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Progesterone (; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the and is the major progestogen in the body. Progesterone has a variety of important functions in the body. It is also a crucial metabolic intermediate in the production of other endogenous , including the and the , and plays an important role in brain function as a neurosteroid.
In addition to its role as a natural hormone, progesterone is also used as a medication, such as in combination with estrogen for contraception, to reduce the risk of Uterine cancer or cervical cancer, in hormone replacement therapy, and in feminizing hormone therapy. It was first prescribed in 1934.
Through its neurosteroid active metabolites, such as 5α-dihydroprogesterone and allopregnanolone, progesterone acts indirectly as a positive allosteric modulator of the GABAA receptor.
Progesterone and some of its metabolites, such as 5β-dihydroprogesterone, are agonists of the pregnane X receptor (PXR), albeit weakly so (EC50 >10 μM). In accordance, progesterone Enzyme inducer several hepatic cytochrome P450 , such as CYP3A4, (2012). 9781609133450, Lippincott Williams & Wilkins. ISBN 9781609133450 especially during pregnancy when concentrations are much higher than usual. Perimenopausal women have been found to have greater CYP3A4 activity relative to men and postmenopausal women, and it has been inferred that this may be due to the higher progesterone levels present in perimenopausal women.
Progesterone modulates the activity of CatSper (cation channels of sperm) voltage-gated Ca2+ channels. Since eggs release progesterone, sperm may use progesterone as a homing signal to swim toward eggs (chemotaxis). As a result, it has been suggested that substances that block the progesterone binding site on CatSper channels could potentially be used in male contraception.
Elevated levels of progesterone potently reduce the sodium-retaining activity of aldosterone, resulting in natriuresis and a reduction in extracellular fluid volume. Progesterone withdrawal, on the other hand, is associated with a temporary increase in sodium retention (reduced natriuresis, with an increase in extracellular fluid volume) due to the compensatory increase in aldosterone production, which combats the blockade of the mineralocorticoid receptor by the previously elevated level of progesterone.
Progesterone is sometimes called the "hormone of pregnancy", and it has many roles relating to the development of the fetus:
The fetus placental progesterone in the production of adrenal steroids.
Hormone replacement therapy, consisting of systemic treatment with estrogen alone or in combination with a progestogen, has well-documented and considerable beneficial effects on the skin of postmenopausal people. These benefits include increased skin collagen content, skin thickness and elasticity, and skin hydration and surface lipids. Topical estrogen has been found to have similar beneficial effects on the skin. In addition, a study has found that topical 2% progesterone cream significantly increases skin elasticity and firmness and observably decreases wrinkles in peri- and postmenopausal people. Skin hydration and surface lipids, on the other hand, did not significantly change with topical progesterone.
These findings suggest that progesterone, like estrogen, also has beneficial effects on the skin and may be independently protective against skin aging.
Neurosteroids are and are neuroprotective, neurogenic, and regulate neurotransmission and myelination. The effects of progesterone as a neurosteroid are mediated predominantly through its interactions with non-nuclear PRs, namely the mPRs and PGRMC1, as well as certain other receptors, such as the σ1 and nACh receptors.
Damage incurred by traumatic brain injury is believed to be caused in part by mass depolarization leading to excitotoxicity. One way in which progesterone helps to alleviate some of this excitotoxicity is by blocking the voltage-dependent calcium channels that trigger neurotransmitter release. It does so by manipulating the signaling pathways of transcription factors involved in this release. Another method for reducing the excitotoxicity is by up-regulating the GABAA receptor, a widespread inhibitory neurotransmitter receptor.
Progesterone has also been shown to prevent apoptosis in neurons, a common consequence of brain injury. It does so by inhibiting enzymes involved in the apoptosis pathway specifically concerning the mitochondria, such as activated caspase-3 and cytochrome c.
Not only does progesterone help prevent further damage, it has also been shown to aid in neuroregeneration. One of the serious effects of traumatic brain injury includes edema. Animal studies show that progesterone treatment leads to a decrease in edema levels by increasing the concentration of and microglia sent to the injured tissue. This was observed in the form of reduced leakage from the blood brain barrier in secondary recovery in progesterone treated rats. In addition, progesterone was observed to have antioxidant properties, reducing the concentration of oxygen free radicals faster than without. There is also evidence that the addition of progesterone can also help remyelinate damaged due to trauma, restoring some lost neural signal conduction. Another way progesterone aids in regeneration includes increasing the circulation of endothelial progenitor cells in the brain. This aids the growth of new vasculature around scar tissue, helping to repair the area of insult.
