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Postmenopause
Published in Carolyn Torkelson, Catherine Marienau, Beyond Menopause, 2023
Carolyn Torkelson, Catherine Marienau
Many FDA-approved bioidentical hormones are on the market. For example, estradiol (E2) is preferred by many practitioners as a first-choice bioidentical estrogen. The addition of progesterone to estrogen therapy is needed if a woman has a uterus to prevent uterine cancer. Progesterone in the form of micronized progesterone (Prometrium) is a commercially available, FDA-approved, bioidentical product. Progestins and progestogens are synthetic progesterone.
Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
MPA is well absorbed orally, with blood levels peaking after 2–4 hours and a half-life of 12–17 hours. It can also be administered in a depot form (i.e., Depo-ProveraTM) by deep intramuscular injection (normally into the gluteal muscle) which provides a half-life of 40–50 days. As with most progestogens, side effects include GI disturbances (e.g., nausea), cardiovascular abnormalities (e.g., hypertension, palpitation, congestive heart failure), depression, fluid retention, breast and menstrual cycle irregularities in women, alopecia, sexual dysfunction, skin reactions, and weight changes. In addition to these general adverse effects, the glucocorticoid effects associated with MPA can lead to Cushingoid syndrome at higher doses. Also, rarely, vision disorders such as retinal thrombosis can occur, in which case treatment should be immediately discontinued. Medroxyprogesterone acetate should be avoided during conception or pregnancy, as genital malformations in the fetus may occur.
Neuroendocrinology of the climacteric period and hormonal replacement therapy
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
A. R. Genazzani, M. Stomati, A. Spinetti, M. M. Greco, A. D. Genazzani, F. Petraglia
Regarding psychological disturbances, HRT and in particular estrogen replacement therapy, positively influences depressive symptomatology, pain perception and affective and sexual behavior. Regarding the effect of progestogens, different doses, routes of administration and types of compound influence their different actions.
A focused report on progestogen hypersensitivity
Published in Expert Review of Clinical Immunology, 2023
Diti H. Patel, Lauren M. Fine, Jonathan A. Bernstein
Progesterone, the main progestogen in the human body, is a steroid hormone derived from cholesterol, and is uniquely composed of 21-carbon atoms. The term ‘progestogen’ refers to any natural or synthetic form of progesterone. The term ‘progestin’ is specific for synthetic progestogens. Progesterone has a spectrum of metabolic and physiologic roles on various organ systems, especially within the reproductive system. It is produced by granulosa cells in the corpus luteum, and one of its primary responsibilities is the maintenance of the endometrial thickness prior to menses. The increase in progesterone during the menstrual cycle occurs due to a luteal hormone (LH) surge, marking the beginning of the luteal phase. When pregnancy occurs, the placenta becomes the primary source of progesterone at around 10 weeks gestation. Progesterone plays a vital role in maintaining the uterus during pregnancy by decreasing the myometrial tone, increasing spiral artery development, and inhibiting prolactin release. Aside from its responsibilities in the reproductive system, progesterone acts on the hypothalamus to increase body temperature and help regulate the immune system. This latter function occurs through the production of inflammatory cytokines by T lymphocytes [4,5] as well as binding to progesterone receptors on mast cells [6]. However, it is still unclear if and how the impact of progesterone on the immune system in normal biology may contribute to the development of hypersensitivity response to progesterone.
The impact of micronized progesterone on cardiovascular events – a systematic review
Published in Climacteric, 2022
L. M. Kaemmle, A. Stadler, H. Janka, M. von Wolff, P. Stute
In symptomatic menopausal women with an intact uterus, current international guidelines recommend combined estrogen–progestogen therapy to ensure endometrial safety [5–7]. Therefore, the question arises of whether the type of progestogen also has an impact on vascular events. Progestogens can be either synthetic (progestins) or biologically identical (micronized progesterone [MP]). MP is available either, for example, as a US Food and Drug Administration (FDA)/European Medicines Agency (EMA)-approved drug or as a customized treatment by compounding pharmacies. Internationally, MP is available at different dosages and routes of application. Also, indication and approval by regulatory authorities may differ from country to country. In Europe, systemic MP is available as a capsule (100 mg, 200 mg) for vaginal or oral application, or as a vaginal gel (8% corresponding to 90 mg MP).
Endometriosis-associated cancer
Published in Climacteric, 2021
Medical management may best be reserved for cases of recurrence of disease after surgery or if surgery is contraindicated. Progestogen administration is the most common medical strategy. Several oral progestogens and the levonorgestrel intrauterine system have been proposed. Aromatase inhibitors have also been proposed because they are likely to decrease production of extra-ovarian and intralesional estrogen. Aromatase inhibitors appear to be effective in reducing pain and the size of lesions, but they can result in menopausal-like adverse effects such as hot flushes, vaginal dryness and decreased bone mineral density. Low-dose estrogen add-back therapy could be an option [42–44]. Management strategies may well have to be tailored according to the age of the patient, where conservative fertility-sparing strategies can be considered in the younger woman whose family is still not complete, but more radical and definitive surgical strategies may have to be considered in the perimenopausal and menopausal/postmenopausal woman. At the time of surgical diagnosis and treatment, consideration for complete resection of pelvic endometriosis, salpingectomy, oophorectomy or hysterectomy should be individualized based on a patient’s age, desire for future fertility and preoperative consultation with the patient. These initiatives, if validated, should substantially reduce the risk of ovarian cancer. As new research becomes available, the recommendations may be refined in terms of both screening and prevention.