Progesterone deficiency

Progesterone deficiency is a common cause of infertility or involuntary interruption of pregnancy in the early stages, which is not so often diagnosed in time. Violations of the ovario-menstrual cycle are very frequent pathology today, and it ranks first among pathologies that are diagnosed in women of reproductive age and young girls. This is due to exogenous factors, severe stresses and stresses that currently surround women and contribute to the disruption of the hormonal background.

[1], [2]

Epidemiology

The epidemiology of this problem has changed in recent times in such a way that violations of the ovario-menstrual cycle that lead to infertility take priority place in the gynecology of women of young reproductive age. With regard to the deficit of progesterone - more than 80% of infertility of hormonal genesis is associated with this problem. The cause of miscarriage at an early age in 25% of cases is the deficit of progesterone. This problem is diagnosed in 80%, which is a good indicator and proves the possibility of preventive treatment.

[3], [4], [5], [6], [7]

Causes of the progesterone deficiency

Progesterone is one of the most important hormones in a woman's body. It is synthesized by the ovaries and this number is sufficient for a normal menstrual cycle. When a woman becomes pregnant, the focus of progesterone synthesis becomes the placenta, so progesterone is also called the hormone of pregnancy. It supports normal placentation and growth of fetal cells.

Speaking about the causes of progesterone deficiency, it is necessary to distinguish between primary and secondary. Primary reasons include insufficiency due to congenital abnormalities in the ovaries, their congenital hypoplasia or aplasia, as well as genetically determined violation of the level of progesterone. Secondary causes of progesterone deficiency occur more often. These are inflammatory diseases of the ovaries, polycystic ovary, ovarian cyst, trauma or postoperative ovarian failure. Any of these pathologies lead to impaired ovarian function and little progesterone is synthesized or it is not synthesized at all. This also contributes to the manifestation of certain clinical signs.

[8], [9], [10]

Risk factors

It is also necessary to identify risk factors that increase the likelihood of this pathology. Such factors include:

1. irregular menstruation;
2. early pregnancies;
3. inflammatory diseases of the genital organs, mainly of the ovaries;
4. ovarian cyst;
5. endometriosis of the uterus external or internal;
6. endocrine diseases of the thyroid gland or adrenal gland;
7. fibro-cystic hyperplasia of the breast in the anamnesis.

These are the main factors that can affect the function of the ovaries and in a secondary way disrupt the synthesis of progesterone.

[11], [12], [13],

Pathogenesis

The pathogenesis of changes with progesterone deficiency depends on the basic functions that the hormone performs in the body. First of all, progesterone provides the first stage of the menstrual cycle. Under the influence of releasing factors, which are secreted by the hypothalamus, the pituitary gland stimulates and the level of follicle-stimulating hormone increases. This hormone increases the production of progesterone and they ensure the maturation of the ovarian follicle. It is the follicle that provides the synthesis of progesterone, which affects the endometrium - it stimulates the proliferation of endometrial cells, its functional layer, that is, the preparation for implantation of the oocyte. Therefore, this hormone is called the pregnancy hormone. Further, when ovulation occurs, the synthesis of progesterone decreases, which stimulates the onset of the secretion phase in the endometrium. Such cyclic changes in the level of progesterone and ensure normal ovulation and the onset of pregnancy. Therefore, the pathogenesis of the development of any changes with a deficiency of progesterone is a violation of the function of the organs even with the slightest fluctuations in the level of this hormone. Therefore, changes in the functioning of the organs and the corresponding clinical symptoms develop not only with a deficiency of progesterone, but also in violation of its fluctuation, that is, when there is no physiological increase or decrease in the level of this hormone.

With regard to the pathogenesis of changes in pregnancy in the case of a deficiency of progesterone, this hormone is synthesized by the placenta, which is an important factor in the development of fetal abnormalities. If it is deficient, there is a violation of the placentation and its attachment to the endometrium of the uterus - all these changes can lead to different consequences. Complications, which can occur in this case - is the wrong attachment of the placenta, fetoplacental insufficiency, spontaneous abortion in the early stages of pregnancy.

All these features and the role of progesterone in the body of a woman need to know in order to prevent possible symptoms of this pathology, affecting mainly the deficit of progesterone.

