Progesterone Therapy

Progesterone works with estrogen to maintain reproductive organs, prepare for conception and pregnancy, and regulate menstrual cycles. One of the many things estrogen does is to thicken and build the endometrium (the lining of a woman's uterus) each month. This is the body's natural way of getting ready for pregnancy. Progesterone is one of the main components that causes this lining to shed each month when pregnancy doesn't happen. This shedding is your menstrual period.

Before menopause, a few women may experience the absence of regular periods for 6 months or more. This condition, known as secondary amenorrhea, is sometimes caused by not having enough progesterone.

Your body makes one-fourth or less the amount of progesterone after menopause. When progesterone isn't there, your menstrual period becomes irregular or infrequent, and the lining of the uterus stays thick and full of blood. Then, if that lining stays thickened month after month, it can be unhealthy. This can increase the chances of developing hyperplasia, or an overgrowth of cells in the uterine lining, which can lead to endometrial cancer. 

HORMONE THERAPY

When you hear the phrase "hormonal therapy", you probably think of estrogen. It is often prescribed to combat the sometimes debilitating symptoms of hormone loss. However, your body loses more than one type of hormone during menopause.

If your uterus is intact, your healthcare provider may prescribe a progestogen with estrogen or an estrogen-androgen combination.  A progestogen:

       ° Helps shed your uterine lining and prevent development of hyperplasia

       ° May be prescribed for part or all of your monthly cycle (the dosing schedule will determine whether you have your period)

       ° May lead to side effects such as spotting, menstrual cramps, bloating, and drowsiness

TREATMENT CHOICES IN PROGESTOGEN THERAPY

Progestins (proh-jest-inz), synthetic (man-made) progestogens, have been available for many years. Although different from natrual progesterone, progestins are made to react in a similar way in your body.

In the last decade, researchers found a way to mass produce absorbable progesterone made from plants. These scientists used micronization , a process that allows the body to easily absorb natural progesterone when it is taken orally. You can ask about choices that come from natural plant sources.

You may have heard about topical progesterone cream or gel preparations that are available either over-the-counter or with a prescription. According to the position statement on the role of progestogen in hormone therapy published by The North American Menopause Society in 2003, such products may not work well enough to protect the endometrium from unopposed estrogen.

DIFFERENCES AMONG PROGESTOGENS

° Micronized progesterone is identical to the natural progesterone produced in your body.

° Synthetic progestins have a different chemical structure from natural progesterone

The way you process micronized progesterones versus progestins is also different, and that is why dosing varies among progestogens. If synthetic progestin were given to you in the same dosage as progesterone, it would be too much for your body to handle.

Progestins may cause other activities that natural progesterone does not:

      ° Some women may feel bloated while taking progestins

      ° Others may have mood swings or become irritable while taking progestins

      ° Progestins change the way carbohydrates are digested and absorbed

In addition, progestins can compromise the positive effects that estrogen has on HDL ("good") cholesterol.  A government-sponsored study (PEPI Trial) of postmenopausal women showed progestin retained a small amount of estrogen's important HDL increases. On the other hand, micronized progesterone helped preserve most of estrogen's HDL increases.

PROGESTOGENS FOR HORMONE THERAPY

All US FDA-approved progestogen formulations will provide endometrial protection if the dose and duration are adequate. 

TALKING ABOUT HORMONE THERAPY

There are many different forms of hormone therapy, and risks and benefits exist with all forms. You should consider all of the options, and be sure to talk to your healthcare provider about them. Whether you are already taking a progestogen as a part of your hormone therapy, or you receive a prescription for one today, it is important to talk openly with your healthcare provider about how you feel in every part of your life, both physically and emotionally. No problem is too small; what may seem trivial to you could be an important aspect of your treatment regimen to your healthcare provider.