Letters to the Editor
Progesterone and progestogens
- Joanne Lipinski, Eveline Mu, Jayashri Kulkarni
- Aust Prescr 2022;45:115
- 1 August 2022
- DOI: 10.18773/austprescr.2022.047
ISSUE 4 AUGUST
Letter
I am concerned by the ambiguity about progesterone/progestogen in the article ‘Hormonal contraception and mood disorders’.1 The summary correctly states ‘The link between oral contraceptive pills and depression relates to the amount and type of progestogen contained in these pills’, but the article subsequently says that progesterone can worsen mood symptoms. Plausible links are said to include progesterone augmentation of GABA-induced inhibition of glutamate transmission, and progesterone increasing the concentrations of monoamine oxidase, resulting in decreased serotonin concentrations. However, these links should be referring to progestogen rather than progesterone.
To my knowledge (and according to all the given references,) progesterone is neuroprotective, whereas progestogen is not. It is the progestogen in oral contraceptive pills that has been linked to depressive mood.
Joanne Lipinski
Pharmacist (non-practising) and Naturopath (practising), Ormond, Vic.
Authors' response
Eveline Mu and Jayashri Kulkarni, the authors of the article, comment:
As we referenced in our paper1 – progestogens in oral contraceptive pills can contribute to the worsening of mood symptoms in susceptible women. This is evidenced by the worsening of mood symptoms in women who use progestogen-only forms of contraception such as the progestogen-only pill and the levonorgestrel intrauterine device.2
Regarding endogenous progesterones, it is believed that women with premenstrual dysphoric disorder have an abnormal GABA response to changes in allopregnanolone levels (a metabolite of progesterone) across the menstrual cycle, contributing to negative mood symptoms.3 As more studies examine the role of allopregnanolone and its metabolite progesterone their neuroprotective effects may be clearer.
Lipinski is correct that the two terms were used interchangeably in the article. We agree that progestogens are more likely to be implicated in depressed mood, but as we learn more about progesterone, the impact of this endogenous hormone on mood is yet to be fully determined.
References
- Mu E, Kulkarni J. Hormonal contraception and mood disorders. Aust Prescr 2022;45:75-9.
- Biegon A, McEwen BS. Modulation by estradiol of serotonin receptors in brain. J Neurosci 1982;2:199-205.
- Chavez C, Hollaus M, Scarr E, Pavey G, Gogos A, van den Buuse M. The effect of estrogen on dopamine and serotonin receptor and transporter levels in the brain: an autoradiography study. Brain Res 2010;1321:51-9.
The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by any responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Joanne Lipinski
Pharmacist (non-practising) and Naturopath (practising), Ormond, Vic.
Eveline Mu
Postdoctoral researcher, Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne
Jayashri Kulkarni
Professor of Psychiatry and Director, Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and The Alfred Hospital, Melbourne
