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The Cochrane Database of Systematic... Mar 2012About 5% of women experience severe symptoms called premenstrual syndrome (PMS), only in the two weeks before their menstrual periods. Treatment with progesterone may... (Review)
Review
BACKGROUND
About 5% of women experience severe symptoms called premenstrual syndrome (PMS), only in the two weeks before their menstrual periods. Treatment with progesterone may restore a deficiency, balance menstrual hormone levels or reduce effects of falling progesterone levels on the brain or on electrolytes in the blood.
OBJECTIVES
The objectives were to determine if progesterone has been found to be an effective treatment for all or some premenstrual symptoms and if adverse events associated with this treatment have been reported.
SEARCH METHODS
We searched the Cochrane Menstrual Disorders and Subfertility Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to February 2011. We contacted pharmaceutical companies for information about unpublished trials, for the first version of this review.The search strings are in Appendix 2.
SELECTION CRITERIA
We included randomised double-blind, placebo-controlled trials of progesterone on women with PMS diagnosed by at least two prospective cycles, without current psychiatric disorder.
DATA COLLECTION AND ANALYSIS
Two reviewers (BM and OF) extracted data independently and decided which trials to include. OF wrote to trial investigators for missing data.
MAIN RESULTS
From 17 studies, only two met our inclusion criteria. Together they had 280 participants aged between 18 and 45 years. One hundred and fifteen yielded analysable results. Both studies measured symptom severity using subjective scales. Differing in design, participants, dose of progesterone and how delivered, the studies could not be combined in meta-analysis.Adverse events which may or may not have been side effects of the treatment were described as mild.Both trials had defects. They intended to exclude women whose symptoms continued after their periods. When data from ineligible women were excluded from analysis in one trial, the other women were found to have benefited more from progesterone than placebo. The smaller study found no statistically significant difference between oral progesterone, vaginally absorbed progesterone and placebo, but reported outcomes incompletely.
AUTHORS' CONCLUSIONS
The trials did not show that progesterone is an effective treatment for PMS nor that it is not. Neither trial distinguished a subgroup of women who benefited, nor examined claimed success with high doses.
Topics: Female; Humans; Premenstrual Syndrome; Progesterone; Progestins; Randomized Controlled Trials as Topic
PubMed: 22419287
DOI: 10.1002/14651858.CD003415.pub4 -
Annals of Allergy, Asthma & Immunology... Feb 2019To review the published medical literature on the clinical presentation, risk factors, and natural history of hypersensitivity reactions to progestogens. (Review)
Review
OBJECTIVE
To review the published medical literature on the clinical presentation, risk factors, and natural history of hypersensitivity reactions to progestogens.
DATA SOURCES
Through the use of PubMed, we conducted a review of allergy, dermatology, and obstetric literature for cases and case series of patients with hypersensitivity reactions to exogenous or endogenous progestogens. There are no longitudinal, prospective studies related to progestogen hypersensitivity.
STUDY SELECTIONS
Publications were selected that described cases that were clinically consistent with progesterone hypersensitivity and positive test results or clear symptoms with exposure to progestogens to confirm the diagnosis.
RESULTS
Progestogen hypersensitivity symptoms can be triggered by endogenous progesterone or exogenous progestins used for contraception or fertility treatments. Symptoms are varied and include dermatitis, urticaria, asthma, and anaphylaxis.
CONCLUSION
Although the medical literature on progestogen hypersensitivity is limited to case reports and small case series, significant heterogeneity exists in clinical presentation among patients.
Topics: Autoimmune Diseases; Dermatitis; Female; Humans; Progesterone; Prognosis; Risk Factors
PubMed: 30712576
DOI: 10.1016/j.anai.2018.10.023 -
Revista de Neurologia May 2022Catamenial pattern epilepsy is defined as an increase in the frequency of seizures during a specific stage of the menstrual cycle compared to baseline. It has been... (Review)
Review
Catamenial pattern epilepsy is defined as an increase in the frequency of seizures during a specific stage of the menstrual cycle compared to baseline. It has been described that around a third of women with epilepsy have a catamenial pattern. The changes in the seizure pattern would be explained by the influence of catamenial fluctuations, of female gonadal hormones on neuronal excitability. Progesterone through its metabolite allopregnanolone plays a protective role by increasing GABAergic transmission; however, its effect on brain progesterone receptors can increase neuronal excitability. The effects of estrogens are complex, they tend to increase neuronal excitability, although their effects depend on their concentration and exposure time. Three catamenial patterns of seizure exacerbation have been proposed: the perimenstrual pattern, the periovulatory pattern, and the luteal pattern. The diagnostic approach is carried out through a systematic process of 4 steps: a) clinical history of the pattern of the menstrual cycle and epileptic seizures; b) diagnostic methods to characterize the menstrual cycle and the pattern of seizures; c) check diagnostic criteria; and d) categorize the catamenial pattern. The treatment options studied require a higher level of evidence, and there is no specific treatment. Optimization of conventional antiseizure treatment is recommended as the first therapeutic option. Other therapeutic options, such as non-hormonal and hormonal treatments, could be useful in case the first therapeutic option proves to be ineffective.
