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Transvaginal administration of progesterone
R Fanchin1, D De Ziegler, C Bergeron
1Department of Obstetrics and Gynecology and Reproductive Endocrinology, Hôpital Antoine Béclère, Clamart, France.
Obstetrics and Gynecology
|September 1, 1997
Summary
Vaginal progesterone gel effectively induced normal endometrial changes in women without ovarian function. This suggests a direct uterine pathway, bypassing systemic circulation for therapeutic effects.
Area of Science:
- Reproductive Endocrinology
- Gynecology
Background:
- Hormone replacement therapy often requires effective progesterone delivery.
- Understanding endometrial response to various progesterone administration routes is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate the endometrial effects of three distinct doses of vaginally administered progesterone in women with ovarian function deprivation.
Main Methods:
- Forty women received estradiol and varying doses of vaginal progesterone gel (45 mg, 90 mg, 180 mg) every other day.
- Hormone levels (gonadotropins, estrogens, progesterone) were monitored.
- Endometrial biopsies were analyzed for dating and receptor expression.
Main Results:
- Vaginal progesterone administration led to normal secretory transformation of the endometrium.
- Plasma progesterone levels varied by dose but were generally lower than expected systemically.
- Estrogen and progesterone receptor distribution mirrored that of normal menstrual cycles.
Conclusions:
- Transvaginal progesterone effectively induces secretory changes in the endometrium.
- A 'first uterine pass effect' is suggested, where progesterone directly impacts the uterus.
- Vaginal progesterone may offer a targeted endometrial treatment option.