Progesterone deficiency

Progesterone deficiency is a common cause of infertility or spontaneous abortion in the early stages, which is not often diagnosed in time. Ovarian-menstrual cycle disorders are a very common pathology today, and they rank first among pathologies diagnosed in women of reproductive age and young girls. This is due to exogenous factors, severe stress and strain that currently surround women and contribute to hormonal imbalance.

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Epidemiology

The epidemiology of this problem has changed recently in such a way that the priority place in the gynecology of women of young reproductive age is occupied by disorders of the ovariomenstrual cycle, which lead to infertility. As for progesterone deficiency, more than 80% of hormonal infertility is associated with this problem. The cause of early miscarriage in 25% of cases is precisely progesterone deficiency. This problem is diagnosed in 80%, which is a good indicator and proves the possibilities of preventive treatment.

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Causes progesterone deficiency

Progesterone is one of the most important hormones in a woman's body. It is synthesized by the ovaries and this amount is sufficient for a normal menstrual cycle. When a woman becomes pregnant, the placenta also becomes the center of progesterone synthesis, which is why progesterone is also called the pregnancy hormone. It maintains normal placentation and fetal cell growth.

When talking about the causes of progesterone deficiency, it is necessary to distinguish between primary and secondary causes. Primary causes include deficiency due to congenital disorders in the ovaries, their congenital hypoplasia or aplasia, as well as genetically determined progesterone level disorders. Secondary causes of progesterone deficiency are more common. These are inflammatory diseases of the ovaries, polycystic ovary disease, ovarian cysts, injuries or postoperative ovarian dysfunction. Any of these pathologies lead to ovarian dysfunction and little progesterone is synthesized or it is not synthesized at all. This contributes to the manifestation of certain clinical signs.

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Risk factors

It is also necessary to highlight 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 the ovaries;
4. ovarian cyst;
5. endometriosis of the uterus, external or internal;
6. endocrine diseases of the thyroid gland or adrenal glands;
7. history of fibrocystic hyperplasia of the mammary gland.

These are the main factors that can affect ovarian function and secondarily disrupt progesterone synthesis.

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Pathogenesis

The pathogenesis of changes in progesterone deficiency depends on the main functions performed by this hormone in the body. First of all, progesterone ensures the first stage of the menstrual cycle. Under the influence of releasing factors secreted by the hypothalamus, the pituitary gland is stimulated 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 ensures the synthesis of progesterone, which affects the endometrium - it stimulates the proliferation of endometrial cells, its functional layer, that is, preparation for the implantation of the egg. Therefore, this hormone is called the pregnancy hormone. Then, when ovulation occurs, progesterone synthesis decreases, which stimulates the beginning of the secretion phase in the endometrium. Such cyclic changes in progesterone levels ensure normal ovulation and the onset of pregnancy. Therefore, the pathogenesis of the development of any changes with progesterone deficiency lies in the disruption of organ function even with the slightest fluctuations in the level of this hormone. Therefore, changes in the functioning of organs and the corresponding clinical symptoms develop not only with progesterone deficiency, but also with a disruption of its fluctuations, that is, when there is no physiological increase or decrease in the level of this hormone.

As for the pathogenesis of changes during pregnancy in case of progesterone deficiency, this hormone is synthesized by the placenta, which is an important factor in the development of disorders of bearing a fetus. With its deficiency, there is a violation of placentation and its attachment to the endometrium of the uterus - all these changes can lead to various consequences. Complications that can arise in this case are incorrect attachment of the placenta, fetoplacental insufficiency, spontaneous miscarriage in the early stages of pregnancy.

All these features and the role of progesterone in a woman’s body need to be known in order to prevent possible symptoms of this pathology, mainly affecting progesterone deficiency.

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Symptoms progesterone deficiency

If a girl is born with progesterone deficiency as a hereditary trait, the symptoms may not be expressed in any way until the menstrual period or even before pregnancy. Most often, progesterone deficiency has signs in the form of menstrual irregularities - these may be scanty menstrual flow due to the fact that the endometrium is not mature enough and not functional enough, because progesterone did not provide normal proliferation of its cells. This may be the only clinical symptom, which in most cases is not paid any attention to. The first signs of obvious progesterone deficiency in this case may appear already when trying to get pregnant. Then the endometrium does not fully mature and the fertilized egg cannot implant - which leads to futile attempts to have a child. If pregnancy does occur, placentation is disrupted, so the embryo does not have normal blood flow, which leads to such disorders as premature miscarriage. Therefore, the main symptom of progesterone deficiency can be considered infertility or normal miscarriage – when three or more miscarriages occur.

