What is the difference between progesterone and prometrium

This is another case of confusing terminology. These umbrella terms confuse the non-medical among us and mask the fact that these products may have different ways of interacting in the body and different safety profiles.

The progestins listed on the right are generic names. Our hormone therapy chart shows all of the available products. Progestins are a class of drugs manufactured in a lab by pharmaceutical companies to act like the progesterone our bodies make. However, the chemical structure of the synthesized molecule is not the same as the naturally occurring one, which has an impact on the way these progesterone-like molecules bind to progesterone receptors in our bodies.

Progesterone dissipates quickly in the body, so progestins were designed to be more potent and have a longer-lasting effect. As such, progestins are more potent than natural progesterone. Progesterone USP, derived from plants and manufactured in a lab, is bioidentical — that is, molecularly identical to the progesterone made in our bodies.

Looking at the chemical structure of progestins and progesterone, it is clear they are not the same. For more types and structure pictures, see the first article in the references below. These images are from PubChem. Quick start guide to progesterone and progestins — by Anna Garrett, pharmacist. Research Suggests: There might safety and tolerability differences between progesterone and progestin products In , a randomized-controlled trial compared different estrogen and progestogen products that have progesterone-like effects combinations on markers of cardiovascular health in postmenopausal women.

These compounds mimic some of the effects of progesterone but may have different actions on progesterone receptors [ 4 ].

Synthetic progestins may be structurally related to progesterone e. The physiologic effects of a particular progestin depend not only on these properties but also on receptor binding.

In addition to binding to progesterone receptors, these compounds may also have an affinity for androgen, glucocorticoid, and mineralocorticoid receptors [ 5 ]. Although some data suggest that MHT increases the risk of breast cancer [ 6 ], the risk of breast cancer may differ depending on the type of MHT used.

Further, breast cancer risk may vary between regimens containing different progestins, with some synthetic progestins exhibiting greater risk than others [ 8 ]. The effects of progesterone have been shown to be growth-promoting, neutral, or anti-proliferative in breast cells, whereas in women, synthetic progestins, especially the combination of CEE and MPA, have been found to be growth-promoting [ 9 ]. In contrast to progestins, progesterone in combination with estrogen has not been associated with increased breast cancer [ 8 ].

Progesterone and synthetic progestins also demonstrate varied effects on lipids, coagulation factors, glucose, and insulin and may therefore differentially impact cardiovascular risk, though data are sparse [ 11 ]. A recent randomized, double-blind, placebo-controlled trial utilizing mg of progesterone daily showed no adverse changes in endothelial function, blood pressure, weight, or markers of inflammation or coagulation.

Although HDL-C was decreased on treatment, the change was not believed to be clinically relevant [ 12 ]. We conducted a systematic review and meta-analysis to synthesize the existing evidence about the effect of progesterone compared to synthetic progestins on the risk of breast cancer and cardiovascular disease. A predefined protocol was developed by experts from the Endocrine Society to conduct this systematic review. The protocol included explicit criteria for study selection and plans for the data extraction and analysis.

The outcomes of interest were the risk of breast cancer and cardiovascular disease. We excluded non-comparative studies, case series, and non-original papers. We expanded the search to include all languages, with the latest date of inclusion to be 17 May The database search was conducted by an experienced Mayo Clinic reference librarian.

Controlled vocabulary supplemented with keywords was used to search for comparative studies of progesterone vs. A detailed search strategy is described in the Additional file 2. Using an online reference management system DistillerSR Distiller SR, Evidence Partners Incorporated, Ontario, Canada , abstracts and titles that resulted from the electronic search strategy were independently evaluated by two reviewers for potential eligibility, and the full-text versions of all potentially eligible studies were obtained.

Two reviewers working independently considered the full-text reports for eligibility. The level of agreement between the two reviewers k level was 0. Disagreements were harmonized by consensus and, if not possible, by consensus through arbitration by a third reviewer. Reviewers determined the methodological quality of studies and collected descriptive, methodological, and outcome data. We extracted the following variables from the studies: study characteristics study design, inclusion and exclusion criteria , baseline characteristics, and patient demographics, and outcome data.

The I 2 statistic was used to assess heterogeneity of the treatment effect among studies for each outcome. Publication bias was not assessed due to the small number of the studies included. The initial search resulted in citations. After screening the abstracts, this was limited to 46 potentially relevant articles.

These were reviewed in full text by two authors and eventually two cohort studies and one population-based case-control study were included with 44 being excluded for the reasons shown in Fig. The included studies enrolled 86, women with a mean age of 59 years and mean follow-up duration of 5 years.

None of the studies evaluated the outcome of cardiovascular disease. The studies included are summarized in Table 1. The overall risk of bias of the included cohort studies was moderate. Samples were somewhat representative in the two studies with no baseline imbalance, and the studies were controlled for the most important factors.

Table 2 describes the detailed risk of bias assessment of the two included cohort studies. Study selection process.

These were reviewed in full text by two authors and eventually two cohort studies and one population-based case-control study were included with 44 being excluded. The effect of progesterone vs. The quality of evidence was low due to the observational nature of the study design, and Fig.

Sensitivity analysis was done to exclude postmenopausal women receiving synthetic progestins other than medroxyprogesterone acetate. The number of breast cancer events in women receiving medroxyprogesterone acetate was 29 in person-years as reported in the study by Fournier et al.

Random effects model of breast cancer risk in postmenopausal women receiving estrogen with progesterone vs. This figure shows that progesterone was found to be associated with lower breast cancer compared to synthetic progestins in combination with estrogen. The effect of combined estradiol and progesterone in comparison with estradiol and synthetic progestin on breast cancer incidence showed a RR 0.

Subgroup analysis was done based on the route of administration, and no differential effect on the risk of breast cancer was apparent between oral and transdermal routes of administration as shown in Table 4. We also identified a population-based case-control study that reported similar results. Clinical trials have shown that oestradiol used with Prometrium represents one of our safest HRTs. Natural oestrogen tends to have cardiovascular benefits and Prometrium complements this, whereas synthetic progestins, such as medroxyprogesterone acetate e.

Provera , tend to block some of the cardiovascular benefits of oestrogen. A recent meta-analysis world review by Dr. Asi has shown that women using oestradiol plus Prometrium have a significantly lower risk of breast cancer than those using HRT regimens containing synthetic progestins.

Most women will choose to take Prometrium orally. When a continuous HRT regimen is desired, a Prometrium mg cap is taken about an hour before bed and swallowed whole.

When used in hormone replacement therapy, progesterone had minimal effect in opposing the effect of estrogen-mediated increase in HDL cholesterol compared to medroxyprogesterone acetate. Prometrium is formulated with peanut oil and should not be used in patients allergic to peanuts. A recent study reported that the maximum serum concentrations ranged from Prometrium is supplied as mg capsules. For secondary amenorrhea, mg is taken as a single dose in the evening for 10 days.

Prometrium has not received FDA approval for use in hormone replacement therapy. Prometrium is FDA approved for the treatment of secondary amenorrhea, but it may be widely used for the prevention of endometrial hyperplasia in postmenopausal women on hormone replacement therapy. The addition of progestogens tends to attenuate the estrogen-mediated elevation of HDL cholesterol. This compared favorably with the 5.

Data suggest that HDL cholesterol may be a negative risk factor for heart disease in women and may be more closely related to heart disease than LDL cholesterol.