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Progesterone substances used for medical uses are called progestogens. They are available in two forms: synthetic versions (progestins) and another version derived from plant sources, which is nearly identical to the body's own hormone and is often called "natural progesterone."

In addition to being included in birth control pills and hormone replacement therapy, progestogens may be used to treat a variety of conditions, including:

• menstrual or bleeding problems
• endometriosis
• breast, kidney or uterine cancer
• appetite and weight loss in AIDS and cancer patients

They are also used as a diagnostic aid to measure estrogen's effect in the uterine lining, and in their natural state may be used to treat infertility.

If you are considering a progestogen product, discuss with your health care professional any medical conditions you may have, especially asthma, epilepsy, cardiovascular or bleeding disorders, high cholesterol, history of blood clots or stroke, kidney or liver disorders, migraines, breast problems, depression or diabetes. Also share information about any medications you are taking.

Typical side effects of progestins include:

• breakthrough bleeding
• menstrual cramps
• bloating caused by water weight gain
• dizziness
• moodiness
• weariness
• symptoms of blood sugar problems (dry mouth, thirst, frequent urination, loss of appetite).

Many of these side effects mimic PMS, which is not surprising since PMS usually occurs when progesterone levels peak. Some women experience rarer side effects like depression, excessive breast milk or breast tenderness, sleep disorders, flushing and changes in body or facial hair.

Talk to your health care professional if you experience side effects. Many of these side effects subside with continued use. If not, switching to a different progestin-based product may help.

Uses of Progestin Products

Abnormal uterine bleeding: Because of their ability to inhibit bleeding, progestins are often used to manage excessive or abnormal uterine bleeding (AUB). Progestins may reduce menstrual bleeding 20 to 60 percent.

Endometriosis: Endometriosis may be treated with a progestin or with an estrogen-progestin birth control pill. The goal is to reduce estrogen production, thus keeping endometrial tissue from growing.

Irregular periods and polycystic ovary syndrome (PCOS) : The shedding of the uterine lining that occurs with menstruation each month reduces the risk of endometrial cancer; thus, maintaining menstrual cycles is important during childbearing years. If you frequently skip periods due to PCOS, being overweight or underweight, or because of another disorder, your health care professional may recommend birth control pills containing estrogen and progestin to ensure regular cycles. If you can't or won't take birth control pills, you may need an occasional prescription for an oral progestin to help you shed the uterine lining.

Birth control: Oral contraceptives typically contain estrogen and progestin. Combination pills suppress ovulation (the release of an egg) each month. The progestin in these pills also reduces the risk of pregnancy by altering the mucus in your cervix, making it harder for the sperm to move and connect with an egg. Continuous progestins in combination birth control pills also prevent the growth of the endometrium and alter uterine secretions to reduce the chance that a fertilized egg could implant in the uterine lining.

Combination pills come in different formulas. Some are based on a 28-day regimen (21 days of active tablets followed by seven days of placebo tablets). Others vary the dose of estrogen and/or progestin that a woman gets throughout her cycle, or add five additional days (tablets) of estrogen at the end of the 21-day cycle.

Seasonale, a 91-day oral contraceptive regimen, provides women with birth control and fewer periods each year. Tablets containing the active hormones progestin (levonorgestrel) and an estrogen (ethinyl estradiol) are taken for 12 weeks (84 days), followed by one week of placebo tablets. So you only have four periods a year. Other oral contraceptives can also be used in a similar long-cycle fashion.

Estrogen-progestin birth control pills have some anti-cancer benefits in addition to birth control. They may reduce ovarian cancer risk, as well as uterine and colon cancer risk. However, combination pills are not recommended for women who have had breast cancer.

It's important to understand that not all of the questions surrounding combined HRT and breast cancer risk have been answered. If you've had breast cancer or have a history of it in your family, discuss your risk with your health care professional.

These products also have side effects, the most common of which are nausea, breast tenderness and breakthrough bleeding. Most side effects decrease or disappear after three months of continuous use. Switching to another type of birth control pill can also relieve side effects.

Combination birth control pills are typically not an appropriate treatment choice if you are over 35 and smoke, have high blood pressure, have a history of blood clots in your lungs or are highly sensitive to side effects of this medication, such as headaches. Smoking while taking combination birth control pills increases your risk of heart attack and stroke, according to the American Heart Association.

Estrogen-progestin contraceptives are available now as a patch (Ortho Evra) and as a ring (Nuvaring).

Ortho Evra is a weekly prescription patch that releases norelgestromin (a progestin hormone), and ethinyl estradiol (an estrogen hormone), through the skin into the blood stream to prevent pregnancy. Each patch is worn for one week. On the same day of the week you start the patch, replace it with another. After three weeks (and three new patches) you have a week that is patch-free, during which you get your period. Recent evidence suggests that its total hormone content is higher than lower dose pills. You should discuss this with your health care professional.

Side effects may include breast tenderness, headache, a reaction at the application site, nausea, upper respiratory infection, menstrual cramps and abdominal pain. Other risks are similar to those from using birth control pills, such as an increased risk of heart attack, blood clots, and stroke, particularly in women who smoke and/or have a history of these conditions.

