Progesterone is a hormone from a corpus luteum, formed by the cyclical rupture of an ovarian follicle. Progesterone is necessary for proper uterine and breast development and function. Progesterone is produced in the female body in the ovaries. Progesterone production is high during the luteal phase (second portion) of the menstrual cycle and low during the follicular phase (first portion), as well as being low before puberty and after menopause.
Natural progesterone and synthetic progestins are structurally different and have differing effects in the body. Progestins are recommended by doctors if estrogen is prescribed during or after menopause, because prolonged estrogen replacement therapy without the addition of progestins (or large amounts of natural progesterone), increases the risk of uterine cancer. However, women who have had a hysterectomy—and therefore no longer have a uterus—are typically prescribed estrogens without progestins.
Although natural progesterone is considered by some doctors to be safer and more effective for a variety of health problems, researchers have studied the effects of supplemental natural progesterone much less than the effects of synthetic progestins.
Preliminary evidence suggests that progesterone plays a role in bone metabolism and could help reduce the risk of osteoporosis. An uncontrolled study, using topically applied natural progesterone cream in combination with diet, exercise, and vitamin and calcium supplementation, reported consistent gains in bone density over a three-year period in postmenopausal women. However, no comparison was made to a similar program without progesterone.
Synthetic progestins have been linked to effects that might increase the risk of heart disease. However, vaginally applied natural progesterone has been reported to significantly enhance the benefits of estrogen replacement therapy on heart function in women with coronary artery disease. More research is needed to evaluate the effects of natural progesterone on heart disease.
Although the differences in the chemical structure of natural progesterone and synthetic progestins are slight, their effects in the body differ considerably and the two forms should not be considered interchangeable. Synthetic progestins may be useful for endometriosis and menorrhagia (prolonged or profuse menstrual flow) because of their specific effects on progesterone receptors in the brain and on the glandular response of the uterine lining. However, these same effects may be detrimental for women with PMS, and may be associated with increased symptoms, such as depression, headaches, and water retention. Thus, natural progesterone may be preferable to synthetic progestins for PMS.
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