Cholesterol undergoes double oxidation to produce 22 R-hydroxycholesterol and then 20α,22 R-dihydroxycholesterol. This vicinal diol is then further oxidized with loss of the side chain starting at position C22 to produce pregnenolone. This reaction is catalyzed by cytochrome P450scc.
The conversion of pregnenolone to progesterone takes place in two steps. First, the 3β-hydroxyl group is oxidized to a ketone group and second, the double bond is moved to C4, from C5 through a keto/enol tautomerization reaction. (2025). 9780471496410, Wiley. ISBN 9780471496410 This reaction is catalyzed by 3β-hydroxysteroid dehydrogenase/δ5-4-isomerase.
Progesterone in turn is the precursor of the mineralocorticoid aldosterone, and after conversion to 17α-hydroxyprogesterone, of cortisol and androstenedione. Androstenedione can be converted to testosterone, estrone, and estradiol, highlighting the critical role of progesterone in testosterone synthesis.
Pregnenolone and progesterone can also be synthesized by yeast.
Approximately 30 mg of progesterone is secreted from the ovaries per day in reproductive-age women, while the adrenal glands produce about 1 mg of progesterone per day. (2012). 9781609133450, Lippincott Williams & Wilkins. ISBN 9781609133450
The major metabolic pathway of progesterone is reduction by 5α-reductase and 5β-reductase, into the dihydrogenated 5α-dihydroprogesterone and 5β-dihydroprogesterone, respectively. This is followed by the further reduction of these metabolites via 3α-hydroxysteroid dehydrogenase and 3β-hydroxysteroid dehydrogenase into the tetrahydrogenated allopregnanolone, pregnanolone, isopregnanolone, and epipregnanolone. (2025). 9780444536303, Elsevier. ISBN 9780444536303 Subsequently, 20α-hydroxysteroid dehydrogenase and 20β-hydroxysteroid dehydrogenase reduce these metabolites to form the corresponding hexahydrogenated (eight different in total), which are then conjugated via glucuronidation and/or sulfation, released from the liver into circulation, and excreted by the into the urine. The major metabolite of progesterone in the urine is the 3α,5β,20α isomer of pregnanediol glucuronide, which has been found to constitute 1530% of an injection of progesterone. Other metabolites of progesterone formed by the enzymes in this pathway include 3α-dihydroprogesterone, 3β-dihydroprogesterone, 20α-dihydroprogesterone, and 20β-dihydroprogesterone, as well as various combination products of the enzymes aside from those already mentioned. Progesterone can also first be hydroxylated (see below) and then reduced. Endogenous progesterone is metabolized approximately 50% into 5α-dihydroprogesterone in the corpus luteum, 35% into 3β-dihydroprogesterone in the liver, and 10% into 20α-dihydroprogesterone.
Relatively small portions of progesterone are hydroxylated via 17α-hydroxylase (CYP17A1) and 21-hydroxylase (CYP21A2), into 17α-hydroxyprogesterone and 11-deoxycorticosterone (21-hydroxyprogesterone), respectively, and are formed secondarily to 17α-hydroxylation. Even smaller amounts of progesterone may also be hydroxylated via 11β-hydroxylase (CYP11B1) and, to a lesser extent, via aldosterone synthase (CYP11B2) into 11β-hydroxyprogesterone. In addition, progesterone can be hydroxylated in the liver by other cytochrome P450 enzymes that are not steroid-specific. Catalyzed mainly by CYP3A4, 6β-Hydroxylation is the major transformation and is responsible for approximately 70% of cytochrome P450-mediated progesterone metabolism. Other routes include 6α-, 16α-, and 16β-hydroxylation. However, treatment of women with ketoconazole (a strong CYP3A4 inhibitor) had minimal effects on progesterone levels, producing only a slight and non-significant increase, suggesting that cytochrome P450 enzymes play only a small role in progesterone metabolism.
After the luteal-placental shift, progesterone levels start to rise further and may reach 100 to 200 ng/mL at term. Whether a decrease in progesterone levels is critical for the initiation of labor has been argued and may be species-specific. After delivery of the placenta and during lactation, progesterone levels are very low.
Progesterone levels are low in children and postmenopausal people. Adult males have levels similar to those in women during the follicular phase of the menstrual cycle.
During human pregnancy, progesterone is produced in increasingly high amounts by the ovaries and placenta. At first, the source is the corpus luteum that has been "rescued" by the presence of human chorionic gonadotropin (hCG) from the conceptus. However, after the eighth week, production of progesterone shifts to the placenta which utilizes maternal cholesterol as the initial substrate, and most of the produced progesterone enters the maternal circulation, but some is picked up by the fetal circulation and used as substrate for fetal corticosteroids. At term, the placenta produces about 250 mg progesterone per day.
