Overview
"Progestin" is a general term for a substance that causes some or all of the biologic effects of progesterone. The term "progestin" is sometimes used to refer to the progesterone made in the laboratory that is in oral contraceptives and hormone replacement therapy. However, all progesterone and progestin products are made in the laboratory. The term "natural progesterone" is really a misnomer. "Natural progesterones," including the prescription products Crinone and Prometrium, are made from a chemical called diosgenin that is isolated from wild yam or soy. In the laboratory, diosgenin is converted to progesterone. The human body is not able to make progesterone from diosgenin, so eating wild yam or soy will not boost your progesterone levels.
Over-the-counter (OTC) progesterone products may not contain progesterone concentrations as labeled. Also, topical progesterone products (preparations applied to the skin) marketed as cosmetics require no FDA approval prior to marketing. There is currently no limit on the amount of progesterone allowed in cosmetic products. In 1993 the FDA proposed a rule to limit the amount of progesterone in these products, but this rule was never finalized.
Patients commonly take progesterone to help restart menstrual periods that unexpectedly stopped (amenorrhea), treat abnormal uterine bleeding associated with hormonal imbalance, and treat severe symptoms of premenstrual syndrome (PMS). Progesterone is also used in combination with the hormone estrogen to "oppose estrogen" as part of hormone replacement therapy. If estrogen is given without progesterone, estrogen increases the risk of uterine cancer.
Progesterone is also used for a variety of other conditions not listed above, but there is no good scientific evidence to support these uses.
How does it work ?
Lab-made progesterone is used to imitate the functions of the progesterone released by the ovaries.
Uses & Effectiveness ?
Likely Effective for
- Absence of menstrual periods (amenorrhea). Taking progesterone by mouth and applying progesterone gel into the vagina are effective strategies for treating absence of menstrual periods in premenopausal patients. Micronized progesterone is FDA-approved for this use, as is intravaginal progesterone gel (Crinone 4%).
- Hormone replacement therapy (HRT). Micronized progesterone (Prometrium) is FDA-approved for use with estrogen as a component of HRT. Research shows that adding progesterone to HRT protects against side effects of estrogen.
- Inability to become pregnant within a year of trying to conceive (infertility). Intravaginal progesterone gel (Crinone 8%) is FDA-approved for use as a part of infertility treatment in patients. Some research suggests that applying progesterone intravaginally and injecting it into the muscle may have similar effectiveness for increasing pregnancy rates as giving it by mouth. Also, research suggests that intravaginal progesterone seems to be as effective for pregnancy rates as human chorionic gonadotropin (HCG).
Possibly Effective for
- Abnormal thickening of the lining of the uterus (endometrial hyperplasia). Some research suggests that applying progesterone (Crinone) into the vagina prevents endometrial hyperplasia in patients with an intact uterus that are taking estrogen replacement therapy. Other early research shows that a specific intravaginal progesterone cream may help reverse abnormal thickening of the endometrium and decrease vaginal bleeding in premenopausal patients with non-cancerous endometrial hyperplasia.
- Breast pain (mastalgia). Some research suggests that applying progesterone (Crinone) into the vagina seems to reduce breast pain and tenderness in females with non-cancerous breast disease.
- Symptoms of menopause. Some research suggests that applying a specific progesterone cream (Progest) to the skin reduces symptoms such as hot flashes in menopausal patients.
- Preterm birth. Most research suggests that applying progesterone gel or inserts into the vagina, alone or along with therapy to delay labor (tocolytic therapy), reduces the risk of premature birth in some patients at high risk of premature birth. However, other research suggests that applying progesterone gel into the vagina does not decrease premature birth rates in patients with a history of premature birth. The effect of progesterone on premature birth in patients with twin pregnancies is not clear.
Possibly Ineffective for
- A skin condition that mainly affects the genital and anal areas (lichen sclerosus). Applying progesterone into the vagina does not seem to improve symptoms of vulval lichen sclerosus. In fact, progesterone seems to be less effective than clobetasol (Temovate) for treating this condition.
- Miscarriage. Most research shows that applying progesterone into the vagina does not reduce the risk of having a miscarriage in patients who are bleeding during pregnancy or with a history of miscarriages in the past. Also, injecting progesterone and another steroid hormone into the muscle after undergoing a test used to diagnose birth defects (called an amniocentesis) does not seem to reduce the risk of miscarriage or preterm delivery. However, some early research suggests that taking progesterone by mouth might reduce the risk of miscarriage in patients who are bleeding during pregnancy.
