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progesterone

Also known as: Progesterone, Progestogen, 4-Pregnene-3,20-dione

Overview

Progesterone is a naturally occurring steroid hormone essential for the menstrual cycle and the maintenance of early pregnancy. Primarily produced by the ovaries, placenta, and adrenal glands, it prepares the uterus for the implantation of a fertilized egg and sustains pregnancy. It is widely used in hormone replacement therapy, contraception, and to support pregnancies, especially in cases of threatened or recurrent miscarriage. Research on progesterone is extensive, with numerous studies assessing its efficacy and safety in various applications. Available evidence, including systematic reviews and meta-analyses, supports its use in preventing preterm birth and aiding pregnancy. Different formulations, such as vaginal and oral forms, are available to suit various clinical needs.

Benefits

Progesterone supplementation is beneficial for several conditions, particularly in women. It has been shown to reduce the risk of preterm birth in high-risk women. Meta-analyses of randomized controlled trials support this finding. Additionally, progesterone may reduce the risk of preeclampsia (PE) and low birth weight (LBW) in pregnancies threatened by miscarriage, with studies indicating a significant reduction in odds ratios for these outcomes. Progesterone is also used to support the luteal phase in assisted reproductive technologies (ART), although its impact on live birth rates can vary. The benefits are most pronounced when supplementation begins early in pregnancy, making it a crucial intervention for women with a history of recurrent miscarriage or those at risk of preterm birth.

How it works

Progesterone primarily acts on the progesterone receptor, a key player in influencing uterine and breast tissue development and function. This interaction is crucial for preparing the uterine lining for embryonic implantation and maintaining a healthy pregnancy. Beyond the reproductive system, progesterone also exerts effects on the nervous and immune systems. Its molecular targets include progesterone receptors located in various tissues throughout the body. The absorption and bioavailability of progesterone vary depending on the formulation used, with vaginal and oral forms being commonly administered for different applications to optimize its effects.

Side effects

Progesterone is generally considered safe when used appropriately, but it can cause side effects. Common side effects, occurring in more than 5% of users, include dizziness, drowsiness, and breast tenderness. Less common side effects (1-5%) involve mood changes and nausea. Rare side effects (less than 1%) may include allergic reactions. Progesterone can interact with certain medications, such as anticoagulants, potentially affecting their efficacy. Contraindications include active liver disease and known or suspected cancer of the breast or reproductive organs. Special caution is advised for patients with a history of depression or thrombophlebitis. Due to potential risks and interactions, progesterone should be used under medical supervision, especially in pregnancy.

Dosage

The minimum effective dose of progesterone varies by application, typically ranging from 100 to 200 mg for luteal phase support. For pregnancy support, doses often range from 100 to 600 mg daily, but the optimal dosage should be guided by clinical need and monitoring. There is no well-defined maximum safe dose, and dosing should align with the specific clinical application, such as early pregnancy support. Vaginal forms are often preferred for luteal phase support due to better bioavailability. Absorption varies by the route of administration. Progesterone use should be guided by healthcare professionals to ensure safety and efficacy.

FAQs

When should progesterone be used during pregnancy?

Progesterone is often prescribed early in pregnancy for women with a history of miscarriage or those at risk of preterm birth. Timing depends on the specific clinical situation and should be determined by a healthcare provider.

What are the common side effects of progesterone?

Common side effects include dizziness, drowsiness, and breast tenderness. Less common side effects may include mood changes and nausea. If side effects are severe or persistent, consult a healthcare provider.

Can progesterone interact with other medications?

Yes, progesterone can interact with certain medications, such as anticoagulants. It's important to inform your healthcare provider of all medications you are taking to avoid potential interactions.

Is progesterone safe for everyone?

Progesterone is generally safe when used appropriately, but it is contraindicated in individuals with active liver disease or known or suspected cancer of the breast or reproductive organs. Consult a healthcare provider before use.

How is progesterone administered?

Progesterone is available in various forms, including oral pills, vaginal suppositories, and injections. The method of administration depends on the specific clinical application and should be determined by a healthcare provider.

Research Sources

https://pubmed.ncbi.nlm.nih.gov/34732210/ – A meta-analysis involving 6439 participants found that early progestogen supplementation may reduce the risk of preeclampsia (OR 0.64, 95% CI 0.42-0.98) and low birth weight (OR 0.57, 95% CI 0.34-0.95). This study suggests that progestogen supplementation in early pregnancy may have significant benefits in reducing adverse pregnancy outcomes.
https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.960393/full – A systematic review examined the efficacy and safety of progesterone for luteal phase support in ART and found no clear relationship between progesterone dose and effect size on live birth rates. This indicates that while progesterone is commonly used for luteal support, the optimal dosage may not directly correlate with improved live birth outcomes.
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/j.0001-6349.2005.00835.x – A meta-analysis of randomized controlled trials showed that progesterone supplementation can reduce the risk of preterm birth in high-risk women. The study highlights the effectiveness of progesterone as a preventive measure against preterm birth in specific populations.