An additional animal source of progesterone is milk products. After consumption of milk products the level of bioavailable progesterone goes up.
Another plant that contains substances readily convertible to progesterone is Dioscorea pseudojaponica, native to Taiwan. Research has shown that the Taiwanese yam contains —steroids that can be converted to diosgenin and thence to progesterone.
Many other Dioscorea species of the yam family contain steroidal substances from which progesterone can be produced. Among the more notable of these are Dioscorea villosa and Dioscorea polygonoides. One study showed that the Dioscorea villosa contains 3.5% diosgenin. Dioscorea polygonoides has been found to contain 2.64% diosgenin, as shown by gas chromatography-mass spectrometry. Many of the Dioscorea species that originate from the yam family grow in countries with tropical and subtropical climates.
It is also used to support pregnancy and fertility and to treat gynecological disorders. Progesterone has been shown to prevent miscarriage in those with vaginal bleeding early in their current pregnancy and having a previous history of miscarriage. Progesterone can be taken by mouth, through the vagina, and by injection into muscle or fat, among other routes.
The 16-DPA intermediate is important to the synthesis of many other medically important steroids. A very similar approach can produce 16-DPA from solanine.
Chemical synthesis of progesterone from stigmasterol and pregnanediol was accomplished later that year. Up to this point, progesterone, known generically as corpus luteum hormone, had been being referred to by several groups by different names, including corporin, lutein, luteosterone, and progestin. In 1935, at the time of the Second International Conference on the Standardization of Sex Hormones in London, England, a compromise was reached between the groups, and the name 'progesterone' (progestational steroidal ketone) was created.
Levels
Relatively low during the preovulatory phase of the menstrual cycle, progesterone levels rise after ovulation and are elevated during the luteal phase, as shown in the diagram. Progesterone levels tend to be less than 2 ng/mL prior to ovulation and greater than 5 ng/mL after ovulation. If pregnancy occurs, human chorionic gonadotropin is released, maintaining the corpus luteum and allowing it to maintain levels of progesterone. Between seven and nine weeks gestation, the placenta begins to produce progesterone in place of the corpus luteum in a process called the luteal-placental shift.
Ranges
Blood test results should always be interpreted using the reference ranges provided by the laboratory that performed the results. Example reference ranges are listed below.
(see diagram below) Nanogram/Millilitre nmol/Litre ng/mL nmol/L ng/mL nmol/L ng/mL nmol/L
• The ranges denoted By biological stage may be used in closely monitored menstrual cycles in regard to other markers of its biological progression, with the time scale being compressed or stretched to how much faster or slower, respectively, the cycle progresses compared to an average cycle.
• The ranges denoted Inter-cycle variability are more appropriate to use in non-monitored cycles with only the beginning of menstruation known, but where the woman accurately knows her average cycle lengths and time of ovulation, and that they are somewhat averagely regular, with the time scale being compressed or stretched to how much a woman's average cycle length is shorter or longer, respectively, than the average of the population.
• The ranges denoted Inter-woman variability are more appropriate to use when the average cycle lengths and time of ovulation are unknown, but only the beginning of menstruation is given.]]
Sources
Animal
Progesterone is produced in high amounts in the ovaries (by the corpus luteum) from the onset of puberty to menopause. It is produced in smaller amounts by the after the onset of adrenarche in both males and females. To a lesser extent, progesterone is produced in nervous tissue, especially in the brain, and also in adipose tissue (fat).
Plants
Progesterone has been positively identified in the plant Juglans regia, a species of walnut. In addition, progesterone-like are found in the plant Dioscorea mexicana, part of the yam family native to Mexico. Dioscorea mexicana contains a steroid called diosgenin which is taken from the plant and converted into progesterone. Diosgenin and progesterone are also found in other Dioscorea species, as well as in other plants that are not closely related, such as fenugreek.
(2025). 9788130800035 ISBN 9788130800035
Medical use
Progesterone is used as a medication. It is used in combination with estrogens mainly in hormone therapy for menopausal symptoms and Hypogonadism. It may also be used alone to treat menopausal symptoms. Studies have shown that transdermal progesterone (skin patch) and oral micronized progesterone are effective treatments for certain symptoms of menopause such as hot flashes and night sweats, otherwise referred to as vasomotor symptoms or VMS.
Chemistry
Progesterone is a naturally occurring pregnane steroid and is also known as pregn-4-ene-3,20-dione. It has a double bond (-ene) between the C4 and C5 positions, and two ketone Functional group (3,20-Dicarbonyl), one at the C3 position and the other at the C20 position.
