Progesterone

Progesterone is a hormone that occurs naturally in the body.

Updated: July 31, 2019

Progesterone is a hormone that occurs naturally in the body. But it can also be made in a laboratory which is refer as progestin. Progesterone, also referred to as 'the pregnancy hormone,' is a common female hormone found naturally in a woman’s body. It also plays an essential role for both before and during a pregnancy. Progesterone helps to regulate your cycle. But its main job is to get your uterus ready for pregnancy. After you ovulate each month, progesterone helps thicken the lining of the uterus to prepare for a fertilized egg. If there is no fertilized egg, progesterone levels drop and menstruation begins. If a fertilized egg implants in the uterine wall, progesterone helps maintain the uterine lining throughout pregnancy.
Progesterone is a hormone released by the ovaries. When progesterone levels are changed, it can contribute to abnormal menstrual periods and menopausal symptoms. Progesterone is also necessary for implantation of the fertilized egg in the uterus and for maintaining pregnancy. Men produce a small amount of progesterone to help in sperm development.
Progestrone supplements or lab-made progesterone is used to regulate the functions of the progesterone released by the ovaries. It is used in in oral contraceptives and hormone replacement therapy. All progesterone and progestin products are made in the laboratory. "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, wild yam or soy is converted to pregnenolone and then to progesterone. As the human body is not able to make progesterone from diosgenin, eating wild yam or soy will not boost your progesterone levels.
Progesterone as a prescribed hormone supplementation is often necessary during Assisted Reproductive Technology (ART) procedures, such as in-vitro fertilization (IVF). This is because the medications you may use during these procedures can suppress your body's ability to produce progesterone. Certain procedures can even, unintentionally, remove progesterone-producing cells from your ovaries. Sometimes, there are other reasons to use progesterone supplementation, such as little or no progesterone production from the ovaries or poorly developed follicles that do not secrete enough progesterone to develop the uterine lining.
Over-the-counter (OTC) progesterone products may not contain progesterone concentrations as labeled. Topical progesterone products (preparations applied to the skin) marketed as cosmetics require no FDA approval prior to marketing and there is currently no limit on the amount of progesterone allowed in cosmetic products.
Progesterone is used to help restart menstrual periods that unexpectedly stopped, 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 cream is sometimes used in hormone replacement therapy and for treating menopausal symptoms such as hot flashes. Progesterone gel is sometimes used inside the vagina to treat breast pain in women with noncancerous breast disease, prevent and treat abnormal thickening of the lining of the uterus (endometrial hyperplasia), and prevent premature labor. Progesterone is also used intravaginally or by injection for treating infertility and symptoms of (PMS).

Low Progesterone Level and Its Concern:

Progesterone is important during childbearing years as it works with testosterone, the precursor for adrenal hormones and complements some effects of estrogen. It is necessary for breast development and breastfeeding. Your progesterone levels should rise when your ovaries releases an egg. Progesterone helps the uterus thicken in anticipation of receiving a fertilized egg. If it is not thick enough, the egg won't implant.
Symptoms of low progesterone in women who aren't pregnant include headaches or migraines, mood changes, including anxiety or depression and irregularity in menstrual cycle.
Low progesterone may cause abnormal uterine bleeding in women who aren't pregnant. Irregular or absent periods may indicate poorly functioning ovaries and low progesterone. If you get pregnant, you still need progesterone to maintain your uterus until your baby is born. Your body will produce this increase in progesterone, which causes some of the symptoms of pregnancy, including breast tenderness and nausea. If your progesterone levels are too low, your uterus may not be able to carry the baby to term. During pregnancy, symptoms of low progesterone include spotting and miscarriage. Low progesterone may indicate ectopic pregnancy. This can result in miscarriage or fetal death.
Estrogen may become the dominant hormone with low progesterone level. This may cause symptoms including weight gain, decreased sex drive, mood swings, and depression, PMS, irregular menstrual cycle, heavy bleeding, breast tenderness, fibrocystic breasts, fibroids and gallbladder problems.

Dietary Supplement:

While foods don't necessarily contain progesterone, some foods may help stimulate the production of progesterone in our body. These include:

  •     beans
  •     broccoli
  •     Brussels sprouts
  •     cabbage
  •     cauliflower
  •     kale
  •     nuts
  •     pumpkin
  •     spinach
  •     whole grains

Some foods are also associated with lowering the amount of estrogen in the body, which could increase the ratio of progesterone to estrogen. These include:

  •     bananas
  •     cabbage
  •     shellfish
  •     walnuts

Incorporating these foods into your diet could help boost natural progesterone levels.

Uses & Effectiveness:

Likely Effective for:

Amenorrhea or Absence of menstrual periods:

Taking progesterone by mouth and applying progesterone gel into the vagina can be effective for treating absence of menstrual periods in premenopausal women. 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. Adding progesterone to HRT protects against side effects of estrogen.

Infertility:

Intravaginal progesterone gel (Crinone 8%) is FDA-approved for use as a part of infertility treatment in women. Applying progesterone intravaginally and injecting it into the muscle may have similar effectiveness for increasing pregnancy rates as giving it by mouth. Also, intravaginal progesterone seems to be as effective for pregnancy rates as human chorionic gonadotropin (HCG).