Progesterone deficiency during pregnancy can manifest itself in the first trimester, then we are talking about a violation of the normal structure of the placenta, its function, place of attachment and the trophic function of the fetal organs. This can manifest itself at a later stage - bloody discharge from the uterus appears, which is not accompanied by pain in the lower abdomen and increased uterine tone, but such bleeding makes the woman worry. In this case, we are talking about placenta previa, which occurs due to violations of its attachment, in particular, due to progesterone deficiency. Such a pregnancy can be saved, but then there may be complications during childbirth. Symptoms of premature placental abruption may appear - then there will be bloody discharge from the uterus and pain in the lower abdomen, there may also be fetoplacental insufficiency. In this case, the fetus suffers and chronic fetal hypoxia occurs.

Progesterone deficiency can also have a negative impact on the lactation process. Under normal conditions, progesterone ensures the growth and development of the glandular structure of the gland, the number of alveoli and the proliferation of their cells increases. This ensures the normal functioning of the milk ducts and the lactation process itself. Progesterone also inhibits the development of new eggs during lactation. Therefore, progesterone deficiency in lactating women can manifest itself as a lack of milk or its absence due to a violation of the alveolar structure of the mammary gland.

Thus, it is clear 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 all, a violation of the menstrual cycle can later lead to problems with pregnancy, so it is necessary to take everything into account carefully.

Complications and consequences

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

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Diagnostics progesterone deficiency

Diagnosis of any disorders related to menstrual function and infertility should begin with a thorough anamnesis. It is necessary to find out the beginning of the first menstruation, because it may be a late start. It is also necessary 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 it is possible to identify inflammatory diseases of the ovaries, which may be the cause of secondary progesterone deficiency. In this case, painful and enlarged ovaries will be palpated on one side or on both sides.

The "gold standard" of progesterone deficiency diagnostics is, of course, testing. It is important to conduct both general and specialized tests. General blood tests and general urine tests are mandatory, as they provide an opportunity to conduct differential diagnostics of certain symptoms. A special diagnostic method is the determination of progesterone in the blood, as well as the determination of other female hormones. To determine the marker of the reproductive panel of progesterone, venous blood is taken as material. It is important for accurate diagnostics to conduct this test on the nineteenth to twenty-first day of the menstrual cycle. The results of the test with a decrease in the level of progesterone may indicate functional uterine amenorrhea, the threat of termination of pregnancy, placental insufficiency, premature aging of the placenta, or intrauterine growth retardation of the fetus. But it is necessary to compare the test result with the phase of the menstrual cycle and take into account the normative value during this period.

Instrumental diagnostics of progesterone deficiency is aimed primarily at identifying the cause of this deficiency. It is necessary to conduct an ultrasound examination of the pelvic organs with visualization of the ovary. In this case, it is possible to determine an ovarian cyst, inflammation, adhesions - these changes can lead to disruption of the functioning of the corpus luteum and decrease progesterone synthesis. If progesterone deficiency is diagnosed during pregnancy, then an ultrasound of the fetus should be performed to assess the condition of the fetus. In this case, it is possible to determine the condition of the placenta, the weight of the fetus and possible delay in its development. Using Dopplerography, it is possible to determine the blood flow in the placenta and find out whether the fetus suffers from progesterone deficiency and whether there is chronic hypoxia.

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Differential diagnosis

Differential diagnostics of progesterone deficiency should be carried out with ovariomenstrual cycle disorders caused by luteal phase deficiency. It is very important to conduct diagnostics with the determination of a hormonal panel, which will allow determining the amount of certain types of hormones.

In case of infertility caused by progesterone deficiency, differential diagnostics with other causes of infertility should be carried out. First of all, if a miscarriage at an early stage of pregnancy occurs for the second or third time, then it is likely that its cause is progesterone deficiency. It is necessary to carry out diagnostics with intracellular inflammatory infections - ureaplasmosis and gonorrhea. This can be done using 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 follicular phase can be carried out - in this case, the changes in the endometrium, which should be with a normal progesterone level, will be expressed to a lesser extent and the cell sphere will be insufficient. This is the main differential feature of such a deficiency of progesterone.

