Progesterone

Progesterone is the most important progestogen in the body. As a potent agonist of the nuclear progesterone receptor (nPR) (with an affinity of KD = 1 nM), the resulting effects on ribosomal transcription play a major role in regulation of female reproduction. of which the expression has regulation effects in reproduction function (oocyte maturation, labor, and sperm motility) and cancer, although additional research is required to further define the roles. It also functions as a ligand of the PGRMC1 (progesterone receptor membrane component 1) which impacts tumor progression, metabolic regulation, and viability control of nerve cells. Moreover, progesterone is also known to be an antagonist of the sigma σ1 receptor, a negative allosteric modulator of nicotinic acetylcholine receptors, Progesterone prevents MR activation by binding to this receptor with an affinity exceeding even those of aldosterone, and glucocorticoids such as cortisol and corticosterone, Progesterone also binds to, and behaves as a partial agonist of, the glucocorticoid receptor (GR), albeit with very low potency (EC50 >100-fold less relative to cortisol). 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 induces several hepatic cytochrome P450 enzymes, such as CYP3A4, 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. ==Biological function==

Hormonal interactions Progesterone has a number of physiological effects that are amplified in the presence of estrogens. Estrogens through estrogen receptors (ERs) induce or upregulate the expression of the PR. One example of this is in breast tissue, where estrogens allow progesterone to mediate lobuloalveolar development. 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. Early sexual differentiation Placental progesterone can be converted into 5α-dihydrotestosterone (DHT), a potent androgen that is responsible for the development of male genitalia. This can be done both by conversion into testosterone, which is then converted to DHT, and via the androgen backdoor pathway, which is particularly important for fetal development. Progesterone is the precursor for both pathways and therefore plays a key role in sexual differentiation. Reproductive system showing changes to the endometrium due to progesterone (decidualization) H&E stain Progesterone has key effects via non-genomic signalling on human sperm as they migrate through the female reproductive tract before fertilization occurs, though the receptor(s) as yet remain unidentified. Detailed characterisation of the events occurring in sperm in response to progesterone has elucidated certain events including intracellular calcium transients and maintained changes, slow calcium oscillations, now thought to possibly regulate motility. It is produced by the ovaries. Progesterone has also been shown to demonstrate effects on octopus spermatozoa. Progesterone is sometimes called the "hormone of pregnancy", and it has many roles relating to the development of the fetus: • Progesterone converts the endometrium to its secretory stage to prepare the uterus for implantation. At the same time progesterone affects the vaginal epithelium and cervical mucus, making it thick and impenetrable to sperm. Progesterone is anti-mitogenic in endometrial epithelial cells, and as such, mitigates the tropic effects of estrogen. If pregnancy does not occur, progesterone levels will decrease, leading to menstruation. Normal menstrual bleeding is progesterone-withdrawal bleeding. If ovulation does not occur, and the corpus luteum does not develop, levels of progesterone may be low, leading to anovulatory dysfunctional uterine bleeding. • During implantation and gestation, progesterone appears to decrease the maternal immune response to allow for the acceptance of the pregnancy. • Progesterone decreases contractility of the uterine smooth muscle. • A drop in progesterone levels is possibly one step that facilitates the onset of labor. • In addition, progesterone inhibits lactation during pregnancy. The fall in progesterone levels following delivery is one of the triggers for milk production. The fetus metabolizes placental progesterone in the production of adrenal steroids. Estrogen induces expression of the progesterone receptors (PR) in breast tissue, and hence progesterone is dependent on estrogen to mediate lobuloalveolar development. RANKL knockout mice show an almost identical mammary phenotype to PR knockout mice, including normal mammary ductal development, but complete failure of the development of lobuloalveolar structures. progesterone may also be involved in ductal development of the mammary glands to some extent. PR knockout mice or mice treated with the PR antagonist mifepristone show delayed although otherwise normal mammary ductal development at puberty. Most progestins, or synthetic progestogens, like medroxyprogesterone acetate, have been found to increase the risk of breast cancer in postmenopausal people in combination with estrogen as a component of menopausal hormone therapy. However, this may simply be an artifact of the low progesterone levels produced with oral progesterone. More research is needed on the role of progesterone in breast cancer. At menopause and thereafter, decreased levels of female sex hormones result in atrophy, thinning, and increased wrinkling of the skin, and a reduction in skin elasticity, firmness, and strength. Homosexuality Dr. Diana Fleischman, of the University of Portsmouth, and colleagues looked for a relationship between progesterone and sexual attitudes in 92 women. Their research, published in the Archives of Sexual Behavior found that women who had higher levels of progesterone scored higher on a questionnaire measuring homoerotic motivation. They also found that men who had high levels of progesterone were more likely to have higher homoerotic motivation scores after affiliative priming compared to men with low levels of progesterone. Nervous system Progesterone, like pregnenolone and dehydroepiandrosterone (DHEA), belongs to an important group of endogenous steroids called neurosteroids. It can be metabolized within all parts of the central nervous system. Neurosteroids are neuromodulators 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. Brain damage Previous studies have shown that progesterone supports the normal development of neurons in the brain, and that the hormone has a protective effect on damaged brain tissue. It has been observed in animal models that females have reduced susceptibility to traumatic brain injury, and this protective effect has been hypothesized to be caused by increased circulating levels of estrogen and progesterone in females. Proposed mechanism The mechanism of progesterone protective effects may be the reduction of inflammation that follows brain trauma and hemorrhage. 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, 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 macrophages 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. Addiction Progesterone enhances the function of serotonin receptors in the brain, so an excess or deficit of progesterone has the potential to result in significant neurochemical issues. This provides an explanation for why some people resort to substances that enhance serotonin activity such as nicotine, alcohol, and cannabis when their progesterone levels fall below optimal levels. • Sex differences in hormone levels may induce women to respond differently than men to nicotine. When women undergo cyclic changes or different hormonal transition phases (menopause, pregnancy, adolescence), there are changes in their progesterone levels. Therefore, females have an increased biological vulnerability to nicotine's reinforcing effects compared to males, and progesterone may be used to counter this enhanced vulnerability. This information supports the idea that progesterone can affect behavior. Societal In a 2012 University of Amsterdam study of 120 women, the women's luteal phase (higher levels of progesterone, and increasing levels of estrogen) was correlated with a lower level of competitive behavior in gambling and math contest scenarios, while their premenstrual phase (sharply-decreasing levels of progesterone, and decreasing levels of estrogen) was correlated with a higher level of competitive behavior. Other effects • Progesterone also has a role in skin elasticity and bone strength, in respiration, in nerve tissue and in female sexuality, and the presence of progesterone receptors in certain muscle and fat tissue may hint at a role in sexually dimorphic proportions of those. • During pregnancy, progesterone is said to decrease uterine irritability. • During pregnancy, progesterone helps to suppress immune responses of the mother to fetal antigens, thus preventing rejection of the fetus. • Progesterone increases core temperature (thermogenic function) during ovulation. • Progesterone reduces spasm and relaxes smooth muscle. Bronchi are widened and mucus regulated. (PRs are widely present in submucosal tissue.) • Progesterone acts as an anti-inflammatory agent and regulates the immune response. • Progesterone reduces gallbladder activity. • Progesterone normalizes blood clotting and vascular tone, zinc and copper levels, cell oxygen levels, and use of fat stores for energy. • Progesterone may affect gum health, increasing risk of gingivitis (gum inflammation). • Progesterone appears to prevent endometrial cancer (involving the uterine lining) by regulating the effects of estrogen. • Progesterone plays an important role in the signaling of insulin release and pancreatic function, and it may affect the susceptibility to diabetes or gestational diabetes. • Progesterone levels in the blood were found to be lower in those who had higher weight and higher BMI among those who became pregnant through in vitro fertilization. • Current data shows that micronized progesterone, which is chemically identical to the progesterone produced in the human body, in combination with estrogen in menopausal hormone therapy does not seem to have significant effects on venous thromboembolism (blood clots in veins) and ischemic stroke (lack of blood flow to the brain due to blockage of a blood vessel that supplies the brain). However, more studies need to be conducted to see whether or not micronized progesterone alone or in combined menopausal hormone therapy changes the risk of myocardial infarctions (heart attacks). • There have not been any studies done yet on the effects of micronized progesterone on hair loss due to menopause. • Despite suggestions for using hormone therapy to prevent loss of muscle mass in post-menopausal individuals (age 50+), menopausal hormone therapy involving either estrogen alone, or estrogen and progesterone combined, has not been found to preserve muscle mass. Menopausal hormone therapy also does not result in body weight reduction, BMI reduction, or change in glucose metabolism. ==Biochemistry==

