occurs naturally in the body but can also be produced in the laboratory. "Progestin" is a general term for substances that produce some or all of the biological effects of progesterone. The term "progestin" is sometimes used to refer to progesterone that is produced in the laboratory and used for oral contraceptives and hormone replacement therapy. In reality, however, all progesterone and progestin products are manufactured in a laboratory, so the term "natural progesterone" is a misnomer. "Natural progesterone" used in pharmaceutical products is made from a chemical called diosgenin, which is isolated from wild yams or soybeans. In the laboratory, this compound is first converted into pregnenolone and then into progesterone. The human body is not capable of producing progesterone from diosgenin, so consuming wild yam or soy will not increase progesterone levels.

Progesterone products available over the counter in some countries may not contain the concentration of progesterone stated on the label. According to a British study, the product Progest (a progesterone cream) contained only 100 mg of progesterone instead of the stated 465 mg. In America, progesterone products that are applied to the skin do not require medical approval. There is also no limit to the amount of progesterone that can be contained in cosmetic progesterone products. Women use oral progesterone to induce the menstrual period, to treat abnormal uterine bleeding associated with hormone imbalance and to treat serious symptoms of premenstrual syndrome. Progesterone is also used in combination with the hormone oestrogen as part of hormone replacement therapy. When oestrogen is administered without progesterone, oestrogen increases the risk of uterine cancer.

Progesterone is also used to relieve withdrawal symptoms when certain medications such as benzodiazepines are discontinued. A progesterone cream is sometimes used as part of hormone replacement therapy and to treat symptoms of the menopause such as hot flushes. Progesterone applied to the skin is also used to treat or prevent certain allergies in which hormones play a role, as well as to treat reduced sex drive, depression, fatigue, headaches, low blood sugar, increased blood clotting, infertility, irritability, memory loss, miscarriages, osteoporosis, bone loss in younger women, symptoms of premenstrual syndrome, thyroid problems, uterine cancer, uterine fibrosis, water retention, weight gain and vaginal irritation.

Progesterone gel is sometimes used inside the vagina to dilate the cervix, to treat breast pain in women with non-cancerous breast conditions and to prevent and treat abnormal thickening of the inner lining of the uterus (endometrial hyperplasia). Progesterone is also used intravaginally or as an injection to treat infertility and symptoms of premenstrual syndrome.

How does progesterone work?

Progesterone is a hormone secreted by the ovaries. Changing progesterone levels can contribute to abnormal menstrual periods and symptoms of menopause. Progesterone is also necessary for the implantation of the fertilized egg in the uterus and for the maintenance of pregnancy. Laboratory-produced progesterone is used to mimic the functions of progesterone secreted by the ovaries.

Progesterone is likely to be effective for the following uses:

Use in combination with estrogen as hormone replacement therapy. Micronized progesterone is approved as a component of hormone replacement therapy in combination with estrogen as a medication.

Absence of the menstrual period. Oral intake of progesterone and intravaginal application of progesterone gel are an effective strategy for the treatment of missed periods in premenopausal women.

Infertility when used as a vaginal cream. Intravaginal progesterone gel is used as part of the treatment of infertility in women.

Progesterone is potentially effective for breast pain when used as an intravaginal gel, for preventing or reducing abnormal thickening of the inner lining of the uterus, for symptoms of menopause and for infertility when given as an injection. Progesterone may be ineffective for premenstrual syndrome, withdrawal symptoms from medications to prevent bone loss after menopause, and vaginal irritation.

There is not enough scientific data to conclude on the effectiveness of progesterone for reduced sex drive, depression, fatigue, headaches, low blood sugar, increased blood clotting, irritability, memory loss, miscarriages, thyroid problems, uterine cancer, uterine fibrosis, water retention, and weight gain, as well as its use to treat or prevent allergies that are affected by hormones. Further scientific research is needed to evaluate the effectiveness of progesterone in these applications.

Safety and side effects

Prescription progesterone supplements are safe and harmless for most people when used as directed by a doctor. However, progesterone can cause many side effects including stomach upset, changes in appetite, weight gain, water retention and swelling, fatigue, acne, fatigue or insomnia, allergic skin rashes, hives, fever, headaches, depression, an uncomfortable feeling in the breasts or enlargement of the breasts, symptoms similar to those of premenstrual syndrome, changes in the menstrual cycle, irregular bleeding, and other side effects.

Precautions and warnings

Pregnancy and breastfeeding: Intravaginal progesterone gel is probably safe when used as part of an infertility treatment. However, you should not use progesterone for any other purpose or in any other way during pregnancy. It is also best not to use progesterone while breastfeeding, as not enough is known about how it might affect the breastfed baby.

Diseases of the arteries: You should not use progesterone if you suffer from arterial disease.

Breast cancer: Unless prescribed by a doctor, people suffering from breast cancer should avoid using progesterone.

Depression: Before using progesterone, you should seek the advice of your doctor if you suffer from depression or have suffered from depression in the past.

Liver disease: Progesterone may aggravate liver disease and should therefore not be used by people suffering from liver disease.

Vaginal bleeding: If you suffer from undiagnosed vaginal bleeding, you should not use progesterone.

Interactions

Care should be taken when combining progesterone with the following medications:

Estrogens

Progesterone and oestrogen are both hormones. They are often used together. Progesterone can reduce some of the side effects of oestrogen. However, progesterone may also reduce the positive effects of oestrogen. Taking progesterone in combination with oestrogen can cause tension in the breasts.

Dosage

The following dosages have been investigated in scientific studies:

Oral

  • As part of hormone replacement therapy: 200 mg of micronized progesterone per day, typically taken for 12 days of a 25-day cycle with 0.625 mg of conjugated oestrogens.

Applied to the skin

  • For hot flashes and other symptoms of menopause: 20 mg of progesterone cream is typically applied daily to rotating areas of the body including the upper arms, thighs and breasts.

Inside the vagina

  • For breast pain associated with breast conditions (other than breast cancer): a typical dose of 4 grams of vaginal cream containing 2.5% natural progesterone is placed inside the vagina from day 19 to 25 of a 28 day cycle.
  • To restore the menstrual period in women who have not yet reached the menopause. An amount of 90 mg of a progesterone gel is typically placed inside the vagina every other day for 6 days per month.
  • As part of hormone replacement therapy, 90 mg of progesterone gel is typically placed inside the vagina on days 17, 19, 21, 23 and 27 of a 28 day cycle in combination with 0.625 grams of conjugated equine estrogens.
  • To reduce vaginal bleeding and reverse thickening of the inner lining of the uterus in premenopausal women suffering from endometrial hyperplasia: a dose of 100 mg of progesterone cream was placed inside the vagina daily from day 10 to 25 of a 28 day cycle.

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