Menopause is a natural process during which a woman permanently stops menstruating and is no longer fertile. Gradually, the ovaries decrease production of the female sex hormones, estrogen and progesterone, and this leads to several physical and emotional symptoms. The body still produces some estrogen but no progesterone, and some women may need hormone replacement therapy after menopause.
Menopause
Menopause is completed when a woman has not had a menstrual period for 12 months. Symptoms of menopause include night sweats, mood swings and hot flashes. Hormone replacement therapy, or HRT, is sometimes used to treat menopausal symptoms. The patient takes an estrogen supplement, to which progesterone should be added for protection of the uterus in women who have not undergone a hysterectomy, according to "Pharmacotherapy: A Pathophysiologic Approach."
Role of Progesterone
Progesterone is a sex hormone that is produced in the ovaries, adrenal glands and the placenta when a woman is pregnant. Progesterone levels rise during the last two weeks of the menstrual cycle and prepare the uterus to receive a fertilized egg. If you become pregnant, progesterone levels will remain elevated. The hormone also stimulates the growth of glands that produce breast milk. If pregnancy does not occur, the level of progesterone drops and menstruation occurs.
Endometrial Hyperplasia
Endometrial hyperplasia is an abnormal overgrowth of the endometrium, which is the layer of cells that lines the uterus, caused by overstimulation from estrogen. Estrogen promotes the growth of the endometrium that usually occurs in the menstrual cycle. When estrogen alone is administered for three to six months, the endometrium thickens and enlarges. This may lead to endometrial hyperplasia in patients who still have a uterus and increase the risk of endometrial cancer.
Progesterone Medication
Progesterone is available with a doctor's prescription as a capsule, vaginal gel, vaginal suppository and intramuscular injection. The capsule is indicated for the prevention of endometrial hyperplasia when the patient is receiving estrogen. The dose given is 200 mg once daily in the evening for 12 days consecutively per 28-day cycle. Progesterone is also available over the counter, but you should use these products with extreme caution because they have not been reviewed for efficacy and safety by the FDA.
Side Effects
Progesterone, when used in combination with estrogen, may lead to common side effects such as headache, dizziness, nausea, vomiting, stomach pain and bloating. These typically occur when you start therapy but decrease with continued use of the drug. You may experience effects on the breast such as tenderness and pain, which has been seen in about 20 percent of patients, according to the "Drug Information Handbook." Joint and muscle pain may also occur. If you develop any of these side effects, speak with your physician; if any side effect becomes severe, seek medical help immediately.
References
- "Pharmacotherapy: A Pathophysiologic Approach"; Joseph T. Dipiro, Robert L. Talbert, et al.; 2008
- Mosby's Medical Dictionary: Endometrial Hyperplasia
- "Drug Information Handbook"; Charles F. Lacy, Lora L. Armstrong, et al.; 2009
