Progestogen use and breast cancer
Barry G. Wren in Progress in the Management of the Menopause, 2020
Although many epidemiological studies have been conducted to assess the relationship between ERT and breast-cancer risk, only a few of them specifically address the role of the progestins. This relates to the rather recent coprescription of progestins with estrogens for menopausal therapy, especially in the United States where most of the large epidemiological surveys were conducted. Also, one must bear in mind that the progestins prescribed for hormone replacement therapy (HRT) differ from country to country, and their effects also differ according to the category to which they belong. In the United States, most of the prescriptions of progestins relate to medroxyprogesterone acetate (MPA), while in Europe derivatives of progesterone are preferred for HRT, such as micronized progesterone (MP), dydrogesterone (DDG), chlormadinone acetate (CIA) derived from 170H-progesterone, or nomegestrol acetate (NOM Ac) derived from 19-norprogesterone.
Reproductive System and Mammary Gland
Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard in Toxicologic Pathology, 2018
Diffuse cystic endometrial hyperplasia, with or without mucometra, is a common observation in dogs related to repeated progestogenic stimulation that can be exacerbated by a previous estrogenic influence. Administration of progestogenic or combined estrogenic + progestogenic oral contraceptives, progestin estrus inhibitors (e.g., medroxyprogesterone acetate, megestrol acetate, or chlormadinone acetate), or other agents resulting in prolonged increases in serum progesterone, invariably induces cystic endometrial hyperplasia in the dog (El Etreby 1979; Johnson 1989; Murakoshi et al. 2000; Sahara et al. 1994; Sokolowski and Zimbelman 1973; Von Berky and Townsend 1993).
Drugs in Pregnancy and Lactation
A. S. Curry, J. V. Hewitt in Biochemistry of Women: Clinical Concepts, 1974
A variety of methods of oral contraception are now available which may be categorized as follows: (1) the combination estrogen-progestogen pill; (2) the sequential method, using estrogen (day 5 to 25) to inhibit ovulation and progestogen (the last 5 days) to initiate shedding of the endometrium with normal menstruation; and (3) low-dosage progestogen administered continuously. These various methods employ the synthetic steroids mestranol or ethynylestradiol as estrogens and chlormadinone acetate, medroxyprogesterone acetate, norethisterone, or norethynodrel, etc. as progestogens (see Figure 3).
Current and emerging drug treatment strategies for polycystic ovary syndrome
Published in Expert Opinion on Pharmacotherapy, 2023
Nafiye Helvaci, Bulent Okan Yildiz
The most widely prescribed COCs contain 20 to 35 µg ethinyl estradiol (EE) and a neutral (desogestrel, gestodene or norgestimate) or antiandrogenic (cyproterone acetate, drospirenone, dienogest, trimegestone, nestorone, chlormadinone acetate) progestin, as they have less metabolic side effects and may be more effective in alleviation of hyperandrogenic symptoms [11]. Although different combinations of COCs are equally effective in the regulation of menstrual cycles [4], their effects on androgen levels and hirsutism are variably reported [4]. A systematic review and meta-analysis of 35 randomized or non-randomized studies comparing the effects of COCs on the clinical and biochemical parameters of hyperandrogenism in women with PCOS revealed that the type of progestin had no important effect on declining androgen levels, but use of COCs containing cyproterone acetate for 12 months had the greatest effect in improving hirsutism (mean difference [MD] −7.96, 95% confidence interval [CI] −8.65 to −7.27); however, there was a significant between-study heterogeneity [12].
Primary choice of estrogen and progestogen as components for HRT: a clinical pharmacological view
Published in Climacteric, 2022
X. Ruan, A. O. Mueck
In our recommendations (Table 6) we have considered the different tolerability of the various progestogens. For example, progesterone and its derivatives present a mostly higher tolerability and are mostly neutral in their metabolic and vascular effects (higher doses are possible to ensure endometrial safety) in contrast to norethisterone and its derivatives, and also considering the lower endometrial efficacy especially of progesterone with the consequence that higher doses are possible, even though this is certainly not needed in all patients. Especially high dosages of progesterone have been used in reproductive medicine (e.g. 800 mg/day) without a high frequency of side effects (with the exception of bloating due to mineralocorticoid metabolites), the strong sedative effect not being a disadvantage for HRT (if applied during evening). For the progestogen challenge test, in earlier years we often used oral NETA (1–2 mg/day) due to its strong endometrial efficacy, but in our countries this is no longer available. Alternatively, chlormadinone acetate (4–6 mg/day), dienogest (2–4 mg/day) or dydrogesterone (10 mg/day) can be recommended. For this test we would not like to recommend progesterone.
Effects of progestin-only contraceptives on the endometrium
Published in Expert Review of Clinical Pharmacology, 2020
Carlo Bastianelli, Manuela Farris, Vincenzina Bruni, Elena Rosato, Ivo Brosens, Giuseppe Benagiano
In 1967, Martinez-Manautou et al. [37] presented their first experience with what became known as the ‘Minipill’ (or progestin-only pill, POP), a new method aimed at producing a local antifertility effect by modifying both the endometrium and the cervical mucus, without suppressing the hypothalamic-pituitary-ovarian axis. They used daily 0.5 mg chlormadinone acetate (CMA), first from day 5 to 25, and later without interruption, with encouraging results. In a further report, Martinez-Manautou [38] summarized information, based on 1070 biopsies, on the endometrial effects of the new method; a secretory endometrium was observed in 67.4 and 79.7% of all samples, depending on timing. This suggested no major interference with glandular development.
Related Knowledge Centers
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- Progestogen
- Hormone Replacement Therapy
- Gynaecology
- Androgen-Dependent Condition