[14], [15], [16], [17], [18]

Symptoms of the progesterone deficiency

If a girl is born with a deficiency of progesterone, as a hereditary sign, the symptoms may not be expressed until the menstruation period or even before pregnancy. Most often, the deficit of progesterone has signs in the form of menstruation - this can be a meager menstrual discharge due to the fact that the endometrium is not mature enough and is not sufficiently functional, because progesterone did not ensure normal proliferation of its cells. This may be the only clinical symptom, which in most cases is not paid any attention. The first signs of an obvious deficit of progesterone in this case may appear already when you try to become pregnant. Then the endometrium does not fully ripen and the fertilized egg can not be implanted - which leads to vain attempts to have a child. If pregnancy occurs, then placenta is broken, so the embryo does not have normal blood flow, which leads to such violations as premature miscarriage. Therefore, the main symptom of progesterone deficiency can be considered infertility or the usual miscarriage of pregnancy - when there are three or more miscarriages.

Deficiency of progesterone during pregnancy can occur in the first trimester, then it is a violation of the normal structure of the placenta, its functions, attachment sites and the function of trophic organs of the fetus. This may occur in a later period - there are spotting from the uterus that are not accompanied by pains in the lower abdomen and an increase in the uterine tone, but such bleeding causes a woman to worry. In this case, we are talking about placenta previa, which is due to violations of its attachment, in particular, due to a deficiency of progesterone. Such a pregnancy can be preserved, but further there may be complications in childbirth. Symptoms of premature detachment of the placenta may appear - then there will be spotting from the uterus and pains in the lower abdomen, and there may also be fetoplacental insufficiency. In this case, the fetus already suffers and chronic fetal hypoxia occurs.

Deficiency of progesterone can negatively affect the process of lactation. Under normal conditions, progesterone provides growth and development of the glandular structure of the gland, the number of alveoli and the proliferation of their cells increase. This ensures the normal functioning of the milk duct and the process of lactation itself. Also, progesterone during lactation inhibits the development of new eggs. Therefore, the deficit of progesterone in breastfeeding women can be manifested by a lack of milk or lack of milk due to a violation of the alveolar structure of the breast.

Thus, it can be seen that the symptoms of estrogen deficiency can be expressed in different ways and it is necessary to know exactly what can be the cause of such disorders. After a violation of the menstrual cycle in the future can lead to problems with pregnancy, so you need to carefully consider everything.

Complications and consequences

The main complications that can occur when a hormone is deficient is infertility. This is a very common problem that can bother women of reproductive age. Deficiency of progesterone from the very beginning can cause functional deficiency of endometrial glands, which in the future is very difficult to correct, even with the help of substitution therapy. Therefore, it is important to identify this problem in time and begin treatment. The consequence of a deficiency of progesterone already during pregnancy in early terms may be miscarriage, and in later terms - placental pathology or premature birth with complications.

[19], [20],

Diagnostics of the progesterone deficiency

Diagnosis of any violations associated with menstrual function and infertility should begin with a careful collection of anamnesis. It is necessary to find out the beginning of the first menstruation, after all it can be later the beginning. You also need to determine the nature of the menstrual function, its regularity. For the purpose of differential diagnosis, it is necessary to exclude pathologies that could lead to infertility, so it is also necessary to carefully examine the woman.

If we are talking about a young woman, then we can identify inflammatory diseases of the ovaries, which may be the cause of secondary insufficiency of progesterone. In this case, painful and enlarged ovaries will be palpated on one side or both sides.

The "gold standard" of diagnosing progesterone deficiency is unconditionally analysis. It is important to conduct both general and specialized analyzes. A general blood test and a general urine test are mandatory, as they enable differential diagnosis of certain symptoms. A special method of diagnosis is the determination of progesterone in the blood, as well as the determination of other female hormones. Venous blood is taken as a material to determine the marker of the progesterone reproductive panel. It is important for accurate diagnosis to carry out this analysis on the nineteenth - twenty-first day of the menstrual cycle. The results of the analysis with a decrease in the level of progesterone may indicate functional uterine amenorrhea, the threat of abortion, placental insufficiency, premature aging of the placenta, the retardation of intrauterine development of the fetus. But you need to compare the result of the analysis with the phase of the menstrual cycle and take into account the normative value precisely in this period.

