A comparative study of the effect of the progestational agents in human menstrual abnormalities.

Abstract

The clinical results obtained by the use of progesterone were compar ed with those of some newer steroids having progestational activity. The drugs used were intramuscular buccal and vaginal progesterone; oral progesterone combined with estrogens; intramuscular 17alpha-hydroxyprogesterone caproate; and 2 of the 19-nor steroid group 17alpha-ethinyl-17-hydroxy-5(10)-estren-3-one and 17alpha-ethinyl-19-nortestosterone. The 2 19-nor steroids were contamin ated with varying amounts of 3-methyl ether of ethinyl estradiol. The agents were evaluated 1) as tests for endogenous estrogen production in amenorrheic women 2) for possible therapeutic value in amenorrhea 3) for possible benefit in the treatment of infertile women with inadequate secretory endometria and 4) as therapeutic agents in the management of anovulatory bleeding. Progesterone given by any route and 125 mg of 17alpha-hydroxyprogesterone caproate produced withdrawal bleeding in amenorrheic women only if the endometrium showed some degree of active proliferation; they are therefore useful in evaluating endogenous estrogen effect. The 19-nor steroids produced withdrawal bleeding from atrophic endometria and are useful in the evaluation of the ability of the endometrium to respond to stimulation but are not useful as indicators of endogenous estrogen production. The clinical response obtained with the 19-nor steroids indicated that these drugs or their metabolites had estrogenic as well as progestational properties. A significant therapeutic effect could not be demonstrated for any of the progestational drugs used in the treatment of amenorrhea or infertility associated with an inadequate secretory endometrium. Recurrent hemorrha ge associated with prolonged anovulatory cycles could be prevented by the production of cyclic withdrawal bleeding with any of the progestational drugs used. Unless estrogen was also given only the 19-nor steroids were effective in preventing frequent anovulatory bleeding.(AUTHORS MODIFIED)