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Sante Publique (Vandoeuvre-les-Nancy,... 2023This article focuses on the hierarchical structure of users of a synthetic progestin, Homodeor and its effects on the construction of a pharmacovigilance plan by a...
This article focuses on the hierarchical structure of users of a synthetic progestin, Homodeor and its effects on the construction of a pharmacovigilance plan by a French health agency, at a time when an institutional desire is being expressed to work more closely with all patient associations. This case study is mainly on a qualitative survey led by interviewing agents, health professionals and user representatives, which aimed to explore the relationships and representations developed around this issue. Despite the diversity of progestin use, a hierarchy between the different user groups was gradually established. The pharmacovigilance measures were designed for a specific group of patients, presented as the ideal users of the drug. The case of Homodeor makes it possible to highlight the dynamics of competition between groups of patients, and more broadly, the challenges of taking minority groups into account in health policies in the light of their development context.
Topics: Humans; Progestins; Health Personnel; Surveys and Questionnaires; Health Facilities; Pharmacovigilance
PubMed: 37336747
DOI: 10.3917/spub.hs2.0049 -
The Journal of Steroid Biochemistry and... Oct 2022Research leading to the discovery and characterization of progesterone (P4) began in the mid 1800 s and followed a path carved by key discoveries in the burgeoning... (Review)
Review
Research leading to the discovery and characterization of progesterone (P4) began in the mid 1800 s and followed a path carved by key discoveries in the burgeoning field of endocrinology. The primary observations leading to the discovery of P4 was that the maternal corpus luteum (CL) is necessary for the establishment and maintenance of pregnancy. Experiments in animal models exploring the consequence of CL ablation and the effects of treatment with CL extract soon followed and formed the basis for the eventual isolation and characterization in 1930 s of the CL hormone, initially referred to as progestin, and subsequently named progesterone. In the following decades research into the physiology, biochemistry and molecular biology of P4 in the context of pregnancy provided fundamental insights into the hormonal control of pregnancy establishment, maintenance and termination. This review highlights the work of pioneering researchers and their seminal discoveries in the research history of P4.
Topics: Animals; Corpus Luteum; Female; Pregnancy; Progesterone; Progestins
PubMed: 35902065
DOI: 10.1016/j.jsbmb.2022.106157 -
Menopause (New York, N.Y.) Apr 2023The menopausal hormone therapy (MHT) association with breast cancer has been controversial for more than 40 years. Most recently, findings from cohort studies have been... (Meta-Analysis)
Meta-Analysis
IMPORTANCE AND OBJECTIVE
The menopausal hormone therapy (MHT) association with breast cancer has been controversial for more than 40 years. Most recently, findings from cohort studies have been discordant compared with those from the Women's Health Initiative (WHI) randomized trials. In cohort studies, both estrogen therapy and estrogen plus progestin were associated with higher breast cancer incidence. In contrast, in the WHI randomized trials, findings for estrogen plus progestin are concordant with cohort study reports, whereas estrogen therapy significantly reduced breast cancer incidence. In addition, concerns have been raised regarding the WHI findings from both trials. In this report, we briefly summarize findings for MHT on breast cancer from cohort studies and the WHI randomized trials. The report focus is addressing, point-by-point, concerns raised regarding the WHI findings.
METHODS
For cohort studies, we relied on the latest findings from (1) the meta-analysis of the Collaborative Group on Hormonal Factors in Breast Cancer and (2) the Million Women's Study. To identify commentaries and editorials, "Menopause" and "Climacteric" were searched from 2002 to present; PubMed and Google Scholar were searched for commentaries, editorials, and breast cancer, MHT, estrogen, conjugated equine estrogen, estradiol, "hormone replacement therapy," and "HRT."
DISCUSSION AND CONCLUSIONS
Thirty commentaries challenging WHI findings were identified. All were reviewed, and issues needing response were identified. Findings from the meta-analysis from the Collaborative Group on Hormonal Factors in Breast Cancer and the Million Women Study were summarized and compared with finding in the two WHI randomized trials evaluating estrogen therapy and estrogen plus progestin. Based on the randomized clinical trials, estrogen therapy, for women with prior hysterectomy, decreases breast cancer incidence and mortality. In contrast, estrogen plus progestin increases breast cancer incidence, which persists through two decades. Women considering estrogen plus progestin use for vasomotor symptoms should understand the breast cancer risk.
Topics: Humans; Female; Progestins; Cohort Studies; Estrogen Replacement Therapy; Randomized Controlled Trials as Topic; Women's Health; Menopause; Estrogens; Neoplasms; Breast Neoplasms
PubMed: 36727752
DOI: 10.1097/GME.0000000000002154 -
Best Practice & Research. Clinical... Nov 2020It is well established that unopposed estrogen, either endogenous or therapeutic, can induce endometrial hyperplasia and potentially endometrial cancer (EC). Anovulatory... (Review)
Review
It is well established that unopposed estrogen, either endogenous or therapeutic, can induce endometrial hyperplasia and potentially endometrial cancer (EC). Anovulatory cycles, obesity, and insulin resistance are major risk factors for EC. Progestogen (progesterone and progestin), including levonorgestrel intrauterine device, are able to prevent or to treat hyperplasia, atypical hyperplasia, and even well-differentiated EC, as presented in this review. During menopausal hormone therapy, progestogens protect the endometrium against the proliferative effects of estrogens in women with a uterus. Whereas, recent epidemiologic data suggest that micronized progesterone (MP) is apparently safer for the breast, it could be less efficient than synthetic progestin on the endometrium. However, several studies from biopsies during treatment with MP do not show any increased risk of hyperplasia. Lack of compliance could explain the results on EC.
