Progestogens used in menopause. Side effects, mood and quality of life

Progesterone receptors are found in many of the same brain areas as estrogen receptors, including the hypothalamus and limbic system. The limbic system, particularly the amygdala, plays a prominent role in regulating emotion and mood. Progestogens decrease brain excitability, whereas estrogens increase it. This explains, in part, why women with epilepsy have a higher frequency of seizures during the late follicular and ovulatory phases of the menstrual cycle than during the luteal phase. In addition, progesterone has been shown to have profound anesthetic properties and to increase the concentration of monoamine oxidase (MAO), the enzyme that catabolizes serotonin in the brain), whereas estrogen decreases MAO, thereby increasing the concentration of serotonin. The purpose of this paper is to review the extant research regarding these biologic effects of progestogens on brain function.