Prometrium (Progesterone) and Libido
Prometrium (oral micronized progesterone) is not indicated for increasing libido and may actually decrease sexual desire in some individuals. While some hormonal therapies can affect sexual function, there is insufficient evidence supporting progesterone as a treatment for low libido.
Effects of Progesterone on Sexual Function
Progesterone has various effects on the endocrine system and sexual function:
- Unlike testosterone, which is associated with increased libido, progesterone is not typically linked to enhanced sexual desire
- In a study examining menopausal women, progesterone was shown to improve sleep and vasomotor symptoms but did not specifically demonstrate libido enhancement 1
- Progestins (synthetic progesterone-like compounds) have been reported to potentially oppose the beneficial effects of estrogen therapy on vaginal tissues, which could lead to vaginal dryness and dyspareunia (painful intercourse) 2
Hormonal Influences on Libido
When considering hormonal factors affecting libido:
- Low testosterone is a more common hormonal cause of reduced libido in both men and women
- The American College of Physicians notes that the prevalence of low testosterone levels in men with erectile dysfunction varies from 12.5% to 35% 3
- Hyperprolactinemia (elevated prolactin levels) is universally associated with reduced libido 4
- For women experiencing sexual dysfunction, the addition of androgens (testosterone) rather than progesterone has proven helpful for libido issues 2
Clinical Considerations
If experiencing low libido, consider these important factors:
- Primary reduced libido (not associated with medical conditions) has different characteristics than secondary reduced libido (associated with conditions like hypogonadism, hyperprolactinemia, or psychopathology) 4
- Medications that affect serotonin levels (like certain antidepressants) can significantly impact libido 3
- Proper evaluation should include assessment for underlying medical conditions that could affect sexual desire
Alternative Approaches for Low Libido
Instead of progesterone, consider these evidence-based approaches:
- For men with erectile dysfunction and low testosterone, testosterone replacement may be considered, though the American College of Physicians notes evidence is inconclusive about its effectiveness even in patients with low testosterone levels 3
- For women with hypoactive sexual desire disorder, medications that increase dopamine and norepinephrine while decreasing serotonin (like flibanserin) have shown some encouraging results 5
- Addressing underlying psychological factors, relationship issues, and stress management can be important for primary reduced libido 4
Potential Benefits of Progesterone
While not indicated for libido enhancement, oral micronized progesterone does have legitimate uses:
- Treatment of vasomotor symptoms (hot flashes and night sweats) in menopausal women 1
- Improvement of sleep quality 1, 6
- Potential beneficial effects on anxiety and depression symptoms 6
- Lower risk profile compared to synthetic progestins regarding cardiovascular disease, breast cancer, and venous thromboembolism 6
In conclusion, if you're experiencing low libido, progesterone is not the recommended treatment. A proper evaluation of hormonal status (particularly testosterone and prolactin levels) and consideration of other medical, psychological, and relationship factors would be more appropriate for addressing libido concerns.