Topics: Endometrial Hyperplasia; Endometrial Neoplasms; Endometrium; Estrogen Replacement Therapy; Estrogens; Female; Humans; Progesterone; Progestins
PubMed: 32732107
DOI: 10.1016/j.bpobgyn.2020.05.003 -
Clinical Obstetrics and Gynecology Dec 2015Postpartum contraception is important to lengthening birth intervals and improving the health of women and children. For breastfeeding women the choice and timing of... (Review)
Review
Postpartum contraception is important to lengthening birth intervals and improving the health of women and children. For breastfeeding women the choice and timing of contraception may influence breastfeeding and infant growth patterns. Nonhormonal methods of contraception are the preferred choice for breastfeeding women. Progestin-only methods comprise a viable next option. Combined hormonal methods of contraception containing estrogen and progestin may be considered as a third option for birth control in breastfeeding women. The objective of this chapter is to review the current literature and recommendations for the use of hormonal and nonhormonal methods of contraception while breastfeeding.
Topics: Amenorrhea; Breast Feeding; Contraception; Contraception, Postcoital; Contraceptives, Oral; Drug Implants; Female; Humans; Intrauterine Devices, Medicated; Lactation; Levonorgestrel; Medroxyprogesterone Acetate; Postpartum Period; Progesterone; Progestins; Time Factors
PubMed: 26457854
DOI: 10.1097/GRF.0000000000000157 -
Cancer Journal (Sudbury, Mass.)Associations of estrogen-alone and estrogen plus progestin with breast cancer incidence and related mortality are reviewed from observational studies (The Collaborative... (Review)
Review
Associations of estrogen-alone and estrogen plus progestin with breast cancer incidence and related mortality are reviewed from observational studies (The Collaborative Group on Hormonal Factors in Breast Cancer and The Million Women Study, 2019) and the Women's Health Initiative's (2020) two randomized trials evaluating conjugated equine estrogen alone, for women with prior hysterectomy or with medroxyprogesterone acetate. Findings are generally concordant for estrogen plus progestin use with both observational and randomized studies reporting higher breast cancer incidence. Findings are discordant for estrogen-alone use where, in the WHI randomized trial, a lower incidence and lower breast cancer mortality was seen. In contrast, in the observational studies, estrogen-alone use was associated with higher breast cancer incidence and higher breast cancer mortality. Although these discordant findings are difficult to fully reconcile, we conclude with a discussion of public health implications of the available evidence on menopausal hormone therapy and breast cancer.
Topics: Breast Neoplasms; Estrogen Replacement Therapy; Estrogens; Female; Humans; Observational Studies as Topic; Postmenopause; Progestins; Randomized Controlled Trials as Topic
PubMed: 35594463
DOI: 10.1097/PPO.0000000000000601 -
Frontiers in Endocrinology 2021Progestin-primed ovarian stimulation (PPOS) is a new ovarian stimulation protocol that can block the luteinizing hormone (LH) surge through progesterone instead of... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Progestin-primed ovarian stimulation (PPOS) is a new ovarian stimulation protocol that can block the luteinizing hormone (LH) surge through progesterone instead of traditional down regulating or gonadotropin-releasing hormone (GnRH) antagonist, and in order to achieve multi-follicle recruitment. This paper aims to investigate the effectiveness of PPOS and its suitability for infertile patients with different ovarian reserve functions.
METHODS
We searched published randomized controlled trials (RCTs) about PPOS on Cochrane Library, PubMed, Embase, and Web of Science. The search period spanned from January 1, 2015 to November 16, 2020. The data were extracted, and the meta-analysis was performed on ovarian stimulation as well as embryological and clinical outcomes. The outcomes were pooled by a random effects model, and the risk of heterogeneity was evaluated. Subgroup analysis was performed for different ovarian reserve patients.
RESULTS
The clinical pregnancy rates and live birth or ongoing pregnancy rates with the PPOS protocol were not different from those with the control group. In the diminished ovarian reserve (DOR) subgroup, the PPOS protocol had a lower rate of premature LH surge [RR = 0.03, 95% CI = 0.01 to 0.13, < 0.001]. The PPOS protocol had a lower rate of ovarian hyperstimulation syndrome (OHSS) [RR = 0.52, 95% CI = 0.36 to 0.76, < 0.001, = 0.00%]. The secondary outcomes showed that the number of oocytes retrieved, MII oocytes, and viable embryos was higher than that of the control protocol in DOR patients [(MD = 0.33, 95% CI = 0.30 to 0.36, < 0.001), (MD = 0.30, 95% CI = 0.27 to 0.33, < 0.001), (MD = 0.21, 95% CI = 0.18 to 0.24, < 0.001)] and normal ovarian reserve (NOR) patients [(MD = 1.41, 95% CI = 0.03 to 2.78, < 0.001), (MD = 1.19, 95% CI = 0.04 to 2.35, < 0.001), (MD = 1.01, 95% CI = 0.21 to 1.81, = 0.01)].
