When you hear the word “progesterone”, the hormone’s role in fertility treatments may be the first thing that comes to mind. After all, it’s “pro” “gest.” Get it?

However, progesterone is not just for women trying to conceive—it also has a critical role in the management of other conditions that affect women throughout their lives.

Progesterone helps women navigate menopause, manage the complexities of polycystic ovarian syndrome (PCOS) and tolerate the chronic pain of endometriosis.

And when delivered intravaginally, it offers a more effective, more targeted treatment without many of the unpleasant side effects associated with oral delivery.

Let’s dive into the details to understand why.

A New Approach to Hormone Replacement Therapy

The characteristic symptoms of menopause such as hot flashes, mood changes, and vaginal dryness are caused by declining levels of the hormones estrogen and progesterone.

And while we hear a lot about the role of estrogen in hormone replacement therapy (HRT), it’s important to shine a light on progesterone too.

Progesterone therapy protects the uterus from developing endometrial hyperplasia, a precancerous condition where the uterine lining becomes abnormally thick. Sustained release of progesterone gel also controls abnormal uterine bleeding in menopausal women. In other words, if you have a uterus and you are supplementing estrogen, you have to take progesterone in some form or another.

Numerous other clinical studies have shown that the use of natural progesterone in postmenopausal women reduces vasomotor symptoms (hot flashes) and has a positive effect on quality-of-life outcomes. I’ve got a couple of friends who treat it like a sleeping pill because for them, the difference is that dramatic.

However, traditional methods of progesterone delivery (like oral pills) come with numerous systemic side effects—mood swings, bloating, and breast tenderness to name a few.

Intravaginal progesterone, on the other hand, offers a targeted, efficient means of delivering the hormone where it’s needed most. This method is less likely to cause issues in other areas of the body, which, historically, have been a major driver of low patient compliance.

Balancing Hormones and Reducing the Risk of PCOS

Polycystic ovarian syndrome (PCOS) is a complex hormonal disorder characterized by:

• Excessive levels of male hormones called androgens.
• Menstrual irregularities, and
• Multiple cysts on the ovaries.

Hyperandrogenism causes numerous symptoms such as male-pattern hair growth (hirsutism), alopecia, acne, infertility, and absent or infrequent periods.

But the real concern here lies in the long-term risks of PCOS from prolonged exposure to unopposed estrogen.

Unopposed estrogen occurs when estrogen becomes the dominant hormone. But how does this happen? And why is it important?

Elevated androgen levels interfere with the normal function of the ovaries which, in short, disrupts the production of progesterone.

Without progesterone’s balancing influence, estrogen may promote rapid cell growth in the uterus and the development of endometrial (uterine) hyperplasia and endometrial cancer.

Progesterone reduces the risk of cancer by regulating the growth of endometrial tissue in the uterus. By extension, it induces ovulation (which produces more progesterone) and regulates menstrual cycles.

Intravaginal progesterone is a particularly beneficial approach for women with PCOS. Since many PCOS sufferers also experience insulin resistance and metabolic issues, bypassing the liver with intravaginal delivery can help avoid exacerbating these problems.

Progesterone for Endometriosis: Pain Management and Beyond

Endometriosis is a chronic condition where endometrial-like tissue grows outside the uterus, causing pain, heavy periods, and sometimes infertility.

The condition is a significant health concern, with the WHO estimating that it affects 10% (190 million) of reproductive-age women worldwide.

While treatment can involve pain medication or surgery, progesterone-based hormonal therapy is currently the most effective course of action for this painful disorder.

Similar to PCOS, the efficacy of progesterone in endometriosis treatment lies in the hormone’s ability to suppress estrogen. In this context, it is believed estrogen dominance causes abnormal growth of tissue outside the uterus.

Progesterone inhibits this growth by counteracting the effect of unopposed estrogen and reducing inflammation—which are suspected to be precursors to endometrial cancer.

Intravaginal delivery is the most effective option because of the vagina’s proximity to the pelvic area where endometriosis lesions tend to form. Attack ‘em at the source!

How Intravaginal Progesterone Optimizes Treatment

Why choose the intravaginal route when oral and injectable progesterone are also available?

You already know how I feel about injected progesterone. No thank you.

The answer lies in how the body metabolizes these treatments. Oral progesterone must pass through the liver, which means women need higher doses to achieve the same therapeutic effect.

Intravaginal delivery bypasses the liver and delivers the hormone straight to the uterus and reproductive tissues where it’s needed.

Women who use intravaginal progesterone report fewer systemic side effects such as chest pain, chills, fever and cold or flu-like symptoms which are more common with oral formulations.

Additionally, the intravaginal route promotes steady delivery of progesterone which avoids the peaks and troughs (read: mood swings) associated with oral delivery.

The intravaginal route improves quality of life for women who experience chronic hormonal imbalances. It also offers a more targeted approach that addresses the root causes of endometriosis and PCOS.

The Efficacy and Versatility of Intravaginal Progesterone

Progesterone is celebrated for its role in fertility, but it’s time we recognize how vital the hormone is for the management of chronic conditions such as menopause, PCOS, and endometriosis.

The same can also be said for the way progesterone is delivered.

Intravaginal delivery is not only the most logical option to treat women’s reproductive health conditions, it’s also the most efficient and the least likely to cause systemic side effects.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245250/

https://pubmed.ncbi.nlm.nih.gov/10928426/

https://www.tandfonline.com/doi/pdf/10.1080/13697137.2018.1455657

https://my.clevelandclinic.org/health/diseases/22363-high-estrogen

https://www.who.int/news-room/fact-sheets/detail/endometriosis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548673/

https://www.mayoclinic.org/drugs-supplements/progesterone-oral-route/side-effects/drg-20075298?p=1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472689/