How do progestins work?
Progestins are hormonal medications used for contraception and in the treatment of many menstrual disorders such as abnormaluterine bleeding, lack ofmenstruation(amenorrhea), andendometriosis. Progestins are also used aspalliative treatmentin advanced stages of certain cancers including endometrial, renal, and breast cancers.
Progestins are synthetic formulations of the natural female sex hormoneprogesteroneand have similar effects. Progesterone regulates the reproductive cycle in women, along with another hormoneestrogen. Progesterone plays a vital role in the regulation of menstruation,implantation, maintenance of pregnancy, and fetal growth.
The reproductive cycle is regulated by a system known as the hypothalamic-pituitary-gonadal axis. Thehypothalamussecretes gonadotropin-releasing hormone (GnRH), which stimulates thepituitary glandto release follicle-stimulating hormone (FSH) andluteinizing hormone(LH).
The hormones FSH and LH stimulateovulationand the production of estrogen. After ovulation, the remains of the follicle (corpusluteum) produce progesterone, in addition to estrogen. After pregnancy, the placenta also starts to produce progesterone, keeping its levels high and preventing ovulation during pregnancy.
Estrogen stimulates the growth of the endometrium, the inner lining of theuterus, while progesterone prepares it for implantation and pregnancy. Progesterone also stimulates the growth of breast tissue, readying it for lactation. In the absence ofconception, the hormone levels fall, leading to menstruation and the beginning of a new cycle.
Progestins work by binding to progesterone receptors, which are protein molecules in cells that respond to progesterone. Progestins work in many ways to prevent pregnancy, regularize menstruation and prevent endometrial tissue growth.
- Progestins prevent pregnancy in the following ways:
- Progestins regularize menstruation by restoring hormonal balance and also supplement natural progesterone deficiency in assisted reproductive therapies
- Progestins have antiestrogenic properties, thought to help in reducing endometrial tissue growth and pain associated with endometriosis, and slowing down the progress of certain types of estrogen-dependent cancers
How are progestins used?
Progestins may be administered through many routes including the following:
- 口语:
- 平板电脑
- Capsules
- Suspensions
- Injections:
- Intramuscular(IM) into the muscle
- Subcutaneous (SC) into the tissue under the skin
- Intrauterinedevices placed inside the uterus
- Subdermal implants under the skin
- Intravaginal:
- Gels
- Inserts
The uses of progestins include:
FDA-approved:
- Contraception in females with reproductive potential.
- Treatment of heavy menstrual bleeding.
- Emergency post-intercourse contraception following unprotected vaginal intercourse, or known or suspected contraceptive failure.
- Metastatic endometrialcarcinoma(as adjunctive therapy and palliative treatment).
- Metastatic renal carcinoma (as adjunctive therapy and palliative treatment).
- Breast cancer(palliative treatment in advanced disease).
- Cancer-relatedcachexia(weakness due towastingof the muscle and weight loss).
- Acquired免疫缺陷syndrome (AIDS)-related cachexia.
- Secondary amenorrhea(absence of menstruation) is due to hormonal imbalance, and not because ofpathologicreasons such asuterine fibroidsor cancer.
- Abnormal uterine bleeding due to hormonal imbalance, and not because of pathologic reasons such as uterine fibroids or cancer.
- Prevention ofendometrial hyperplasia(thickening) inpostmenopausalwomen on estrogen for hormone replacement therapy (HRT) for menopausal symptoms.
- Management of pain associated with endometriosis (a disorder in which endometrial tissue is present outside the uterus).
- As part of assistive reproductive technology (ART) treatment for infertility in women with progesterone deficiency.
- Reduction of risk of preterm labor in women who have a history of spontaneous preterm birth. The FDA has proposed withdrawal of this approval because the available evidence does not show the effectiveness of progestins for this use.