Topics: Epilepsy, Reflex; Female; Humans; Menstrual Cycle; Pregnanolone; Progesterone; Seizures
PubMed: 35484702
DOI: 10.33588/rn.7409.2022041 -
Reproduction & Fertility Apr 2022In November 2021, NICE updated its clinical guideline that covers the management of threatened miscarriage in the first trimester. They recommended offering vaginal...
UNLABELLED
In November 2021, NICE updated its clinical guideline that covers the management of threatened miscarriage in the first trimester. They recommended offering vaginal micronised progesterone twice daily until 16 completed weeks of pregnancy in those with a previous miscarriage. However, the duration of treatment is not evidence based. In the major clinical trial that informed the guideline, there was no benefit in starting progesterone after 9 weeks and the full effect of progesterone was present at 12 weeks of pregnancy. There are theoretical risks impacting offspring health in later life after maternal pharmaceutical progesterone treatment. As the effect of progesterone seems to be complete by 12 weeks of gestation, we should consider carefully whether to follow the guidance and treat up to 16 weeks of pregnancy.
LAY SUMMARY
In November 2021, new guidelines were published about the management of bleeding in early pregnancy. If someone who has had a previous miscarriage starts bleeding, they should now be treated with progesterone as this slightly reduces the chance of miscarriage. The guideline says progesterone should be given if the pregnancy is in the womb, and potentially normal, until 16 weeks of pregnancy. However, in the big studies looking at progesterone's effect in reducing miscarriage the beneficial effects of progesterone were complete by 12 weeks of pregnancy. At that stage, it is the placenta and not the mother's ovary that makes the progesterone to support the pregnancy. We do not know the long-term effects of giving extra progesterone during pregnancy on the offspring. Some research has raised the possibility that there might be some adverse effects if progesterone is given for too long. Maybe the guidance should have suggested stopping at 12 weeks rather than 16 weeks of pregnancy.
Topics: Abortion, Spontaneous; Abortion, Threatened; Female; Humans; Pregnancy; Pregnancy Trimester, First; Progesterone; Progestins; Vagina
PubMed: 35514538
DOI: 10.1530/RAF-21-0122 -
Reproductive Biomedicine Online Dec 2014ART has evolved over time and frozen-thawed embryo transfer (FET) is now a frequently performed, successful option. During the last decade, cryopreservation techniques... (Review)
Review
ART has evolved over time and frozen-thawed embryo transfer (FET) is now a frequently performed, successful option. During the last decade, cryopreservation techniques have received considerable interest, whereas interest in the priming and preparation of the endometrium prior to and after embryo transfer was more limited. The available evidence for the rationale and timing of progesterone supplementation as well as an understanding of the differences among progesterone formulations with respect to efficacy, optimum use, and patient preference is worth examining. A Summit was convened to review the literature on progesterone supplementation in ART and after FET and to provide guidance on the most clinically relevant issues. Utilizing an innovative consensus-building model to examine the evidence, Summit faculty drafted summit statements prior to the meeting, completed a literature search, and created a presentation based on this. At the conclusion of their discussion the faculty developed final summit statements, evaluating the strength of the evidence supporting each statement, and rating their level of support for each statement. The clinically relevant topic areas were the rationale for progesterone supplementation, timing and appropriate dosing, whether progesterone sérum levels reflect outcomes, and distinguishing among progesterone formulations with respect to efficacy, tolerability, and patient preference/satisfaction.
Topics: Administration, Oral; Embryo Implantation; Embryo Transfer; Endometrium; Female; Fertilization in Vitro; Humans; Injections, Intramuscular; Patient Satisfaction; Progesterone; Suppositories; Time Factors; Treatment Outcome
PubMed: 25679949
DOI: 10.1016/S1472-6483(14)50063-6 -
Acta Obstetricia Et Gynecologica... Nov 2015The physiologic and clinical value of progesterone is undisputed and a cornerstone of human reproduction. Better understanding of the exact dynamics and effects of... (Review)
Review
The physiologic and clinical value of progesterone is undisputed and a cornerstone of human reproduction. Better understanding of the exact dynamics and effects of endogenous progesterone secretion, as well as its therapeutic actions, is critical to ensure optimal clinical results in artificial reproduction technology, and to enhance chances of successfully completing pregnancy. Novel progesterone-based drugs and administration regimens will provide clinicians with greater options to make the management and treatment of infertile couples less burdensome and more successful.