Instrumental diagnosis of progesterone deficiency is mainly aimed at identifying the cause of this deficiency. It is necessary to perform ultrasound examination of the pelvic organs with visualization of the ovary. In this case, you can determine the ovarian cyst, inflammation, adhesions - these changes can lead to disruption of the body and reduce the synthesis of progesterone. If progesterone deficiency is diagnosed during pregnancy, fetal ultrasound should be performed to assess the condition of the fetus. In this case, you can determine the condition of the placenta, the weight of the fetus and the possible delay in its development. With the help of Doplerography, you can determine the blood flow in the placenta and find out whether the fetus is not suffering from a deficit of progesterone and whether there is chronic hypoxia.

[21], [22], [23], [24]

Differential diagnosis

Differential diagnosis of progesterone deficiency should be performed with violations of the ovario-menstrual cycle, which are caused by insufficiency of the luteal phase. It is very important to conduct diagnostics with the determination of the hormonal panel, which will determine the number of certain types of hormones.

Infertility caused by a deficiency of progesterone should be carried out differential diagnosis with other causes of infertility. First of all, if a miscarriage at the early pregnancy occurs a second or third time - it is likely that its cause is precisely the deficit of progesterone. It is necessary to carry out diagnostics with intracellular inflammatory infections - ureoplasmosis and gonorrhea. This can be done with a bacterioscopic smear from the vagina. If it is not possible to identify progesterone deficiency, then a histological examination of the endometrial smear in the folliculin phase can be carried out-with changes in the endometrium that should be at normal progesterone levels will be less pronounced and the cell balloon will be inadequate. This is the main differential feature of this deficiency is progesterone.

[25], [26]

Treatment of the progesterone deficiency

During treatment before starting any therapy, you need to decide on the goal that stands before you. Any violations with a deficiency of progesterone require the appointment of substitution therapy with progesterone drugs. But if the goal of treatment is preparation for pregnancy and normal implantation of the egg, then in addition it is necessary to maintain a normal level and estrogens for sufficient secretion of the glands of the functional layer of the endometrium. Progesterone deficiency needs to be replenished with medicines, but there are also non-drug treatments - these are alternative and physiotherapy tools.

The main drugs that are used are hormone progesterone preparations, but they should have a small amount of estrogen in their composition:

1. Utrozhestan is a drug that is analogous to the female hormone progesterone. It has effects all that are characteristic of this natural hormone - enhances the secretion of the endometrial glands and facilitates the preparation of the uterus for implantation of the egg. This drug is available in the form of capsules and vaginal suppositories. In the case of preparation for fertilization, suppositories are preferred, but when it is necessary to supplement the deficit of progesterone, then oral intake is recommended, which increases its concentration throughout the day. Dosage of the drug - one capsule one hundred milligrams twice a day. Side effects are possible in the form of minor bloody vaginal discharge, as well as changes in the nervous system - dizziness, drowsiness, irritability. Precautions - the drug should not be taken in case of bloody discharge from the uterus, that is, when there is a suspicion of abortion, and should be taken with caution in case of violations of the liver function.
2. Krajnon is a hormonal drug, the component of which is progesterone. Its effects are similar to progesterone - it affects not only the endometrium of the uterus, but also the mammary glands, enhancing the proliferation and differentiation of alveolar cells. In pregnancy, the drug is used to eliminate the threat of interruption caused by a deficiency of progesterone. The drug is available in the form of vaginal gel in disposable dose applicators. Dosage is selected individually, as a rule, one applicator per day. Method of application - it is necessary to insert the applicator into the vagina, then squeeze the contents and the applicator out. Side effects are possible in the form of local and systemic manifestations. Local symptoms are the appearance of burning, itching, pain, discomfort or minor bleeding from the uterus. Of the systemic manifestations most often observed dizziness, headache. Precautions - it is necessary to carefully prescribe the drug when breastfeeding, as well as in the presence of a woman with kidney disease and the pathology of the clotting system.
3. Duphaston is a preparation containing predominantly progesterone. It helps to replenish the deficit of this hormone and normalizes its level in the blood. The advantage of the drug is its selective effect on progesterone receptors, which are located in the uterus. This contributes to the fact that the drug does not affect the ovum, but acts only on the epithelium of the endometrium. It does not have a virilizing effect, which is especially important when applied to maintain a pregnancy. The drug is available in the form of tablets of ten milligrams. Duphaston dosage to replenish its deficiency by one tablet twice a day. In case of threat of termination of pregnancy with the purpose of prolonging pregnancy, twice the dose is used. Side effects are possible in the form of allergic manifestations, as well as uterine bleeding, which requires an increase in the dose and a second consultation of the doctor. Precautions - when breastfeeding it is necessary to stop taking the drug. It is necessary to take differentiation with estrogen preparations if necessary for replacement therapy.
4. Progesterone is a natural hormone that, thanks to the form of release, allows you to quickly supplement the deficit of progesterone. The drug is available in ampoules for injection in the form of an oil solution in 1% and 2.55 solution. This remedy is used for the threat of abortion or when it is necessary to quickly achieve a normal level of thickness of the endometrium. In this case, the dose is selected individually. Side effects are possible - this is the delay of sodium and water, which can increase blood pressure and stimulates the formation of edema. Precautions - this method in women with impaired renal and liver function.