Orphan designation:
- Immune thrombocytopenic purpura, anautoimmunebleeding disorder that leads to low platelet levels
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Side effects of progestins may include the following:
- Menstrual irregularities such as:
- Oligomenorrhea (infrequent menstruation)
- Amenorrhea (absence of menstruation)
- Spotting
- Breakthrough bleeding
- Menorrhagia(abnormally heavy menstrual bleeding)
- Irregular uterine bleeding
- Increased or reduced menstrual flow
- Withdrawal bleeding with discontinuation
- Dysmenorrhea (painful menstruation)
- Vulvovaginitis (inflammation of the vulva andvagina)
- Leucorrhea (white to yellowishvaginal discharge)
- Genitalpruritus(itching)
- Vaginalcandidiasis
- Bacterialvaginitis
- Enlarged ovarian follicles
- Benignovariancystsand associated complications
- Changes in cervical secretions
- Cervicalerosion
- Cervicaldilation
- Shortenedcervix
- Pregnancy and labor-related complications such as:
- Ectopic pregnancy
- Cervical incompetence
- Prematureruptureof membranes
- Headache
- Migraine
- Breast pain
- Breast lump
- Breast tenderness
- Breast enlargement
- Galactorrhea(milky secretion from the nipples)
- Suppressed lactation
- Abdominal pain
- Pelvic pain
- Perineal pain
- Back pain
- Arthralgia(joint pain)
- Myalgia(muscularpain)
- Pain in extremities
- Chest pain
- Cramps
- Dizziness
- Hypersensitivity reactions such as:
- Acne
- Rash
- Dry skin
- Urticaria(hives)
- Pruritus (itching)
- Chloasma (facial skinpigmentationdisorder)
- Seborrhea(skin disorder with rash and dandruff)
- Angioedema(swelling in the tissue under the skin ormucousmembranes)
- Anaphylactic reactions (severe allergic reactions)
- Alopecia(hair loss)
- Hirsutism(inappropriate male pattern hair growth in women)
- Hypertrichosis (abnormally excessive hair growth)
- Fluid retention
- Edema
- Injection site reactions such as:
- Insertion site pain with subdermal implants
- Complications with intrauterine devices such as:
- Failed insertion
- Cervical perforation
- 德vice breakage
- Uterine bleeding
- Sepsis
- Sweating
- Pyrexia (fever)
- Flu-like symptoms
- Hot flashes
- Pharyngitis(throat inflammation)
- Rhinitis(inflammation of thenasal passage)
- Cough
- Dyspnea(shortness of breath)
- Asthma
- Chest discomfort
- Insomnia
- Somnolence(drowsiness)
- Asthenia(weakness)
- Fatigue
- Malaise
- Anxiety
- Irritability
- Nervousness
- Listlessness
- Emotionallability(mood swings)
- 德pression
- Euphoria
- Drunk feeling and unsteadygait
- Dysarthria(difficulty with speech)
- Facialpalsy
- Paresthesia(abnormal skin sensation)
- Convulsions
- Syncope(fainting)
- Probabledementiain postmenopausal women over 65 years
- Dysuria(painful urination)
- Urinary tractinfections
- Pelvicinfection
- Weight change
- Diarrhea
- 肠胃气胀
- Bloating
- Abdominaldistention
- Indigestion
- Constipation
- Nausea
- Vomiting
- Increase in appetite
- Anorexia(loss of appetite)
- Thromboembolic (blood clot-related) events include:
- 德ep vein thrombosis/DVT (blood clot in deep veins)
- Pulmonary embolism/PE (blood clot in the lung)
- Thrombophlebitis(inflammation in the wall of a vein with an associated blood clot)
- Retinalthrombosis
- Anemia
- Optical neuritis (optic nerve inflammation)
- Adrenal insufficiency
- Corticoid-like effects such asCushing syndrome, a disorder caused by highcortisollevels
- Hypertension(high blood pressure)
- Tachycardia(rapid heartbeat)
- Myocardial infarction(heart attack)
- Stroke
- 德creased glucose tolerance
- Hypercalcemia(high calcium levels in the blood)
- Cholestaticjaundice(jaundice due to impairedbileflow)
- Hepatitis(inflammation of the liver)
- 德creasedlibido
- Impotence
- Erectile dysfunction
- Dyspareunia (pain during sexual intercourse)
- Invasive breast cancer in postmenopausal women
Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with travel medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.
What are the names of progestin drugs?
Genericand brand names ofprogestindrugs include:
- Aftera
- Aygestin
- Camila
- Crinone
- 德blitane
- 德po-SubQ Provera104
- DepoProvera
- Econtra EZ
- Endometrin
- Errin
- etonogestrel
- Fallback Solo
- Heather
- hydroxyprogesterone caproate
- Implanon
- Jencycla
- Jolivette
- Kyleena
- levonorgestrelintrauterine
- levonorgestrel oral
- Liletta
- Lyza
- Makena(The FDA has proposed withdrawal of approval for this medication because the available evidence does not show effectiveness for reducing preterm birth risk)
- medroxyprogesterone
- Megace
- Megace ES
- megestrol
- Mirena
- MPA
- My Way
- Nexplanon
- Next ChoiceOne Dose
- Nor QD
- Nora-BE
- norethindrone
- norethindrone acetate
- norethisterone
- Norhisterone
- Norlutate
- Opticon One-Step
- Plan B One-Step
- Preventeza
- Prochieve
- progesterone intravaginal gel
- progesterone micronized
- Progesterone, Vaginal
- Prometrium
- Provera
- React
- Sharobel
- Skyla
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https://www.fda.gov/drugs/drug-safety-and-availability/cder-perspective-recently-published-results-epppic-meta-analysis
https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/progesterone