CONCLUSION
The findings suggest that PPOS is an effective ovarian stimulation protocol and is beneficial for patients with different ovarian reserve functions, which needs to be validated in more RCTs with larger samples.
Topics: Female; Humans; Pregnancy; Fertilization in Vitro; Infertility, Female; Live Birth; Ovarian Reserve; Ovulation Induction; Pregnancy Rate; Progestins; Randomized Controlled Trials as Topic
PubMed: 34531825
DOI: 10.3389/fendo.2021.702558 -
Ugeskrift For Laeger May 2024This review summarises the present knowledge of prophylactic progesterone and preterm birth. Preterm birth (less-than 37 weeks) is a leading cause of neonatal mortality... (Review)
Review
This review summarises the present knowledge of prophylactic progesterone and preterm birth. Preterm birth (less-than 37 weeks) is a leading cause of neonatal mortality and morbidity worldwide. The incidence varies globally but remains low in the Nordic countries (5-6%). Prediction and prevention are complicated due to diverse aetiology, but obstetric history and cervical length can improve prediction. Prophylactic vaginal progesterone initiated between 12 and 24 weeks of gestation is recommended to reduce preterm birth less-than 33-35 weeks in singleton pregnancies with a history of preterm birth or with a short cervix (less-than 25 mm) and can be considered for twin pregnancies with the same risk factors.
Topics: Humans; Premature Birth; Pregnancy; Progesterone; Female; Progestins; Administration, Intravaginal; Risk Factors; Cervical Length Measurement; Cervix Uteri
PubMed: 38847312
DOI: 10.61409/V10230636 -
Minerva Obstetrics and Gynecology Aug 2022In this paper, we report general pharmacological profile and major biological activities of natural progesterone (P) and progestins. The aim of this article consists of... (Review)
Review
INTRODUCTION
In this paper, we report general pharmacological profile and major biological activities of natural progesterone (P) and progestins. The aim of this article consists of synthesizing the principal aspects of pharmacology and metabolism of P and progestins related to the clinical consequences of their use.
EVIDENCE ACQUISITION
We review scientific literature on the topic "progestins," evaluating the most relevant data from original articles, reviews, and meta-analyses.
EVIDENCE SYNTHESIS
Progestins represent a specific class of synthetic analogues of P clinically employed (alone or associated with estrogens) to manage several gynecological conditions, for instance multiple abortions, luteal phase defect, premenstrual syndrome, abnormal uterine bleeding, endometriosis, and menopause (for hormone replacement therapy). Besides their use in the field of contraception, many non-contraceptive benefits of estroprogestins are mostly due to the activities of progestins. Pharmacological characteristics, dosage and individual metabolism could be listed among the principal aspects influencing their clinical effects.
CONCLUSIONS
The choice of each progestin according to its pharmacological profile is crucial for the appropriate management of any gynecological condition. An aware knowledge of these compounds is fundamental to hone medical practice.
Topics: Contraception; Estrogens; Female; Humans; Pregnancy; Progesterone; Progesterone Congeners; Progestins
PubMed: 34180615
DOI: 10.23736/S2724-606X.21.04881-8 -
Current Opinion in Obstetrics &... Jun 2024The use of progestins as pituitary suppressors has increased progressively, along with more detailed indications for their use, thereby consolidating an alternative... (Review)
Review
PURPOSE OF REVIEW
The use of progestins as pituitary suppressors has increased progressively, along with more detailed indications for their use, thereby consolidating an alternative approach to the personalization of ovarian stimulation.
RECENT FINDINGS
Based on the ability of progesterone to inhibit ovulation, progestins have been used in ovarian stimulation (OS) follicular protocols to prevent a luteinizing hormone surge in patients undergoing in vitro fertilization (IVF), as an alternative to gonadotropin-releasing hormone (GnRH) analogue administration. This review explores the different types of progestogen protocols and their efficacy depending on the type of population or reproductive procedure in which they are administered and in comparison with that of GnRH analogues. Their effect on oocytes and embryos and their safety and cost-effectiveness are also analyzed.
SUMMARY
Progestins have proven their effectiveness as a gonadotropin adjuvant in terms of ovarian response, reproductive outcome, and safety. In addition, they offer the convenience of oral administration and a lower cost than GnRH analogues. Whereas oocytes or embryos should be vitrified as it displaces the receptive period with the consequent asynchrony between embryo and endometrium. The evidence endorses progestins as a more friendly approach to OS, especially when frozen-thawed embryo transfer is planned.
Topics: Humans; Female; Ovulation Induction; Progestins; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Pregnancy
PubMed: 38295019
DOI: 10.1097/GCO.0000000000000941