The use of progesterone and its analogues have many medical applications. Because of the poor bioavailability of progesterone when taken orally, many synthetic progestins have been designed with improved oral bioavailability. Progesterone was approved by the United States Food and Drug Administration as vaginal gel on July 31, 1997, an oral capsule on May 14, 1998 in an injection form on April 25, 2001 and as a vaginal insert on June 21, 2007.
Progesterone does not dissolve in water and is poorly absorbed when taken orally unless micronized in oil. Products are often sold as capsules containing micronised progesterone in oil. Progesterone can also be administered through vaginal or rectal suppositories or pessaries, transdermally through a gel or cream, or via injection (though the latter has a short half-life requiring daily administration).
“Natural progesterone” products derived from yams, do not require a prescription but there is no evidence the human body can convert its active ingredient (diosgenin, the plant steroid that is chemically converted to produce progesterone industrially) into progesterone.
Duphaston
Duphaston (Dydrogesterone) is made by Solvay Healthcare Limited. It is a synthetic (artificial) progestogen and is similar to the progesterone produced naturally by the ovaries. The precise action of Duphaston is not fully understood. Duphaston reduces the normal build-up of the uterus lining by oestrogen during the monthly cycle. This action also stops the build-up of endometriosis in other sites. Generally, periods are not stopped and some spotting may occur between periods.
Duphaston comes in tablet form in a strength of 10mgs and is taken one, two or three times daily from day five to day twenty-five of the cycle. In some circumstances, especially in the treatment of endometriosis, the treatment is taken continuously, and may be given at higher doses. Treatment is usually for six to twelve months. There are no reported contra-indications for Duphaston.
Side effects of Duphaston include Nausea, Breast tenderness, Headache , Bloating, Dizziness, Skin rashes, Breakthrough bleeding between periods may also occur. This can usually be corrected by increasing the dose
Depo-Provera
DP is a synthetic (artificial) progestogen and is similar to the progesterone produced naturally by the ovaries. DP works by stopping the ovaries ovulating (producing eggs) and tricking the body into a pseudo (false) pregnancy. Periods usually stop during treatment, but return within two to three months of treatment ending. DP is given as an intra-muscular injection in the buttock or the upper arm. DP is given at twelve week intervals. It is important that the injection be given only during the first five days after the beginning of a period. Some blood spotting may occur during treatment, but no action is required for this.
Contra-indications to treatment with DP include Liver disease, Pregnancy, Lactating women (breast feeding), Undiagnosed vaginal bleeding,
History of thrombosis, Undiagnosed urinary tract bleeding, Oestrogen dependent cancer, Patients with a known sensitivity to DP
Precautions in the use of DP
Diabetic patients should be regularly checked. Epileptic patients should be regularly checked.
Patients with high blood pressure should have regular blood pressure checks.
Patients receiving treatment for depression should be monitored closely.
Patients with asthma need regular peak flow checks. Patients with kidney problems require close monitoring.
Side effects of DP include Cramps, Weight gain, Depression, Irregular bleeding, Headaches, Bloating, Fluid retention, Nausea, Sore breasts,
Lethargy, Dizziness, Loss of sleep, Acne, Increased hair growth, Skin rashes, Hair loss, Dry vagina.
In most women, periods generally return within two to three months after completion of treatment. There is no evidence that it causes permanent infertility.