MON-LB9 Cyclic Progesterone Therapy in Androgenic Polycystic Ovary Syndrome (PCOS) - Person-Related 6-Month Experience Changes

Sonia Shirin; Faye Murray; Maryam Hajjaran; Azita Goshtasebi; Dharani Kalidasan; Jerilynn C Prior

doi:10.1210/jendso/bvaa046.2332

Reproductive Endocrinology Ovarian Hormones

MON-LB9 Cyclic Progesterone Therapy in Androgenic Polycystic Ovary Syndrome (PCOS) - Person-Related 6-Month Experience Changes

Shirin S, Murray F, Hajjaran M, Goshtasebi A, Kalidasan D, Prior JC

Published May 8, 2020 Journal of the Endocrine Society, 4(Supplement_1)

DOI 10.1210/jendso/bvaa046.2332 PMC PMC7208794

RRM Academy Synopsis

Cyclic progesterone linked to shorter cycles in one woman with PCOS

A 2020 pilot found one woman with androgenic PMOS had shorter cycles, at 28.17 days, on cyclic progesterone. PMOS is polyendocrine metabolic ovarian syndrome, formerly polycystic ovary syndrome (PCOS). She kept a diary for six cycles and used no other therapy. Fluid retention, breast tenderness and mucus dropped too.

Key Findings

Cycle length was 28.17+/-0.8 days on cyclic oral micronized progesterone, against slightly irregular cycles of about 35 days before.
Scores fell for breast tenderness (P=0.000), fluid retention (P=0.000) and stretchy cervical mucus (P=0.048). Anxiety and flow stayed the same.
Comparing baseline with cycles 3 and 6, fluid retention was the only one of the selected follicular phase symptoms that dropped significantly (P=0.017).
She volunteered that her aching joints, sleep and gastrointestinal problems got better.

Interpretation

A 2020 pilot case study followed one woman, aged 31, through six cycles of cyclic oral micronized progesterone therapy, scoring her own symptoms on a 19-item diary. Her symptom improvements were linked with the therapy, which the authors call luteal phase replacement. The authors call for prospective, controlled trials to confirm these findings.

RRM Context

Restorative reproductive medicine works with the cycle. The authors call cyclic progesterone "luteal phase replacement" therapy, which supports the second half of the cycle. The woman could not tolerate birth control pills. The abstract names endometrial cancer and infrequent periods as risks in androgenic PCOS and says cyclic progesterone could prevent both.

Our editorial summary of this paper, not the article's abstract.

Abstract

Endometrial cancer1 and oligomenorrhea2 are common risks for women living with androgenic PCOS (WLWP); cyclic progesterone therapy could prevent both. Cyclic oral micronized progesterone therapy (Cyclic OMP; 300 mg at hs/14 days/cycle) also corrects the neuroendocrine origins of PCOS3. Although vaginal progesterone is used in PCOS ovulation induction 4, and short Cyclic OMP decreases LH and/or Testosterone 5,6, no WLWP person-level prospective data with Cyclic OMP therapy are published. A WLWP, aged 31, BMI 20.1, with heavy flow and slightly irregular ~35-day cycles, was unable to tolerate birth control pills. She was prescribed Cyclic OMP (300 mg/h.s. cycle days 14-27)7. She began keeping the Menstrual Cycle Diary© (Diary), a 19-item tool (scored 0-4), during her 1st Cyclic OMP cycle and took no other therapy. This pilot study was designed to understand Cyclic OMP-related experience changes in Wlwp: 1) by documenting experience changes on the 1st to the 6th complete Diary; and 2) by assessing follicular phase changes in baseline data (no Rx) vs. cycles 3 and 6. We entered data from six consecutive Diaries into an SPSS (Version 24) database. Analysis #1 used Wilcoxon Signed Ranks Tests (for within-person ordinal data) and #2 repeated measures ANOVA.

Research Question

What Cyclic OMP-related experience changes occurred for a WLWP? On Cyclic OMP, she spontaneously reported improvements in aching joints, sleep and GI problems. We assessed selected, potentially E2-related Diary changes: flow, fluid retention, breast tenderness, stretchy cervical mucus and anxiety. Cyclic OMP was associated with shorter cycle lengths of 28.17+/-0.8 days. Fluid retention (P=0.000), mucus (P=0.048), and breast tenderness (P=0.000) all decreased, but anxiety and flow were unchanged. Follicular phase only fluid retention significantly decreased (F (1.2, 14.7) = 6.7, P =0.017). Although open-label, these prospective analyses suggest that Cyclic OMP, alone, is related to short-term benefits in androgenic PCOS. Prospective studies and controlled comparative trials of this innovative “luteal phase replacement” PCOS therapy are needed. Reference:1Barry J Hum Reprod Update 2014 20:748. 2Azziz R Nat Rev Dis Primers 2016;2:16057. 3Blank S Hum Reprod Update 2006;12:351. 4Montville C Fertil Steril 2010;94:678. 5Livadas S Fertil Steril 2010;94:242. 6Bagis T J Clin Endocr Met 2002;87:4536. 7Prior J https://hellocluecom/articles/cycle-a-z/the-case-for-a-new-pcos-therapy 2018

Topics

Reproductive Endocrinology › Ovarian Hormones › Progesterone · Therapeutics › Hormonal Agents › Progesterone and Progestins · Menstrual Cycle › Cycle Disorders › Abnormal Uterine Bleeding

Sonia Shirin, Faye Murray, Maryam Hajjaran, Azita Goshtasebi, Dharani Kalidasan, Jerilynn C Prior

S Shirin, F Murray, M Hajjaran, A Goshtasebi, D Kalidasan, J Prior

DOI 10.1210/jendso/bvaa046.2332 10.1210/jendso/bvaa046.2332 Shirin et al. 2020, Shirin 2020

MON-LB9 Cyclic Progesterone Therapy in Androgenic Polycystic Ovary Syndrome (PCOS) - Person-Related 6-Month Experience Changes

Cyclic progesterone linked to shorter cycles in one woman with PCOS

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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