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Progesterone; Treatment.

Progesterone substances used for medical uses are called progestogens. They are available in two forms: synthetic versions (progestins) and another version derived from plant sources, which is nearly identical to the body's own hormone and often called "natural progesterone."

In addition to being included in birth control pills and hormone replacement therapy, progestogens may be used to treat a variety of conditions, including:

* menstrual or bleeding irregularities

* endometriosis

* breast, kidney or uterine cancer

* appetite and weight loss in AIDS and cancer patients.

They are also used as a diagnostic aid to measure estrogen's effect in the uterine lining.. Progesterone, the natural hormone, may also be used as an infertility treatment or an adjunct to some infertility procedures.

If you are considering a progestogen product, make sure to discuss with your health care professional any medical conditions you may have, especially asthma, epilepsy, cardiovascular or bleeding disorders, kidney or liver disorders, migraines, breast problems, depression or diabetes. Also share information about any medications you are taking.

Typical side effects of progestins include:

* breakthrough bleeding

* menstrual cramps

* bloating caused by water weight gain

* dizziness

* moodiness

* weariness

Many of these side effects mimic premenstrual syndrome, which is not surprising since PMS usually occurs when progesterone levels are at their peak. Some women experience rarer side effects like depression, excessive breast milk or breast sensitivity, sleep disorders, flushing, and changes in body or facial hair. Talk to your health care professional if you experience side effects. Many of these side effects subside with continued use. If not, switching to different progestin-based product may help.

Types of Progestin

Types of progestins available include intramuscular, oral and cream. Depo-Provera (medroxyprogesterone) is an injectable form of progestin. Provera, (medroxyprogesterone), and Aygestin (norethindrone), are taken orally and may reduce AUB. The Progestasert IUD, which slowly releases progestin into the uterus for up to one year, may help reduce menstrual flow up to 40 percent. The Mirena IUD, which is worn continuously for five years, may also reduce menstrual bleeding, but the FDA has not formally approved it for this purpose.

Crinone or Prochieve, is a vaginal-gel form of natural progesterone used for treating amenorrhea (absent menstrual periods) and also for infertility procedures. Prometrium, a plant-derived micronized progesterone, is also used to treat amenorrhea as well as used for menopausal hormone therapy. (When a medication is micronized it is absorbed more quickly by your body.) These have not been tested for treating AUB.

Natural progesterone creams are available over-the-counter (OTC), but be aware that they are not as strong as synthetic progestins or micronized progesterone and should not be used as a substitute for the progestogens contained in combination estrogen products. The OTC progesterone creams are not as effective at protecting against endometrial cancer and can't be used as the progesterone part of estrogen and progesterone therapy, nor are they expected to improve AUB.

Uses for Progestin Products

Abnormal uterine bleeding:

Because of their ability to inhibit bleeding, progestins are used to manage excessive or abnormal uterine bleeding (AUB). Progestins may reduce menstrual bleeding by up to 20 percent. Endometrial hyperplasia (pre-cancer) or endometrial cancer as a cause for the abnormal uterine bleeding should be ruled out before progestins are prescribed. for abnormal uterine bleeding.

Endometriosis:

Endometriosis may be treated with a progestin or with an estrogen-progestin oral contraceptive combination. The goal is to manage the stimulation of endometrial tissue by inhibiting the production of estrogen.

Irregular periods and polycystic ovary syndrome (PCOS):

The shedding of the uterine lining that occurs with menstruation each month reduces the risk of endometrial cancer; thus, maintaining menstrual cycles is important during childbearing years. If you frequently skip periods due to PCOS, being overweight or underweight, or because of another disorder, your health care professional may recommend birth control pills containing estrogen and progestin to get your cycles going again and ensure regularity. If you are missing periods and can't take birth control pills, or would simply prefer not to take them, you may need an occasional prescription for an oral progestin to induce shedding of the uterine lining.

Birth control:

Oral contraceptives typically contain estrogen and progestin. Combination pills suppress ovulation (the release of an egg) each month and therefore prevent pregnancy by denying sperm a chance to connect with an egg and fertilize it. The progestin in these pills also decreases the chance of pregnancy by altering the mucus in a woman's cervix, thus making it harder for sperm to move into contact with an egg. Continuous progestins in combination oral contraceptives also inhibit the growth of the endometrium, which is triggered by estrogen. They also alter uterine secretions to reduce the chance for implantation of the egg.

Combination pills come in different formulations. Some are based on a 28-day regimen (21 days of active tablets followed by seven days of placebo tablets). Others vary the dose of estrogen and/or progestin that a woman gets throughout her cycle, or add five additional days (tablets) of estrogen at the end of the 21-day cycle.