Vitamins with progesterone deficiency play an important role, as they improve the trophism of endometrial tissue and blood circulation, which increases the positive effects of progesterone replacement therapy and normalizes its level. Recommended vitamin preparations - Actovegin, Ascorutin, as well as complex vitamin preparations.

Physiotherapy treatment gives a good effect in the treatment of ordinary miscarriages, which are caused by a deficiency of progesterone due to deficiency of the yellow body. Magnetotherapy is used on the pelvic area, as well as radiotherapy to improve blood circulation in the ovary and stimulate ovulation. Increased blood circulation also stimulates the regeneration of the endometrium.

Operative treatment of pure progesterone insufficiency is not used, but complex infertility treatment is possible with the use of operative methods in case of concomitant pathologies in the form of adhesions on the ovaries or in the obstruction of the tubes. Then treatment methods with progesterone replacement therapy can be combined with operative methods.

Alternative treatment of progesterone deficiency

Alternative treatment of progesterone deficiency can be used in the form of complex therapy, in which this effect only increases. When acting not only on the endometrium, but also when acting on the ovaries, tubes, the immune system of a woman - the probability of faster recovery and pregnancy is increased. Use such alternative means:

1. Not so long ago, the property of avocado in increasing the level of progesterone was proved. But its assimilation is not so great with oral intake, so use special tools. For medicinal purposes, the avocado is peeled, cut and the bone is extracted, then the flesh of this vegetable is wiped on a small grater. In this pulp dipped gauze swab and inserted into the vagina for two hours in the evening before going to bed. The course of treatment is about a week.
2. Seeds of sunflower need to be rubbed with walnuts and add two teaspoons of honey. Such a mixture must be grinded to a shallow state and taken on a teaspoon twice a day, in the morning and in the evening. The course of treatment is two weeks.
3. Three tablespoons of boletus uterus should be insisted in one cup of boiling water, then overnight douching with the solution for three days, then this solution to conduct a wash. Such treatment can be carried out for two weeks.

Treatment with herbs should be done with some peculiarities. Phytotherapy should be carried out in the second phase of the menstrual cycle, when there is such a deficiency of the hormone. At the same time, it is necessary to monitor the general condition of the woman and concomitant therapy with substitution medications. The main medicinal herbs that are used for this purpose are the following:

