What is the difference between medroxyprogesterone and progesterone

Transvaginal Progesterone. Transvaginal progesterone delivery is the most practical nonoral route of administration. A new progesterone vaginal gel Crinone has sustained-release properties that were not available in the original intravaginal preparations.

Intravaginal administration produces uterine effects with minimal systemic side effects. The pharmacologic effects of synthetic progestins differ from those of natural progesterone. Reported androgenic effects of synthetic progestins include fluid retention, reduction of HDL cholesterol levels, headaches and mood disturbance.

Consequently, there has been interest in synthesizing progestins that better mimic the natural hormone. The classification of progestins has caused confusion.

The designation of first-, second-or third-generation progestin is based on time since market introduction and not on structural and physiologic differences or efficacy. Another classification scheme, presented in Table 1 , is based on structural derivation and divides progestins into estranes, gonanes and pregnanes.

Some of the progestins derived from nortestosterone are considered to be strongly androgenic and capable of producing side effects such as hirsutism and acne. Attempts have been made to alter the progestins to reduce the relative androgenicity. The side effects of various progestational agents are listed in Table 2.

Many of these reported effects are based on limited data. One full applicator of 4 percent gel in vagina every other day for up to six doses; if no response, repeat regimen using 8 percent gel. Montvale, N. Cost to the patient will be higher, depending on prescription filling fee.

Progestational agents have been used successfully to induce withdrawal bleeding in women with oligomenorrhea or secondary amenorrhea. The progestin most commonly used for this purpose has been medroxyprogesterone acetate Provera. This agent produces predictable withdrawal bleeding of an estrogen-primed endometrium. Short courses of orally administered medroxyprogesterone acetate 5 mg twice daily for five days have produced withdrawal bleeding in 93 percent of amenorrheic women.

One study found that oral micronized progesterone mg per day produced withdrawal bleeding in 90 percent of women with oligomenorrhea or amenorrhea. Another study found that progesterone vaginal gel was successful in inducing withdrawal bleeding in women with secondary amenorrhea. This bleeding usually results from anovulation and occurs at the extremes of life.

Most instances of anovulatory bleeding are examples of estrogen withdrawal or estrogen-progestin breakthrough bleeding. In most situations, dysfunctional uterine bleeding can be managed without surgical intervention.

Progestational agents, singly or in combination with estrogen, are often used to correct the bleeding. Although progestins cannot eliminate the cause of anovulatory cycles, they are effective in alleviating the consequences on a monthly basis. Immaturity of the hypothalamic-pituitary-ovarian axis predisposes up to one third of adolescents to dysfunctional uterine bleeding.

It is important to administer therapy for short periods three to six months and then reevaluate the patient. As many as 93 percent of adolescents with dysfunctional uterine bleeding respond to medical therapy.

Perimenopausal Women. In this age group, it is particularly important to rule out endometrial atypia and cancer before initiating therapy.

However, patient age is not as important as duration of exposure to unopposed estrogens. Although endometrial hyperplasia is a benign finding, atypical endometrial hyperplasia is a true precursor to adenocarcinoma and has a significant tendency to progress if it is not treated with progestational agents.

The potential for progression to adenocarcinoma in women with atypical endometrial hyperplasia ranges from 8 to 29 percent. Because the majority of hyperplasias in women of reproductive age result from chronic anovulation, most benign hyperplasias regress without progestin therapy if spontaneous ovulation occurs. If anovulation recurs on a regular basis, progestins are generally administered for seven days minimum duration for the prevention of hyperplasia to 12 days of each cycle.

In a study comparing the effects of micronized progesterone mg per day and the progestin norethisterone 15 mg per day in premenopausal women, menstrual cycles were well controlled with either agent, but cessation of dysfunctional uterine bleeding was achieved more frequently in the women who took progesterone.

Recurrences were reported in 24 percent of women after the discontinuation of progestin and in 10 percent of women after the discontinuation of micronized progesterone. Therefore, progestational therapy should be continued on a long-term basis in perimenopausal women with chronic anovulation.

Repeat endometrial sampling may be required. Postmenopausal Women. Endometrial hyper-stimulation resulting from unopposed estrogen administration can be reduced by adding a progestin in postmenopausal women. Therapy with a progestin for 12 or more days each month can prevent new cases of endometrial hyperplasia and significantly reduce the risk of endometrial carcinoma.

Unwanted uterine bleeding is one of the most frequent factors in a postmenopausal woman's decision to discontinue hormone replacement therapy. It has been shown that complete secretory gland maturation and subsequent withdrawal bleeding are not required for the prevention of endometrial hyperplasia.

The appropriate dose and duration of progesterone therapy are those that reduce secretory gland mitoses to a very low rate with marginal secretory gland transformation and that induce a high incidence of amenorrhea without irregular bleeding. Continuously administered hormone replacement therapy can provide the same endometrial protection as sequential therapy, yet avoid withdrawal bleeding. Although continuous medroxyprogesterone acetate therapy achieves amenorrhea in more than 90 percent of women, it can lead to severe endometrial atrophy with resultant irregular bleeding.

A regimen consisting of low-dose micronized progesterone mg per day and micronized estradiol Estrace; 1. This regimen avoids the cyclic bleeding linked to a simulated endometrial cycle and reduces the bleeding associated with severe atrophy. Most of the antiovulatory effects of oral contraceptive pills derive from the action of the progestin component.

