Gestagens: progesterone and derivates - instituto bernabeu

What are gestagens?

The gestagens hormones (also known as progestagens) main function, is to maintain pregnancy (they are pro-gestational), and play a key role in the menstrual cycle regulation.  

Gestagens are a class of steroid hormones, along estrogens, androgens, minearlocorticoids and glucocorticoids. This big steroid hormones family is characterized by their basic 21-carbon skeleton, called a pregnane skeleton (C21). In similar manner, the estrogens possess an estrane skeleton (C18), and androgens, an androstane skeleton (C19).

What types of
gestagens can we find?

Within gestagens, we can find those produced naturally and the analogous synthetics. Progesterone is the most natural gestagens in our body, it is mainly synthesised in the ovaries from cholesterol within the blood. Artificial gestagens, created in laboratories, are known as progestin.

What is the role of
gestagens?

Pregesterone is produced in ovaries and, in case of pregnancy, in the placenta. Adrenals and liver also produce progesterone but in lower values. Its main function whilst menstrual cycles is to prepare the endometrium for a possible pregnancy. Once implantation has taken place, progesterone maintains pregnancy and relaxes the uterus muscles, keeping the uterine vascularisation.

Prepares the breasts glands during breast feeding for the milk’s secretion

When and how do we supply
gestagens?

Progesterone can be administered in vaginal, intramuscular, subcutaneous or oral form.

Vaginal: usually in ovum form of 100, 200 y 400mg. Administration is very easy and the most frequent side effect is vaginal irritation. Most frequent commercial names are Progeffik®, Utrogestán® and Cyclogest®.

  • Subcutaneous administration: it has good bioavailability and the most frequent side effect is irritation in the injection area. In Spain is commercialized as Prolutex®.
  • Intramuscular: Achieves good concentrations, but it is a painful administration and requires medical assistance so is no longer in use.
  • Oral administration: Its effectiveness is lower due to hepatic pass to undergo metabolism and side effects are numerous (somnolence, sickness) this is why is not the most recommended administration way for these treatments.

What are the advantages and disadvantages of the use of
gestagens in fertility treatment?

Low progesterone levels are associates with implantation failure, recurrent miscarriage and premature labour.

Knowing progesterone values and the optimal levels allow us to evaluate the cycle at different moments on both in vitro fertilization cycles and natural cycles

  1. At the cycle’s beginning, it let us confirm the previous cycle luteal inhibition.
  1. Around ovulation time, it let us know if the endometrium is receptive or not.
  2. At luteal phase, it let us know if there’s a correct progesterone natural production or medication absorption.

Progestagens also have side effects, mostly minor, among which are liquid retention, nausea, vomit, breasts bloating, modo changes, libido decrease and drowsiness.

Dr Cristina Gavilán, a gynaecologist at Instituto Bernabeu.

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