Progesterones

Question 1

Role of progesterone

Answer 1

thicken endometrium,
stabilize endometrium,
thicken cervical mucus,
relaxes smooth muscle of uterus,
this vaginal mucosa

Question 2

progesterone in contraception MOA

Answer 2

thickening cervical mucus to inhibit sperm migration,
suppresses ovulation,
lower mid cycle peak of FSH and LH,
slow egg movement through fallopian tube,
thin endometrium

Question 3

progesterone formulations

Answer 3

1. Etonogestel implant (nexplanon).
2. levonorgestrel- releasing intraunterine device (IUD) (Mirena, skyla).
3. Depot medroxyprogesterone (DMPA) injections (Depo-provera).

Question 4

progestin only pills

Answer 4

dose is lower than combined oral contraceptives.

1. Norethindrone (camila): continuous. does not cosistently supress ovulation. must take consistently.
2. Drospirenone (Slynd) : 24 active/ 4 inert tablets.

Question 5

progesterone in contraception adverse effects

Answer 5

irregular breakthrough bleeding,
breast tenderness,
galactorrhea,
nausea

Question 6

progesterone in contraceptives contraindiations

Answer 6

known or suspected pregnancy,
known or suspected breast cancer,
undiagnosed abnormal uterine bleeding,
benign or malignant liver tumors, cirrhosis, active liver disease.

Question 7

drug interactions

Answer 7

metabolism is increased with any drugs that are increasing the liver microsomal enzyme activity.
anticonvulsants…

gabapentic, levetiracetam, laproate, zonisamide do not reduce efficacy.

rifampin is only abx proven to reduce serum EE and progestin levels.

Question 8

progesterone in menopause indications

Answer 8

MUST add this to MHT for women with uterus!!! prevents endometrial hyperplasia. cannot stand alone

not indicated in women who have undergone hysterectomy.

not indicated in low risk women on low dose vaginal estrogen.

Question 9

Medroxyprogesterone acetate (MPA) in menopause

Answer 9

associated with increased risk of breast cancer, CAD and unfavorable effects on lipids.

cyclic 5-10 mg daily orally.
continuous 1.25-2.5 mg daily orally..
NOT PREFFERED OPTION of progesterone.

Question 10

micronized progesterone.

Answer 10

PREFERRED FORMULATION OF progesterone
bioidentical to progesterone that is secreted on ovary.

cyclic: 200 mg orally daily
natural progesteron (prometrium). every day. get 1 month withdrawal bleed. need to take estrogen with it

continuous 100 mg orally daily.
taken separately of estrogen. induces amenorrhea.

protects endometrium. minimal effects on lipid, no known risk of beast cancer or CAD.

Question 11

combination estrogen-progestin products

Answer 11

oral (progestin derived from testosterone): Norethindrone, Norgestimate, Drospirenonone.

transdermal option ( 17 beta estradol combined with progestin). applied once or twice a week.

Question 12

IUD in menopause

Answer 12

not approved in the U.S for endometrial protection in menopausal women who are on estrogen.

can be used off label for women who cannot tolerate oral progestin

Question 13

adverse effects of progesterone in menopause

Answer 13

irregular bleeding,
bloating,
mood changes

Question 14

progesterone antagonist

Answer 14

mifepristone (mifeprex, korlym)
indication: termination of intrauterine pregnancy, cushing’s syndrome.

Risk of serious bleeding and bacterial infections.

Question 15

Which progesterone offers a decrease in androgenicity when compared with the other progesterones?

Answer 15

desogestrel and norgestimate

Question 16

Which of the following contraceptive methods contains only progesterone?

Answer 16

nexplanon