For many years, as drugs on the basis of the female sex hormone progesterone have been used successfully in the treatment of various pathologies of the reproductive system in women, and also as a primary contraceptive. How was this unique medication, how it safely and effectively? What are the most common misconceptions about progesterone and hormonal therapy? The answers to these and other questions, read our material.
- A BIT OF HISTORY
- HOW DOES PROGESTERONE
- THE EFFECTIVENESS OF PROGESTERONE DEPENDS ON THE ROUTE OF ADMINISTRATION
- THE MYTH ABOUT PROGESTERONE AND PREGNANCY
- THE FLY IN THE OINTMENT FOR PROGESTERONE
- WHY PROGESTERONE IS NOT DESIRABLE DURING PREGNANCY?
A bit of history
For many years doctors and scientists have searched for a means by which to control the birth rate. Since ancient times, mankind has known fact that if a woman gets pregnant while she is pregnant, to get pregnant again she can’t. Apparently, in the body of a pregnant woman stands out a factor (substance) that prevents conception. The same thing happens during menopause. Thus, pregnancy, and menopause can be considered a physiological menopause state in which there is no ovulation and menstruation.
Further long-term observations of physicians showed that menstrual pain in women was lost during pregnancy and at menopause. Suspicion fell on the yellow body. Most likely, it contains some miraculous substance, which in the 19th century were not yet able to isolate and identify because of technical limitations. However, despite this, doctors began to use hood yellow body for therapeutic purposes. In particular, it is used to treat endometriosis and to eliminate menstrual cramps in the abdomen and even as a contraceptive. It is noteworthy that all processes were reversible. After some time the woman could get pregnant.
A thorough analysis of the yellow body, finally come to fruition. Several independent groups of scientists published a scientific article where they talk about the new substance of the corpus luteum the progesterone. One of the scientists who worked with extracts of the corpus luteum, was the American Willard Allen, who in 1935 called allocated the hormone progestin. However, almost at the same time it failed and his German colleagues Karl Slotte, Ludwig Frankel and Erich Fels. Carl Slotte called hormone latisternum. And not started a conflict of interests scientists were democratically resolved at a scientific conference in London, where the name progesterone was made on the basis of a progestin and southeastern.
Interesting fact
Everyone hated the cholesterol turned out to be not that harmful, but very useful component, vital for the organism. It turns out that cholesterol is a precursor of progesterone. Under the influence of luteinizing hormone, cholesterol is converted into pregnenolone, which then becomes progesterone. Thus, a fierce battle against cholesterol may turn into a real tragedy for the body in the form of a lack of sex hormones. And this is only one of the components of cholesterol in the body performs many other important functions.
How does progesterone
Acts as the main hormone of the corpus luteum? To this question many years tried to answer scientists from different countries. With the advent of molecular biology techniques was able to completely unravel the mechanism of action of progesterone in the body.
Progesterone binds to receptors on the cell surface of target organs. Then, after this binding, the hormone enters the nucleus where it activates certain areas of the DNA that leads to the synthesis of the desired RNA, which then serves as a matrix for protein synthesis in the cell.
Progesterone creates all the necessary conditions for implantation of a fertilized egg, reduces the sensitivity of the uterus to oxytocin and relaxes the muscles. The hormone contributes to increased fat deposits, increasing levels of basal and induced insulin. Progesterone inhibits the production of factors in the release of luteinizing and follicle stimulating hormones.
All the instructions pharmacological actions has been well studied and confirmed experimentally. Medications containing progesterone, is effective, however, they should appoint only a doctor, because the drug is not deprived of adverse action, as will be discussed later.
The effectiveness of progesterone depends on the route of administration
How quickly and effectively will operate the progesterone, depends on the shape progesteronethe of the drug.
- Percutaneous introduction creams and gels containing progesterone. Some studies show that the effectiveness of progesterone in this form is 60-63%. Other data suggests that in this introduction the effectiveness of the drug is negligible, and that there is a scientific explanation. The skin contains Fremont 5-alpha reductase, which promotes the rapid degradation of the hormone, which means that not all of the progesterone enters inside. Based on those characteristics, to achieve clinical effect, it is necessary to apply progesterone is in a cream for a relatively large area of the body commensurate with the chest.
- Intramuscular. Associated with significant discomfort due to pain oil injection form of this drug, especially as to the maintenance of appropriate hormone concentrations in the blood injection should be carried out daily. Moreover, the risk of occurrence of local reactions, blue in the face, redness, pain, suppuration of buttocks. The progesterone is absorbed almost immediately after intramuscular injection, and high concentration in serum is reached after 2 hours (maximum after 8 hours).