Seasonale, a 91-day oral contraceptive regimen, provides women with birth control and fewer periods each year. Tablets containing the active hormones progestin (levonorgestrel) and an estrogen (ethinyl estradiol) are taken for 12 weeks (84 days), followed by one week of placebo tablets. Therefore, the number of expected menstrual periods is reduced from once a month to about once every three months. As with the conventional 28-day regimen, women will have their period while taking the placebo tablets. Breakthrough bleeding is a common side effect in the first three months. After that, it usually disappears or is significantly reduced. Other oral contraceptives can also be used in a similar long-cycle fashion.

Estrogen-progestin birth control pills have some anti-cancer benefits in addition to birth control. They may reduce ovarian cancer risk, as well as uterine and colon cancer risk. However, combination pills are not recommended for women who have had breast cancer or who have a family history of breast cancer.

These products also have side effects, the most common of which are nausea, breast tenderness and breakthrough bleeding. Most side effects decrease or disappear after three months of continuous use. Switching to another formulation can also relieve side effects. The estrogen in the pills can cause headaches in some women as well.

Combination birth control pills are typically not an appropriate treatment choice if you smoke have high blood pressure, have a history of pulmonary embolism (blood clots in your lungs), or are highly sensitive to side effects of this medication, such as headaches. Smoking while taking combination birth control pills increases your risk of heart attack and stroke, according to the American Heart Association.

Estrogen-progestin contraceptives are available now as a patch (Ortho Evra) and as a ring (NuvaRing).

Ortho Evra is the first skin patch approved by the FDA for birth control. The weekly prescription patch releases norelgestromin (a progestin hormone), and ethinyl estradiol (an estrogen hormone), through the skin into the blood stream to prevent pregnancy. The one-and-three-quarter inch square patch consists of three layers, with the hormones embedded in the adhesive layer. These hormones are slowly released when the patch is applied to the skin (lower abdomen, buttocks or upper body, but not breasts). Each patch is worn continuously for one week. On the same day of the week you start the patch, replace it with another. After three weeks (and three new patches) you have a week that is patch-free, during which you get your period.

Side effects may include breast symptoms, headache, a reaction at the application site, nausea, upper respiratory infection, menstrual cramps and abdominal pain. Other risks are similar to those from using birth control pills.

Another new contraceptive is the NuvaRing which consists of a soft, flexible, transparent, ring that measures approximately 2.1 inches in diameter. It contains a combination of estrogen and progestin hormones (ethinyl estradiol and levonorgestrel). After it is inserted into the vagina, these hormones are slowly released on a continual basis. You need to insert a new ring each month for continuous contraception. You can insert the ring yourself into your vagina, where it should remain for three weeks. Then you remove the ring for one week, during which you have your period.

Side effects of the NuvaRing may include vaginal discharge, vaginitis, and irritation. Like oral contraceptives, NuvaRing may increase the risk of blood clots, heart attack, and stroke. Women who use NuvaRing are strongly advised not to smoke, as it may increase the risk of heart-related side effects.

Some women choose to take a progestin-only pill instead. Called the "mini-pill," progestin-only pills allow women to avoid some of the worst side effects of estrogen, while improving menstrual regularity and preventing conception. If you are breast-feeding, you may want to consider the mini-pill, since combination products tend to have adverse effects on breast milk.

Progestin-based mini-pills are highly effective for preventing pregnancy (about 99.5 percent) if taken correctly, but missing a pill or taking it a different time of day can be riskier than with combination estrogen-progestin pills. That's because the mini-pill's effects can wear off after a day, making you vulnerable to pregnancy. Women on mini-pills also ovulate frequently-even when they take the pills correctly-and if you miss a day, the fact that more eggs are available for fertilization makes getting pregnant more likely.

Levonorgestrel (Plan B) can be used for emergency contraception within 72 hours of unprotected sex. (Combination birth control pills can also be used for this purpose, and may be the better option if you already have a prescription for them. A product called Preven, which contains estrogen and levonorgestrel, is also available and is specially designed for emergency contraception.) Ask your health care professional or pharmacist for more information about how and when to use this product, if you want to keep it on hand.

Longer-acting progestins may be a good birth control option if you want reliable protection without having to remember to take a pill each day. Injected medroxyprogesterone (Depo-Provera) is also used as contraception and it lasts three months. The Progestasert and Mirena IUDs, which deliver progesterone directly and continuously into the uterine lining for one year and five years respectively, are additional longer-term options. These birth control methods are all highly effective.

Perimenopause and menopause: For perimenopausal women with irregular or absent periods, the low-dose estrogen/progestin combination found in oral contraceptives often alleviates symptoms and helps their menstrual cycles stay on schedule.

Postmenopausal hormone therapy using either estrogen alone (ET) or an estrogen-progestin combination (HT) has been a commonly recommended treatment option for perimenopausal or postmenopausal women with moderate to severe menopausal symptoms or for women who are not getting relief from non-hormonal methods.

