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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 Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Progestins are a group of chemically related hormones with similar actions. Progesterone is the only natural progestin and is not well absorbed by the oral route unless given in micronized form. Synthetic progestins structurally related to progesterone are more commonly used. Low-dose progestins are used for contraception with an estrogen, and are used in the therapy of menstrual disorders at higher doses. In the 1960s and 1970s much higher doses of progesterones were used for oral contraception (Schardein, 2000), and are currently used to treat threatened abortion.
Fetal programming
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Katherine E. Pelch, Jana L. Allison, Susan C. Nagel
Progestin is a component of oral contraceptive pills (OCP) and limited exposure during the periconceptual period occurs with failure of oral contraception. Continued use of OCPs until detection of pregnancy occurs in 2% to 5% of pregnancies and can expose fetuses to exogenous hormones during critical windows of fetal development (42). In addition, emergency contraception exposes fetuses to even higher doses of exogenous hormones and is not 100% effective at preventing implantation. Prior to the advent of modern pregnancy tests that detect human chorionic gonadotropin in urine, the major indication for progestins in pregnancy occurred from progestin administration for 3 to 5 days to induce withdrawal menstruation. Today, the major indications for progestin therapy are to prevent preterm birth and treat recurrent pregnancy loss. Progestin supplementation is also utilized in assisted reproduction protocols to promote endometrial development favorable for implantation of a transferred embryo.
Hormonal and natural contraceptives: a review on efficacy and risks of different methods for an informed choice
Published in Gynecological Endocrinology, 2023
Andrea R. Genazzani, Tiziana Fidecicchi, Domenico Arduini, Andrea Giannini, Tommaso Simoncini
Progestins are classified in categories according to their structural origins. They have been divided in generations according to the time of first synthesis. Among those used in the field of HC, pregnanes (17-hydroxyprogesterone derivatives and 19-norprogesterone derivatives, i.e. chlormadinone acetate) and estranes (testosterone derivatives, i.e. norethindrone, norethynodrel, norethindrone acetate, and ethynodiol diacetate) are considered first generation progestins. Only few of these are still used in HC due to their androgenic properties that cause bothersome side effects, as oily skin, acne, and reduced levels of high density lipoproteins (HDL) [30]. Second-generation progestins are called gonanes and derive from testosterone. This includes some of the most widely used progestins, such as levonorgestrel. Third generation include desogestrel, gestodene, norgestimate/norelgestromin, and etonogestrel. These molecules progressively lose the androgenic activity, acquiring a non-androgenic or an antiandrogenic effect. The newest progestins are the fourth-generation ones, that include nonethylated estranes (i.e. dienogest and drospirenone, a spironolactone derivative) and 19-norprogesterones-derivatives pregnanes (i.e. nomegestrol acetate) [29–31].
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.
Menopausal hormone therapy: what are the problems in the perception of Chinese physicians?
Published in Climacteric, 2022
Y. Deng, W. Wang, Q. Zheng, Y. Feng, Y. Zou, H. Dong, Z. Tan, X. Zeng, Y. Zhao, D. Peng, X. Yang, A. Sun
However, most of the respondents thought that MHT could increase the risk of endometrial cancer, and more than one-third of the respondents thought that MHT could cause weight gain. For women with an intact uterus, unopposed systemic estrogen therapy increased the risk of endometrial cancer, but combined estrogen–progestin therapy did not increase the risk of endometrial cancer [20]. Neither unopposed systemic estrogen therapy nor combined estrogen–progestin therapy can cause extra weight gain in perimenopausal and postmenopausal women [21]. Similarly, a survey conducted 6 years ago in China reported that nearly 40% of gynecological endocrinologists and 54% of non-gynecological endocrinologists mistakenly believed that combined MHT could increase the risk of endometrial cancer [10]. Although many menopause management training programs for physicians have been performed during the past few years, the misunderstanding that MHT could increase the risk of endometrial cancer have not yet been corrected. Therefore, more in-depth and problem-targeted educational programs about MHT for physicians are urgently needed.