Low progesterone is an endocrine disorder characterized by insufficient secretion of the hormone progesterone by the yellow body in the second phase of the menstrual cycle. The symptoms of the disorder are irregular and painful menstruation, abnormal pregnancy or infertility due to implantation disorders. For diagnosis, the level of the main sex hormones in the blood serum is determined, ultrasound examination of the uterus and its appendages, biopsy and histology of the endometrium are performed. Treatment is reduced to replacement therapy with progesterone drugs, the regimen of which is developed individually.
General information
Low progesterone is otherwise called insufficiency of the corpus luteum or luteal phase. Synonymous names are associated with the fact that the yellow body normally produces the hormone progesterone in the second (luteal) phase of the menstrual cycle – if its function is lowered, this endocrine syndrome occurs. There is no exact data on the prevalence of the disorder in gynecology, as it is often confused with other forms of hormonal imbalance in women. The diagnosis is made in the presence of a low level of the hormone against the background of an ovulatory menstrual cycle. At the same time, this condition is capable of provoking a cascade of endocrine disorders, including leading to an anovulatory cycle, which further complicates the diagnosis of the underlying pathology. It is believed that the disorder develops more often in women aged 18-25 years.
Causes
Reliable causes of endocrine syndrome are unknown, there are only assumptions about the influence of disorders of various nature on its development. Among them:
- Genetic factors, for example, X-chromosome aberrations and some mutations affecting the work of the ovaries, pituitary gland, enzyme systems. Such disorders can lead to hereditary transmission of endocrine disorder from mother to daughter.
- Defeat of the ovaries. Pathology can be caused by polycystic fibrosis, traumatic lesions or ovarian tumors.
- Violation of the pituitary gland. Injuries and tumors of the gland lead to numerous endocrine disruptions, including those affecting sex hormones.
- Diseases of other organs and systems. The development of low progesterone is noted against the background of kidney pathologies (CRF, pyelonephritis), liver, diabetes mellitus, thyrotoxicosis and other disorders.
- A woman’s lifestyle. Bad habits (smoking, alcohol consumption), obesity, excessive physical (including sports) loads, diets can also contribute to the development of low progesterone.
Many factors play a role in the development of the syndrome at once. There are indications of a persistent decrease in the level of progesterone in the luteal phase in some women after prolonged use and withdrawal of combined oral contraceptives. Individual cases of progesterone insufficiency against the background of hypothyroidism treatment, the use of growth hormone and other hormonal drugs are described.
Pathogenesis
With low progesterone, the yellow body formed after ovulation produces an insufficient amount of progesterone, which causes a cascade of disorders. Normally, this hormone transfers the endometrium into the secretory phase, preparing the conditions for embryo implantation. At the onset of pregnancy, it reduces the motor activity of the uterus and stops the development of immune reactions to the fetus. Insufficient progesterone level disrupts the structure of the endometrium, making implantation difficult. If it does occur, then an insufficient decrease in the tone of the uterus and the activity of the immune system creates a threat of termination of pregnancy. In the future, according to the feedback principle, low progesterone leads to a reduced formation of FSH, a decrease in the release of estrogen and a slowdown in the formation of the follicle for the next ovulation. Estrogen-low progesterone develops, an anovulatory menstrual cycle occurs.
There are several theories of the molecular pathogenesis of low progesterone. The generally accepted hypothesis sees the cause of the syndrome in a change in the endocrine feedback, which leads to a violation of the proportion between the levels of follicle-stimulating (FSH) and luteinizing (LH) hormones. This may be a consequence of changes in the sensitivity of receptors or anomalies of signal circuits due to a genetic defect. The same violation is caused by an abnormal level of other hormones (sexual, thyroid, pituitary). Other theories of the development of the disorder indicate the possibility of defects in endometrial receptors or the occurrence of oxidative stress with the release of large amounts of free radicals in the tissues of the uterus and ovaries.
Symptoms of low progesterone
Initially, the manifestations are erased, the symptoms gradually increase as hormonal failures progress. The first sign is a violation of the menstrual cycle – its duration increases or decreases, menstruation becomes painful, the amount of discharge changes. This pattern can persist for a long time (months and years). The next most common manifestation of the syndrome is infertility, manifested either by the absence of conception, or by frequent spontaneous miscarriages. In case of preservation of the fetus, pregnancy proceeds with complications – fetal hypoxia, high or low water, premature birth.
