Progestogen adverse effects

Adverse effects of progestogens are irritability, depression, headache, mood swings, fluid retention, and sleep disturbance. 

Hormonal contraception relies on the actions of estrogens and progestogens, of which oral contraceptives contain a mixture. The adverse effects of the separate components are discussed in other monographs. 

For a complete account of the adverse effects of progestogens, readers should consult the following monographs as well as this one ... 

In 104 women with established postmenopausal osteoporosis, continuous estrogen + progestogen therapy resulted in increases in bone mineral density of the femoral neck and a fall in systolic blood pressure the most common adverse effects were mastalgia (44%) and vaginal bleeding (29%) (2). 

In another study an estrogen + progestogen combination produced no adverse effects on serum lipids or lipoproteins (21), but this again may depend very much on the exact combination and duration of treatment. 

Various anti-progestogenic routines for the termination of pregnancy continue to be compared. Of 354 women who were given mifepristone 200 mg in the clinic and then sent home with two tablets of misoprostol 200 micrograms to take 48 hours later, 324 (91.5%) had a successful termination (7). The most common adverse effects were pain or cramps (93%) and nausea (67%), followed by weakness (55%), headache (46%), and dizziness (44%). Overall acceptability of the regimen was high 63% of women reported that it was very satisfactory and another 23% found it satisfactory . There were no serious complications and the simplified routine, with a much reduced duration of hospital care, was considered acceptable. 

Progestogens given alone for contraceptive purposes can cause a number of adverse effects, some of which may reflect their other hormonal properties while others are non-specific. Headache, nausea and vomiting, breast tenderness, and pain in the back or abdomen can occur. 

Tibolone is an agonist at estrogen and progestogen receptors, with weak androgenic activity. It is given as an alternative to hormone replacement therapy, without added progestogen, and has been in use for some 30 years to treat bone loss in post-menopausal women. Some long-term studies (for example over 10 years) appear to have confirmed its safety and relative freedom from adverse effects (1). In particular there is little or no increase in thrombotic events and the incidence of breast tenderness is low. 

Because the dose of oestrogens and progestogens used in HRT products is low, the majority of women experience no adverse effects on liver function. Occasionally hepatic changes such as cholestatic jaundice, vascular complications and enlargement of haemangiomas have occurred. See the Clinical studies and Case reports sections below for further details. 

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