Progesterone is an essential hormone in the process of reproduction. Although the pharmacokinetics and pharmacodynamics of progesterone have been well studied, its use in the pathophysiology of pregnancy remains controversial. One of these concerns is also the way in which the hormone is administered. Progesterone can be administered by three routes: orally, vaginally or intramuscularly. Oral administration guarantees optimal compliance by patients but shows several disadvantages, the main one is being its extreme variability in the plasma concentrations obtained due to individual variability in gastric filling and enteropathic circulation. The oral route also results in side effects such as nausea, headache and sleepiness. The vaginal route results in higher concentrations in the uterus but does not reach high and constant blood levels. Progesterone administered intramuscularly occasionally induces non-septic abscesses, but it is the only route that results in optimal blood levels In obstetrics the most frequent uses of progesterone are in the treatment of threatened abortion, prevention of recurrent miscarriage, or in the support of the luteal phase in assisted reproduction programmes, and in threatened preterm labour. Randomized, controlled trials showed that women who received progesterone were statistically significantly less likely to have recurrent miscarriages before 34 weeks, to have an infant with birth weight of 2.5 kg or lower, or to have an infant diagnosed with intraventicular hemorrhage. There is currently, however, insufficient information to allow recommendations regarding the optimal dose, route and timing of administration of progesterone supplementation. Progesterone has shown to be efficacious when continuation of pregnancy is hampered by immunological factors, luteinic and neuroendocrine deficiencies and myometrial hypercontractility. This may explain the reduction in the incidence of preterm birth in high-risk pregnant women using high-dosage prophylactic progesterone.
Progesterone and Pregnancy
DI RENZO, Giancarlo;GERLI, Sandro
2005
Abstract
Progesterone is an essential hormone in the process of reproduction. Although the pharmacokinetics and pharmacodynamics of progesterone have been well studied, its use in the pathophysiology of pregnancy remains controversial. One of these concerns is also the way in which the hormone is administered. Progesterone can be administered by three routes: orally, vaginally or intramuscularly. Oral administration guarantees optimal compliance by patients but shows several disadvantages, the main one is being its extreme variability in the plasma concentrations obtained due to individual variability in gastric filling and enteropathic circulation. The oral route also results in side effects such as nausea, headache and sleepiness. The vaginal route results in higher concentrations in the uterus but does not reach high and constant blood levels. Progesterone administered intramuscularly occasionally induces non-septic abscesses, but it is the only route that results in optimal blood levels In obstetrics the most frequent uses of progesterone are in the treatment of threatened abortion, prevention of recurrent miscarriage, or in the support of the luteal phase in assisted reproduction programmes, and in threatened preterm labour. Randomized, controlled trials showed that women who received progesterone were statistically significantly less likely to have recurrent miscarriages before 34 weeks, to have an infant with birth weight of 2.5 kg or lower, or to have an infant diagnosed with intraventicular hemorrhage. There is currently, however, insufficient information to allow recommendations regarding the optimal dose, route and timing of administration of progesterone supplementation. Progesterone has shown to be efficacious when continuation of pregnancy is hampered by immunological factors, luteinic and neuroendocrine deficiencies and myometrial hypercontractility. This may explain the reduction in the incidence of preterm birth in high-risk pregnant women using high-dosage prophylactic progesterone.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
