Are All Progestins Equal For Managing Menopause?

We will Discuss about Are All Progestins Equal For Managing Menopause? So, Everyone is different when it comes to sensitivity to hormones and there are also differences in structures and actions of closely related hormones. A classic example is Progestogens as part of HRT.

The Role of Progesterone and Progestogens

Progesterone is one of the natural female sex hormones. The production of progesterone from ovaries reduces during peri menopause and stops eventually during menopause. Progestogens are synthetic forms of progesterone.

Progesterone’s Functions in HRT

The main function of progesterone as part of HRT is to protect the womb lining against the unopposed effects of oestrogen which can cause womb cancer. Progesterone also helps with sleep quality and reduction in hot flushes.

Variability in Side Effects and Risks

The risk and types of side effects vary between different progestogens, their dosage and different modes of delivery. The common effects include – irregular bleeding, constipation, breast tenderness, acne, oily skin, bloating/fluid retention, mood changes and weight gain.

Comparing Progestogens: Safety and Side Effects

Body-identical micronised natural progesterone and body-similar dydrogesterone are currently thought to be the safest amongst progestogens with regards to risks of blood clotting and breast cancer. They have minimal androgenic side effects such as scalp hair thinning, acne, hirsutism and oily skin. Dydrogesterone also does not have any action on glucocorticoid receptors.

On the other hand, Medroxyprogesterone, Norethisterone and Levonorgestrel which are traditionally used synthetic progestogens tend to have androgenic side effects for some and tend be associated with a slightly higher risk of blood clotting and breast cancer with long- term use as part of HRT. Overall risks are still very small.

Tailoring HRT for Individual Needs

While natural progesterone and dydrogesterone from plant sources are popular for these reasons and work well for majority, some experience persistent premenstrual symptoms and breakthrough or heavy bleeding with them and find that the traditional progestogens work better for them with better bleed control and less PMS symptoms.

Addressing Sensitivity to Progesterone

Some individuals can be very sensitive to progesterone (‘progesterone sensitivity’).
There are some options as part of HRT which can be useful to minimise this. These include using natural progesterone rather than synthetic progestogen, changing route of delivery (oral/coil/patch), choosing the minimum required licensed dose for womb protection, trying alternative regimens such as vaginal progesterone or 14 days of progesterone every 60-70 days (these are unlicensed regimens of HRT and need consent and clinical supervision with regards to womb lining protection). Bazedoxifene combined with oestrogen (currently unavailable in UK) could avoid all PMS symptoms and could be a game changer.

A Personalized Approach to HRT

One size certainly does not fit all and the availability of all different hormone options in HRT is important so that individuals can chose what suits them best after understanding the benefits and risks associated with specific preparations.

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