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Treatment progesterone deficiency

During treatment, before starting any therapy, it is necessary to determine the goal that is set before you. Any violations with progesterone deficiency require the appointment of replacement therapy with progesterone drugs. But if the goal of treatment is to prepare for pregnancy and normal implantation of the egg, then in addition to this, it is necessary to maintain a normal level of estrogens for sufficient secretion of the glands of the functional layer of the endometrium. Progesterone deficiency must be replenished with medications, but there are also non-drug treatments - these are folk and physiotherapeutic means.

The main drugs used are progesterone hormonal drugs, but they should also contain a small amount of estrogen:

1. Utrozhestan is a drug that is an analogue of the female hormone progesterone. It has all the effects that are characteristic of this natural hormone - it increases the secretion of the endometrial glands and helps prepare the uterus for implantation of the egg. This drug is available in the form of capsules and vaginal suppositories. In case of preparation for fertilization, suppositories are preferred, but when it is necessary to replenish the progesterone deficiency, then oral administration is recommended, which increases its concentration throughout the day. The dosage of the drug is one capsule of 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 termination of pregnancy, and it should also be taken with caution in case of liver dysfunction.
2. Crinone is a hormonal drug, the component of which is progesterone. Its effects are similar to progesterone - it affects not only the uterine endometrium, but also the mammary glands, enhancing the proliferation and differentiation of alveolar cells. During pregnancy, the drug is used to eliminate the process of threatened miscarriage caused by progesterone deficiency. The drug is available in the form of a vaginal gel in disposable dosed applicators. The dosage is selected individually, usually one applicator per day. Method of application - it is necessary to insert the applicator into the vagina, then squeeze out the contents and throw away the applicator. Side effects are possible in the form of local and systemic manifestations. Local symptoms are the appearance of burning, itching, pain, discomfort or minor bloody discharge from the uterus. Of the systemic manifestations, dizziness and headache are most often observed. Precautions – the drug should be administered with caution during breastfeeding, as well as if the woman has kidney disease or pathology of the coagulation system.
3. Duphaston is a drug containing mainly progesterone. It helps to replenish the deficiency of this hormone and normalizes its level in the blood. The advantage of the drug is its selective action on progesterone receptors, which are located in the uterus. This contributes to the fact that the drug does not affect the egg, but only affects the epithelium of the endometrium. It does not have a virilizing effect, which is especially important when used to maintain pregnancy. The drug is available in the form of tablets of ten milligrams. The dosage of Duphaston to replenish its deficiency is one tablet twice a day. In case of a threat of termination of pregnancy, a dose of twice as much is used to prolong pregnancy. Side effects are possible in the form of allergic reactions, as well as uterine bleeding, which requires an increase in the dose and repeated consultation with a doctor. Precautions - when breastfeeding, it is necessary to stop taking the drug. It is necessary to differentiate with estrogen drugs if replacement therapy is necessary.
4. Progesterone is a natural hormone that, due to its form of release, allows you to quickly replenish the progesterone deficiency. The drug is available in ampoules for injections in the form of an oil solution in 1% and 2.55 solution. This drug is used in case of a threat of termination of pregnancy or in cases where it is necessary to quickly achieve a normal level of endometrial thickness. In this case, the dose is selected individually. Side effects are possible - this is sodium and water retention, which can increase blood pressure and stimulate the formation of edema. Precautions - this is taking in women with impaired renal and hepatic function.

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

Physiotherapy treatment is effective in treating common miscarriages caused by progesterone deficiency due to corpus luteum insufficiency. Magnetic therapy is used on the pelvic organs, as well as radiation therapy to improve blood circulation in the ovary and stimulate ovulation. Increased blood circulation also stimulates endometrial regeneration.

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

Folk remedies for progesterone deficiency

Folk remedies for progesterone deficiency can be used as a complex therapy, in which this effect is only enhanced. When acting not only on the endometrium, but also on the ovaries, tubes, and the woman's immune system, the likelihood of a faster recovery and pregnancy increases. The following folk remedies are used:

1. Not long ago, the property of avocado in increasing progesterone levels was proven. But its absorption is not so great when taken orally, so special means are used. For medicinal purposes, avocado is peeled, cut and the pit is removed, then the pulp of this vegetable is rubbed on a fine grater. A gauze tampon is dipped in this pulp and inserted into the vagina for two hours in the evening before going to bed. The course of treatment is about a week.
2. Grind sunflower seeds with walnuts and add two teaspoons of honey. Grind this mixture to a fine powder and take one teaspoon twice a day, morning and evening. The course of treatment is two weeks.
3. Three tablespoons of the orthilia secunda should be infused in one cup of boiling water, then douche with the solution at night for three days, then wash with this solution. This treatment can be carried out for two weeks.

