Progesterone adverse effects

Dysphoric adverse effects, mostly depression and anxiety, of progesterone are well-documented and might be responsible for some side effects of combined... 

Eplerenone is a spironolactone analog with much greater selectivity for the mineralocorticoid receptor. It is several hundred-fold less active on androgen and progesterone receptors than spironolactone, and therefore eplerenone has considerably fewer adverse effects. 

The corpus luteum arises from the ruptured follicle and secretes progesterone, which has an important role in the estrous or menstrual cycle. Luteal progesterone is also required to maintain early pregnancy in most mammalian species, including humans (Csapo Pulkkinen, 1978). Therefore, establishment and maintenance of normal corpora luteaare essential for normal reproductive function. However, with the exception of evaluations to establish their presence or absence, these structures are not evaluated in routine testing. Increased rates of follicular atresia and oocyte toxicity may lead to premature menopause in humans. Altered follicular development, failure to ovulate or altered corpus luteum formation and function can disrupt cyclicity, reduce fertility and interfere with normal sexual behaviour. Therefore, significant increases in the rate of follicular atresia, evidence of oocyte toxicity, interference with ovulation or altered corpus luteum formation or function should be considered adverse effects. 

The fact that progesterone when given by mouth has poor systemic availability can be largely overcome by micro-nization, and the first product based on this concept was marketed in France as long ago as 1980. Studies and reviews have appeared, particularly since 1997, suggesting that it is indeed less likely to cause adverse effects than... 

Epierenone is a potassium-sparing diuretic. It is similar to spironolactone as an aldosterone antagonist, but has less affinity for androgen and progesterone receptors and may therefore have fewer adverse effects (1). 

Another variant on hormone replacement therapy involves using aU three types of sex steroid in parallel, starting from the argument that during the fertile period all three are sjmthesized by the ovary (7). A natural version of this therapy uses estradiol, testosterone (with or without dehydroepiandrosterone), and progesterone in an appropriate pharmaceutical form (for example micro-nized), so that absorption is attained without the need for 17-substitution. This approach naturally avoids some of the undesirable effects of the synthetic steroids, and has been stated to improve menopausal depression and anxiety. However, the adverse effects of all three types of component can be experienced. 

Sexual complaints attributed to interferon alfa, namely decreased hbido, impotence, or erectile failure, are usually concomitant to other neuropsychiatric symptoms, and cases of reversible impotence are anecdotal (315). The mechanisms accounting for these adverse effects are unclear, and changes in sex hormone concentrations have not been consistently reported. In one study in healthy women, interferon alfa produced falls in serum progesterone and estradiol concentrations (316), but neither impairment of libido nor impairment of fertility has apparently been reported in women. No evidence of gonadal toxicity or sexual dysfunction was found in 43 men with hairy cell leukemia who received interferon alfa for 2-12 months compared with 33 patients who... 

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