Estrogen-alone therapy is prescribed only if you've had a hysterectomy. Most women take the combination estrogen-progestin pill because the progestin helps offset estrogen's stimulating effects on the endometrium. These effects are linked with a heightened risk of endometrial cancer. Adding progestin promotes endometrial shedding, reducing the risk of endometrial cancer to that of women who don't use HT.

Some postmenopausal hormonal therapy products provide continuous progestin (progestin in each daily dose). Others are designed more like combination birth-control pills, with progestin added during part of a monthly cycle and then withdrawn. Women on the intermittent-progestin regimen report more bleeding problems than women on continuous therapy regimens, which have become more popular in recent years.

Estrogen-progestin combinations may require that you take different pills on different days, resulting in monthly bleeding akin to menstruation. Many women prefer taking both hormones every day so as to avoid monthly bleeding, which usually stops after three to six months of daily combination therapy.

The U.S. Food and Drug Administration (FDA) now advises health care professionals to prescribe postmenopausal hormone therapies at the lowest possible dose and for the shortest possible length of time to achieve treatment goals. This recommendation was made after findings from major studies of postmenopausal women conducted as part of the landmark federal Women's Health Initiative (WHI), were released in July 2002 and March 2004.

Among these findings:

* HT given to older (average age of 63) women, does not help women with heart disease and may even worsen their condition and estrogen alone therapy does not affect (either increase or decrease) heart disease. A more recent study found that even estrogen plus progestin had no significant effect on heart disease risk.

* estrogen-only therapy appears to increase stroke risk, but decrease the risk of hip fracture. However, the increased risk of stroke with estrogen-alone therapy was found to outweigh any potential health benefits in the population of older asymptomatic women studied.

* there is a small but statistically significant increase in the risk of invasive breast cancer with HT. In the study, there were 38 women in the HT group and 30 women in the placebo group who were diagnosed with invasive breast cancer, an increase of 26 percent Although this difference seems small, it translates into one new case of breast cancer for every 1,250 women on HT. From a population of millions of women on HT, this is significant when viewed from a public health perspective.

* the WHI trial concluded in 2002 revealed that while estrogen and progestin are effective for short-term relief from hot flashes and night sweats, they have no significant impact on general health, or quality of life factors, such as energy, mental health, symptoms of depression, or sexual satisfaction in the group of women tested who were an average age of 62, with no menopausal symptoms.

* findings from a memory sub-study of the WHI, using only women 65 and older who enrolled in the study and were then started on HT, indicated that in these older women a higher risk of developing dementia, including Alzheimer's disease was found.

Perimenopausal women who take menopausal hormone therapy should be aware that the doses of estrogen and progestin taken for menopausal symptoms are not adequate to provide protection against an unwanted pregnancy. A woman who is still fertile must use oral contraceptives containing higher levels of hormones or nonhormonal birth control methods.

Non-Contraceptive Progestin-Only Products At-A-Glance:

* hydroxyprogesterone (injected); marketed under the names Gesterol LA 250, Hy/Gestrone, Hylutin, Prodrox and Pro-Span; prescribed for abnormal uterine bleeding, amenorrhea and readying the uterus for menstruation

* medroxyprogesterone (tablets and injection); marketed under the names Amen, Curretab, Depo-Provera (injection) and Provera; tablets prescribed for abnormal uterine bleeding, amenorrhea; readying the uterus for menstruation, and as part of menopausal hormone replacement therapy with estrogen; injection prescribed for kidney or uterine cancer

* megestrol (liquid and tablets, Megace); liquid prescribed for appetite or weight loss related to AIDS; tablets prescribed for breast or uterine cancer, or appetite or weight loss related to cancer

* norethindrone (tablets), marketed as Aygestin; prescribed for abnormal uterine bleeding, amenorrhea or endometriosis

Progesterone products

* Micronized oral progesterone (Prometrium 100 mg or 200 mg taken daily or cyclically)

* Progesterone vaginal cream-(Prochieve 4 percent and 8 percent applied vaginally every other day for six doses.

Progestin-Only Contraceptive Products At-A-Glance

* levonorgestrel (tablets and implants); marketed as Plan B (tablets for emergency contraception), and the Mirena Levonorgestrel-releasing Intrauterine System

* medroxyprogesterone (injected); marketed as Depo-Provera Contraceptive Injection

* norethindrone (tablets); marketed as Micronor and Nor-QD

* norgestrel (tablets), marketed as Ovrette

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Editorial Staff of the National Women's Health Resource Center 2002/02/20 2005/03/16 Progesterone is one of the vital hormones in our bodies that stimulate and regulate various functions. It is a female hormone that acts with estrogen to maintain reproductive organ functioning. Endometrium,Estrogen,Hormones,Menopausal hormone therapy,Menopause,Perimenopause,Premenstrual syndrome,Progesterone
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Date:Mar 16, 2005
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