Hormone Therapy : What Are We Doing in 2019 ?

Progesterone Versus Progestins: Clinical Dilemmas and Concerns James H. Liu, MD, NCMP. Obstetrics and Gynecology and Reproductive Endocrinology, University Hospitals, MacDonald Women’s Hospital, Cleveland, OH As clinicians, we utilize progesterone and progestins every day for hormone therapy, contraceptive purposes, and control of uterine bleeding, yet we lack in-depth knowledge regarding this major steroid compound class and its plethora of desired biological effects and side effects. The goal of this presentation and Plenary Symposium is to focus on these less obvious effects on biological tissues. We will limit our discussion to mainly compounds used in hormone therapy: progesterone (P4), medroxyprogesterone acetate (MPA), norethindrone (NET), and drospirenone. Progesterone receptors are widely distributed throughout the body and have been localized to tissues including endometrium, myometrium, breast, bone, liver, brain, leukocytes, lymphocytes, and vascular endothelium. Dr. Mesiano’s and Dr. Rubinow’s presentations will focus on myometrium, brain, and immune cells. The endometrial effects of progestins are well known and the minimal duration (10 to 12 days) and dose for each progestin for its protective secretory effects have been well established. Less obvious, are the impact of various progestins and its active metabolites on other tissues such as liver, breast, bone, and blood vessels. These will be discussed in context with clinical scenarios presented to show how progestins can be used in ways that target other tissues besides endometrium. Our hope is that clinicians will take away useful clinical pearls that be used for care of their future patients.