Concomitant symptoms of low progesterone are iron deficiency anemia due to heavy menstruation, decreased sexual desire in women, signs of other endocrine disorders. Women using the method of measuring basal temperature for contraception reveal its insufficient increase in the second phase of the menstrual cycle. The reduced release of progesterone is indicated by a temperature difference of less than 0.4-0.5 degrees between the ovulatory (first) and luteal (second) phases. There may also be swelling associated with water retention in the body, premature aging of the skin, irritability.
Complications
The most common complications of low progesterone are infertility and miscarriage. The weakening of the feedback between the release of progesterone, follicle-stimulating hormone and estrogen leads to a greater imbalance of the endocrine part of the reproductive system. The consequence of this is the development of ovarian cysts and anovulatory menstrual cycle. Endometrial trophic abnormalities and changes in the nature of the cervical canal secretion increase the risk of infection of the uterine mucosa with pathogenic microflora (endometritis). Hormonal imbalance leads to breast pathologies. Against the background of this condition, mastopathy occurs, during pregnancy with a lack of progesterone, galactorrhea is very often registered. A prolonged course of endocrine disorder without treatment can provoke the development of tumors of the mammary glands – both benign and malignant.
Diagnostics
To confirm the diagnosis of progesterone deficiency, a comprehensive and multilateral examination is required. It can take a long time, since a number of diagnostic procedures are informative only during certain phases of the menstrual cycle.
- Consultation and examination of a gynecologist. During it, the doctor finds out the phase of the menstrual cycle and the general condition of the reproductive system. When questioned, the dates and duration of the last few menstruations are determined, unusual phenomena that occur during them (pain, changes in the volume of secretions). Based on these data, the date of the next studies is set.
- Analysis of the level of sex hormones. The study is performed in screening mode, i.e. for several months on different days of the cycle to determine the dynamics of changes. The levels of progesterone, estrogen, follicle-stimulating and luteinizing hormones are studied.
- Ultrasound of the pelvic organs. During the diagnosis, the structure and structure of the ovaries, endometrium, uterus, their correspondence to the age of the woman and the day of the cycle, the presence or absence of leading follicles are determined. As well as hormone testing, ultrasound is performed repeatedly in different phases to assess the functional activity of the reproductive system.
- Endometrial biopsy by micro-curette or aspiration. The determination of the histological structure of the endometrium in different phases is used as an additional method for diagnosing infertility and the causes of frequent miscarriages. In some cases, biochemical tests are carried out to determine the reaction of the tissue to female sex hormones.
Sometimes additional tests are prescribed to determine the level of thyroid hormones, kidney and liver activity, and the main enzyme systems. It is also recommended to diagnose inflammatory diseases of the female genital area. If a woman has a pregnancy, the condition of the fetus is determined, the correspondence of its development to the term, the presence or absence of intrauterine pathology.
Treatment of low progesterone
In case of progesterone deficiency, replacement therapy is used – progesterone preparations. They can be used in the form of tablets, capsules, vaginal suppositories, in hospital conditions, oil solutions are prescribed for intramuscular administration. The course of treatment is developed by an obstetrician-gynecologist or endocrinologist, strictly taking into account individual characteristics. These are the presence or absence of pregnancy, the duration of the menstrual cycle, the level of endogenous progesterone in different phases. The duration of treatment depends on its goals (for example, successful pregnancy and carrying a child), the causes of the syndrome, age and other factors.
An auxiliary role in the treatment of the condition is played by the normalization of the general hormonal background, the elimination or relief of pathologies of other organs and systems. It is necessary to get rid of bad habits, if any, to avoid exhausting diets, significant physical exertion. To reduce the effects of emotional stress, sedatives may be prescribed, in some cases, antidepressants. Treatment of complications of progesterone deficiency – iron deficiency anemia, endometritis, mastopathy – is performed by appropriate specialists according to indications. In some cases (with polycystic ovaries), surgical intervention may be prescribed.
Prognosis and prevention
The prognosis for life is usually favorable, endocrine syndrome rarely leads to severe life-threatening conditions. With regard to the possibility of a woman to become pregnant and bear a child, the outcome of the pathology depends on many factors – the causes of Low progesterone, the duration of its course, compliance with the treatment plan. With properly selected dosages of progesterone preparations, conception is possible already 2-3 months after the start of therapy, during pregnancy it is continued taking into account changes in the hormonal background. To prevent the condition, it is necessary to mark the beginning and end of each menstruation in the calendar, thereby monitoring the duration of the cycle, timely treat inflammatory diseases of the genitals, endocrine system, kidneys. If the duration of the menstrual cycle or the nature of menstruation changes, you should consult a doctor.
