From the Guidelines
Progesterone supplementation is not the first-line treatment for polycystic ovary syndrome (PCOS) in non-pregnant women, and instead, combination oral contraceptive pills are often recommended to manage symptoms and reduce the risk of endometrial cancer. The American College of Obstetricians and Gynecologists (ACOG) notes that the optimal progestin and the optimal duration and frequency of treatment to prevent endometrial cancer in women with PCOS is not known 1. However, for women with PCOS who are trying to conceive or have achieved pregnancy, progesterone supplementation may be beneficial in supporting early pregnancy and reducing the risk of miscarriage.
Some studies suggest that medroxyprogesterone acetate (MPA) can suppress circulating androgen levels and pituitary gonadotropin levels in women with PCOS 1. However, more recent studies have highlighted the potential benefits of natural micronized progesterone (MP) in hormone replacement therapy, including a lower risk of cardiovascular disease and venous thromboembolism 1.
When prescribing progesterone supplementation, clinicians should consider the individual patient's needs and medical history, as well as the potential risks and benefits of different progestins. The use of natural micronized progesterone (MP) is recommended as the first choice due to its favorable safety profile and effectiveness in inducing secretory endometrium 1. Patients should be advised of the potential side effects of progesterone supplementation, including vaginal irritation, breast tenderness, mood changes, and drowsiness, but these are generally well-tolerated.
In terms of specific treatment regimens, the dose and duration of progesterone supplementation will depend on the individual patient's needs and medical history. For example, women with PCOS undergoing ovulation induction or assisted reproductive technology may require vaginal progesterone supplementation, while pregnant PCOS patients with a history of recurrent pregnancy loss may require intramuscular progesterone supplementation. The decision to prescribe progesterone supplementation should be made on a case-by-case basis, taking into account the individual patient's needs and medical history, as well as the potential risks and benefits of different treatment regimens.
From the Research
Progesterone for PCOS
- Progesterone is a hormone that plays a crucial role in ovulation, implantation, and luteal phase support in women with Polycystic Ovary Syndrome (PCOS) 2.
- Low levels of progesterone have been found in the early luteal phase in PCOS patients, and granulosa cells from polycystic ovaries show an altered progesterone production 2.
- Progesterone may be administered to PCOS patients to induce withdrawal bleeding, suppress secretion of luteinizing hormone, induce ovulation in clomiphene citrate-resistant patients, and provide luteal phase support in assisted reproduction 2.
Treatment Strategies for PCOS
- Combined oral contraceptives (COCs) are the first-line medical treatment for the long-term management of PCOS, as they restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer 3, 4, 5.
- COCs contain low doses of estrogen and different types of progestin, and their use may increase the risk of venous thromboembolism (VTE) and have potential cardiometabolic risks 3, 4, 5.
- A tailored clinical approach to oral contraception in women with PCOS requires individualized risk stratification and management by determination of each PCOS patient's personal cardiometabolic risk profile at baseline and during follow-up 3, 5.
Benefits and Risks of Progesterone and COCs in PCOS
- The benefits of hormonal contraception, including progesterone and COCs, outweigh the risks in the vast majority of women with PCOS 4, 5.
- However, concerns have been raised about potential adverse cardiovascular and metabolic effects of COCs, and individual risk assessment is the key to avoiding unfavorable outcomes related to COC use in women with PCOS 3, 4, 5.