Progesterone and Endo

Hi there everybody. Our next webinar is Feb 28th, on the topic of Bowel Endo. It should be a good time.
Someone asked about progesterone, and what effects it has on endo. It works in 2 ways, really. Progesterone suppresses ovulation and the normal cyclicity of the ovaries. This reduces estrogen production somewhat, and typically stops menstruation (amenorrhea is the term we use for no periods). Progesterone also is able to induce atrophy of endometriosis and endometrium, both by a direct effect on the endo cells, and by lowering estrogen levels. Typically, synthetic progestins are used rather than bioidentical progesterone, due to easier absorption and a more pronounced effect to suppress the endo cells.
There are 2 problems with progestins - they don't always work, and about 10-15% have side-effect issues. They don't always work because some women have irregular bleeding while taking them continuously, and some women just don't get any pain relief from them. The side effects can be weight gain, moodiness, depression, and the irregular bleeding stuff. This has led to alternate forms of progestins, specifically an iud containing a progestin. This eliminates the systemic side effects, and works great for women with menorrhagia (heavy periods), and has been used in women with endo with some promise.
It's hard to compare the studies of birth control pills, progestins alone, and lupron because they don't use the same outcomes. Most studies show somewhere around 85% of women having some degree of pain relief from any of the above, but how much relief is anyone's guess. They don't publish that info. The good news is that for women who get relief from progestins, they are safe to take long-term, cheap (relative to lupron or surgery), and readily available, and generally a whole lot more tolerable than Lupron and other drugs of that category.

Somebody else asked about polycystic ovaries (PCO). That's a loaded question, as there are some unanswered questions yet about the best way to treat those women. PCO is a syndrome where there's too much estrogen floating around and that messes up the feedback mechanisms so that ovulation doesn't happen. This leads to many small follicles (cysts) that never ovulate (rupture, then regress), so the ovaries get enlarged. There are several metabolic conditions associated with this syndrome - insulin resistance and increased testosterone are the main ones. The insulin resistance is sort-of a pre-diabetic condition, which is why some people advocate using metformin, a drug that reverses insulin resistance. The last I checked, the recommendations are for those not wanting to get pregnant to use OCPs to suppress the endometrium and regulate their periods, and for those trying to conceive, to use metformin along with possible clomid or other ovulation induction agents. There are those that disagree with these recommendations, and I'll leave this debate to the endocrinologists and infertility guys.
Thanks for reading, and I'll try to be a little more consistant with the blog.
Take care, and I'm still doing free record reviews.
Dr. Mos