Progesterone in Peri- and Postmenopause: A Review

Abstract

Around 14.5 million peri- and postmenopausal women currently live in Germany. Moreover, approximately 450 000 women, each with a life expectancy of around 85 years, reach menopause every year in Germany. The challenge is therefore to find a therapy with few side effects which could improve the quality of life of women with menopausal symptoms. The aim of hormone therapy (HT) is to remedy hormone deficiencies using substances that offer the best trade-off between benefits and risks. This is where progesterone has a new and important role to play. Progesterone is one of the most important gestagens. Biologically effective progesterone formulations created with micronization techniques have been used in clinical practice since 1996. Nevertheless, up until 2003 preference was given to synthetic gestagens rather than progesterone. The increased breast cancer hazard ratio of 1.23 reported in the WHI study and of 2 given in the Million Women Study has been associated with the use of synthetic gestagens. In a comparison between synthetic gestagens and progesterone, the E3N Study showed that the transdermal administration of estrogen and progesterone did not lead to an increase in breast cancer rates (RR: 1.08). The administration of progesterone does not change the HDL/LDL cholesterol ratio. Because of its anti-mineralocorticoid effect, progesterone has no impact on carbohydrate metabolism, hemostasis, blood pressure, thrombogenicity and body weight. The administration of 200 mg/day progesterone over 12 days of a menstrual cycle or a daily administration of 100 mg combined with an estrogen are a safe and well-tolerated option to treat menopausal symptoms, with a better benefit risk profile compared to synthetic gestagens.

Zusammenfassung

Aktuell leben 14,5 Millionen peri- und postmenopausale Frauen in Deutschland. Gleichzeitig gibt es ungefähr 450 000 neue menopausale Frauen pro Jahr, die eine Lebenserwartung von bis zu 85 Jahren haben. Die Herausforderung besteht daher in einer möglichst nebenwirkungsarmen Therapie bei den Frauen mit menopausalen Beschwerden, um einer Verschlechterung ihrer Lebensqualität entgegenzuwirken. Ziel einer Hormontherapie (HT) sollte die Behebung des Hormonmangels sein, wobei Substanzen mit dem besten Nutzen-Risiko-Profil eingesetzt werden sollten. Hier spielt Progesteron eine neue und wichtige Rolle. Beim Progesteron handelt es sich um den wichtigsten Vertreter der Gestagene. Durch Mikronisierungsverfahren können biologisch wirksame Formulierungen hergestellt werden, sodass es seit 1996 Anwendung im klinischen Alltag findet. Dennoch wurde bis 2003 den synthetischen Gestagenen und nicht dem Progesteron der Vorzug gegeben. Die Erhöhungen des Mammakarzinomrisikos in der WHI-Studie auf eine Ratio von 1,23 und in der Million-Women-Studie auf bis zu 2 sind daher auch unter diesem Aspekt zu werten. Beim Vergleich zwischen synthetischen Gestagenen und Progesteron konnte in der E3N-Studie gezeigt werden, dass es unter einer transdermalen Östrogengabe zusammen mit Progesteron nicht zu einer Erhöhung der Mammakarzinomrate (RR von 1,08) kommt. Progesteron verändert nicht die HDL/LDL-Cholesterinratio. Es hat keinen Einfluss auf den Kohlenhydratstoffwechsel, die Hämostase, den Blutdruck, die Thrombogenität und das Körpergewicht, da es auch antimineralokortikoid wirkt. Die Gabe von 200 mg Progesteron pro Tag über 12 Tage im Zyklus oder die tägliche Gabe von 100 mg in Kombination mit einem Östrogen stellen daher eine sichere Option in der Behandlung der menopausalen Beschwerden dar, bei gleichzeitig besserem Nutzen-Risiko-Profil als die synthetischen Gestagene.

Key words

hormone therapy - progesterone - menopause - menopausal symptoms

Schlüsselwörter

Hormontherapie - Progesteron - Menopause - Wechseljahresbeschwerden

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