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ABOUT VAGINAL PROGESTERONES
What is progesterone?
Progesterone is often called “the pregnancy hormone”. It is necessary for preparing the lining of the uterus or womb (endometrium) for implantation of a fertilized egg (embryo). The necessary changes that take place in the uterus at the site where the embryo implants itself are dependent on progesterone. During the first half of the menstrual cycle when the follicles are growing within the ovary, estrogen is the dominant hormone present. After ovulation (which is the release of a mature egg from a follicle) the second half of the cycle (called the “luteal phase”) begins and progesterone is produced by the ovaries. Specifically, progesterone is produced by cells of the ovarian follicles that reorganize themselves after ovulation into a structure called the corpus luteum.
If the fertilized egg does not implant itself into the uterus, levels of progesterone drop and menstruation begins. If implantation is successful and pregnancy occurs, corpus luteum production of progesterone continues until about 10 weeks gestation when the placenta takes over and continues to produce high levels of progesterone.
Is progesterone needed to treat infertility?
Progesterone is an essential part of infertility treatment. For example, progesterone is used for luteal phase support during in vitro fertilization (IVF). During IVF, a woman’s normal production of progesterone may be lowered for several reasons:
- Medications used to prevent premature ovulation (such as Lupron, Ganirelix or Cetrotide) may reduce the production of progesterone following egg collection.
- At the time of follicle aspiration to obtain mature eggs, many progesterone-producing cells may also be removed due to the mechanics of the procedure itself.
To assure that the endometrium is prepared for implantation of the fertilized egg, most women undergoing IVF will be given progesterone after the retrieval of her eggs.
How is progesterone given?
Women undergoing IVF may begin using progesterone starting at the time between egg retrieval and embryo transfer. Once a positive pregnancy test is confirmed, progesterone treatment may continue for a total duration of up to 10 weeks – 12 weeks (1st trimester). Progesterone can be given orally (by mouth), by injection, or vaginally. Progesterone taken orally is not reliable because it is metabolized by a woman’s liver after it is absorbed by the digestive tract, which can reduce its effectiveness and cause side effects. Although progesterone injections are effective, this method is the most uncomfortable form for a woman to take.
The use of vaginal progesterone avoids the problems of both oral and injectable progesterone.
Are there different types of vaginal progesterone?
There are four types of generally available progesterone preparations that can be used vaginally:
- Progesterone suppositories are made-to-order by a pharmacist based on the dose of progesterone and frequency of use as prescribed by the IVF specialist. This form is usually given multiple times a day.
- Progesterone Gel is placed in the vagina once a day for progesterone supplementation or twice a day for progesterone replacement using a special applicator.
- Vaginal Capsules containing progesterone in oil are placed in the vagina multiple times a day
- Vaginal Tablets are placed in the vagina two or three times a day using a special applicator.
All four forms can be effective; however, some have been clinically studied more than others, and vaginal suppositories and vaginal capsules are not FDA approved for this use. Additionally, the effectiveness of vaginal tablets in women over 35 years of age has not yet been established. Women using vaginal progesterone should not use other types of vaginal medications for the duration of treatment unless instructed by their physician. Side effects may vary by type and brand of vaginal progesterone and women should make sure to discuss potential side effects with their specialist.
Last modified on: 14 April 2008
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