1. Boron uterus - a plant that is widely used for a long time to treat infertility and various pathologies of the female reproductive system. This plant, in addition to stimulating the function of the yellow body and releasing progesterone, has an anti-inflammatory effect. This improves the function of the ovaries and endometrium, which contributes to the treatment of infertility. For medical infusion it is necessary to take three tablespoons of herbs, pour boiling water and boil over low heat for another five minutes, this infusion should be covered and insisted for three hours. Take this infusion in warm form five times a day for two tablespoons. The course of treatment is three weeks.
2. Alcohol tincture of the hog uterus in combination with the leaves of the plantain has a more pronounced effect, as the plantain enhances the action of this plant. To make the tincture you need to take one teaspoon of leaves of the hog queen and one teaspoon of plantain and pour 50 milliliters of alcohol, then insist for three days and take a teaspoon twice a day.
3. Raspberry leaves also have a good stimulating effect on the ovaries. In this case, take dry raspberry leaves, pour boiling water and insist for several minutes. Such an hour should be drunk on a glass throughout the day instead of regular tea. Such a solution also increases local immunity and normalizes the amount of prostaglandins that relax the endometrium and improve blood circulation.
4. Sage reduces the spasm of the muscular layer of the uterus and improves blood circulation, which increases the sensitivity of receptors to progesterone, and also normalizes the release of progesterone by the yellow body. You can use infusion of sage, as well as syringing with this solution. For the preparation of medical infusion it is necessary to take ten grams of sage leaves and pour boiling water, then take this tea half a cup three times a day. Douching should be carried out with the same solution at night, at least five times in a row.
5. Prutnjak is a plant whose fruits can increase the synthesis of progesterone through central action and enhance the work of not only the yellow body, but also the adrenal glands, which also synthesize progesterone. For the preparation of medical infusion it is necessary to take the fruits of this plant, grind them and pour boiling water, insist for five hours and then take a tincture on a teaspoon throughout the day five to six times a day. The course of treatment is ten days.

Homeopathic remedies are also widely used to stimulate progesterone production. Such drugs have both a hysterotropic effect and a systemic central effect on the hypothalamus, which increases the production of releasing factors and increases the production of progesterone along with estrogens. Dosage of different drugs can be different, which determines the selective level of progesterone. The main homeopathic remedies:

1. Zhenximax is a homeopathic herbal combination that is not a purely medicinal product, but it is used as a dietary supplement for various hormonal disorders in young women, including those with a deficiency of progesterone. This product is available in the form of drops. Dosage - five milliliters of syrup twice a day. Side effects are possible in the form of allergic rashes, other side effects are not described. Precautions - you need to consider the composition of the drug to patients with concomitant diabetes.
2. Cyclovitis is a preparation that contains vegetable, vitamin components, as well as lutein, which promotes the synthesis of progesterone by a yellow body. Therefore, the drug is indicated with a deficiency of progesterone, as well as in violation of blood circulation and to improve the trophism of the endometrium. The drug is available in the form of tablets of two components, so you should take into account the phase of the menstrual cycle and take only such tablets that correspond to it. Dosage - one tablet a day. Side effects during the drug were not identified. Precautions - can not be used for girls under the age of 14 years, and when taking vitamin preparations of other groups, hypervitaminosis is possible.
3. Mastodinone is a homeopathic remedy that has a central mechanism of action by inhibiting the production of prolactin, which increases the activity of the yellow body and stimulates the production of progesterone. Therefore, with a deficiency of progesterone in women who do not breast-feed to increase the concentration of this hormone, Mastodinon is a very effective remedy. It is available in the form of drops and tablets and is taken twice a day. Dosage - one tablet or 30 drops at a time. Side effects - dyspepsia and a feeling of heaviness in the stomach.
4. Sulfur is a homeopathic remedy of inorganic origin. The drug has a healing effect, antibacterial and regenerating, which has a good effect on the restoration of the endometrium and increases the sensitivity of the receptors to the action of progesterone. The drug is released in the pharmacological form of homeopathic granules and drops are dosed three granules three times a day for half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and not washed down with water. Side effects are not common, but there may be stool disorders, dyspepsia and allergic reactions. Precautions - You can not use the drug immediately after a miscarriage.

These are the main alternative treatments that accompany the normalization of progesterone deficiency in conjunction with drug hormone therapy.

Prevention

Prophylaxis of progesterone deficiency is nonspecific measures. In the case of pregnancy and the identification of this problem, it is necessary to carefully monitor and carry out preventive medication or treatment with herbal remedies.

[27], [28]

Forecast

Prognosis progesterone prognosis for life is favorable, and for reproductive function is also favorable with timely correction of this deficiency.

Deficiency of progesterone is a frequent pathology, which is associated with female infertility and miscarriage. Timely diagnosis of this condition before pregnancy will help to avoid various complications and violations of normal delivery. Therefore, you need to pay attention to any symptoms that are detected from the very beginning and do not delay with a visit to the doctor.

[29], [30]