Progestins of today and tomorrow

Abstract

Purpose of reviewTo review the current literature on the multiple types and uses of progestins in reproductive healthcare. Recent findingsProgestins for contraceptive use are available in multiple forms, with the ongoing development of transdermal, intravaginal, and male contraception formulations. Noncontraceptive use of progestins often overlaps with contraceptive indications, which allows for simultaneous multipurpose progestin use, especially in reproductive-aged patients. More studies are needed to determine contraceptive doses of progestins used for noncontraceptive purposes. Side effect profiles of progestins are dependent on their formulation and cross-reactivity with other steroid receptors. Development of newer progestins includes manipulating pharmacologic properties to avoid undesired side effects.

Proliferative Endometrium in Menopause

“…Side effects associated with progestins include bloating, weight gain, irritability, and depression, which are more likely to occur with oral formulations than with the LNG-IUS. 9 There are patients, though, who may be uncomfortable with having a foreign body placed and the risk of uterine perforation on insertion.…”

Reversible interventions for menstrual management in adolescents and young adults with gender incongruence

“…30,39 For patients who desire menstrual suppression in the form of a daily pill but who either do not require or do not desire contraception, NETA 2.5-20 mg is a reasonable choice for menstrual suppression. 3,30,37,39 In practice, the author recommends that if SDM techniques result in the use of NETA, the initial dose may be 5 mg/day and can increase to up to 20 mg/day by 2.5-5 mg increments every 4-8 weeks as needed to control bleeding or decreased to 2.5 mg/day to control side effects.…”

“…40 Ovulation is not reliably suppressed at doses less than 10 mg per day. 39 If contraception or non-daily intervention for menstrual management is desired, subcutaneous or intramuscular preparations of DMPA may be used. These are both very effective contraceptives and effective menstrual suppressants.…”

“…These are both very effective contraceptives and effective menstrual suppressants. 6,7,23,24,37,39,40,44,53 Both the subcutaneous and intramuscular preparations of DMPA carry a black-box warning from the FDA regarding a deleterious effect on bone health with the use of either of these medications for longer than 2 years, although the risk of fracture with prolonged use of DMPA is less clear. 56 If patients desire specific contraception, DMPA in either form is an excellent choice although the provider should counsel on the risks of changes to bone health, weight gain, and delay in return to fertility.…”

Editorial: Updates in contraception and abortion care: turbulence, upheaval, and chaos, but keeping calm and continuing to care

“…In a comprehensive review of both ‘once and future’ progestins, Liu et al provide a wealth of information highlighting recent research on the various formulations, routes of administration, mechanisms of action, side effects, and noncontraceptive indications for the plethora of progestin-dominant contraceptives both available now and in development [1]. Importantly, in settings in which religious mandates currently prohibit prescriptions for or dispensation of modern contraceptives (or should the right to privacy in contraception be compromised), it's these noncontraceptive indications and workarounds that provide a lifeline to those needing effective and often long-acting methods [2].…”