- Premenstrual syndrome (PMS). Although some clinical research suggests that applying progesterone into the vagina or the rectum before menstruation reduces symptoms of PMS, most evidence shows that giving progesterone by mouth or rectally does not reduce PMS symptoms.
Side Effects
When applied to the skin: The progesterone prescription products that have been approved by the Food and Drug Administration (FDA) are LIKELY SAFE for most people when applied to the skin with the advice and care of a healthcare professional.
When given as a shot: The progesterone prescription products that have been approved by the Food and Drug Administration (FDA) are LIKELY SAFE for most people when injected into the muscle with the advice and care of a healthcare professional.
When applied into the vagina: The progesterone prescription products that have been approved by the Food and Drug Administration (FDA) are LIKELY SAFE for most people when applied into the vagina with the advice and care of a healthcare professional.
However, progesterone can cause many side effects including stomach upset, changes in appetite, weight gain, fluid retention and swelling (edema), fatigue, acne, drowsiness or insomnia, allergic skin rashes, hives, fever, headache, depression, breast discomfort or enlargement, premenstrual syndrome (PMS)-like symptoms, altered menstrual cycles, irregular bleeding, and other side effects.
Special Precautions and Warnings
There isn't enough reliable information to know if progesterone is safe to use when breast-feeding. Stay on the safe side and avoid use.
Arterial disease: Don't use progesterone if you have arterial disease.
Breast cancer: Avoid use unless you are directed to do so by your healthcare provider.
Depression: Get your healthcare provider's advice first before using progesterone if you have major depression now or a history of major depression.
Liver disease: Progesterone might make liver disease worse. Don't use it.
Porphyria: Progesterone might cause an attack of porphyria. Don't use it.
Vaginal bleeding: If you have undiagnosed vaginal bleeding, don't use progesterone.
Interactions ?
Estrogens interacts with PROGESTERONE
Progesterone and estrogen are both hormones. They are often taken together. Progesterone can decrease some of the side effects of estrogen. But progesterone might also decrease the beneficial effects of estrogen. Taking progesterone along with estrogen might cause breast tenderness.
Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.Paclitaxel (Abraxane, Onxol) interacts with PROGESTERONE
Injecting high-doses of progesterone intravenously (by IV) in combination with the drug paclitaxel might increase levels of paclitaxel in the blood. However, the combination does not seem to increase the side effects of paclitaxel. Until more is known, use progesterone cautiously or avoid using in patients being treated with paclitaxel.
Moderate Interaction
Be cautious with this combination
Dosing
BY MOUTH:
- For hormone replacement therapy (HRT): 200 mg micronized progesterone (Prometrium) per day is typically taken for 12 days of a 25-day cycle with 0.625 mg conjugated estrogens.
- For inability to become pregnant within a year of trying to conceive (infertility): 300 mg micronized progesterone per day is usually taken for about 30 days after the embryo has been placed in the uterus.
- For preventing preterm birth: 100 mg micronized progesterone twice daily starting at week 20 of pregnancy has been used.
- For symptoms of menopause: 20 mg progesterone cream (equivalent to 1/4 teaspoon Progest cream) is typically applied daily to rotating places on the body including upper arms, thighs, or breasts.
- For breast pain (mastalgia): a typical dose of 4 grams of vaginal cream containing 2.5% natural progesterone is placed inside the vagina from the 19th to the 25th day of a 28-day cycle.
- For absence of menstrual periods (amenorrhea): one applicator (90 mg) of progesterone gel (Crinone 4% or 8%) is typically placed inside the vagina every other day for 6 days per month.
- For reducing abnormal thickening of the lining of the uterus (endometrial hyperplasia): a dose of 90 mg (Crinone 8%) or 100 mg progesterone cream placed inside the vagina daily from day 10 to day 25 or on days 17, 19, 21, 23, 25, and 27 of a 28-day cycle has been used.
- For inability to become pregnant within a year of trying to conceive (infertility): 90 mg progesterone (Crinone 8%) or 100-600 mg of other types of progesterone have been placed inside the vagina every day for about 2 weeks after the embryo has been placed in the uterus.
- For preventing premature labor: 90-400 mg progesterone in the form of gel or an insert has been placed in the vagina every day starting at about 18-22 weeks of pregnancy.
- For inability to become pregnant within a year of trying to conceive (infertility): 50-100 mg progesterone each day with in vitro fertilization has been used.
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