- Rectal. Characterized by variable conditions of absorption and depends on the depth of insertion of the candle. Progesterone, absorbed in the lower part of the rectum through the lower anal veins goes directly into the bloodstream bypassing the liver, however, absorption from the lower part of the rectal ampoule, through the upper rectal veins, he falls into the secondary circulation. Peak levels of progesterone after rectal observed after 8 hours and decreases gradually (can range from 15 to 52 ng/ml after administration of 100 mg of the hormone).
- Nasal introduction. As you know, the nasal mucosa contains a large number of vessels, and the presence of a large number of microvilli increase the area of absorption of the drug. However, despite all these features, in relation to the progesterone to achieve a therapeutic effect from this administration failed.
- Vaginal introduction. Vaginal administration of progesterone in a pill is growth hormone concentrations more than 10 times in the endometrium. In this way imposing the burden of progesterone and its metabolites on the liver and other organs (which are under stress with systemic administration of the drug) is markedly reduced and is practically reduced to zero.
- The oral administration. As for the oral administration of progesterone, in this case, the biological availability of the drug is lower. The drug is absorbed in the small intestine, and then through the secondary circulation enters the liver, where it is metabolism.
The myth about progesterone and pregnancy
In the countries of the former USSR common this diagnosis as progesterona insufficiency during pregnancy. They say that because of low level of progesterone is disrupted fetal development, which leads to the death of the latter. However, actually, the diagnosis progesterona failure is quite rare. What’s the matter? Why doctors so often diagnosed by assigning women progesteronethe drugs?
During pregnancy the corpus luteum continues to produce progesterone in an amount necessary for normal growth and development of the fetus. This happens on average to 8 weeks, after which the level of production decreases. If in this period there is a miscarriage, the doctors concluded that this was due to low progesterone levels.
What’s really going on? A miscarriage is due to other causes of genetic abnormalities, infections, injuries and other circumstances, which are not compatible with the life of the fetus. Naturally, the fetal death and reduced production of progesterone, because the body gives a clear signal to the yellow body on the termination of pregnancy. Thus, the miscarriage is the reason for the decline in the progesterone level, and not Vice versa. Therefore, to prescribe progesterone to women during subsequent pregnancies do not need (except for medical indications, when the drug is really necessary).
When progesterone is prescribed during pregnancy
According to the rules of evidence-based medicine, pregnancy progesteronethe medications administered in the following situations:
- Women with history of habitual abortion (two or more spontaneous miscarriages in a row).
- Women who have another pregnancy after in vitro fertilization.
- Women who had preterm delivery (before 37 weeks of pregnancy).
- Women who have short cervix on the 20-22nd week of pregnancy.
The fly in the ointment for progesterone
Who should not use progesterone? First and foremost, of course, it is hypersensitivity to the drug. Capsules of the drug cannot be taken with the expressed violations of the liver, the propensity to trombozam, acute phlebitis, vaginal bleeding, porphyria.
The solution in oil is contraindicated in breast cancer and genital organs, expressed violations of the liver and kidneys, pregnancy (2nd and 3rd trimester), the propensity to trombozam, in acute forms of phlebitis, vaginal bleeding and porphyria.
Have progesteronethe drugs, there are restrictions for use, namely:
- Capsules. Preparations in the form of capsules are not recommended for patients with cardiovascular disease, hypertension, bronchial asthma, severe violations of the kidneys and liver. In addition, with caution used capsules progesterone diabetes, depression, epilepsy, migraine, 2, and 3 trimester of pregnancy and breast feeding.
- Solution in the oil. In this form, precautions should be taken by individuals with cardiovascular diseases, bronchial asthma, migraine, diabetes, pregnancy, breastfeeding.
To side effects of progesterone are the following States:
- sleepy;
- dizziness;
- disorder of the menstrual cycle;
- nausea;
- vomiting;
- loss of appetite;
- other changes (carefully study the instructions to the drug).
Why progesterone is not desirable during pregnancy?
The list of contraindications to the drugs indicated Progesteronum pregnancy. In the 70-ies of the last century, American doctors found that synthetic progesterone is taken during the first trimester of pregnancy can lead to the development of minor malformations of the genitals in boys and girls in utero.
After the conclusion of the Federal administration on control of medicines and foodstuff (FDA) banned the use of progesterone in pregnant women up to 4 months, as in this case, it is possible to develop small defects in the fetus. In addition, the proven and the relationship between progesteronelike drugs and ectopic pregnancy.
SEE ALSO:
- PROGESTERONE