Synthesis
Progesterone is commercially produced by semisynthesis. Two main routes are used: one from yam diosgenin first pioneered by Marker in 1940, and one based on soy scaled up in the 1970s. Additional (not necessarily economical) semisyntheses of progesterone have also been reported starting from a variety of steroids. For the example, cortisone can be simultaneously deoxygenated at the C-17 and C-21 position by treatment with iodotrimethylsilane in chloroform to produce 11-keto-progesterone (ketogestin), which in turn can be reduced at position-11 to yield progesterone.
Marker semisynthesis
An economical semisynthesis of progesterone from the plant steroid diosgenin isolated from yams was developed by Russell Marker in 1940 for the Parke-Davis pharmaceutical company. This synthesis is known as the Marker degradation.
Soy semisynthesis
Progesterone can also be made from the stigmasterol found in soybean oil also. c.f. Percy Julian.
Total synthesis
A total synthesis of progesterone was reported in 1971 by William S. Johnson. The synthesis begins with reacting the phosphonium salt 7 with phenyl lithium to produce the phosphonium ylide 8. The ylide 8 is reacted with an aldehyde to produce the alkene 9. The ketal of 9 are hydrolyzed to produce the diketone 10, which in turn is cyclized to form the cyclopentenone 11. The ketone of 11 is reacted with methyl lithium to yield the tertiary alcohol 12, which in turn is treated with acid to produce the tertiary cation 13. The key step of the synthesis is the π-cation cyclization of 13 in which the B-, C-, and D-rings of the steroid are simultaneously formed to produce 14. This step resembles the cationic cyclization reaction used in the biosynthesis of steroids and hence is referred to as biomimetic. In the next step the enol orthoester is hydrolyzed to produce the ketone 15. The cyclopentene A-ring is then opened by oxidizing with ozone to produce 16. Finally, the diketone 17 undergoes an intramolecular aldol condensation by treating with aqueous potassium hydroxide to produce progesterone.
History
George W. Corner and Willard M. Allen discovered the hormonal action of progesterone in 1929. By 1931–1932, nearly pure crystalline material of high progestational activity had been isolated from the corpus luteum of animals; by 1934, pure crystalline progesterone had been refined and obtained, and the chemical structure of progesterone was determined. This was achieved by Adolf Butenandt at the Chemisches Institut of Gdańsk Technical University in Danzig, who extracted this new compound from several thousand liters of urine.
Veterinary use
The use of progesterone tests in dog breeding to pinpoint ovulation is becoming more widely used. There are several tests available, the most reliable being a blood test with the blood sample drawn by a veterinarian and sent to a lab for processing. Results can usually be obtained within 24 to 72 hours. The rationale for using progesterone tests is that increased numbers begin in close proximity to preovulatory surge in gonadotrophins and continue through ovulation and estrus. When progesterone levels reach certain levels they can signal the stage of estrus the female is. Prediction of birth date of the pending litter can be very accurate if ovulation date is known. Puppies deliver within a day or two of nine weeks gestation in most cases. It is not possible to determine pregnancy using progesterone tests once a breeding has taken place, however. This is due to the fact that, in dogs, progesterone levels remain elevated throughout the estrus period.
Pricing
Pricing for progesterone can vary depending location, insurance coverage, discount coupons, quantity, shortages, manufacturers, brand or generic versions, different pharmacies, and so on. As of 2023, 30 capsules of 100 mg of the generic version, Progesterone, from CVS Pharmacy is around $40 without any discounts or insurance applied. The brand version, Prometrium, is around $450 for 30 capsules without any discounts or insurance applied. In comparison, Walgreens offers 30 capsules of 100 mg in the generic version for $51 without insurance or coupons applied. The brand name costs around $431 for 30 capsules of 100 mg.
External links
Categories: 5α-reductase Inhibitors, 11β-hydroxysteroid Dehydrogenase Inhibitors, Alkene Derivatives, Antimineralocorticoids, Diketones, Gabaa Receptor Positive Allosteric Modulators, Glucocorticoids, Glycine Receptor Antagonists, Neurosteroids, Hepatotoxins, Hormones Of The Hypothalamus-pituitary-adrenal Axis, Hormones Of The Hypothalamus-pituitary-gonad Axis, Hormones Of The Hypothalamic-pituitary-prolactin Axis, Hormones Of The Ovary, Hormones Of The Placenta, Hormones Of The Suprarenal Cortex, Hormones Of The Brain, Hormones Of The Pregnant Female, Human Female Endocrine System, Human Hormones, Pregnane X Receptor Agonists, Pregnanes, Progestogens, Prolactin Releasers, Sex Hormones, Sigma Antagonists, Steroid Hormones, Total Synthesis
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