Progesterone

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PROGESTERONE (Fertility/PMS/Menopause)

Progesterone is an essential hormone that helps regulate female menstrual cycles and impacts fertility. By a women’s late 20s or 30s, progesterone levels often significantly drop. It could be from taking birth control pills (which suppresses progesterone production) or from stress. Adrenal glands produce progesterone, and dealing with stress diverts the body away from this production. Progesterone is an essential hormone that assists in holding the pregnancy. If Progesterone levels drop, either infertility or miscarriage can occur. Low levels of progesterone also contribute to menopausal symptoms

For a good article introducing Progesterone benefits and uses by women, read Dr. Pingels article published in December 2010 by clicking here.

(the following excerpt is from Progesteronefaqs.com)

Progesterone is naturally secreted by the ovary in the second two weeks of themenstrual cycle. Progesterone has been used also as therapy for PMS syndrome and for women with infertility or frequent pregnancy loss.Progesterone is made in the ovaries of menstruating women and by the placenta during pregnancy. About 20-25 mg of progesterone are produced per day during a woman’s monthly cycle and up to 300-400 mg are produced daily during pregnancy. Progesterone is a precursor to most steroid hormones and performs a myriad of different functions.

Is there a difference between progesterone and progestogens or progestins (synthetic progesterone)?

Progesterone has the identical chemical structure to the substance made in a woman’s body by the ovarian corpus luteum (gland formed after an egg is ovulated each month). Actually the progesterone is now synthetically made but it behaves as best we know, just like the body’s natural progesterone once it is absorbed into the blood stream. This is to be distinguished from synthetic progesterone-like chemicals called progestogens which bind to the body’s progesterone receptors and function for the most part, just like progesterone. Because they are chemically different than natural progesterone, they often have side effects or actions that are different than progesterone.

Progestogens were originally developed because they were capable of being absorbed into the blood when ingested in pill form, whereas progesterone itself was not orally absorbed. Recently, however, it has been found that micronization of progesterone (making very tiny crystals of the progesterone) enhances absorption from the gastrointestinal tract. Thus, micronized progesterone is now sometimes being used for menopausal hormone replacement therapy instead of progestogens. Birth control pills still have progestogens as the active progesterone-like component.

Natural progesterone does not seem to suppress good cholesterol (HDL), has no effect on blood pressure or mood, and shows less of a tendency to cause increased male-hormone-like effects such as facial hair growth. This is in contrast to some of the progestogens such as medroxyprogesterone acetate (Provera®, Cycrin®).  Each synthetic progestogen may have a somewhat different side-effect profile so it is not easy to generalize.

Is it better to take progesterone as a pill, a shot, a vaginal suppository or a cream?

All of the above forms of progesterone and progestogens have been used. The method of administration is best determined by availability, convenience of use and price. Absorption and duration of action will vary by the form of progesterone used:

• pills – peak absorption is about 1-4 hours and is cleared by 24 hours. Taking the pills with food enhances absorption.
• shots – usually given in the form of progesterone in oil, doses peak at about 12 hours after administration and take at least 48 hours or more to clear. There are depot forms of medroxyprogesterone acetate (Depo-Provera®) that last at least 12 weeks which gives it its contraceptive effect.
• vaginal suppositories, cream – absorbed to peak in 4 hours and cleared by 24 hours. Sometimes mixed in cocoa butter or propylene glycol as the carrying agent. A cream is also commercially available (Crinone®).
• skin creams – Progesterone Cream has the identical chemical structure to the substance made in a woman’s body by the ovarian corpus luteum (gland formed after an egg is ovulated each month). Natural Progesterone Cream is now made in a lab from plants and it behaves as best we know, just like the body’s natural progesterone once it is absorbed into the blood stream. Well absorbing creams, without petroleum jelly, should be applied twice daily. This method of supplementing progesterone has become the most widely used method of avoiding synthetic, dangerous hrt drugs by women in spite of their doctor’s objections.

What are the effects of too little or too much progesterone?

Progesterone acts to stabilize the tissue lining of the uterus (endometrium). If it is absent or low, irregular and heavy menstrual bleeding often occurs after a period without any menstrual bleeding. Thus progesterone is used to prevent this irregularity of bleeding when it is given continuously. If, on the other hand, a onetime bolus of progesterone is given such as with a shot or with only 5 days of oral pills, then the falling progesterone levels will actually cause an estrogen-primed endometrium to slough and therefore start a menses.

Too much progesterone often causes tiredness and even sedation. This side effect can be beneficial in a women who has epilepsy or even uterine irritability causing preterm labor because progesterone in high doses can decrease seizure activity and uterine contractions.

Progesterone tends to promote vaginal dryness by counteracting the effect on lubrication of estrogens. It can also decrease the amount of menstruation or block it entirely by reversing estrogen effect on the growth of the uterine lining. If a woman has stopped having menses on a birth control pill, the progestogen component needs to be decreased if menstrual bleeding is desirable.

Does progesterone block or lessen the beneficial effect of estrogen on heart disease and osteoporosis prevention?

The effect of various estrogen and progestogen/progesterone combinations have been looked at extensively in the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial, Writing Group for the PEPI Trial: Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the postmenopausal estrogen/progestin interventions (PEPI) trial. JAMA 1995;273:199-208. . Some of the following generalizations can be drawn:

high density lipoproteins – basically progestogens such as Provera® lessen some of the estrogen effect of raising HDL (good cholesterol) but in combination with estrogen, the net effect is still to raise HDL a small amount. Natural progesterone does not blunt this response and when used with estrogen, HDLs rise more than when Prover® is used.

• low density lipoproteins – all of the hormone regimen combinations lowered the bad cholesterol (LDL)
• blood pressure – there were no effects of estrogen alone or any of the combinations with progestogens or progesterone on either systolic or diastolic blood pressure.
• weight and abdominal girth – interestingly, all women, even those who had no estrogen or progesterone, gained weight and increased abdominal girth during this menopausal study. The women who took any hormonal therapy gained LESS weight and had LESS increase in abdominal girth.
• Blood sugar – all hormonal regimens resulted in a lower fasting blood sugar. However,the estrogen with medroxyprogesterone acetate (Provera®) raised the 2-hour post glucose blood sugar implying that the progestogen may worsen a diabetic tendency.

Does progesterone cause mood changes?

The brain has both estrogen and progesterone receptors. In women who have epilepsy, seizures are known to occur more frequently during times of high estrogen (late follicular phase and ovulation) and they are decreased when progesterone is high. In this sense, progesterone acts a a brain anesthetic to some degree. High doses of progesterone can be very sedating.

Women who have depression, have lower brain levels of serotonin, thus the success of medications that block the body’s degradation of serotonin and allow brain levels to remain higher. Estrogens are known to block one of the enzymes (monoamine oxidase – MAO) which degrades serotonin with the result of elevating mood.Progestogens, probably more so than natural progesterone, increase MAO concentration thus producing depression and irritability.

Pure progestogen treatment without estrogen, such as DepoProvera® is know to worsen depression in women who already have a tendency toward or clinical signs of depression. The combination of estrogen plus progestogens such as used in birth control pills and menopausal hormonal replacement therapy does not tend to worsen mood because the compounds are neutralizing each other. There are some women who are more sensitive to certain hormones so their doses may need to be adjusted.