Progesterone

INTRODUCTION

Indications

Secondary amenorrhea and abnormal uterine bleeding due to hormonal imbalance. Prometrium: Prevention of cell overgrowth in the uterine lining in postmenopausal women who have not had a hysterectomy (with estrogen). Part of assisted reproductive technology (ART) in the management of infertility (4% and 8% vaginal gel). Endometrin: Support of embryo implantation and early pregnancy. Unlabeled Use: Corpus luteum dysfunction.

Action

Produces Secretory changes in the endometrium; Increase in basal body temperature; Histologic changes in vaginal epithelium; Relaxation of uterine smooth muscle; Mammary alveolar tissue growth; Pituitary inhibition; Withdrawal bleeding in the presence of estrogen. Therapeutic Effects: Restoration of hormonal balance with control of uterine bleeding. Successful outcome in assisted reproduction.

Adverse Reactions/Side Effects

CNS: depression. EENT: retinal thrombosis. CV: PULMONARY EMBOLISM, THROMBOEMBOLISM, thrombophlebitis. GI: gingival bleeding, hepatitis. GU: cervical erosions. Derm: chloasma, melasma, rashes. Endo: amenorrhea, breakthrough bleeding, breast tenderness, changes in menstrual flow, galactorrhea, spotting. F and E: edema. Local: irritation or pain at IM injection site. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS AND ANGIOEDEMA, weight gain, weight loss.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of thrombophlebitis (localized pain, swelling, warmth, erythema, tenderness) and pulmonary embolism (shortness of breath, chest pain, cough, bloody sputum). Notify physician immediately, and request objective tests (Doppler ultrasound, lung scan, others) if thromboembolism is suspected.

• Monitor signs of allergic reactions, including anaphylaxis and angioedema. Signs include pulmonary symptoms (tightness in the chest and throat, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, swelling in the face). Notify physician immediately if these reactions occur.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Report signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flu-like symptoms, and muscle/joint pain.

• Monitor and report depression or other changes in mood and behavior.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or sustained weight loss or gain, or a substantial change in lean body mass.

• Monitor IM injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Because of the risk of thromboembolism, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Caution patient and family/caregivers about risks of thromboembolism, ...