The estrogen doses in these pills are not sufficient to produce a consistent antiovulatory effect. The estrogenic component of oral contraceptive pills potentiates the action of the progestin and stabilizes the endometrium so that breakthrough bleeding is minimized. The progestin-only methods of contraception work by a similar mechanism.

Progesterone suppresses gonadotropin-releasing hormone, thereby inhibiting the release of follicle-stimulating hormone and luteinizing hormone. This action prevents ovulation. The atrophic endometrium that results from prolonged exposure to progestins minimizes the likelihood of implantation. By promoting the development of a thick cervical mucus, progestin-only contraceptives also make sperm penetration less likely. The breakthrough bleeding that occurs with progestin-only contraceptives is usually worse during the first few months of use and relates more to changes occurring in the endometrium than to fluctuating endogenous hormones.

Injectable medroxyprogesterone acetate in crystalline form Depo-Provera is a highly effective contraceptive that can be administered at any time as long as there is verification of a negative pregnancy test. The standard dose of mg is injected intramuscularly every three months.

Women who are breast-feeding can receive injectable medroxyprogesterone acetate postpartum once lactation has been established. If this form of contraception is not initiated while menses is occurring, a backup method of contraception should be employed for at least seven days. The subdermal contraceptive implant system Norplant consists of six flexible capsules, with each capsule containing 36 mg of levonorgestrel. These implants are inserted surgically in the upper arm and can be left in place as long as five years.

In adolescents, this contraceptive method has been shown to have greater efficacy than oral contraceptive pills. Lactating women are good candidates for this contraceptive method. Progesterone USP, derived from plants and manufactured in a lab, is bioidentical — that is, molecularly identical to the progesterone made in our bodies.

Looking at the chemical structure of progestins and progesterone, it is clear they are not the same. For more types and structure pictures, see the first article in the references below. These images are from PubChem. Quick start guide to progesterone and progestins — by Anna Garrett, pharmacist.

Research Suggests: There might safety and tolerability differences between progesterone and progestin products In , a randomized-controlled trial compared different estrogen and progestogen products that have progesterone-like effects combinations on markers of cardiovascular health in postmenopausal women. Early evidence in studies about the differential breast cancer risk with progesterone versus progestin. Another finding: controlled studies and most observational studies published over the last five years suggest that the addition of synthetic progestins to estrogen in hormone replacement therapy, particularly in a continuous-combined regimen, increases the breast cancer risk compared to estrogen alone.

By contrast, a recent study suggests that the addition of natural progesterone in cyclic regimens does not affect breast cancer risk. In terms of comparing safety, there has not yet been a randomized trial that demonstrates that bioidentical progesterone is safer than progestins synthetic, non-bioidentical.

However, recent reviews of observational studies have raised the question of whether bioidentical progesterone is safer with respect to breast cancer risk than progestins like Provera medroxyprogesterone acetate 6,7.

You can see where these fit in out hormone therapy chart here. Developing a drug and getting it approved by the FDA is a multi-stage, multi-million dollar investment that takes years on average, and most drugs do not make it to approval. For drugs that do, they are granted seven years of patent protection, a time when no other company can copy their product so that they can make back the costs of developing the drug and hopefully a bit more for profit. Because progesterone is made from naturally occurring plant-based sources, it is difficult to claim the product is unique in order to qualify for a patent and protect the investment in developing the drug.

This is not yet proven, but some studies, like those in the box above, seem to be showing a safety difference between the two. All progestins are not created equal. Frank Z. Steroids 68 — However, their uniqueness results in the addition of chemical side chains. Thus, while they partially mimic human hormones, the chemical difference when compared to human hormones has been found to cause unwanted side effects and risks.

All women would prefer their own hormones if they could produce them. That being said, they prefer a replacement most like the hormone they previously manufactured.

Women now live 30 years, on average, beyond menopause. Increased estrogen and declining progesterone levels exacerbate these conditions. This makes the issue of hormone safely imperative. Diphtheria; tetanus, and influenza Vaccinations not routinely given but safe to use if you may come into contact with the disease are hepatitis B, pneumonia, rabies, and polio. Vaccinations not to be used during pregnancy include measles, mumps, rubella, varicella-zoster, or any vaccine containing live viruses.

Tylenol mg every 8 hours is OK. Unless discussed with your doctor, avoid ibuprofen Motrin, Advil as well as naproxen Aleve.

Both Dr. Kollar and Dr. Velez support and encourage our patients to investigate this exciting and often beneficial advancement in medicine. Click on www. Estrogen is not one hormone but is a group of similar hormones of varying degrees of activity all made by the ovary. In the case of progesterone, only a single hormone is found.

These synthetic progestins lack many of the other abilities of natural progesterone. This confusion still exists in the minds of many physicians and writers. Remember, hormones themselves are not bad. Unequal balance of hormones is what can cause problems. Progesterone is a natural hormone made by the adrenal glands and ovaries and testes in men. Although progesterone and synthetic progestins both prevent proliferation of the uterine lining, they are very different compounds with very different effects in the body.

Progesterone is an integral part of the hormone balance and is a precursor hormone to Cortisol, aldosterone, estrogen, and testosterone.