Progestins
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Reproductive Pharm
- Leuprolide
- Anastrozole
- Estrogens
- Clomiphene
- Progestins
- Mifepristone
- Copper IUDs
- Danazol
- Terbutaline, Ritodrine
- Minoxidil
- Androgens (Testosterone, Methyltestosterone)
- Flutamide
- PDE-5 Inhibitors (Sildenafil, Vardenafil, Tadalafil)
- Finasteride
Summary
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Key Points
- Progestins
- Medications
- Levonorgestrel
- Found in OCPs and IUDs
- Medroxyprogesterone
- Found in OCPs or depot injections
- Norethindrone
- Found in OCPs
- Etonogestrel
- found in vaginal rings and implants
- Megestrol
- Levonorgestrel
- Mechanism
- Synthetic progesterone agonists
- Binds progesterone receptors on the uterus and hypothalamus
- Synthetic progesterone agonists
- Indications
- Contraception
- Anovulation
- in oral contraceptives/patch/depot injections
- Synthetic progestins act on the hypothalamus to induce negative feedback→ decreased GnRH → decreased LH/FSH → decreased LH surge → no ovulation
- Thickens cervical mucus
- in IUDs/progestin-only pills
- Limits the sperm access to ova
- Thinning of uterine lining
- All progesterones therefore impair embryo implantation
- This is a minor effect in comparison to the above
- Anovulation
- Reduces growth of endometrial tissue
- Used in the treatment of endometrial hyperplasia/cancer and endometriosis
- Increases endometrial vascularity and shedding for menses
- Counteracts endometrial growth/hyperplasia induced by estrogens in combined OCPs
- Progestin challenge for abnormal uterine bleeding
- presence of withdrawal bleeding excludes anatomic defects (i.e. Asherman syndrome) and chronic anovulation without estrogen
- Contraception
- Adverse Effects
- PE/DVT and other hypercoagulable events seen in combined progestin/estrogen OCPs
- Due to estrogen, not progesterone in formulation; Used alone, progestins have NOT been associated with thromboembolic events.
- Decreased bone density (osteoporosis)
- PE/DVT and other hypercoagulable events seen in combined progestin/estrogen OCPs
- Medications