Topics: Endometrium; Female; Humans; Progesterone; Progestins; Reproductive Techniques, Assisted; Uterine Hemorrhage
PubMed: 26443945
DOI: 10.1111/aogs.12791 -
Biochemical and Biophysical Research... Dec 2020Different progestogens are widely used in hormonal therapy and mediate their therapeutic actions via the progesterone receptor (PR). Little published data exist on their...
Different progestogens are widely used in hormonal therapy and mediate their therapeutic actions via the progesterone receptor (PR). Little published data exist on their relative efficacies and potencies via the PR, while those available may be confounded by off-target receptors, different methodologies and model systems. We performed dose-response analysis to investigate the efficacies and potencies for transcription of progesterone and several progestins widely used in contraception via the B isoform of human PR (PR-B). We compared responses using three different cell lines and two different transient transfection conditions. Results show that in vitro biological responses via PR-B for the select progestogens can vary significantly in biocharacter, rank order and absolute values for efficacies and potencies, depending on the cell line and transfection condition. Progestogen rank orders for published relative binding affinities are mostly different to those for relative efficacies and potencies. These in vitro differences suggest that rank orders and absolute values of the efficacies and potencies of the progestogens are likely to vary in vivo in a cell-specific and progestogen-specific manner, and cannot easily be extrapolated from in vitro data, as is usually the practice. While obtaining such data in vivo is not possible, these in vitro data show proof of concept for likely significant cell- and progestogen-specific PR-B effects.
Topics: Animals; COS Cells; Cell Line, Tumor; Chlorocebus aethiops; Contraceptive Agents, Hormonal; Humans; Progesterone; Progestins; Receptors, Progesterone; Transcription, Genetic; Transfection
PubMed: 33008590
DOI: 10.1016/j.bbrc.2020.09.058 -
Molecular and Cellular Endocrinology Jun 2012Steroid hormones coordinate and control the development and function of many organs and are implicated in many pathological processes. Progesterone signaling, in... (Review)
Review
Steroid hormones coordinate and control the development and function of many organs and are implicated in many pathological processes. Progesterone signaling, in particular, is essential for several important female reproductive functions. Physiological effects of progesterone are mediated by its cognate receptor, expressed in a subset of cells in target tissues. Experimental evidence has accumulated that progesterone acts through both cell intrinsic as well as paracrine signaling mechanisms. By relegating the hormonal stimulus to paracrine signaling cascades the systemic signal gets amplified locally and signaling reaches different cell types that are devoid of hormone receptors. Interestingly, distinct biological responses to progesterone in different target tissues rely on several tissue-specific and some common paracrine factors that coordinate biological responses in different cell types. Evidence is forthcoming that the intercellular signaling pathways that control development and physiological functions are important in tumorigenesis.
Topics: Animals; Female; Humans; Paracrine Communication; Progesterone; Progestins; Signal Transduction
PubMed: 21945477
DOI: 10.1016/j.mce.2011.09.018 -
British Medical Journal Sep 1951
Topics: Eclampsia; Female; Humans; Pregnancy; Progesterone
PubMed: 14869682
DOI: No ID Found -
CNS Drugs May 2018Substance use disorders (SUDs) remain problematic as many individuals are untreated or do not benefit from the currently available interventions. Thus, there is an... (Review)
Review
Substance use disorders (SUDs) remain problematic as many individuals are untreated or do not benefit from the currently available interventions. Thus, there is an urgent need to develop novel pharmacological interventions to treat SUDs. Evidence suggests that the female sex hormone, progesterone, attenuates the craving for and the euphoric effects of drugs of abuse. Research to date has demonstrated that progesterone may modulate responses to drugs of abuse and may have utility as a novel treatment for SUDs. A literature search was conducted to identify and examine studies that administered exogenous progesterone. Sixteen publications were identified, exploring the utility of exogenous progesterone or its metabolite, allopregnanolone, among a range of substances, including amphetamines (one study), benzodiazepines (one study), cocaine (nine studies), and tobacco/nicotine (five studies). Results indicated that exogenous progesterone and, its metabolite allopregnanolone, demonstrated preliminary efficacy as a treatment for substance use in both men and women. Notably, progesterone appears to target negative affect and augment cognitive functioning, especially among female substance users. Additional research is needed to explore the potential use of exogenous progesterone and allopregnanolone in the treatment of SUDs, including that associated with alcohol and opioids, but considering the current promising findings, exogenous progesterone and allopregnanolone may have utility as novel pharmacological treatments for SUDs.
Topics: Animals; Female; Humans; Male; Progesterone; Psychotropic Drugs; Substance-Related Disorders
PubMed: 29761343
DOI: 10.1007/s40263-018-0525-5