Progesterone, progestins and psychosomatic health of women

Psychosomatics as a medical perspective and discipline focuses on the interaction of physical and mental health in the specific life situation of a patient, taking into account the physical and emotional well-being, role functioning, satisfaction with the partner and family relationship, as well as sexual function and satisfaction. There are two important effects of progesterone on the combined physical, mental and sexual well-being of the climacteric patient. The first is the antiestrogenic effect of progesterone on the peripheral physical level which not only protects the endometrium against overstimulation but also reduces individual suffering from heavy bleeding, breast tension, bloating and general discomfort. The second effect is due to the complex action of progesterone in the brain. Studies using different progestins in different dosages and in different regimens show contradictory results. Some studies demonstrate an increase in depressed mood and reduced well-being while using synthetic progestins. Other studies, however, indicate an anxiolytic and sometimes antidepressant effect of progesterone and progesterone-like progestins with an improvement of emotional well-being and quality of life. In the individual patient, the positive or negative emotional and mental state can be conditioned by various pathways of progesterone and progestins. The antiestrogenic effect can attenuate the psychotropic effect of estradiol (E2) on the brain, thus reducing emotional well-being. Progesterone interacting with many brain areas can have a mood stabilizing and anxiolytic effect through the action on the GABA receptor. This effect seems to be strongest when using natural progesterone and the effect varies considerably among different progestins and different dosages due to metabolic pathways involving the production of allopregnanolone or other metabolites. In conclusion, the positive anxiolytic and sedative effects of progesterone on the central nervous system depend on the type of progestogen, the dosage, the timing of application, the combination with estrogen, etc. Progesterone and progestins have important potential to maintain or improve the psychosomatic health of women. Their use must, however, be tailored to specific symptom clusters and to the individual's pre-existing psychosomatic health status.