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Progesterone is a natural hormone produced by the ovary during the second half of the menstrual cycle.

It provides natures way to change the lining of the uterus so that the cells which line the uterus can provide nutrition to the developing embryo during the earliest phases of development after conception.

If conception fails to occur, then lower levels of progesterone and estrogen in the blood leads to menstruation which is a shedding of the lining of the uterus. This natural periodic shedding is an important prevention of the development of uterine cancer.

Women lacking adaquate progesterone and who produce or are exposed to persistent levels of estrogen are at greater risk for this form of cancer.

Other benefits of progesterone include assisting in the final development of the female breast during puberty.

As progesterone has a mild sedative effect, many clinicians feel Premenstrual Syndrome (PMS) is related to progesterone but not well understood.

Side effects when progesterone is administered may include fluid retention, irritability, depression, and hypoglycemia attacks.

The two general forms of progesterone available pharmacologically in the United States are progesterone and progestins. Progesterone has 21 carbon atoms.

Progestogins are derived from a powerful male hormone, testosterone, which has 19 carbon atoms. Their chemical structures are very similar.

There were two reasons why it was necessary to develop these synthetic progestogins:

1. Progesterone has unpredictable adsorption except when micronized for oral use or made into vaginal suppositories.

2. There are good natural sources for the progesterone molecule from the same molecules used to manufacture progestogins which is found in many plant sources such as Mexican sweet potatoes.

The progestogens most commonly used for menopause management is Medroxyprogesterone acetate (Provera, Amen, Cycrin) which comes in 2.5 mg, 5.0 mg, and 10.0 mg tablets.

Unfortunately, many women have side effects to this preparation, particularly the 10mg dose.

There are other progestogens including:

Norethindrone acetate (Aygestin) 5 mg (which is a bit too potent for most women)

Norethindrone (NorQD, Micronor) 0.35 mg and dl-Norgestrel (Ovrette) 0.075 mg are birth control pills and potent enough to reverse the effects of estrogen on the uterus when given 2 or 3 tablets daily.

Megestrol acetate (Megace ) 20 mg, 40 mg is also a progestogen used in the treatment of cancer and endometriosis with dosages of 20-40 mg daily which is potent enough for menopause management.

Other forms of progesterone include micronized progesterone capsules and vaginal suppositories (manufactured by pharmacists) in 25 mg, 50 mg, 100 mg, 200 mg, and progesterone in oil injection 50 mg/ml, and depo-medroxyprogesterone acetate.

Ingestible progesterones are not appropriate for menopause management.

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