1. Introduction
Progesterone is a naturally occurring hormone and a key component in the regulation of the menstrual cycle, pregnancy maintenance, and other reproductive processes. It is used as a medication in various conditions, such as hormone replacement therapy (HRT), fertility treatments, and prevention of preterm labour. Synthetic and natural formulations of progesterone are available for oral, vaginal, and injectable use.
2. Indications
- Hormone replacement therapy (HRT) for postmenopausal women (in combination with oestrogen)
- Secondary amenorrhoea (absence of menstrual periods)
- Luteal phase support in assisted reproduction (e.g., IVF)
- Prevention of preterm labour
- Management of abnormal uterine bleeding due to hormonal imbalance
- Progesterone deficiency-related infertility
- Endometrial hyperplasia prevention in women taking oestrogen
3. Dosage
Adults:
- Hormone replacement therapy (HRT):
- 200 mg daily for 12–14 days of each 28-day cycle (with oestrogen).
- Secondary amenorrhoea:
- 400 mg daily at bedtime for 10 days.
- Luteal phase support in IVF:
- Vaginal gel: 90 mg once daily.
- Vaginal capsules: 200–400 mg once or twice daily.
- Prevention of preterm labour:
- Vaginal suppositories: 200–400 mg daily.
Elderly:
- Use standard adult doses unless there are other health concerns.
Children:
- Not recommended for paediatric use.
4. Administration
- Oral capsules: Take with food, preferably at bedtime, to reduce dizziness or drowsiness.
- Vaginal gel/capsules: Insert into the vagina using the applicator provided.
- Injectable forms: Administered intramuscularly by a healthcare professional.
5. Forms Available
- Oral capsules: 100 mg, 200 mg
- Vaginal capsules: 100 mg, 200 mg
- Vaginal gel: 8% (90 mg per applicator)
- Injectable solution: 50 mg/mL
6. Side Effects
6.1 Common Side Effects:
- Drowsiness or dizziness
- Bloating
- Breast tenderness
- Mood swings or irritability
- Vaginal discharge (with vaginal formulations)
6.2 Less Common Side Effects:
- Nausea or vomiting
- Acne or skin rashes
- Headache
- Weight gain
6.3 Rare but Serious Side Effects:
- Blood clots (deep vein thrombosis, pulmonary embolism)
- Severe allergic reactions (e.g., swelling of the face, lips, or throat)
- Jaundice or liver dysfunction
7. Warnings
- Thromboembolic Disorders: Use cautiously in patients with a history of blood clots, stroke, or myocardial infarction.
- Liver Dysfunction: Avoid in patients with severe liver disease.
- Breast Cancer Risk: Long-term use in HRT (with oestrogen) may increase the risk of breast cancer.
- Depression: Monitor mood changes, as progesterone can exacerbate depressive symptoms.
8. Precautions
- Use cautiously in patients with diabetes, hypertension, or a history of depression.
- Avoid alcohol or sedatives while taking oral progesterone, as it may increase drowsiness.
- Monitor closely in patients with epilepsy or migraines, as progesterone can exacerbate symptoms.
9. Interactions
- CYP450 Inducers (e.g., rifampin, carbamazepine): May reduce progesterone levels.
- Antifungals (e.g., ketoconazole): May increase progesterone levels.
- Anticoagulants: Monitor closely, as progesterone may affect clotting factors.
- Barbiturates and phenytoin: May reduce the efficacy of progesterone.
10. Monitoring Parameters
- Monitor endometrial thickness in women using HRT.
- Assess for signs of venous thromboembolism (e.g., leg swelling, shortness of breath).
- Evaluate mood changes or signs of depression.
- Monitor liver function tests periodically in long-term use.
11. Use in Children
- Progesterone is not recommended for use in children or adolescents.
12. Use in Pregnancy
- Pregnancy Category B: Progesterone is commonly used in pregnancy to support the luteal phase and prevent preterm labour.
- Safe for short-term use under medical supervision.
13. Use in Elderly
- Can be used as part of HRT in postmenopausal women but should be closely monitored for cardiovascular and thromboembolic risks.
14. Use in Kidney Disease
- Use cautiously in severe renal impairment, as progesterone metabolism may be affected.
15. Use in Liver Disease
- Avoid in patients with severe liver dysfunction. Monitor liver function tests in those with a history of liver disease.
16. Patient Counselling Points
- Take oral progesterone with food to reduce nausea and drowsiness.
- Inform your doctor if you experience unusual bleeding, severe headaches, or signs of blood clots (e.g., leg swelling or chest pain).
- Use vaginal formulations exactly as prescribed, and do not miss doses during IVF or luteal phase support.
- Avoid alcohol and sedatives while taking progesterone, especially oral formulations.
- Report any mood changes or depression to your doctor promptly.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Prometrium | AbbVie | 100 mg Capsule | $35 (30 capsules) |
Utrogestan | Besins Healthcare | 200 mg Capsule | $45 (30 capsules) |
Crinone | Allergan | 8% Vaginal Gel (90 mg) | $150 (15 applicators) |
Generic Progesterone | Various | 100 mg Capsule | $20 (30 capsules) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Progesterone used for?
Progesterone is used for HRT, secondary amenorrhoea, luteal phase support in IVF, and preventing preterm labour.
2. How does Progesterone work?
It mimics natural progesterone, supporting the uterine lining and regulating menstrual cycles.
3. What is the usual dose of Progesterone?
The dose depends on the condition; typically 200–400 mg/day for HRT or IVF support.
4. Can Progesterone cause drowsiness?
Yes, drowsiness is a common side effect, particularly with oral formulations.
5. Is Progesterone safe during pregnancy?
Yes, it is often used to support pregnancy in cases of progesterone deficiency.
6. Can Progesterone cause weight gain?
Yes, weight gain due to fluid retention is a potential side effect.
7. Can Progesterone cause blood clots?
Yes, there is a risk of thromboembolism, especially in high doses or long-term use.
8. How should I take vaginal progesterone?
Insert the gel or capsule into the vagina using the applicator provided, as prescribed.
9. Can Progesterone be taken with food?
Yes, oral progesterone should be taken with food to reduce nausea and dizziness.
10. How long can Progesterone be used?
Duration depends on the condition; long-term use should be regularly reviewed by a doctor.
11. Can Progesterone cause mood changes?
Yes, mood swings or depression are possible side effects.
12. Is Progesterone effective for irregular periods?
Yes, it can help regulate periods in cases of hormonal imbalance.
13. Does Progesterone interact with other medications?
Yes, it interacts with CYP450 inducers, antifungals, and anticoagulants.
14. Can Progesterone be used in menopausal women?
Yes, it is often used in combination with oestrogen for HRT in menopausal women.
15. How should Progesterone be stored?
Store at room temperature, away from moisture and heat.