What conditions does progesterone help with?

Progesterone's Clinical Applications

Progesterone is primarily effective for preventing preterm birth in pregnant women with short cervical length or history of spontaneous preterm birth, and for treating secondary amenorrhea and protecting the endometrium in women taking estrogen therapy. 1, 2

Prevention of Preterm Birth

Women with Prior Spontaneous Preterm Birth (SPTB)

• 17-alpha-hydroxyprogesterone caproate (17P) 250 mg IM weekly starting at 16-20 weeks until 36 weeks is recommended for women with singleton gestations and prior SPTB 1
• In a landmark study of 463 women with singleton gestation and prior SPTB, 17P reduced preterm birth <37 weeks by 34% (RR 0.66) and decreased neonatal complications 1
• If 17P is unavailable, vaginal progesterone may be considered as an alternative 1

Women with Short Cervical Length (CL) without Prior Preterm Birth

• Vaginal progesterone is strongly recommended for women with singleton pregnancy and short cervix (≤20 mm) identified at 18-24 weeks 1
• Two major RCTs demonstrated significant benefits:
  • Fonseca et al: 200 mg vaginal progesterone reduced preterm birth <34 weeks from 34.4% to 19.2% (RR 0.56) 1
  • Hassan et al (PREGNANT Trial): 90 mg vaginal progesterone gel reduced preterm birth <33 weeks from 16.1% to 8.9% (RR 0.55) and decreased respiratory distress syndrome 1
• Patient-level meta-analysis confirmed 42% reduction in preterm birth <33 weeks and 43% reduction in neonatal morbidity/mortality 1

Gynecological Applications

Secondary Amenorrhea

• Progesterone capsules 400 mg daily at bedtime for 10 days is indicated for treatment of secondary amenorrhea 2
• Helps restore menstrual cycles when amenorrhea is due to progesterone deficiency 2

Endometrial Protection

• Progesterone 200 mg daily at bedtime for 12 continuous days per 28-day cycle is recommended for postmenopausal women with intact uterus taking estrogen 2
• Prevents estrogen-induced endometrial hyperplasia that may lead to endometrial cancer 2

Other Clinical Applications

Menopausal Symptoms

• Oral micronized progesterone (300 mg at bedtime) has shown effectiveness for vasomotor symptoms (hot flashes and night sweats) in menopausal women 3
• Improves sleep quality in menopausal women without causing depression 3

Reproductive Medicine

• Used for luteal phase support in assisted reproductive technology (ART) cycles 4
• Commonly administered in intrauterine insemination cycles 4
• Used in early pregnancy disorders including threatened abortion and recurrent miscarriage, though evidence for efficacy is inconsistent 5, 4

Administration Routes and Considerations

Administration Routes

• Intramuscular: Preferred for preterm birth prevention (17P) 1
• Vaginal: Effective for short cervix and luteal support 1
• Oral: Used for secondary amenorrhea and endometrial protection 2

Important Precautions

• Contains peanut oil - contraindicated in patients with peanut allergies 2
• May cause fluid retention - use with caution in cardiac or renal dysfunction 2
• Can cause dizziness and drowsiness - should be taken at bedtime 2
• Not recommended during pregnancy 2
• Should not be used to prevent heart disease, stroke, or dementia 2

Monitoring and Follow-up

• For preterm birth prevention: Regular cervical length monitoring may be indicated 1
• For menopausal symptoms: Evaluate symptom improvement after 2-3 cycles 6
• For secondary amenorrhea: Assess for return of menstrual cycles

Progesterone is a versatile hormone with multiple clinical applications, but its use should be targeted to specific conditions where evidence supports its efficacy, particularly in preventing preterm birth in high-risk women and protecting the endometrium in women taking estrogen therapy.