Biosynthesis , showing progesterone among the progestogens (yellow area) In mammals, progesterone, like all other steroid hormones, is synthesized from pregnenolone, which itself is derived from cholesterol. Cholesterol undergoes double oxidation to produce 22R-hydroxycholesterol and then 20α,22R-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 keto group and second, the double bond is moved to C4, from C5 through a keto/enol tautomerization reaction. 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. Distribution Progesterone binds extensively to plasma proteins, including albumin (5054%) and transcortin (4348%). It has similar affinity for albumin relative to the PR. Progesterone has an elimination half-life of only approximately five minutes in circulation. 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. 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. 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 pregnanetriols 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. Catalyzed mainly by CYP3A4, 6β-Hydroxylation is the major transformation and is responsible for approximately 70% of cytochrome P450-mediated progesterone metabolism. 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. 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. 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. • 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 An additional animal source of progesterone is milk products. After consumption of milk products the level of bioavailable progesterone goes up. Plants Progesterone has been positively identified in the plant Juglans regia, a species of walnut. In addition, progesterone-like steroids 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. Another plant that contains substances readily convertible to progesterone is Dioscorea pseudojaponica, native to Taiwan. Research has shown that the Taiwanese yam contains saponins—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. ==Medical use==

Progesterone is used as a medication. It is used in combination with estrogens mainly in hormone therapy for menopausal symptoms and low sex hormone levels. 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. 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. ==Chemistry==

Progesterone is a naturally occurring pregnane steroid and is also known as pregn-4-ene-3,20-dione. It has a double bond (4-ene) between the C4 and C5 positions, and two ketone groups (3,20-dione), one at the C3 position and the other at the C20 position. 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. of progesterone from diosgenin Soy semisynthesis Progesterone can also be made from the stigmasterol found in soybean oil also. c.f. Percy Julian. to progesterone synthesis Total synthesis 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 protecting groups 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. 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. 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. == References ==