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

1. Orthilia secunda is a plant that has been 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 corpus luteum and the secretion of progesterone, has an anti-inflammatory effect. This improves the function of the ovaries and endometrium, which helps treat infertility. For a medicinal infusion, take three tablespoons of the herb, pour boiling water over it and simmer for another five minutes, cover the infusion and leave it for three hours. Take this infusion warm five times a day, two tablespoons at a time. The course of treatment is three weeks.
2. Alcohol tincture of orthilia secunda in combination with plantain leaves has a more pronounced effect, since plantain enhances the effect of this plant. To prepare the tincture, take one teaspoon of orthilia secunda leaves and one teaspoon of plantain and pour 50 milliliters of alcohol, then leave 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, you need to take dry raspberry leaves, pour boiling water over them and leave for a few minutes. You need to drink a glass of this during the day instead of regular tea. This solution also increases local immunity and normalizes the amount of prostaglandins, which relaxes the endometrium and improves blood circulation.
4. Sage reduces spasms of the uterine muscle layer and improves blood circulation, which increases the sensitivity of receptors to progesterone, and also normalizes the secretion of progesterone by the corpus luteum. You can use sage infusion, as well as douching with this solution. To prepare a medicinal infusion, take ten grams of sage leaves and pour boiling water over them, then drink half a glass of this tea three times a day. Douching should be done with the same solution at night, at least five times in a row.
5. The twig is a plant whose fruits are capable of increasing progesterone synthesis due to the central action and strengthening the work of not only the corpus luteum, but also the adrenal glands, which also synthesize progesterone. To prepare a medicinal infusion, you need to take the fruits of this plant, grind them and pour boiling water over them, leave for five hours and then take the tincture by the 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. The dosage of different drugs may be different, which determines the selective level of progesterone released. The main homeopathic remedies are:

1. Zhensimaks is a homeopathic herbal combination remedy that is not a purely medicinal product, but is used as a dietary supplement for various hormonal imbalances in young women, including progesterone deficiency. This remedy is available in the form of drops. Dosage is five milliliters of syrup twice a day. Side effects are possible in the form of allergic rashes, other side effects are not described. Precautions - it is necessary to take into account the composition of the drug for patients with concomitant diabetes.
2. Cyclovita is a drug that contains plant and vitamin components, as well as lutein, which promotes the synthesis of progesterone by the corpus luteum. Therefore, the drug is indicated for progesterone deficiency, as well as for circulatory disorders 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 those tablets that correspond to it. Dosage - one tablet per day. Side effects during the use of the drug have not been identified. Precautions - cannot be used for girls under 14 years of age, and when taking vitamin preparations of other groups, hypervitaminosis is possible.
3. Mastodinone is a homeopathic remedy that has a central mechanism of action due to the suppression of prolactin production, which increases the activity of the corpus luteum and stimulates the production of progesterone. Therefore, in case of progesterone deficiency in women who do not breastfeed, Mastodinone is a very effective remedy to increase the concentration of this hormone. It is available in the form of drops and tablets and is taken twice a day. Dosage - one tablet or 30 drops per dose. Side effects - dyspeptic symptoms and a feeling of heaviness in the stomach.
4. Sulfur is a homeopathic remedy of inorganic origin. The drug has a healing, antibacterial and regenerating effect, which has a good effect on the restoration of the endometrium and increases the sensitivity of receptors to the action of progesterone. The drug is available in the pharmacological form of homeopathic granules and drops, dosed three granules three times a day half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and not to drink water. Side effects are not common, but stool disorders, dyspeptic phenomena and allergic reactions may occur. Precautions - the drug cannot be used immediately after a miscarriage.

These are the main folk remedies that accompany the normalization of progesterone deficiency together with drug hormonal therapy.

Prevention

Prevention of progesterone deficiency is non-specific measures. In case of pregnancy and detection of this problem, it is necessary to undergo a thorough examination and take preventive medications or herbal treatment.

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Forecast

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

Progesterone deficiency is a common pathology associated with female infertility and miscarriage. Timely diagnosis of this condition before pregnancy will help to avoid various complications and disruptions of normal childbirth. Therefore, you need to pay attention to any symptoms that are detected from the very beginning and not delay going to the doctor.

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