Another new contraceptive is Nuvaring, which consists of a soft, flexible, transparent, ring about 2.1 inches in diameter. It contains a combination of estrogen and progestin hormones (ethinyl estradiol and levonorgestrel). After it is inserted into the vagina, these hormones are slowly released on a continual basis. You need to insert a new ring each month for continuous contraception, removing it after three weeks, during which you have your period.

Side effects are minimal but may include vaginal discharge, vaginitis, and irritation. Like oral contraceptives, Nuvaring may increase the risk of blood clots, heart attack, and stroke. Women who use Nuvaring are strongly advised not to smoke, as it may increase the risk of heart-related side effects.

Some women choose to take a progestin-only pill instead. Called the "mini-pill," progestin-only pills allow women to avoid some of the worst side effects of estrogen, while improving regular menstrual cycles and preventing pregnancy. If you are breast-feeding, you may want to consider the mini-pill, since combination products may dry up your milk supply.

Progestin-based mini-pills are highly effective for preventing pregnancy (about 99.5 percent) if taken correctly, but missing a pill or taking it at a different time of day is riskier than with combination estrogen-progestin pills. That's because the mini-pill's effects can wear off after a day, making you vulnerable to pregnancy. Women on mini-pills also ovulate frequently -- even when they take the pills correctly -- and if you miss a day, the fact that more eggs are available for fertilization makes getting pregnant more likely.

Longer-acting progestins may be a good birth control option if you want reliable protection without having to remember to take a pill each day. Injected medroxyprogesterone (Depo-Provera) lasts three months. The Progestasert and Mirena IUDs, which deliver progesterone directly and continuously into the uterine lining for one year and five years respectively, are additional longer-term options. All are highly effective. The Food and Drug Administration (FDA) added a "black box" warning to Depo-Provera in November 2004, noting that prolonged use may result in the loss of bone density.

Progestin-Only Contraceptive Products At-A-Glance

• Levonorgestrel (tablets and implants); marketed as Plan B (tablets for emergency contraception), and the Mirena levonorgestrel-releasing Intrauterine System
• Medroxyprogesterone (injected); marketed as Depo-Provera Contraceptive Injection
• Norethindrone (tablets); marketed as Micronor and Nor-QD
• Norgestrel (tablets), marketed as Ovrette

Emergency contraception. Levonorgestrel (Plan B) can be used for emergency contraception within 72 hours of unprotected sex. (Combination birth control pills can also be used for this purpose, and may be the better option if you already have a prescription for them. A product called Preven, which contains estrogen and levonorgestrel, is also available and is specially designed for emergency contraception.) The FDA has just approved Plan B without a prescription. Plan B is expected to be available for purchase over the counter by the end of 2006. Ask your health care professional or pharmacist for more information about how and when to use this product, if you want to keep it on hand.

Perimenopause and menopause. For perimenopausal women with irregular or absent periods, the low-dose estrogen/progestin combination found in oral contraceptives often alleviates symptoms and helps maintain regular menstrual cycles.

Additionally, postmenopausal hormone therapy using either estrogen alone (ET) or an estrogen-progestin combination (HT) is often recommended to treat moderate to severe perimenopausal or postmenopausal symptoms. Estrogen-only therapy is prescribed only if you've had a hysterectomy. If you still have your uterus, you'll need to take some progestin with the estrogen because the progestin helps offset estrogen's stimulating effects on the endometrium, which could increase your risk of endometrial cancer.

Some postmenopausal hormonal therapy products provide continuous progestin (progestin in each daily dose). Others are designed with progestin added during part of a monthly cycle and then stopped. Women on the intermittent-progestin regimen report more bleeding problems than women on continuous therapy regimens, which have become more popular in recent years.

Estrogen-progestin combinations may require that you take different pills on different days, resulting in monthly bleeding similar to menstruation. Many women prefer taking both hormones every day so they can avoid monthly bleeding. It usually takes three to six months of daily combination therapy before the bleeding stops.

Non-Contraceptive Progestin-Only Products At-A-Glance:

Progestins

Types of progestins available include intramuscular, oral and cream. They include:

• Hydroxyprogesterone (injected); marketed under the names Gesterol LA 250, Hy/Gestrone, Hylutin, Prodrox and Pro-Span; prescribed for abnormal uterine bleeding, amenorrhea and readying the uterus for menstruation.

• Medroxyprogesterone (tablets and injection); marketed under the names Amen, Curretab, Depo-Provera (injection), and Provera; tablets prescribed for abnormal uterine bleeding, amenorrhea; get the uterus ready for menstruation, and as part of menopausal hormone therapy with estrogen; injection prescribed for kidney or uterine cancer.

• Megestrol (liquid and tablets, Megace); liquid prescribed for appetite or weight loss related to AIDS; tablets prescribed for breast or uterine cancer, or appetite or weight loss related to cancer.

• Norethisterone acetate (tablets), marketed as Norethindrone and Aygestin; prescribed for abnormal uterine bleeding, amenorrhea or endometriosis.

Progesterone

Progesterone products include:

• Micronized oral progesterone (Prometrium 100 mg or 200 mg taken daily or cyclically)

• Progesterone vaginal cream -- Prochieve 4 percent and 8 percent applied vaginally every other day for six doses.