Possibly Effective for:

Endometrial hyperplasia or Abnormal thickening of the endometrium:

Applying progesterone (Crinone) into the vagina prevents endometrial hyperplasia in women with an intact uterus that are taking estrogen replacement therapy. Also, a specific intravaginal progesterone cream may help reverse abnormal thickening of the endometrium and decrease vaginal bleeding in premenopausal women with non-cancerous endometrial hyperplasia.

Mastodynia or Breast pain:

Applying progesterone (Crinone) into the vagina seems to reduce breast pain and tenderness in women with non-cancerous breast disease.

Menopausal symptoms:

Applying a specific progesterone cream (Progest) to the skin reduces symptoms such as hot flashes in menopausal women.

Premature labor:

Applying progesterone gel into the vagina, alone or along with therapy to delay labor (tocolytic therapy), reduces the risk of premature delivery in some women at high risk of premature birth. However, intravaginal progesterone gel does not decrease the frequency of premature birth in women with a history of premature birth.
Possibly Ineffective for:

Miscarriage:

Applying progesterone into the vagina does not reduce the risk of having a miscarriage during the first trimester in women at high risk for miscarriage. 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.

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.

Vulval lichen sclerosis or Vaginal irritation:

Applying progesterone into the vagina does not seem to improve symptoms of vulval lichen sclerosis. In fact, progesterone seems to be less effective than clobetasol (Temovate) for treating this condition.

Insufficient Evidence for:

Osteoporosis or Preventing bone loss:

Applying progesterone to the skin is not effective for increasing bone mineral density in postmenopausal women. Applying progesterone to the skin for 2 years may be as effective for preventing bone loss as drinking isoflavone-containing soy milk. However, the combination of soy milk plus progesterone seems to result greater bone loss than either single treatment alone.

Withdrawal symptoms from drugs such as diazepam (Valium), alprazolam (Xanax), temazepam (Restoril), and others:

Taking micronized progesterone by mouth may not be effective for relieving symptoms of withdrawal and for helping people to abstain from taking diazepam.

Cocaine dependence:

Taking progesterone by mouth does not decrease the risk of cocaine use in methadone-stabilized male cocaine users.

Postpartum or Depression after childbirth:

Applying progesterone into the rectum does not reduce symptoms of postpartum depression.

Pre-eclampsia or High blood pressure during pregnancy:

Single injections of progesterone reduce blood pressure, swelling, and other symptoms in women with pre-eclampsia.

Heart disease:

Applying progesterone into the vagina may increase exercise endurance compared to taking a similar steroidal drug (medroxyprogesterone) by mouth in women with heart disease or women that previously experienced a heart attack.

Injury due to brain trauma:

Injecting progesterone soon after brain injury prevents death and disability. However, some research suggests that progesterone does not decrease the frequency of death or disability.
More evidence is needed to rate the effectiveness of progesterone for the below uses.   

  •     Treating or preventing allergies affected by hormones.
  •     Bloating.
  •     Decreased sex drive.
  •     Fatigue.
  •     Headaches.
  •     Low blood sugar (hypoglycemia).
  •     Increased blood clotting.
  •     Irritability.
  •     Memory loss.
  •     Thyroid problems.
  •     "Foggy thinking".
  •     Uterine cancer.
  •     Uterine fibroids.
  •     Water retention.
  •     Weight gain.
  •     Other conditions.

Side Effects & Safety:

The progesterone prescription products that have been approved by the Food and Drug Administration (FDA) are likely safe for most people when used by mouth, applied to the skin, applied into vagina, or injected into the muscle with the advice and care of a healthcare professional.
However, progesterone can cause many side effects including stomach upset, changes in appetite, weight gain, breast discomfort or enlargement, premenstrual syndrome (PMS)-like symptoms, altered menstrual cycles, irregular bleeding, fluid retention and swelling (edema), fatigue, acne, drowsiness or insomnia, allergic skin rashes, hives, fever, headache, depression, and other side effects.

Special Precautions & Warnings:

Pregnancy and breast-feeding:

Intravaginal progesterone gel is likely safe when used as part of infertility treatment or to prevent premature birth. However, progesterone is likely unsafe when used during pregnancy for any other purpose. There is not enough reliable information about the safety of taking progesterone if you are 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.

Vaginal bleeding:

If you have undiagnosed vaginal bleeding, don't use progesterone.

Interactions:

Be cautious with the below combination as this can have moderate interaction:

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.

Dosing:

The following doses have been studied in scientific research:

By Mouth:

For hormone replacement therapy:

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 infertility:

300 mg micronized progesterone per day is usually taken for about 30 days after the embryo has been placed in the uterus.

Applied To The Skin:

For hot flashes and other 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.

Inside The Vargina:

For breast pain associated with noncancerous breast disease:

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 restoring menstrual periods in women who have not reached menopause:

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 vaginal bleeding and reversing the thickening of the lining of the uterus in premenopausal women with noncancerous 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 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 has been placed in the vagina every day starting at about 18-22 weeks of pregnancy.

As An Injection:

For infertility:

50-100 mg progesterone each day with in vitro fertilization has been used.


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