Micronized progesterone, progestins, and menopause hormone therapy

Area of Science:

• Reproductive Endocrinology
• Menopause Management
• Pharmacology

Background:

• Hormone therapy, particularly estrogens, is a primary treatment for menopausal vasomotor symptoms.
• Progestins (PG) are necessary for women with a uterus to prevent endometrial hyperplasia.
• Different progestins possess varying biological activities, impacting safety and efficacy.

Purpose of the Study:

• To review the benefit/risk balance of micronized progesterone (P) versus synthetic progestins (PGs) in menopause hormone therapy (MHT).
• To guide clinicians in selecting the optimal progestin component for women with bothersome menopausal symptoms and a uterus.

Main Methods:

• Narrative review of existing literature.
• Comparative analysis of safety, efficacy, and risk profiles of micronized progesterone and synthetic progestins.
• Focus on cardiovascular and breast cancer risks, as well as metabolic profiles.

Main Results:

• Micronized progesterone (P) is suggested to be safer than synthetic progestins (PGs).
• P demonstrates an acceptable metabolic profile compared to some synthetic PGs.
• The choice of progestin significantly influences the overall risk-benefit assessment of MHT.

Conclusions:

• Micronized progesterone may be a preferred option for the progestin component in MHT for women with a uterus.
• Careful selection of the progestin is crucial for optimizing MHT safety and tolerability.
• Further research may be warranted to fully elucidate class effects and long-term outcomes.